Sky is no limit for ureteroscopy: extending the indications and special circumstances

Abstract

Ureteroscopy is effective and reliable tool capable of treating the majority of stones even in the most complicated clinical scenarios and will have more fundamental roles in endourology. The lack of definitive conclusions is due to the great heterogeneity in collecting study's results; multicentric randomized trials that define in advance the parameters to be studied should be encouraged.

Mortality and flexible ureteroscopy: analysis of six cases

“…If high pressures are necessary, planning a second look or the use of endoluminal isoproterenol irrigation could be helpful [6] Do not exceed an operative time of 2 h (1 for children) If there is a complex case or high stone burden, a staged procedure is advisable [1] Carefully monitor patients in the early postoperative phase If there is postoperative fever promptly check procalcitonin levels (90 % of septic complications occur within 6-12 h) and start with antibiotics [9,10] …”

“…Adequate training and sharing the tricks of the trade with the experts in the field during the start-up phase are necessary. Furthermore, detailed and frank counselling of the patients is strongly encouraged to inform them not only about the minimal invasiveness but also about outcomes of the surgeons/centers and the potential for staged multiple procedures in the most difficult cases and the possibility, although rare, of major complications" [1].…”

“…Despite its safety profile, some severe complications have been described [1,2]. The available literature reports on only two cases of death after RIRS [3,4].…”

“…Retrograde intrarenal surgery (RIRS) represents an intriguing technique that allows surgeons to successfully treat renal stones, usually managed by both shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL), even in demanding clinical scenarios such as pregnancy, anatomic malformations, coagulopathies and large stone burdens [1]. Despite its safety profile, some severe complications have been described [1,2].…”

The Use of Apnea During Ureteroscopy

“…Over the last decades RIRS indications have further expanded; Procedures in delicate patients such as pregnant women or patients with bleeding diathesis have been reported to have good outcomes 11 . These procedures are now widely used even for complex cases and require extremely precise manoeuvers during laser use.…”