Semirigid Ureteroscope Research Articles

Ultrathin semirigid retrograde ureteroscopy versus antegrade flexible ureteroscopy in treating proximal ureteric stones 1-2cm, a prospective randomized multicenter study.

To compare the outcomes of using Ultrathin semirigid retrograde ureteroscopy and antegrade flexible ureteroscopy to treat proximal ureteric stones of sizes 1-2cm. A prospective randomized multicenter study included patients who had proximal ureteric stones 1-2cm, amenable for ureteroscopy and laser lithotripsy between August 2023 and February 2024. Two hundred thirty patients were divided evenly into two treatment groups. Group I included patients treated with antegrade flexible ureteroscopy and holmium laser stone fragmentation, and Group II included patients treated with retrograde ultrathin semirigid ureteroscopy. The study groups were compared in terms of patient demographics, stone access success, operation time, reoperation rates, peri-operative complications, and stone-free status. Group I included 114 patients, while Group II included 111. The mean age of the patients was 33.92 ± 10.37years, and the size of the stones was 15.88 ± 3mm. The study groups had comparable demographics and stone characteristics. The mean operative time was significantly longer in group I than in group II (102.55 ± 72.46min vs. 60.98 ± 14.84min, respectively, P < 0.001). Most reported complications were MCCS grades I and II, with no significant difference between the study groups. The stone-free rate after four weeks was 92.1% and 81.1% for groups I and II, respectively, which increased to 94.7% and 85.6% after eight weeks (P > 0.05). Antegrade flexible ureteroscopy is equivalent to retrograde ultrathin semirigid ureteroscopy in treating proximal ureteric stones regarding stone-free status and procedure-related morbidity. However, the antegrade approach has a longer operative time, greater fluoroscopy exposure, and longer hospital stays.

Investigation of Predictors of Systemic Inflammatory Response Syndrome After Endourological Procedure of Upper Urinary Tract Stones.

Background: In order to prevent infectious complications following endourological procedure of upper urinary tract stones, it is essential to determine which patients are at high risk of developing this complication. We aimed to identify predictors that may cause systemic inflammatory response syndrome (SIRS) after the endourological procedure of upper urinary tract stones. Materials and Methods: Patients who underwent percutaneous nephrolithotomy (PNL), flexible ureteroscopy (F-URS), or semirigid ureteroscopy (SR-URS) in our center between January 2011 and June 2020 were evaluated retrospectively. After surgery, patients were pursued for SIRS criteria. Logistic regression analyses were applied to identify predictors of SIRS. Results: A total of 1471 patients were included in the study. The rates of SIRS after PNL, F-URS, and SR-URS were 12.9%, 6.3%, and 1.7%, respectively. In multivariate analysis, predictors for SIRS were determined to be stone volume, operative time, and history of recurrent urinary tract infection (UTI) in the PNL group; ipsilateral stone surgery history, stone volume, and operative time in the F-URS group; and stone volume, operative time, and history of recurrent UTI in the SR-URS group. Conclusion: Stone volume and operative time were determined to be independent predictors of SIRS in endourological surgery of upper urinary tract stones.

Bilateral Complete Ureteral Duplication with Obstructing Stones in Both Left Ureters: A Case Report and a Review of Literature

Congenital anomalies like duplex renal collecting systems are rare developmental conditions. Among these anomalies, ureteral duplication is rarely observed, with partial ureteral duplication comprising a majority of cases. Bilateral ureteral complete duplication, where fully duplicated ureters drain separately into the bladder via separate orifices, is extremely rare, making it a seldom-documented anomaly in the medical literature. A case of bilateral complete ureteral duplication complicated by calculi in both the upper and lower moieties of the left kidney presented to the urology outpatient department with complaints of left flank pain for one month. His computed tomography-urogram revealed complete duplication of bilateral collecting systems with bilateral double ureters with an 8.2×5.9 mm2 sized stone in the pelvi-ureteric junction of the left upper moiety and 11.9×5.6 mm2 sized stone in the proximal ureter of left lower moiety causing hydronephrosis of both upper and lower moiety pelvicalyceal system. Calculi in both the upper and lower moieties were cleared in a single setting using a Ureteroscopic Lithotripsy. Duplex renal systems, while often asymptomatic, are linked to a higher occurrence of treatable conditions like stones and renal reflux diseases. The duplicated structure may lead to stagnant urine, causing obstructions and consequently infections. Stones that obstruct the ureter for a prolonged period can cause renal impairment and require active intervention. Currently, flexible or semirigid ureteroscopy with laser lithotripsy is the standard procedure. Even in this case, both stones were effectively managed in a single session using a standard procedure.

