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Ureteroscopy: Background and Current Controversies

As ureteroscopic technology and familiarity with this approach to treat stones continues to grow, the relative number of stones being treated in this fashion has been growing rapidly as well. The latest estimates of surgical practice from the past decade show that ureteroscopy has replaced shock wave lithotripsy as the most commonly performed treatment of kidney stones, accounting for 54% of upper urinary tract stone procedures. Along with the widespread adoption of this procedure, two main techniques have evolved into practice, the optimal one of which remains unclear.

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 Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond

Ureteroscopy (URS) stands beside shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) in the trilogy of minimally invasive therapies performed in patients with urolithiasis. Since the early descriptions by Marshall et al. in 1964, it has undergone many modifications, both in terms of the equipment used as well as the surgical techniques applied. Ureteroscopy has become an increasingly popular surgical intervention for conditions such as urinary stone disease. As new technologies and techniques become available, debate regarding their proper use has risen. This includes the role of single use ureteroscopes, optimal laser for stone lithotripsy, basketing versus dusting, the impact of ureteral access sheath, the need for safety guidewire, fluoroscopy free URS, imaging and follow up practices are all areas which have generated a lot of debate.

Articles of Interest

Controversies associated with ureteral access sheath placement during ureteroscopy

In the past decades of urologic surgery, technological development in flexible ureteroscopy has greatly expanded in its role for the treatment of kidney stone disease. With this rapid development, supporting instruments were created to ease and facilitate this treatment modality, including the introduction of the ureteral access sheath...

Cystoscopy & Ureteroscopy

The risks of cystoscopy and ureteroscopy include •UTIs •abnormal bleeding •abdominal pain •a burning feeling or pain during urination •injury to the urethra, bladder, or ureters •urethral narrowing due to scar tissue formation •the inability to urinate due to swelling of surrounding tissues •complications from anesthesia.

Emergency ureteroscopy is safe and effective

Obstructive ureteral stones are treated by ureteroscopy or extracorporeal shockwave lithotripsy. Although lithotripsy is more common, success rates vary according to the stones' location. Ureteroscopy is relatively invasive, but technological advances in ureteroscopes have improved stone-free rates and decreased complication rates.

Emergency vs elective ureteroscopy for a single ureteric stone

Emergency URS can be as safe and effective as elective URS for the treatment of a single ureteric stone if it is performed in patients without fever or turbid urine.

Is a ureteral stent required before flexible ureteroscopy?

In summary, we found that preoperative ureteral stent placement can help to decrease the operative time and improve the SFRs for patients undergoing fURS, but not significantly so. Preoperative stenting extended the length of hospital stay and increased hospital costs, but had no influence on complication and re-operation rates. These findings lead to the conclusion that preoperative ureteral stent placement before fURS for the treatment for upper urinary calculi is not reasonable.

The efficacy of flexible ureteroscopy for large volume stones and hazards of ureteral access sheath usage: A prospective randomized study

Many factors, such as stone site and size, patients’ comorbidities and previous modalities of treatments, should be considered to properly manage upper urinary tract stones (UUTS). Despite percutaneous nephrolithotripsy (PCNL) being considered the standard treatment modality for renal stones >20 mm, it carries serious complications like bleeding and adjacent organ injury.

Tips and tricks of ureteroscopy: consensus statement Part I. Basic ureteroscopy

Ureteroscopy is fast becoming the first line treatment option for the majority of urinary tract stones. Ureteroscopy training can be performed in a variety of ways including simulation, hands on ureteroscopy courses and supervised operative experience. We report an “expert consensus view” from experienced endourological surgeons, on all aspects of basic ureteroscopic techniques, with a particular focus on avoiding and getting out of trouble while performing ureteroscopy.

Ureteroscopy

Ureteroscopy often a good option for small stones in the ureter or kidney. Its success rate at clearing these types of stones is generally higher than that for shockwave lithotripsy. Compared with shockwave lithotripsy however, it may associated with increased discomfort after surgery, especially when a stent is required. Ureteroscopy also does not always work as well with very large stones, as the small size of the instrument makes it difficult to completely treat and remove such stones. In these cases a percutaneous approach may be preferable.

Ureteroscopy: Non-invasive Treatment for Kidney Stones

Ureteroscopy can be an ideal solution for people with small to medium stones that can be removed in one piece. For large stones, ureteroscopy can still be an option.