Type Of Ureteroscope Research Articles

Multicentre study comparing outcomes of RIRS using traditional suction ureteral access sheath (SUAS) and flexible and navigable suction UAS (FANS)

Objective: We aim to compare the stone-free rate (SFR), complications, and re-treatment rates in retrograde intrarenal surgery (RIRS) using a traditional suction ureteral access sheath (SUAS) with the more advanced flexible and navigable suction UAS (FANS). Materials and methods: Retrospective analysis was performed on patients who underwent RIRS using SUAS versus FANS across five institutions internationally as part of an audit. We analysed baseline and pre-operative characteristics such as stone location and density, intra-operative characteristics such as type of ureteroscope and laser, laser, and fluoroscopy time, as well as post-operative complications and residual fragments (RFs). Results: A total of 45 patients were included in each arm, with no significant difference in baseline characteristics. The commonest sheath size in the FANS group was 10–12 Fr (64.4%), while 11–13 Fr was preferred in SUAS (73.3%). Despite similar lasers (thulium fibre laser (TFL) and high-power holmium laser with MOSES), stone dusting (48.9%) and popcorning (95.6%) were carried out in FANS with minimal need for baskets (4.4%), while popcorning (64.4%) and basket extraction (40.0%) were required in SUAS. Although FANS had significantly longer operative times (65 minutes versus 55 minutes), it also had significantly higher rates of 100% SFR (80.0% versus 13.3%), and lower rates of clinically significant residual fragment (CSRF) (8.9% versus 53.3%), clinically insignificant residual fragment (CIRF) (11.1% versus 33.3%), and reintervention for CSRF (4.4% versus 37.8%). In addition, minor complications such as intra-operative oozing from mucosa not requiring intervention (8.9% versus 31.1%) and post-operative fever (11.1% versus 40.0%) were less common in FANS. On additional multivariate analysis, FANS was the only significant factor for higher SFR. Discussion and conclusion: The results of our study demonstrate that with its flexible and navigable tip, FANS proves advantageous over SUAS in terms of improving immediate SFR with negligible complications. By navigating the sheath into targeted individual calyces, fragments and dust are more successfully aspirated. FANS can therefore help to achieve the trifecta of high single-stage SFR, minimal minor and no major complications, and negligible reintervention rates. Level of evidence: Not applicable.

Ergonomics in the OR: An Electromyographic Evaluation of Common Muscle Groups Used During Simulated Flexible Ureteroscopy – a Pilot Study

ObjectiveTo assess the effects of different surgeon positions and ureteroscope types on muscle activation as measured by surface electromyography (sEMG) during simulated ureteroscopy in an endourology box-trainer model and the kidney phantom. MethodsFor this exploratory study, sEMG was used to quantify muscle activation of 3 endourology fellows during various ureteroscopic tasks. Electrodes were placed on the ureteroscope-holding side of the following muscles: thenar, forearm flexor, forearm extensor, biceps, triceps, deltoid, and trapezius. Subjects wore fitted lead aprons in an operating room and used a cystoscopy table with surgical drapes and an endoscopic video tower. Trials were completed with a disposable and reusable ureteroscope, both in the standing and sitting positions. Each subject performed an identical set of tasks in a phantom silicone kidney and ureteroscopy box trainer to recreate the procedural components of basketing, navigating a renal collecting system, and dusting. Raw EMG data for each task was processed and normalized as a percent of each subject's maximum voluntary contraction to allow comparison. ResultsThe forearm extensor was the most heavily utilized muscle. The trapezius and deltoid muscles were activated more during sitting whereas the forearm flexors had increased activity during standing. The heavier reusable ureteroscope had increased forearm extensor activation compared to the disposable ureteroscope. ConclusionPreliminary data show measurable differences in muscle activation based on both surgical posture and type of ureteroscope used. This highlights the need for more extensive EMG studies to identify techniques and equipment to optimize ergonomics and potentially minimize injury during flexible ureteroscopy.

Thulium fiber laser pre-settings during ureterorenoscopy: Twitter's experts' recommendations.