Ultra-mini Percutaneous Nephrolithotomy (UM-PCNL) with a Semi-rigid Ureteroscope in Preschool Children: An Innovative Experience in Southern Iran.

Percutaneous nephrolithotomy (PCNL) has undergone extensive modification to reduce complications. One of the recent advances in minimally invasive procedures is the advent of ultra-mini PCNL (UM-PCNL), which provides miniaturized access to the kidney. However, the specific instruments applied in UM-PCNL may not be found in centers with limited resources. This study evaluated the safety, feasibility, results, and short-term complication rates of performing UM-PCNL using a semi-rigid ureteroscope in preschool children. Between September 2013 and September 2021, a total of 68 patients, including 42 boys and 26 girls with a mean age of 3.2 ± 2.4 years, underwent UM-PCNL with a 4.5French tip ureteroscope instead of an ultra-mini nephroscope in children aged less than 7 years old. The procedure was done under general anesthesia in the prone position. The nephrostomy tract was dilated to 12F. Stones were fragmented using a pneumatic lithotripter. Irrigation was done with normal saline. The early stone-free rate (SFR) was 91%, and the short-term total SFR was 97%. No statistically significant difference was found in pre-operative and post-operative Hb, BUN, Cr, Na+, and K+. Fever (11 patients) and ileus (5 patients) constituted the majority of complications, and only one patient required a blood transfusion. None of the cases undergoing UM-PCNL with this method required a re-do PCNL. Our experience shows that with sufficient experience in handling semi-rigid ureteroscopes, urologists practicing in centers with limited resources could perform UM-PCNL with relatively favorable outcomes.

Optimal parameter settings of thulium fiber laser for ureteral stone lithotripsy: a comparative study in two different testing environments.

This study aims to identify optimal parameters for using Thulium fiber lasers (TFL) in ureteral stone lithotripsy to ensure laser safety and maximize efficacy. Our goal is to improve the outcomes of single-use semi-rigid ureteroscopy for treating stones located in the proximal ureter. A clinically relevant thermal testing device was designed to investigate heating effects during TFL stone fragmentation. The device was utilized to identify safe power thresholds for TFL at various irrigation rates. Three other devices were used to assess varying pulse energy effects on stone fragmentation efficiency, dusting, retropulsion, and depth of tissue vaporization. Comparative experiments in fresh porcine renal units were performed to validate the efficacy and safety of optimal TFL parameters for semi-rigid ureteroscopy in proximal ureteral stone procedures. Our study found that the improved device generated a higher thermal effect. Furthermore, the safe power threshold for laser lithotripsy increased as the irrigation rate was raised. At an irrigation rate of 40ml/min, it is safe to use an average power of less than 30 watts. Although increasing pulse energy has a progressively lower effect on fragmentation and dust removal efficiency, it did lead to a linear increase in stone displacement and tissue vaporization depth. Thermal testing showed 20W (53.87 ± 2.67°C) indicating potential urothelial damage. In our study of laser lithotripsy for proximal ureteral stones, the group treated with 0.3J pulses had several advantages compared to the 0.8J group: Fewer large fragments (> 4mm): 0 vs. 1.67 fragments (1-2.25), p = 0.002, a lower number of collateral tissue injuries: 0.50 (0-1.25) vs. 2.67 (2-4), p = 0.011, and lower stone retropulsion grading: 0.83 (0.75-1) vs. 1.67 (1-2), p = 0.046. There was no significant difference in operating time between the groups (443.33 ± 78.30s vs. 463.17 ± 75.15s, p = 0.664). These findings suggest that TFL irradiation generates a greater thermal effect compared to non-irradiated stones. Furthermore, the thermal effect during laser lithotripsy is influenced by both power and irrigation flow rate. Our study suggests that using a power below 15W with an irrigation flow rate of 20ml/min is safe. Moreover, a pulse energy of 0.3J appears to be optimal for achieving the best overall stone fragmentation effect.

Ureteroscopic treatment of urolithiasis: How do we measure and optimise outcomes?

