Evidence-Based Instrumentation for Flexible Ureteroscopy: A Review

Abstract

Instrumentation is the key to success in endourology. Indeed, endourology could be redefined as "enginurology," as the marriage between engineering and urology, and developing instrumentation to improve patient outcomes is the key facilitator in the advancement of minimally-invasive techniques. This review article will identify the evidence base that supports our current recommendations for equipment used during ureteroscopy.

Instrumentation in endourology

“…While the Stryker and Wolf scopes each experienced early catastrophic failure (fewer than 10 cases) in one of three sites, this occurred at all sites for the ACMI. In an older study published in 2007, the ACMI was noted to be one of the most durable scopes [Holden et al 2008]. It can be seen that the ACMI has lost its status as the most robust scope with the improvement in scope design from other manufacturers.…”

“…An ideal guidewire requires little force to flex in response to resistance and requires a large force to perforate tissue. A slippery hydrophilic guidewire is used to obtain access to the ureter or to bypass an impacted calculus, whereas a stiffer guidewire that is less likely to slip out is used to straighten a tortuous ureter, or to pass instruments and access sheaths into the upper collecting system [Holden et al 2008]. …”

“…It was previously shown that the Cook NCircle 3.0 Fr facilitated efficient stone capture in ureteral models while the Sacred Heart Halo was more efficient in calyceal models [Lukasewycz et al 2004a[Lukasewycz et al , 2004b. For stones less than 1 mm in size, the Cook NCompass has a webbed configuration to assist with stone capture [Holden et al 2008].…”

Urological Aspects of Management

“…6,7,8,9). They are also used to dilate benign ureteral strictures to allow for upper tract instrumentation including lithotripsy and stone retrieval [91].…”

A New Robot for Flexible Ureteroscopy: Development and Early Clinical Results (IDEAL Stage 1–2b)

“…However, FURS represents a technically challenging procedure that requires specific endourologic skills [7][8][9]. Despite progress in the design of ureterorenoscopes and accessories, FURS cannot be performed as solo surgery ( Table 1).…”