• J. C. Gingell
Part of the Clinical Practice in Urology book series (PRACTICE UROLOG)


Recent advances in endoscopic urological instruments have opened up a whole new field of urological practice described in this section. The development of purpose-built nephroscopes has allowed percutaneous stone removal to replace open surgical removal of renal calculi in all modern urological units. The detailed technique is comprehensively described by Whitfield, who undertakes his own renal access, an aspect of the procedure which in many units is performed by a radiologist. As he rightly indicates in his contribution, this can be the most difficult step in the operation and demands a skill that all urological trainees should endeavour to acquire. The range and design of the instruments themselves and the necessary accessories of forceps and stone baskets have developed only by the close cooperation of urologists and instrument manufacturers. Indeed, this has proved to be the most encouraging and continually productive aspect of urological endoscopic development and in no small measure has contributed to the advances outlined in this section. This particularly applies to ureteroscopy, described by Miller. The development of the rigid ureteroscope has had a major impact upon the management of the all-too-common and painful problem of ureteric calculi. He describes well the therapeutic options of in situ treatment of larger calculi or their disimpaction for percutaneous removal or extracorporeal shock wave lithotripsy (ESWL). Clearly no single technique can be adapted to manage all stones in the upper urinary tract, and individual skills and experience must be acquired to make full and appropriate use of the various options available.

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© Springer-Verlag Berlin Heidelberg 1988

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  • J. C. Gingell

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