Background: Patients with urolithiasis have access to a wide range of efficacious therapeutic surgical options, including shockwave lithotripsy (SWL), retrograde ureteric or intrarenal surgery with semi-rigid and flexible ureteroscopes (URS or fURS) and percutaneous nephrolithotomy (PCNL). In recent years, there have been many peer-reviewed publications evaluating new techniques and new equipment, such as pulse-modulated Holmium:YAG and thulium fibre lasers. However, when reviewing this extensive literature, it becomes apparent that there is no consensus on what constitutes a ‘successful’ stone treatment outcome. Objectives: The purpose of this article is to review the existing measures of ‘success’ after the ureteroscopic treatment of urolithiasis and to promote a standardised and holistic approach to reporting outcomes in clinical trials. Methods: Our narrative review focussed on studies examining measures of success in urolithiasis treatment published within the last 10 years. Conclusions: Due to markedly different reported outcome measures of treatments for urolithiasis, comparing results between studies can be difficult. In addition to measuring clinical outcomes, there is an increasing acknowledgement of the importance of patient-reported outcome measures (PROMs) in determining treatment success, and the need to consider the cost-effectiveness and environmental sustainability of various treatments. We suggest that all future studies on this common urological condition should incorporate holistic and tranpsarent outcome measures. Level of evidence: Not applicable

Safety and efficacy of ureteroscopy for the treatment of large impacted proximal ureteralstones

Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter. Improvements in ureteroscopic technology increased the efficacy and safety of ureteroscopy (URS) as a first-line treatment in large impacted stones in the proximal ureter. The objective of this retrospective study is to evaluate the efficacy and safety of URS for the management of impacted proximal ureteral stones ≥ 10 mm. Material and methods: The medical records of 700 patients with ureteral stones, who underwent ureteroscopy and intracorporeal lithotripsy between January 2016 and Аpril 2024 were retrospectively reviewed. 179 patients had impacted stones ≥ 10 mm located in the proximal ureter – 125 (70%) were stones sized 10÷15 mm and 54 (30%) – stones ≥ 15 mm. URS was performed with 8.6 or 6.4Fr semirigid ureteroscope and Holmium laser. Flexible URS was performed in cases with tortuous ureter or stone retropulsion. Data on patients‘ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients’mean age was 54.1±12.3 years and mean stone size – 14.7±.4.8 mm. 30 % of the patients had previous unsuccessful shock- wave lithotripsy of the stone. Mean operative time was 45.1±15.7 min min and overall success rate – 85.3%. 66.2% of patients were treated with semirigid URS and 33.8% – with flexible URS. On subgroup analysis patients with stones 10÷15 mm and patients with stones ≥ 15 mm had similar preoperative characteristics. Success rate after a single procedure was higher and operating times significantly shorter in the subgroup of stones sized 10÷15 mm (87.1% vs 71.3%, p=0.159 and 41.3±12.9 vs 53.3±21.3 min, p=0.040,respectively). There were no statistically significant differences between the two subgroups in intraoperative stent JJ placement (34.1% vs 50.0%, p=0.400), stone retropulsion (21.3% vs 23.1%, p=0.847) and overall postoperative complications rate (9.3% vs 0%, p=0.161). Conclusion: The results of this study suggest that URS is a safe and effective treatment for management of patients with large impacted proximal ureteral stones. Larger stone size was a predictor of lower success rate after a single procedure.

Https://jemis.org/efficacy-and-safety-of-laser-endoureterotomy-for-the-treatment-of-ureteral-strictures-with-length-%e2%89%a4-10-mm/

Introduction: Ureteral strictures are severe and difficult to treat disorders and significantly affect the quality of life of patients. Endoscopic laser ureterotomy is a minimally invasive procedure that is increasingly used for the management of ureteral strictures. Objective:The objective of our study is to evaluate the efficacy and safety of Holmium laser endoureterotomy in the treatment of ureteral strictures with length ≤ 10 mm. Material and methods:A retrospectively collected database of 21 patients who unederwent laser endoureterotomy for uretereral strictures with length ≤ 10 mm between January 2018 and January 2021 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. The endoureterotomy was performed under direct vision using a semirigid or flexible ureteroscope. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 57.5±12 years and male-to-female ratio – 52.4%/47.6%. Mean length of the ureteral stricture was 7.2±2 mm. Eighteen of the patients (85.7%) were with secondary ureteral structures mainly with anamnesis for previous endoscopic surgery for impacted ureteral stones. There were no intraoperative complications. In 20 of the patients (95.2%) stent JJ 7 Fr was put postoperatively. The stent JJ was removed mean 84.2±51.6 days after the procedure. The success rate after the endoureterotomy was 85,7% (18/21), while 3 cases(14.3%) presented with a recurrent stricture. The mean follow-up period was 30.5±14.9 months. Conclusions: Ureteroscopicholmium:YAG laser endoureterotomyfor the treatment of ureteral strictures is a minimally invasive, short-stay out-patient procedure associated with a good success rate and less morbidity.

