Purpose of review The pace of technology development with single-use endoscopy has led to a range of disposable ureteroscopes. We review the development of single-use scopes, deconstruct the basic design and functional characteristics of available devices, and discuss future directions for next-generation platforms. Recent findings Currently available devices are differentiated on the basis of several core features. The optical, deflection and irrigation characteristics are marginally different with no device clearly superior in every category. Studies comparing single-use ureteroscopes in patients linked to outcomes are limited. The incorporation of next-generation technologies into these platforms include sensors to monitor intrarenal pressure and temperature, suction of fluid and fragments, and computer vision for artificial intelligence. Summary Each ureteroscope has specific features that may be advantageous in different circumstances. Single-use devices could transform the ureteroscope from a visual conduit to a transformative surgical instrument that improves outcomes and reduces complications.
Introduction: Irrigation parameters during flexible ureteroscopy (fURS) may impact patient outcomes, yet there are limited data on current practice patterns of irrigation methods and parameter selection. We assessed the common irrigation methods, pressure settings, and situations that present the most problems with irrigation among worldwide endourologists. Methods: A questionnaire on fURS practice patterns was sent to Endourology Society members in January 2021. Responses were collected through QualtricsXM over a 1-month period. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Surgeons were from North America (the United States and Canada), Latin America, Europe, Asia, Africa, and Oceania. Results: Questionnaires were answered by 208 surgeons (response rate 14%). North American surgeons accounted for 36% of respondents; 29% Europe, 18% Asia, and 14% Latin America. In North America, the most common irrigation method was the pressurized saline bag using a manual inflatable cuff (55%). Saline bag (gravity) with a bulb or syringe injection system was the most common method in Europe (45%). Automated systems were the most common method in Asia (30%). For pressures used during fURS, the majority of respondents used 75–150 mmHg. The clinical scenario which had the greatest issue with adequate irrigation was during biopsy of urothelial tumor. Conclusion: There is variation in irrigation practices and parameter selection during fURS. North American surgeons primarily used a pressurized saline bag, in contrast to European surgeons who preferred a gravity bag with a bulb/syringe system. Overall, automated irrigation systems were not commonly used.
INTRODUCTION AND OBJECTIVE: The feasibility of ultrasonic propulsion and burst wave lithotripsy (BWL) to noninvasively reposition distal ureteral stones to facilitate passage and relieve pain was tested.METHODS: Patients presenting to the kidney stone clinic or emergency department (ED) with a distal ureteral stone were recruited after standard of care pain management. To attempt to move the stone, 10 subjects underwent ultrasonic propulsion (lower amplitude, longer duration bursts) alone, and 10 subjects also received intermittent BWL (higher amplitude, shorter duration bursts). All participants were awake without anesthesia and underwent:$ a screening ultrasound to ensure the stone was visible$ a pain assessment preand post-procedure $ contact once a week for three weeks to assess for adverse events$ follow-up imaging and chart review within 12 weeksSubjects were sub-categorized based on whether their stone was acute or chronic ( 10 days or >10 days from their ED visit, respectively).RESULTS: Demographic data and effectiveness outcomes are presented in Tables 1 and 2. Overall, 93% of acute stones passed in an average of 3.6 days post-procedure. There was no control group, but Table 2 includes published passage rates and times for potentially similar untreated groups as reference. Stone motion was observed in 16 of 20 cases, including a stone pushed into the bladder, ureteral jets were observed following propulsion bursts in 9 of 20 cases and fragmentation was observed in 3 of 10 BWL cases. Pain reduced post-procedure in 10 of 20 subjects, while pain increased in only one subject; although, the average score was low prior to treatment, and the average decrease was not statistically significant (p[0.13). Adverse events were limited to slight reddening of the skin (N[6), hematuria on only the initial urination post-procedure (BWL only, N[3), and a mild sensation, akin to a pinprick, on fewer than 10 of 620 propulsion bursts among 3 subjects.CONCLUSIONS: This feasibility study showed the potential for facilitating stone passage of distal ureteral stones and relieving pain with ultrasonic propulsion and BWL.
The increasing use of flexible ureteroscopy has occurred against a background of the development of single-use flexible ureteroscopes (su-fURS). We assessed current su-fURS practice and attitudes toward next-generation technologies through a worldwide survey of endourologists.METHODS: An anonymous online questionnaire on su-fURS and practice patterns consisting of 30 items was sent to Endourology Society members in January 2021. Responses were collected through QualtricsXM over a 1-month period. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).RESULTS: Questionnaires were answered by 208 surgeons (response rate 14%). U.S surgeons accounted for 30% of all respondents. fURS was routinely performed by respondents with 54% performing >101 cases/year. 26% of surgeons did not use su-fURS, 43% used it for <25% of their cases, while 2% used it for all cases. 34% noted a decrease in OR time when using su-fURS. The three most common indications were lower pole (LP) stone, stone >2 cm, and horseshoe kidney. Cost was ranked the number 1 most important limiting factor in its adoption (Fig. 1). Image quality (39%) was ranked the most important characteristic in current devices. For improvements in scope design, the top 3 features were smaller shaft size (19%), vision (16%), and wireless connectivity (14%). When asked about the importance of next-generation technologies in su-fURS, fragment suction capability was the most popular and considered very important/essential by 70% (Fig. 2).CONCLUSIONS: In this survey, su-fURS was not used by 26% of surgeons, and sparingly used by the majority. The most common indications for use of a su-fURS were LP stone, stone >2 cm, and horseshoe kidney. The major limitation in adoption was the cost. Suction and pressure sensor were considered the most important future developments.
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