Is a safety guidewire needed for retrograde ureteroscopy?

Molina, Wilson; Pessôa, Rodrigo; Silva, Rodrigo Donalísio da; Gustafson, Diedra; Nogueira, Letícia; Meller, Alex

doi:10.1590/1806-9282.63.08.717

Cited by 3 publications

(3 citation statements)

References 12 publications

(32 reference statements)

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“…Currently, there is a lack of solid data supporting the need for safety guidewire insertion in all procedures. 4 A randomized controlled trial suggests that safety guidewire substantially increased the resistance against moving a semi-rigid ureteroscope up and down the ureter. The safety guidewire may thus be an obstacle to the ureteroscopic procedure and may even increase the risk of harming the ureter in some patients.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the outcome of trans-ureteral lithotripsy for uncomplicated ureteral stones with or without safety guidewire: A randomized clinical trial

et al. 2022

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Introduction: Using a safety wire during trans-ureteral lithotripsy (TUL) might minimize ureteral injuries. Conversely, others suggest safety wire itself may increase the risk of ureteral injuries that its routine use is not mandatory in all cases. This randomized clinical trial was conducted to compare the outcome of TUL in the presence or absence of a safety guidewire. Methods: This randomized clinical trial was conducted on patients referred to our center with a ureteral stone less than 1.5 cm; candidate for TUL after not passing the stone after 2 weeks of conservative management and had no sign of infections or anatomic abnormalities. The primary outcome was the rate of ureteral injuries. Patients were randomly divided into two groups; using safety wire (SGW) and not using safety wire (NSGW). Patients, the data collecting physician, and the Statistical analyst; were concealed from the randomization process. Demographic factors were recorded for each participant. Patients were followed up for at least 1 month; registering intra-operative and post-operative complications. Results: From 2020 to 2021, 348 patients were randomized in two arms. Considering the lost cases during the study, 124 patients were finally analyzed in the SGW and 96 patients in the NSGW. Complications were not different between the two groups ( p > 0.05); though, operation time was significantly longer in the SGW group (31.7 min in SGW vs 28 min in NSGW p = 0.02) Conclusion: The safety guidewire seems to add no significant benefit to the TUL procedure outcomes in uncomplicated cases.

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Section: Introductionmentioning

confidence: 99%

“…Expected complicated surgery such as impacted stones or anatomical abnormalities, narrow ureteral caliber, ectopic kidney, severe ureteral edema, lack of optimal visibility 4…”

Section: Introductionmentioning

confidence: 99%

Comparison of the outcome of trans-ureteral lithotripsy for uncomplicated ureteral stones with or without safety guidewire: A randomized clinical trial

et al. 2022

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“…This meta-analysis recommended further comparative studies on stone clearance rate in patients with distal ureteric stones, undergoing URS with and without SGW. 7,8 As no local studies were found in the literature. So, this study was aimed to compare the stone clearance rate in patients with distal ureteric stones undergoing URS with and without SGW.…”

Section: Introductionmentioning

confidence: 99%

Comparison of stone clearance rate in patients with distal ureteric stones, undergoing URS with and without a safety guide wire.

Ahmad

Ullah

Ahmed

et al. 2021

TPMJ

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Objective: To compare stone clearance rate in patients with distal ureteric stones, undergoing URS with safety guide wire and without safety guide wire. Study Design: Randomized Clinical Trial study. Setting: Department of Urology, Pir Abdul Qadir Shah Institute of Medical sciences. Period: January, 2020 to December 2020. Material & Methods: The study patients fulfilling the inclusion criteria were divided into two groups using the lottery method. Group A: Patients underwent URS with insertion of safety guidewire (SGW). Group B: These patients underwent URS without safety guidewire (SGW). Patients in both groups were compared for stone clearance. Results: Mean age in Group A was 37.79±12.44 years and in Group B were 33.31±11.48 years. Group wise distribution of gender showed 79 (73.83%) male and 28 (26.17%) females in Group A and 70(65.42%) male and 37 female (34.57%) in Group B. In comparison of both groups, 65.42% stone clearance was noted in Group A while 78.50% stone clearance was found in Group B and p-value found to be significant (P=0.033). Conclusion: Our study concluded that stone clearance in patients with distal ureteral stones undergoing URS without SGW is higher in comparison to URS with SGW, without any added advantage.

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Sheathed flexible retrograde intrarenal surgery without safety guide wire for upper urinary tract stones

Asali

2022

Arch Ital Urol Androl

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Objectives: To assess the success rate and intraoperative complications of flexible ureterorenoscopy (f-URS) in patients with upper urinary tract (UUT) stones using a ureteral access sheath (UAS) without a safety guide wire (SGW). Patients and methods: Between April 2010 and March 2022, 464 renal units in patients with renal stones with and without concomitant ureteral stones (UUT), underwent ureterorenoscopy by one surgeon, and UAS was used in all of them. The primary endpoint was the stone-free rate (SFR). SFR was defined as no residual fragments at all. The following characteristics were examined: age, sex, laterality, renal/ureteral stones, stone diameter, SFR, Hounsfield unit, auxiliary procedures, double-J stent insertion, and intraoperative complications. This study was retrospective, with all the data recorded prospectively. Patients with residual stones were scheduled for the 2nd RIRS. The Clavien-Dindo classification was used to report complications. Results: The mean patient age was 52.9 years. The mean stone size was 13.1 mm. Lower pole, upper and middle calyces, renal pelvis and ureteral stones were found in 51.5% (239), 34.9% (162), 18.3% (85) and 46.9% (218) of cases, respectively. The mean diameter was 8.1 mm, 8 mm, 12.5 mm and 8.1 mm for the lower pole, upper and middle calyces, renal pelvis and ureteral stones, respectively. The single- and second-session SFRs were 90% and 100%, respectively. The mean number of procedures per renal unit was 1.1. Ureteral double-J stents were inserted in 45.7% (212) of patients. In 96 cases, a stent was placed before surgery. Postoperative complications were minor, with no avulsion or perforation of the ureters; readmission and insertion of a DJ stent occurred in one patient. Ureteral stricture developed in one patient (0.2%) and needed treatment with laser ureterotomy. Conclusions: f-URS is a safe and effective mode of surgical management of renal and simultaneous renal and ureteral calculi using the ureteral access sheath without a safety guide wire. A guide wire should not be routinely used in these cases.

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Is a safety guidewire needed for retrograde ureteroscopy?

Cited by 3 publications

References 12 publications

Comparison of the outcome of trans-ureteral lithotripsy for uncomplicated ureteral stones with or without safety guidewire: A randomized clinical trial

Comparison of the outcome of trans-ureteral lithotripsy for uncomplicated ureteral stones with or without safety guidewire: A randomized clinical trial

Comparison of stone clearance rate in patients with distal ureteric stones, undergoing URS with and without a safety guide wire.

Sheathed flexible retrograde intrarenal surgery without safety guide wire for upper urinary tract stones

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