Postoperative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles

ObjectiveTo prospectively capture patient-reported outcomes to assess the recovery profile of ureteroscopy. Materials and MethodsAdults undergoing ureteroscopy for renal/ureteral stones were eligible for inclusion (11/2020-8/2022). Patients prospectively completed PROMIS – Pain Intensity, -Pain Interference, and -Ability to participate in social roles and activities in-person pre-operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T-scores (normalized to US pop., mean=50) with a change of 5 (0.5 SD) considered clinically significant. Results178 participants enrolled at POD 0 (POD 1=87, POD 7=83, POD 14=70, POD30=67). There was a worsening of quality of life from day 0 to day 1 and day 0 to 7. All dimensions then improved with an increase in scores from day 0 to day 14 and day 0 to day 30. On multivariable analysis, the presence of a pre-operative ureteral stent (OR 0.14) and use of semi-rigid ureteroscopy (OR 0.33) were associated with a reduced odds for severe pain interference at day 1. The use of semi-rigid ureteroscopy (OR 0.20) was associated with a reduced odds for severe worsening in the ability to participate in social roles at day 1. ConclusionsAbility to participate in social roles declines immediately post-operatively, while pain intensity and interference sharply increase. There is a gradual improvement until POD 30. Findings suggest pre-operative stents may influence post-operative recovery. Results offer meaningful insight to assist in counseling and setting expectation for patients post-operatively.

Semirigid ureteroscopy and tamsulosin therapy as dilatation methods before flexible ureteroscopy: evaluation and benefits

ObjectiveTo evaluate the effect of semirigid ureteroscopy and tamsulosin therapy as dilatation methods before flexible ureteroscopy advancement to the renal collecting system.Patients and methodsThis prospective study included patients with renal stones less than 2 cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. The patients were randomized into two groups: group A patients were given a placebo for 1 week before flexible ureteroscopy, and group B patients were administered 0.4 mg of tamsulosin once daily for 1 week before surgery and underwent active dilatation using semirigid ureteroscopy before flexible ureteroscopy. The ability of the flexible ureteroscope to reach the collecting system in both groups during the same operative session was assessed. Operative outcomes and complications were collected and analyzed in both groups.ResultsA total of 170 patients were included in our study, with each group comprising 85 patients. In group B, the flexible ureteroscope successfully accessed the kidney in 61 patients, while in group A, the flexible ureteroscope was successful only in 28 cases (71.4% versus 32.9%). In group A, 33 (38.8%) patients had lower urinary tract symptoms compared to 17 (20.2%) patients in group B (P = 0.013).ConclusionUsing tamsulosin therapy and semirigid ureteroscopy as dilatation methods before flexible ureteroscopy increased the success of primary flexible ureteroscopy advancement to renal collecting system.

Understanding ureteroscopy complications according to modified Clavien classification system.

To determine the complications of ureteric stone treatment with semi-rigid uretero-renoscopy in accordance with the modified Clavien classification system. The descriptive, prospective study was conducted at the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, from June 30, 2020, to December 29, 2021, and comprised patients of either gender aged 18-70 years having ureteric stones. All patients were subjected to ureterorenoscopy using a semi-rigid ureteroscope under general anaesthesia. The patients were followed up for 2 months. All complications were noted and graded in line with the Modified Clavien Complication System. Ultrasound and X-ray were used to determine the stone-free rate. Data was analysed using SPSS 23. Of the 414 patients, 304(73.4%) were males and 110(26.5%) were females. The overall mean age was 40.22±13.10 years. There were 106(25.6%) proximal, 134(32.3%) middle, and 174(42%) distal ureteric stones. Stent placement was done in 56(13.5%) cases. There were 260(62.8%) patients with no complication, 90(21.7%) with grade I complications, 34(8.2%) with grade II complications, 10(2.4%) with grade IIIa, 8(1.9%) with grade IIIb, and 12 (2.9%) with grade IVa complications. Uretero-renoscopy was found to be a safe procedure, as it had minimal associated complications with optimal stone clearance and great dexterity. The Modified Clavien classification system was found to be an easy way to classify surgical complications of uretero-renoscopy.

Retracted: Semirigid Ureteroscopy Therapy against Childhood Kidney Stones.

