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Vaccaro C, Lorusso V, Palmisano F, Rosso M, Nicola M, Granata AM, Gregori A, Talso M. Single-Use Flexible Ureteroscopes: How Difficult Is It Today to Stay Up to Date? A Pictorial Review of Instruments Available in Europe in 2023. J Clin Med 2023; 12:7648. [PMID: 38137717 PMCID: PMC10743947 DOI: 10.3390/jcm12247648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The invention of the flexible ureteroscope (fURS) and its subsequent spread have revolutionized the surgical management of urolithiasis and upper tract urothelial carcinoma (UTUC). During the last few years, single-use flexible ureteroscopes (su-fURSs) have been developed to improve the limitations of reusable fURSs, namely their cost, durability and risk of device contamination. Since the introduction of the first fully disposable digital fURS, several su-fURSs have been developed by various manufacturers. In this pictorial review, we combined the different physical and technical features of su-fURSs currently available on the market with Food and Drug Administration (FDA) and European Conformity (CE) approval, in order to help surgeons choose the appropriate device according to each case requirement and personal preferences. To the best of our knowledge, 17 su-fURSs with CE and FDA approval have been developed to date.
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Affiliation(s)
- Chiara Vaccaro
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
- University of Milan, 20122 Milan, Italy
| | - Vito Lorusso
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
| | - Franco Palmisano
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
| | - Marco Rosso
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
| | - Massimiliano Nicola
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
| | | | - Andrea Gregori
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.V.)
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Raynal G, Malval B, Panthier F, Roustan FR, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Ureteroscopy and ureterorenoscopy. Prog Urol 2023; 33:843-853. [PMID: 37918983 DOI: 10.1016/j.purol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.
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Affiliation(s)
- G Raynal
- Department of urology, clinique Métivet, 48, rue d'Alsace Lorraine, 94100 Saint-Maur-des-Fossés, France
| | - B Malval
- Clinique Saint-Hilaire, Rouen, France
| | - F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | | | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Geavlete B, Mareș C, Popescu RI, Mulțescu R, Ene C, Geavlete P. Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS). J Med Life 2023; 16:372-380. [PMID: 37168298 PMCID: PMC10165511 DOI: 10.25122/jml-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/28/2023] [Indexed: 05/13/2023] Open
Abstract
Flexible ureteroscopy (fURS) is a well-established procedure for treating multiple upper-urinary tract pathologies, particularly renoureteral lithiasis. Endoscopes have undergone significant advancements, including miniaturization, improved optics, and increased maneuverability. In addition, advancements in accessory instruments, such as the performance of laser fibers, guidewires, and extraction probes, have played a significant role in improving the overall performance of flexible ureteroscopy procedures. However, despite these advancements, unique circumstances can make achieving optimum results during flexible ureteroscopy challenging. These include congenital renal anomalies (horseshoe kidneys, ectopic kidneys, rotation anomalies), as well as the unique intrarenal anatomy (infundibulopelvic angle, infundibular length) or the specifications of the endoscope in terms of maneuverability (active and passive deflection). This review explored challenging scenarios during flexible ureteroscopy procedures in the pyelocaliceal system.
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Affiliation(s)
- Bogdan Geavlete
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
- Corresponding Author: Cristian Mareș, Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania. E-mail:
| | | | - Răzvan Mulțescu
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Cosmin Ene
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
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Yamada A, Tani T. Flexible ureteroscope capable of acute-angled and balanced omnidirectional bending based on soft and flexible porous tube and crossed control wiring. Med Biol Eng Comput 2023; 61:799-809. [PMID: 36607505 DOI: 10.1007/s11517-022-02762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
Flexible ureteroscopes (fURSs) have performance limitations in accessing acute-angled calyxes and omnidirectional bending. We propose and develop a fURS based on a soft and flexible porous tube and crossed control wiring to overcome these limitations. The fURS prototype comprises a flexible solid polyamide-12 tube and a stretch-retractable expanded polytetrafluoroethylene distal tube with 40% porosity connected by a unique cylindrical wire-routing hook (CWH). The series tube includes four crossed but not contacting loop-formed control wires to provide balanced omnidirectional bending and optimized distal tube bending performance. Bending performance was assessed compared with a conventional fURS, and feasibility studies were performed using a renal phantom. The prototype achieved a 275° omnidirectional maximum bend angle by combining up-down and right-left directions. The bent shape was more compact than the conventional fURS. Thus, the prototype achieved approximately a 1.6-fold larger maximal active bending angle within the restricted environment and a 5.5-fold larger passive bending angle. The crossed control wiring design reduced CWH offset distance by about 75% compared with conventional straight wire routing. The prototype exhibited considerably improved steering performance, exemplified by its ability to access an acutely angled calyx. Our design could improve treatment outcomes and shorten operation times associated with calyceal stone removal.
