FLEXIBLE URETEROSCOPES: A SINGLE CENTER EVALUATION OF THE DURABILITY AND FUNCTION OF THE NEW ENDOSCOPES SMALLER THAN 9Fr

Afane, Jose S.; Olweny, Ephrem O.; Bercowsky, Eduardo; Sundaram, Chandru P.; Dunn, Matthew D.; Shalhav, Arieh L.; McDougall, Elspeth M.; Clayman, Ralph V.

doi:10.1016/s0022-5347(05)67133-9

Cited by 161 publications

(55 citation statements)

References 9 publications

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“…4 A singlecentre evaluation of the durability of flexible ureteroscopes smaller than 9-F showed that they need repair after 6-15 uses. 20 We suggest a number of reasons 21 who concluded that it is the arduous nature of upper tract stone surgery that determines how long these scopes last. The recently described method of advancing a 200 µm laser fibre through a 2-F catheter placed in the working channel of the scopes could potentially enhance their durability.…”

Section: Discussionmentioning

confidence: 99%

Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Ms¹,

Mf²,

Rc³

et al. 2004

Ann R Coll Surg Engl

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Objective: To report our outcomes with small diameter, actively deflectable flexible ureterorenoscopy from a prospective database. Patients and Methods: 114 flexible ureterorenoscopies were performed in 105 patients (mean age, 49.5 years; range, 19-85 years; 71 males, 34 females) over a 9-month period. Of these, 101 were for refractory stones following failed ESWL and 13 for diagnostic reasons. An Olympus URF P3 flexible ureteroscope with pressure irrigation was used. Electrohydraulic lithotripsy was used to fragment stones and the fragments were retrieved with Graspit, triradiate graspers or tipless baskets. Results: Stents had previously been placed in 53% and dilatation of the ureteric orifice was necessary in 15%. In the stone group, the median operating time was 55 min (range, 15-210 min) and the median screening time 2.2 min (range, 0.3-9.1 min). Success was defined as complete stone clearance or good fragmentation to 2 mm or less. Overall success in this group was 72.3%. There was no statistically significant difference between lower and other calyces (P = 0.83 Chi-square test). Successful outcome was achieved in 72% for stone size 10 mm or less, 80% for 11-20 mm and 50% for greater than 20 mm. Two or more procedures were needed in 8 patients. In the diagnostic group, the median operating time was 45 min (range, 20-60 min) and the median screening time 2 min (range, 0.3-8.3 min). The majority were for upper tract filling defects. Access and successful diagnosis was achieved in all cases. The major complication rate was 2.6%. The ureteroscope needed repair once during this series. Conclusions: Flexible ureterorenoscopy is an effective diagnostic and therapeutic tool in a select group of patients. It should be considered for ESWL-resistant upper tract stones but the results are poor in stones larger than 20 mm and percutaneous nephrolithotomy may be a better option in these patients.

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Section: Discussionmentioning

confidence: 99%

Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Ms¹,

Mf²,

Rc³

et al. 2004

Ann R Coll Surg Engl

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“…There was no greater pixel loss than with the traditional ureteroscopes and the fibre-optic bundle was not replaced during the series. Previous studies reported that damage to a standard ureteroscope requiring repair occurs after 6-15 cases [18]. Pietrow et al [19] showed that certain techniques and precautions might increase ureteroscope longevity and their ureteroscopes averaged 27.5 cases before repair was necessary.…”

Section: Discussionmentioning

confidence: 99%

Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes

Johnson

Grasso

2003

BJU International

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The arrival of the flexible ureteroscope has been of great value to urologists, allowing access to virtually all parts of the collecting system. Authors from two centres in the New York area and Taiwan write in this section about their experience with new types of flexible ureteroscopes. Their views are sure to be of interest to readers.OBJECTIVETo increase the clinical usefulness of the actively deflectable flexible ureteroscope by making sequential changes in design and then using these prototypes clinically; and to develop a clinical series using the optimum prototype and contrast it with an extensive database of patients treated with the traditional flexible ureteroscope.METHODSA series of prototypic flexible ureteroscopes was developed and used clinically. The active deflection of the prototype ureteroscope was evaluated with and with no accessories in the working channel, and compared with a standard 7.5 F ureteroscope. Clinical data were then accrued and compared with a previously published database.RESULTSThe progression of prototypes led to a final version which incorporated > 300° primary active deflection, shaft miniaturization (8.4 F) and an increase in endoscope shaft stiffness. The prototype flexible ureteroscope had significantly greater active deflection than the standard ureteroscope, especially when working channel accessories were used. In all, 115 endoscopic procedures were carried out, the indications for which included endoscopic lithotripsy for distal calculi (51), treatment of upper tract urothelial carcinoma (27), diagnostic endoscopy (26) and retrograde endopyelotomy (three). No guidewire was required to place the flexible ureteroscope into the upper urinary tract in 27% of patients. Active intramural dilatation for access was only required in 3% of the procedures. All lower pole calyces were accessed with this instrument.CONCLUSIONSAdding exaggerated deflection is a timely advance in flexible ureteropyeloscopy. This and the other changes in design facilitated complex retrograde endoscopic procedures and increased the therapeutic potential of the instrument.

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“…However, ureteroscopy can be limited by difficult ureteric access, which can result from stricture formation, severe intravesical inflammation or extensive carcinoma in situ , previous ureteric implantation or difficulty in negotiating the prostatic median lobe in men [11]. The operational cost and particularly maintenance of the finer flexible ureteroscopes might limit the availability of this procedure [12].…”

Section: Discussionmentioning

confidence: 99%

“…MAU was used in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the mean (range) stone size was 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)) mm, with 30 stones in the upper, 69 in the mid-and 13 in the lower ureter. In 15 patients the stones were impacted and there were signs of infection in the proximal ureter.…”

Section: Methodsmentioning

confidence: 99%

Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

2003

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RESULTSMAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10-44) min and the hospital stay 42 (24-72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30-150) mL. The drain was removed after 5 (5-7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1-7) days after surgery. The mean time to resumption of work was 16 (8-35) days. CONCLUSIONSMAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. KEYWORDS mini-access, ureterolithotomy, technique, complications, indications, surgeon OBJECTIVETo report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODSMAU was undertaken in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8-22) mm, with 30 stones in the upper, 69 in the mid-and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter.

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FLEXIBLE URETEROSCOPES: A SINGLE CENTER EVALUATION OF THE DURABILITY AND FUNCTION OF THE NEW ENDOSCOPES SMALLER THAN 9Fr

Cited by 161 publications

References 9 publications

Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes

Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

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