Thulium fiber laser (TFL) is a novel laser in the field of urology. There is no consensus for optimal parameters. As most urologists use social media, being Twitter the platform with the most dissemination in healthcare, we aim to review the preferred TFL settings chosen by the experts and, to evaluate their pros and cons. A Twitter review was performed from November 2019 (firsts TFL experiences in urology) until October 2021 using the hashtags: "thuliumfiber", "ThuliumFiberLaser", "TFL" "soltive", "fiberdust", "OlympusUrology", "quanta_system", "IPG_Photonics", "rocamed". Only board-certified urologists were considered. The "tweets" selected include information about TFL preferred settings for stone lithotripsy and tissue ablation. Additionally, we also seek information regarding laser technique, fiber size, laser time, stone type and equipment. A total of 42 opinions were identified. The 23 endourologists have a median of 2.298 followers (range 202-10.000). Most comments were about TFL settings for kidney stone dusting (61%). There was a significant difference (p < 0.05) for kidney stone dusting settings (dusting, frequency, and power) between endourologists. Only 24% reported their fiber size, 4 reported the stone composition and 2 endourologists mentioned their type of ureteroscope. There was no discussion about technique used (burst or continuous) nor equipment. Surgery time was reported 3 times. There is no consensus in TFL pre-settings. When a pre-setting is proposed, it should also recommend technique to be used. Settings are personal and related to multiple factors, such as training, technique, equipment and fiber size.

Factors Predicting Operating Room Time in Ureteroscopy and Ureterorenoscopy

Backgrounds/Aims: Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. Methods: We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. Results: Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. Conclusions: The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

PD42-11 A MECHANICAL COMPARISON OF NEW URETERAL ACCESS SHEATHS: TERUMO GLIDEWAY VS. BOSTON SCIENTIFIC NAVIGATOR HD

INTRODUCTION AND OBJECTIVES: Ureteral access sheaths (UAS) are commonly used to facilitate flexible ureteroscopy in the treatment of urolithiasis. Selection of the UAS among the armamentarium of models typically depends on physician familiarity, technical factors, and type of ureteroscope. However, the physical properties of the UAS may play a role in their clinical applicability. Dilator tip shape, flexibility, and ease of removal may affect ureteral safety during sheath advancement and extraction. Sheath strength and ability to withstand a diversity of directional forces may impact utility during UAS insertion. In an in vitro study, we examine the physical and mechanical properties of the UAS that may impact ergonomics, efficacy, and patient safety. METHODS: In vitro testing of two new UAS was performed, the Glideway (GW, Terumo, 11/13Fr, 12/14Fr) and Navigator HD (NHD, Boston Scientific, 11/13Fr, 12/14Fr). Safety characteristics (1. tip perforation through foil, 2. edge deformation against a stone, 3. dilator removal force, 4. frictional force through bologna), and strength (5. tip bending, 6. sheath buckling and 7. kinking-perpendicular compression force) were examined. Experiments were conducted using a motorized stage and a digital force gauge (Mark-10, NY). The UAS was equipped with an Amplatz Superstiff guidewire inserted coaxially (Boston Scientific, MA, USA). UAS tips were measured with digital calipers and radiopacity was assessed. RESULTS: The GW had significantly lower foil perforation forces (0.29 lb.) than the NHD (0.63, p1⁄43.41X10-4) and required significantly greater force to remove its inner dilator (0.14 vs. 0.04 lb., p1⁄42.42X10-7). The two UAS were equally stiff, requiring similar forces for tip bending (GW 3.69, NHD 4.17 lb., p1⁄40.15) and sheath buckling (GW 1.06, NHD 1.10 lb., p1⁄40.11). Both were equally resistant to kinking (GW 3.69, NHD 3.77 lb., p1⁄40.92). The NHD sheath had significantly lower frictional forces than the GW (0.04 vs. 0.09 lb., p1⁄47.0X10-3). The GW exhibited moderate-severe deformation of its edge at 2.5 lb., while the NHD showed only mild deformation at the same force. The NHD was more uniformly radiopaque, while the GW’s sheath edge and inner dilator tip were barely visible on X-RAY. The NHD’s outer sheath had a mild taper, while the GW’s did not. CONCLUSIONS: The GW’s sharp tip may pose a greater risk of ureteral perforation as compared to the NHD. The GW’s inner dilator is more difficult to remove. The GW’s edge is easily distorted, which may make multiple sequential stone extractions more challenging. The GW has a higher coefficient of friction than the NHD.

