Approximately 10% of Caucasian men will expect to suffer from renal stone disease by the age of 70 years. It is a growing problem in the UK, with a cross-sectional prevalence of approximately 1.2%. These statistics mean there are approximately 720,000 individuals with a history of kidney stones in the UK. 1 The increased prevalence of kidney stones parallels the well-publicised increase in the nation's prevalence of obesity and its well-documented relationship to urolithiasis. 2In 1912, the first visualisation of the upper urinary tract was performed by Hampton Young. He achieved this by passing a cystoscope into a mega-ureter of a paediatric patient. Subsequent developments in optics have revolutionised endourology and established the ureteroscopic treatment of ureteric and renal calculi.Although a comparison between extracorporeal shockwave lithotripsy (ESWL) and ureterorenoscopy (URS) removal of stones from the lower calyx of the kidney has failed to show a significantly better result with URS, 3 the updated 2007 American Urological Association/European Association of Urology (AUA/EAU) guidelines, and recent Cochrane meta-analysis, suggest that stone-free rates are superior with URS for all stone sizes and for all positions in the ureter, apart from stones in the upper third less than 10 mm in size. 4 Standard access to the ureter for endoscopic management of stone disease may be difficult due to anatomic abnormalities, a narrow ureteric lumen, tortuous ureteric path or previous instrumentation (Fig. 1). Failure of access will usually lead to the placement of a ureteric stent. The alternative for these difficult, tight ureters is extensive balloon dilatation, with the risk of trauma and the potential for long-term stricture formation. Difficulty may be encountered with retrograde access for rigid and flexible ureterorenoscopy (URS) due to anatomic abnormalities, a narrow ureteric lumen, tortuous ureteric path or previous instrumentation. Ureteric dilatation using a balloon or tapered dilator can occasionally fail and will usually lead to the placement of a ureteric stent. We present our experience and incidence of pre-stenting after failed standard access and dilatation techniques, the aim being to quote a figure for the patient at the time of consent. PATIENTS AND METHODS Data were collected prospectively from a single surgeon at a regional tertiary referral stone unit. The outcomes of those patients pre-stented, for failed access, were recorded. RESULTS Between December 2007 and December 2008, a total of 119 patients underwent flexible and rigid URS. Mean patient age was 49 years (range, 19-86 years). Of these, 107 cases were undertaken for urolithiasis and 12 cases for diagnosis of upper tract malignancy. 12% (13/107) of cases were for pain and non-diagnostic imaging and 8.4% (9/107) of patients were pre-stented because of failed access, without complication, and subsequently had successful interval treatment. Of the remaining successful cases of confirmed urolithiasis, 33% (28/85) and 67% (56/85) were und...

Tomorrow's Doctors was first published by the General Medical Council (GMC) in 1993. The recommendations provide a framework for UK medical schools to use to design detailed curricula and schemes of assessment in the training of future doctors. They also set out the minimum standards that are used to judge the quality of undergraduate teaching. In 2003 this guidance was revised and a further 2009 version has now been published. A constant feature of these important documents is a list of therapeutic procedures that all graduates are expected be able to perform safely and effectively. These include male and female urethral catheterisation.

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