Abstract
INTRODUCTION AND OBJECTIVE: The accessible range of a lower pole calyx according to retrograde ureteral access using a flexible ureteroscope with the usual two deflected directions is often limited. We developed and evaluated a flexible ureteroscope with omni-directional bending using a joystick unit (URF-Y0016). METHODS: The URF-Y0016 possesses the features of omni-directional bending in the tip of a flexible ureteroscope, which is integrated by four deflected directions and the controlling element of a handgun type with a joystick unit. We compared the accessible range of the URF-Y0016 with the URF-P6 (Olympus, Japan) by using a three-dimensional (3D) pyelocaliceal model ex vivo. The 3D pyelocaliceal model was constructed by upper, middle, and lower pole calyces (Fig. 1-A). Each inside of the calyx dome was distributed d the index of reachable angle by a 10-degree interval in eight directions (Fig. 1-B,C). Four experts of stone surgery evaluated the accessible range of the eight directions in each calyx between the URF-Y0016 and URF-P6. RESULTS: The URF-Y0016 can reached a significantly broader range in the lower pole calyx than that of the URF-P6 (p=0.002) (Fig. 2). In particular, the 0 and 1:30 o’clock directions in the anterior, and the 6 and 7:30 o’clock directions in the inferior parts in all eight directions in the lower pole calyx were significantly different between the URF-Y0016 and URF-P6 (48.8 degrees vs 13.8 degrees, p=0.003; 42.5 degrees vs 17.5 degrees, p=0.001; 53.8 degrees vs 11.3 degrees, p=0.003; and 66.3 degrees vs 11.3 degrees, p=0.001, respectively). However, the reachable range in the upper pole and middle pole calyces were not significantly different between the URF-Y0016 and URF-P6 (p=0.446 and p=0.295). CONCLUSIONS: The URF-Y0016 is a novel flexible ureteroscope with omni-directional bending. This ureteroscope may have great potential for easily reaching the lower pole calyx, especially the anterior and inferior lower pole calyces, in clinical practice.Source of Funding: none
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