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Affiliation(s)
- Atsushi Yamada
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Shiga, 520-2192, Japan.
| | - Tohru Tani
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Shiga, 520-2192, Japan
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Best Practice in Interventional Management of Urolithiasis: An Update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. Eur Urol Focus 2023; 9:199-208. [PMID: 35927160 DOI: 10.1016/j.euf.2022.06.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/27/2022] [Accepted: 06/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The European Association of Urology (EAU) has updated its guidelines on clinical best practice in urolithiasis for 2021. We therefore aimed to present a summary of best clinical practice in surgical intervention for patients with upper tract urolithiasis. MATERIALS AND METHODS The panel performed a comprehensive literature review of novel data up to May 2021. The guidelines were updated and a strength rating was given for each recommendation, graded using the modified Grading of Recommendations, Assessment, Development, and Evaluations methodology. RESULTS The choice of surgical intervention depends on stone characteristics, patient anatomy, comorbidities, and choice. For shockwave lithotripsy (SWL), the optimal shock frequency is 1.0-1.5 Hz. For ureteroscopy (URS), a postoperative stent is not needed in uncomplicated cases. Flexible URS is an alternative if percutaneous nephrolithotomy (PCNL) or SWL is contraindicated, even for stones >2 cm. For PCNL, prone and supine approaches are equally safe. For uncomplicated PCNL cases, a nephrostomy tube after PCNL is not necessary. Radiation exposure for endourological procedures should follow the as low as reasonably achievable principles. CONCLUSIONS This is a summary of the EAU urolithiasis guidelines on best clinical practice in interventional management of urolithiasis. The full guideline is available at https://uroweb.org/guidelines/urolithiasis. PATIENT SUMMARY The European Association of Urology has produced guidelines on the best management of kidney stones, which are summarised in this paper. Kidney stone disease is a common condition; computed tomography (CT) is increasingly used to diagnose it. The guidelines aim to decrease radiation exposure to patients by minimising the use of x-rays and CT scans. We detail specific advice around the common operations for kidney stones.
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De Coninck V, Somani B, Sener ET, Emiliani E, Corrales M, Juliebø-Jones P, Pietropaolo A, Mykoniatis I, Zeeshan Hameed BM, Esperto F, Proietti S, Traxer O, Keller EX. Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review. J Clin Med 2022; 11:jcm11175128. [PMID: 36079058 PMCID: PMC9456781 DOI: 10.3390/jcm11175128] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, 2930 Brasschaat, Belgium
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Correspondence: ; Tel.: +32-3-650-50-56
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, N-5021 Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ioannis Mykoniatis
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Belthangady M. Zeeshan Hameed
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Campus Bio-Medico University, 00128 Rome, Italy
- Unit of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Olivier Traxer
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Juliebø-Jones P, Keller EX, Haugland JN, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST). JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - Øyvind Ulvik
- Department of Clinical Medicine, University of Bergen, Norway
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Knoedler MA, Best SL. Disposable Ureteroscopes in Urology: Current State and Future Prospects. Urol Clin North Am 2021; 49:153-159. [PMID: 34776048 DOI: 10.1016/j.ucl.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.
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Affiliation(s)
- Margaret A Knoedler
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA.
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA
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