1072 In vivo and ex vivo comparison of optics and performance of a novel dual channel fiberoptic ureteroscope

INTRODUCTION AND OBJECTIVES: Flexible ureteroscopy has become a standard for the treatment of small renal calculi. Ureteroscopic equipment has a well-documented limited lifespan prior to need for maintenance. The most common location and etiology of scope damage is due to passing or misfiring a laser fiber in the working channel of a flexible ureteroscope. Conventional laser fibers utilize a blunt tip that can be difficult to pass through a deflected scope, and can potentially result in damage. A new laser fiber has become commercially available with a ball-shaped output tip. This is proposed to pass more easily through a fully deflected ureteroscope in an atraumatic manner. Our objective was to evaluate the use of this ball-tipped fiber and its effect on the incidence and cost of ureteroscope repairs. METHODS: Our institution began using the single-use ball-tipped fibers in January 2013. We retrospectively reviewed the charts of the first 80 patients undergoing ureteroscopy with laser lithotripsy utilizing the ball-tipped laser fiber, and compared them to the 80 patients immediately prior to the switch, where a reusable blunt tip fiber was utilized. We collected basic patient demographics, as well as stone location, stone size, type of ureteroscope used, use of a ureteral access sheath, total operative time, and energy used for lithotripsy. Repair data of the flexible ureteroscopes, including cost and type of damage was obtained. Pertinent repair costs included those related to damaged working channels. A cost analysis was performed to see if decrease ureteroscope repair cost justified the increase cost of the single use ball-tip fiber. RESULTS: During the review period, 58 patients underwent flexible ureteroscopy with the traditional blunt tip laser fiber and 60 patients with the ball tip fiber. There was no significant difference in patient age, stone burden, or operative time between the two groups. During use of the blunt tip fiber there were 5 repairs to working channels, incurring a cost of $28,018, while 2 working channel repairs, costing $12,408 were attributed to use of the ball-tipped fiber. Accounting for the increased cost of the ball tipped fiber of $195 per use, it was associated with a net savings of $81.27 per case. CONCLUSIONS: The use of a ball tipped laser fiber during flexible ureteroscopy with laser lithotripsy may be associated less frequent working channel repairs, and a modest cost savings.

PD37-06 THE IMPACT ON COST AND FREQUENCY OF URETEROSCOPE REPAIRS USING A BALL-TIPPED LASER FIBER FOR URETEROSCOPY

You have accessJournal of UrologyStone Disease: New Technology II1 Apr 2014PD37-06 THE IMPACT ON COST AND FREQUENCY OF URETEROSCOPE REPAIRS USING A BALL-TIPPED LASER FIBER FOR URETEROSCOPY Scott Johnson, Daniel Lew, Carley Davis, and Amy Guise Scott JohnsonScott Johnson More articles by this author , Daniel LewDaniel Lew More articles by this author , Carley DavisCarley Davis More articles by this author , and Amy GuiseAmy Guise More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flexible ureteroscopy has become a standard for the treatment of small renal calculi. Ureteroscopic equipment has a well-documented limited lifespan prior to need for maintenance. The most common location and etiology of scope damage is due to passing or misfiring a laser fiber in the working channel of a flexible ureteroscope. Conventional laser fibers utilize a blunt tip that can be difficult to pass through a deflected scope, and can potentially result in damage. A new laser fiber has become commercially available with a ball-shaped output tip. This is proposed to pass more easily through a fully deflected ureteroscope in an atraumatic manner. Our objective was to evaluate the use of this ball-tipped fiber and its effect on the incidence and cost of ureteroscope repairs. METHODS Our institution began using the single-use ball-tipped fibers in January 2013. We retrospectively reviewed the charts of the first 80 patients undergoing ureteroscopy with laser lithotripsy utilizing the ball-tipped laser fiber, and compared them to the 80 patients immediately prior to the switch, where a reusable blunt tip fiber was utilized. We collected basic patient demographics, as well as stone location, stone size, type of ureteroscope used, use of a ureteral access sheath, total operative time, and energy used for lithotripsy. Repair data of the flexible ureteroscopes, including cost and type of damage was obtained. Pertinent repair costs included those related to damaged working channels. A cost analysis was performed to see if decrease ureteroscope repair cost justified the increase cost of the single use ball-tip fiber. RESULTS During the review period, 58 patients underwent flexible ureteroscopy with the traditional blunt tip laser fiber and 60 patients with the ball tip fiber. There was no significant difference in patient age, stone burden, or operative time between the two groups. During use of the blunt tip fiber there were 5 repairs to working channels, incurring a cost of $28,018, while 2 working channel repairs, costing $12,408 were attributed to use of the ball-tipped fiber. Accounting for the increased cost of the ball tipped fiber of $195 per use, it was associated with a net savings of $81.27 per case. CONCLUSIONS The use of a ball tipped laser fiber during flexible ureteroscopy with laser lithotripsy may be associated less frequent working channel repairs, and a modest cost savings. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e948 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Scott Johnson More articles by this author Daniel Lew More articles by this author Carley Davis More articles by this author Amy Guise More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ureteroscopic management of lower ureteric calculi: a 15‐year single‐centre experience

