Ureteroscopy with and Without Safety Guide Wire: Should the Safety Wire Still be Mandatory?

Abstract

No superior results were found at the hospital with the routine use of an SGW. It may be questioned if the SGW still should be considered mandatory.

Is a safety guidewire needed for retrograde ureteroscopy?

“…Similarly, access sheaths were used in 31.6% of the cases in the group with SGW compared to only one case in the group without it (p<0.0005). 12 The reported success rates of passing the ureteroscope through the ureteral orifice, the ability to access the ureteral stone and the ability to place a ureteral stent when needed after the endoscopy were not significantly different between the two groups of patients. 12 There was no significant difference in the overall intraoperative complication rates at the two hospitals.…”

“…12 The reported success rates of passing the ureteroscope through the ureteral orifice, the ability to access the ureteral stone and the ability to place a ureteral stent when needed after the endoscopy were not significantly different between the two groups of patients. 12 There was no significant difference in the overall intraoperative complication rates at the two hospitals. The overall stone-free rates were 77.1% and 85.9% with and without the SGW, respectively (p=0.001).…”

“…It seems that there is a belief that the routine use of an SGW may not be necessary and may even be deleterious, mainly due to the fact that working without a safety wire often facilitates access to the kidney (less friction passing the ureteroscope), scope manipulation (less torque to rotate the scope), and makes it easier to laser and basket fragments. 5,9,12 Moreover, many publications have described their successful experience with both semi-rigid and flexible URS for the treatment of both ureteral and renal stones without the use of an SGW. 5,6,[9][10][11][12] The idea of historical longstanding dogma of "SGW always in endourology" may have come from a time when the ureteroscopes, lithotripsy equipment and disposable materials were under development.…”

“…There were no complications in the group without a safety wire secondary to loss of upper tract access. 11 Ulvik et al 12 compared the results of URS for the treatment of ureteral stones at two different hospitals where the SGW was either routinely used or omitted. Both groups had 500 patients each.…”

“…A significant increase in the number of patients (14 patients, 3.4%) was found to have post endoscopic ureteral stenosis at the hospital where the SGW was routinely used than at the hospital where an SGW was omitted (six patients, 1.2%), p=0.039. 12 …”