Today we had another patient with difficult ureteral insertion. We have encountered nearly ten cases of such patients. Reasons: 1 , ureteral orifice malformation, congenital ureteral orifice stenosis, ectopic or abnormal angle, congenital duplicate ureter, so preoperative IVU or CTU examination is necessary. 2 , ureteral stone obstruction. 3 , male patients with prostatic hyperplasia, the ureter is difficult to find or located in the visual dead space due to prostate. 4 , cystitis or prolonged time with ureter, bladder mucosa edema, resulting in unclear ureteral orifice. Treatment: 1. Preoperatively, patients with cystitis or bladder bleeding should control inflammation and eliminate bladder edema. 2. Preoperative imaging to rule out ureteral malformations and understand the location of the ureter. 3. Before intubation, there should be adequate estimation, and the entry of the mirror should be gentle to reduce the damage to the bladder mucosa and reduce bleeding. When searching for the ureteral opening and inserting the guidewire, be patient and remember to venture in blindly, causing damage to the orifice and bleeding so that the orifice will be more difficult to identify.4. You can find the orifice on the normal side first and follow the ureteral ridge to find the orifice on the diseased side. You can also fill or empty the bladder, the shape of the ureteral orifice is prominent, often with a collection of blood vessels; when the orifice is not clear, do not rush to insert the catheter, you can adjust the angle of the mirror and gently insert the guidewire, if the guidewire is not suitable or to replace the guidewire. Avoid rough insertion of the guidewire or ureteroscope body causing damage to the bladder mucosa or the formation of a false channel. At this time, the tube should be flushed while the outer upper side of the tube mouth, gently manipulated to find the tube mouth. Follow the fiber walk to find it.5. You can also consider replacing the cystoscopic cannula or using an electrodesiccoscope to remove the surface of the bulge of the canal before looking for the canal (this method is not usually used). To be continued at the end