Is a safety guidewire needed for retrograde ureteroscopy?

Comparison of the outcome of trans-ureteral lithotripsy for uncomplicated ureteral stones with or without safety guidewire: A randomized clinical trial

Introduction:

Using a safety wire during trans-ureteral lithotripsy (TUL) might minimize ureteral injuries. Conversely, others suggest safety wire itself may increase the risk of ureteral injuries that its routine use is not mandatory in all cases. This randomized clinical trial was conducted to compare the outcome of TUL in the presence or absence of a safety guidewire.

Methods:

This randomized clinical trial was conducted on patients referred to our center with a ureteral stone less than 1.5 cm; candidate for TUL after not passing the stone after 2 weeks of conservative management and had no sign of infections or anatomic abnormalities. The primary outcome was the rate of ureteral injuries. Patients were randomly divided into two groups; using safety wire (SGW) and not using safety wire (NSGW). Patients, the data collecting physician, and the Statistical analyst; were concealed from the randomization process. Demographic factors were recorded for each participant. Patients were followed up for at least 1 month; registering intra-operative and post-operative complications.

Results:

From 2020 to 2021, 348 patients were randomized in two arms. Considering the lost cases during the study, 124 patients were finally analyzed in the SGW and 96 patients in the NSGW. Complications were not different between the two groups ( p > 0.05); though, operation time was significantly longer in the SGW group (31.7 min in SGW vs 28 min in NSGW p = 0.02)

Conclusion:

The safety guidewire seems to add no significant benefit to the TUL procedure outcomes in uncomplicated cases.

Sheathed flexible retrograde intrarenal surgery without safety guide wire for upper urinary tract stones

OBJECTIVES

To assess the success rate and intraoperative complications of flexible ureterorenoscopy (f-URS) in patients with upper urinary tract (UUT) stones using a ureteral access sheath (UAS) without a safety guide wire (SGW).

PATIENTS AND METHODS

Between April 2010 and March 2022, 464 renal units in patients with renal stones with and without concomitant ureteral stones (UUT), underwent ureterorenoscopy by one surgeon, and UAS was used in all of them. The primary endpoint was the stone-free rate (SFR). SFR was defined as no residual fragments at all. The following characteristics were examined: age, sex, laterality, renal/ureteral stones, stone diameter, SFR, Hounsfield unit, auxiliary procedures, double-J stent insertion, and intraoperative complications. This study was retrospective, with all the data recorded prospectively. Patients with residual stones were scheduled for the 2nd RIRS. The Clavien-Dindo classification was used to report complications.

RESULTS

The mean patient age was 52.9 years. The mean stone size was 13.1 mm. Lower pole, upper and middle calyces, renal pelvis and ureteral stones were found in 51.5% (239), 34.9% (162), 18.3% (85) and 46.9% (218) of cases, respectively. The mean diameter was 8.1 mm, 8 mm, 12.5 mm and 8.1 mm for the lower pole, upper and middle calyces, renal pelvis and ureteral stones, respectively. The single- and second-session SFRs were 90% and 100%, respectively. The mean number of procedures per renal unit was 1.1. Ureteral double-J stents were inserted in 45.7% (212) of patients. In 96 cases, a stent was placed before surgery. Postoperative complications were minor, with no avulsion or perforation of the ureters; readmission and insertion of a DJ stent occurred in one patient. Ureteral stricture developed in one patient (0.2%) and needed treatment with laser ureterotomy.

CONCLUSIONS

f-URS is a safe and effective mode of surgical management of renal and simultaneous renal and ureteral calculi using the ureteral access sheath without a safety guide wire. A guide wire should not be routinely used in these cases.