[This retracts the article DOI: 10.1155/2022/7771920.].

Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana.

Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana. This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches. The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30-39 years - 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1-2 days) with P < 0.0001. Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.

Safety and feasability of ureteroscopy for pediatric stone, in children under 5 Years (SFUPA 5): A French multicentric study

Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14Kg (6.3-23). Median stone size was 13mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91% procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2% for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2% of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.

A Comparative Study between Dusting and Fragmentation in Intracorporeal Laser Lithotripsy in Distal Ureteric Stone

Background: Ureteric stones commonly have an impact on the quality of life of the patient. There are many treatment choices for the condition, including medical treatment, extra-corporeal shock wave lithotripsy (ESWL), endoscopic intervention by ureteroscope (URS), or surgery (open or laparoscopic). Semi-rigid URS with laser lithotripsy is used to fragment ureteric stones, especially those in the distal ureter. Objectives: To assess the efficacy and complications of the dusting versus the fragmentation method for lower ureteric stones using holmium laser lithotripsy by analyzing intra-operative and post-operative variables. Patients and methods: One hundred and twenty patients with distal ureteric stones were included in the current study conducted in Ghazi AL-Hariri Teaching Hospital for Surgical Specialties from December 2020 to July 2022. The cases were divided into two groups: The first is the dusting group and the second is the fragmentation group. Both groups are further subdivided into the 10-15 mm and &lt; 10 mm stone groups. The time of the operation, the rate of being stone-free, stone size, the rate of Double-J stents (DJS), and intraoperative complications were compared for the study groups. Results: the operative time was more among Group A (dusting) than Group B (fragmentation) with a statistically significant association, stone-free rate more in Group A (dusting) than Group B (fragmentation) without a statically significant Need for DJ in Group b (fragmentation) than group a (dusting) with statically significant association Regard intraoperative complication (mucosal injury, stone migration, perforation) more in group b (fragmentation) a (dusting) without any significant association. Conclusion: The dusting method resulted in fewer intraoperative complications (mucosal injury, stone migration, perforation) and a lower need for DJ insertion than the fragmentation method. However, it needed a longer operative time than the fragmentation method. Received: Nov,, 2022 Accepted: April, 2023 Published: Oct.2023

SAFETY AND EFFICACY OF SEMI-RIGID URETEROSCOPE IN RETROGRADE INTRARENAL SURGERY FOR RENAL PELVIC STONES UPTO 2 CM

Objectives: To determine the efficacy and safety of RIRS with rigid URS for renal pelvis stone between 1 to 2cm. Materials and Methods: This is a prospective observational case series of 48 patients who under RIRS at Institute of Kidney Diseases, Peshawar during 1st January 2022 and 31st December The primary indication was single renal pelvic calculi of up to 2 cm diameter in patients with previously failed treatment modalities or as primary cases. Data was analysed regarding patient demographics, stone size, surgery time, complications and clearance rates within a 2 months follow-up period. Results: Total of Forty-eight patients with 29 (60.4%) males and 19 (39.6%) females in a ratio of 1.5 to 1. The mean age was 38.7 ± 10.8 years (range: 19 – 60 years). Mean stone diameter was 15.3 ± 2.6 mm. Early postoperative complications included fever, haematuria and retained stones. There were 12 (25%) cases of postoperative fever who resolved without any major sequelae, and 11 (22.9%) cases of early postoperative haematuria of which 4 (8.3%) patients received blood transfusions. The overall clearance rate after fi rst RIRS was 87.5% (n = 42) with a P value of 0.01 and is clinically signifi cant. Six (12.5%) patients were found to have stone fragments retained. The clearance rate after 2nd look RIRS was 95.83% (n = 46). Conclusion: Retrograde intrarenal surgery using semi-rigid ureteroscope for renal pelvic stones has favourable stone free rates and the results are comparable to percutaneous nephrolithotripsy. Complications requiring intervention are below ten percent and are non-fatal.

A Good Craftsperson Knows Their Tools: Understanding of Laser and Ureter Mechanics in Training Urologists.