To review our 15-year experience with ureteroscopic treatment of distal ureteric calculi and to determine the impact of improved technology and techniques on the efficacy, success and complications of the procedure. We retrospectively reviewed the medical records of 4512 patients who underwent 5133 ureteroscopic procedures for the treatment of distal ureteric calculi at our institution from January 1991 to December 2005. The patient and stone characteristics, treatment variables and clinical outcomes were assessed. Factors such as type of ureteroscope, procedure duration, procedure success, complication rate and hospital stay were evaluated. Data obtained from a cohort of patients that underwent the procedure from 1991 to 1995 (group 1) were statistical compared with those obtained from a cohort of patients from 1996 to 2005 (group 2). Logistic regression analysis was used to identify associated factors with the major complications of ureteroscopy. Overall, the stone-free rate after the procedure was 94.6%, the mean (sd; range) operative duration was 43 (15.0; 25-120) min, the intraoperative complication rate was 6.67%, the postoperative complication rate was 9.9%, and the mean (sd) hospital stay was 1.7 (1.1) days. The clinical and radiological follow-up (mean 36.8 months) for 71.3% of eligible patients detected only 12 ureteric strictures (0.23%). On comparing group 1 with group 2, the overall success of ureteroscopic stone extraction improved from 85.7% to 97.3% (P < 0.001), significant ureteric perforation decreased from 3.3% to 0.5% (P = 0.05), ureteric avulsion decreased from 1.3 to 0.1% (P < 0.05), ureteric stricture decreased from 0.7% to 0.1% (P < 0.007), the mean (sd) procedure time significantly decreased from 75 (42.9) min to 36.5 (12.5) min (P < 0.001), and the mean hospital stay significantly decreased from 2.5 (1.6) days to 0.5 (1.2) days, with a trend toward outpatient treatment. Logistic regression analysis showed a significant association of the major ureteroscopic complications with increased operative duration, type of ureteroscope used, stone impaction, stone size and surgeon experience. The present series shows the high success rate, with minor complications, that can be achieved with ureteroscopic treatment of distal ureteric calculi. Improvements in ureteroscope design, accessories, technique and experience have led to a significant increase in the success rate and decrease in the complication rate.

Ureteroscopy: Effect of Technology and Technique on Clinical Practice

Technical advances in ureteroscopy allow for more aggressive management of upper tract pathology. We evaluate to what extent clinical practice and treatment efficacy have been impacted by improvements in technology and technique. In 1998, 176 consecutive patients underwent 182 ureteroscopic procedures at our institution. Retrospective chart review was performed. Factors such as clinical indication, pathology location, type of ureteroscope, procedure duration, procedure success, complication rate and length of stay were evaluated. Data from the 1998 cohort were compared to those obtained from a cohort of patients from 1992. Statistical analysis was performed using chi-square test. Overall stone extraction rate was 94.4% (1992) vs 88.5% (1998) (p = 0.05). Proximal stones were treated in 13.5% (1998) vs 28.3% (1998) of cases. Distal stone extraction rate was 97.2% (1992) vs 95.1% (1998) (p = 0.43) and proximal stone extraction rate was 76.5% (1992) vs 71.9% (1998) (p = 0.73). Diagnostic inspection success rate was 98.3% (1992) vs 98.3% (1998). Use of flexible ureteroscopy was 11.5% (1992) vs 29.4% (1998). Complication rate was 12% (1992) vs 10.2% (1998) (p = 0.76). Of the cases 76.1% were outpatient in 1998 vs only 50% in 1992. Recent advances in ureteroscopic technology permit more aggressive instrumentation of the upper tract as reflected in higher use of flexible ureteroscopy and more frequent attempts to manage proximal ureteral calculi. These advances have not translated into better efficacy of calculus treatment. Furthermore, our data reflect a nationwide trend toward outpatient treatment.

Radiation Exposure During Ureteroscopy

Use of fluoroscopy during ureteroscopy increases the risk of radiation exposure to the urologist and patient. Radiation entrance dosages were measured at skin level in 37 patients, and at the neck, trunk and finger of the urologist, and neck and trunk of the circulating nurse. Radiation exposure time was measured in 79 patients, and was related to the purpose of the procedure and the type of ureteroscope used, whether rigid or flexible. Exposure could be minimized by decreasing the fluoroscopy time. A portable C-arm fluoroscopy unit with electronic imaging and last image hold mode should be used to minimize exposure time. Lead aprons and thyroid shields should be used by the urologist and other personnel in the endoscopy room.