الفهرس 
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Abstract
During the period bel ween July 1995 to Decem ber 1997, fifty patients with upper two third ureteric stones were subjected to endourological procedures using retrograde stone displacement or flushing back to the kidney.
All patients were subjected to percutaneous ncphroslomy either for PCNL for cases with successful retrograde flushing techn ique or antcgrade renoureteroscopy for cases with failed retrograde f1 ushing and in whom flushing was not attempted because of non visualized ureteric orifice,
Thirty seven patients were mules (74%) and therteen were Iernules (26%). Their ages ranged from 15 to 68 years and mean age was 41 years old Forty two patients (84%) were presented by flank ruin, six patients (12%) by urosepsis and two patients (4%) discovered accidental during plain abdominal x-ray, ’
The stones were located in the upper I jJ ureter in 40 patients
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(76%), middle 1/3 ureter in’ patients (I 8%) and in both upper and
middle 1/3 of the same side in one patients {2%}. In seven patients ureteral stones were associated with renal stones which. were removed during the same sitting
The stone size ranged from 0.5 X 0.5 to 2.2 X 1.2 em in its largest diameter and the averagesize is 1.4 X 0.9 em. Stones <Icm in its largest diameter faced with in 8 patiens (16%), from I to 2 ern in 39 patients (78%) and> 2 cm in 3 patient” (6%). Tile largest stone j nvited for retrograde flushing technique was 2 X 1.2 em in it’> largest diameter <If. measured from the plain U.T.
from the forty patients (80%) who had upper 1/3 ureteral stones, stone impaction met wah in 7 patients and [rom ten patients with middle 1/3 ureteral stones 3 patients had impacted stones ..
from the fifty patients, retrograde stone displacement or flushing was attempted in 44 patients (83%). The technique succeeded in 41 patients (93.2%) and in those patients the stones were removed by PCNL.
Six trial was attempted for retrograde stone flushing before the technique considered failed. Open tip 7-Fr. ureteric catheter (first trial) succeeded in 3 patients (6_ 8%,) Saline injection 5-1 () cc (second trial) succeeded in 21 patients (5l2%) Surgical lubricant mi xed with saline I: I (3rd trial) succeeded in 5 patients (25%). Xylocain liquid mixed with saline 3:1 was instillated slowly to rei ieve ureteric spasm around the stones and the trials were reeattempted after 2-3 minute again, The re-using of the ureteric. catheter (4th trial) succeeded in one patients (6.6%). Saline re-
injection (5th trial) succeeded in 3 patients (21.4%). Radioopaque dye + saline (Ll ) succeeded in 8 patients (72.7%),
The auxiliary steps had been used with the Hushing technique was trendelenburg position in 10 patient» (22.7%) and both trcndclcburge position with manual pushing up of the kidney (Mertz technique) were used in another [0 patients (22,7%). This is help in straightening a kinked or tortous ureter and also prevent the re-descent of’the atone in the ureter again.
The operative complications during flushing technique were ureteral perforation below the stone in 2 patients (4.5%) either due to acute kink in one patient. and during dislodgement of big impacted stone in the another one.
There are three failures with this techn ique all ofthem had stones impaction; the stones size in the failed cases were 1-2 em in 2 cases or failure and >2cm. in one casco In addition the stones were located in the upper tf3 in one case of failure, middle If3 in another one and in the last one, both upper and middle 1/3 ureteral stone of same side.
Puncture through posterior lower calyx carried out in 39 patients (78%) and through posterior middle calyx in 11 patients. Percutaneous nephrostomy tract had been performed in all uf the patients either for peNL {for cases with succeeded flushing