Introduction: Recent decades have seen a move to minimally invasive techniques to manage urolithiasis. Trainees are expected to develop competency in common endourology procedures. Knowledge of ureter mechanics and the theory behind new technologies is important to ensure safe and efficient techniques. We aim to evaluate the exposure to endourology, self-reported competency in common techniques and knowledge of basic ureter biomechanics and technology in training urologists. Methods: An online survey was circulated to all training urologists in the Republic of Ireland. Questions focused on self-reported competency, clinical knowledge, ureter mechanical properties and laser technology. Results: Thirty responses were received with a range of 1-8 years of urology experience (mean=4 years). The respondents reported high levels of exposure to endourology with the majority reporting competency in flexible ureterorenoscopy (FURS) (n=18, 60%) and semi-rigid ureteroscopy (URS) (n=21, 70%). The respondents demonstrated good clinical knowledge but variable knowledge of laser settings, laser thermodynamics and ureter mechanics. Half of the respondents (n=15, 50%) correctly described fragmentation laser settings, with 10 trainees (n=33%) accurately identifying both factors that increase ureteral access sheath (UAS) insertion force. Most of the respondents (n=20, 67%) described the proximal ureter as the site with the greatest compliance, while the site of the greatest force during ureteroscope insertion was correctly identified by 17% (n=5). Conclusion: To our knowledge, this represents the first study evaluating urologist understanding of laser technology and the mechanical properties of the human ureter. Despite trainees reporting high levels of experience in endourology, there is a variable understanding of the principles of laser technology and ureter mechanics. Further research and education are needed with a focus on laser safety, suitable laser settings and the safe limit of insertion forces.

Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?

ObjectiveTo evaluate the feasibility of fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy. MethodsForty patients with abnormal (Group A) and 80 patients with normal (Group B) renal anatomy who had 10–20 mm renal stones were included. They were treated with LithoVue single-use flexible ureteroscopy (Boston Scientific, Marlborough, MA, USA) after ureteric dilatation by two different size semi-rigid ureteroscopes. This technique was chosen as the aim was to exclude any ureteric pathology (e.g., stone or stricture), confirm the placement of a safe guidewire, avoid balloon dilatation of the ureter, and achieve safe insertion of a 12 Fr, 35/45 cm ureteric access sheath with optical and tactile sign and without fluoroscopy image for guidance. ResultsThe mean ages were 43 years and 45 years in group A and group B, respectively. The mean stone burden was 14.62 (standard deviation: 5.35) mm3 and 14.79 (standard deviation: 4.58) mm3 in Group A and Group B, respectively. There is no significant difference between both groups according to the mean operative time, hospital stay, or stone-free rate. The stone-free rate was about 93% in both groups when the stone size was between 10 mm and 15 mm, and less than 54% when the stone size was more than 15 mm to 20 mm. In the majority of cases (80% in Group A and 92.5% in Group B), we completed the procedure without fluoroscopy. The perioperative complication rates were comparable in the two groups. ConclusionFluoroscopy-free single-use flexible ureteroscopy, when performed by expert urologist, is a feasible treatment for pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.

Our Experience of Semi-rigid Ureteroscopy with Pneumatic LithoClast for Impacted Upper Ureteric Calculi

Our Experience of Semi-rigid Ureteroscopy with Pneumatic LithoClast for Impacted Upper Ureteric Calculi

Using vacuum-assisted ureteral access sheath in the treatment of complex steinstrasse.

Steinstrasse is an iatrogenic condition resulting from upper urinary tract lithotripsy. Uncomplicated steinstrasse can be managed expectantly. Complex steinstrasse can pose a therapeutic challenge. The vacuum-assisted ureteral access sheath (vaUAS) is similar to a conventional ureteral access sheath but has a side branch that can be connected to vacuum apparatus. This device seemed to be useful in the management of complex steinstrasse. 35 patients with complex steinstrasse, defined as steinstrasse containing ≥ 4 stones or with an aggregate length of ≥ 1.5cm, were treated in four tertiary medical centers using the vaUAS in this prospective and non-randomized study. The vaUAS was inserted into the ureter over a guidewire until the tip of the vaUAS was in contact with the lowermost stone fragment. A 7Fr./8.4Fr. semirigid ureteroscope and a holmium laser were used to pulverize the obstructing stone. All the stone fragments were aspirated either in the space between the scope and the sheath, or through the channel of the sheath by withdrawing the scope to the proximal of the aspiration port. All patients were steinstrasse-free at end of the procedure, as assessed visually and by KUB. At the 3-month follow-up, 94.3% of patients were stone-free with or without a supplementary procedure. There were no perioperative complications. Five patients experienced postoperative fever and/or significant hematuria, and one patient had transient sepsis, a grade I and IV Clavien complication, respectively. vaUAS can be an effective adjunctive device in the management of complex steinstrasse.