#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

ADVANCES IN FLEXIBLE URETEROSCOPY – INDICATIONS, TECHNIQUES, AND MANAGEMENT OF COMPLICATIONS


Authors: E. J. Moskowitz;  B. Alexander;  M. Grasso
Published in: Urol List 2014; 12(4): 13-20

Overview

Advancements in instrumentation over the past 30 years have improved the management of upper urinary tract disorders, emphasizing minimally invasive strategies to treat a host of clinical presentations. Major developments in materials, imaging technologies, and deliverable energy sources have led to an evolution in treatments highlighted by improved outcomes, shortened hospitalizations, while minimizing complications. Upper urinary tract calculi that were once treated with “blind basketing” (fluoroscopically guided basketing) or open ureterolithotomy are now routinely addressed ureteroscopically, with efficient direct stone fragmentation facilitated by powerful laser lithotrites. Similar techniques are routinely employed for upper urinary tract urothelial malignancies and stricture disease. Endoscope and accessory instrument miniaturization combined with enhanced active deflectability (i.e. steerability) have improved access to upper tract lesions and minimized ureteral trauma associated with the most complex treatments. The improvements combined with refined surgical technique have led to expanded indications that include endoscopic lithotripsy for the large intra‑ renal stones, as well as strategies beyond dia­gnosis to the definitive treatment of upper tract urothelial tumors. This review will define the mechanical, optical, and material advances, as well as the corresponding progressive strategies employed with the actively deflectable, flexible ureteroscope.

Key words:
ureteropyeloscopic treatment, ureteroscopic laser lithotripsy, upper tract urothelial lesions, flexible ureteroscopy, diagnostic ureteropyeloscopy


Sources

1. Bagley DH. Active versus passive deflection in flexible ureteroscopy. J Endourol 1987; 1(1): 15– 18.

2. Rajamahanty S, Grasso M. Flexible ureteroscopy update: indications, instrumentation and technical advances. Indian J Urol 2008; 24(4): 532– 537. doi: 10.4103/ 0970‑ 1591.44263.

3. Grasso M, Alexander B, Pyo P et al. Ureteroscopy. Medscape Reference. [online]. Available from: http:/ / emedicine.medscape.com/ article/ 451329- overview.

4. Bagley DH. Ureteral endoscopy with passively deflectable, irrigating flexible ureteroscopes. Urology 1987; 29(2): 170– 173.

5. Grasso M. Flexible fiberoptic ureteropyeloscopy. In: Smith AD, Lingeman JE, Bagley DH et al (eds). Smith‘s textbook of endourology. St Louis, MO: Quality Medical Publishing 1996: 443–454.

6. Grasso M, Bagley D. A 7.5/ 8.2 F actively deflectable, flexible ureteroscope: a new device for both dia­gnostic and therapeutic upper urinary tract endoscopy. Urology 1994; 43(4): 435– 441.

7. Bagley DH. Intrarenal access with the flexible ureteropyeloscope: effects of active and passive tip deflection. J Endourol 1993; 7(3): 221– 224.

8. Marshall VF. Fiber optics in urology. J Urol 1964; 91: 110– 114.

9. Bagley DH, Huffman JL, Lyon ES. Combined rigid and flexible ureteropyeloscopy. J Urol 1983; 130(2): 243– 244.

10. Bagley DH, Huffman JL, Lyon ES. Flexible ureteropyeloscopy: dia­gnosis and treatment in the upper urinary tract. J Urol 1987; 138(2): 280– 285.

11. Alexander B, Fishman AI, Grasso M. Ureteroscopy and laser lithotripsy: technologic advancements. World J Urol 2014. [In press].

12. Johnson GB, Grasso M. Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes. BJU Int 2004; 93(1): 109– 114.

13. Grasso M, Fishman AI, Alexander B. Ureteropyeloscopic management of upper urinary tract calculi. In: Grasso M, Goldfarb D (eds). Urinary stones: medical and surgical management. USA: Wiley‑ Blackwell 2014.

14. Binbay M, Yuruk E, Akman T et al. Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol 2010; 24(12): 1929– 1934. doi: 10.1089/ end.2010.0211.

15. Cohen JH, Traxer O, Rao P et al. Small diameter, digital flexible ureteroscopy: initial experience. Torino, Italy: Videourology 2011.

16. Monga M, Best S, Venkatesh R et al. Prospective randomized comparison of 2 ureteral access sheaths during flexible retrograde ureteroscopy. J Urol 2004; 172(2): 572– 573.

17. Grasso M, Loisides P, Beaghler M et al. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock‑ wave lithotripsy failures. Urology 1995; 45(3): 363– 371.

18. Grasso M, Fraiman M, Levine M. Uretero­pyeloscopic dia­gnosis and treatment of upper urinary tract urothelial malignancies. Urology 1999; 54(2): 240– 246.

19. Johnson GB, Portela D, Grasso M. Advanced ureteroscopy: wireless and sheathless. J Endourol 2006; 20(8): 552– 555.

20. Elbahnasy AM, Shalhav AL, Hoenig DM et al. Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol 1998; 159(3): 676– 682.

21. Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol 1999; 162(6): 1904– 1908.

22. Blute ML, Segura JW, Patterson DE. Ureteroscopy. J Urol 1988; 139(3): 510– 512.

23. Abdel‑ Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol 1992; 148(6): 1788– 1792.

24. Harmon WJ, Sershon PD, Blute ML et al. Ureteroscopy: current practice and long‑term complications. J Urol 1997; 157(1): 28– 32.

25. Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am 2000; 27(4): 623– 631.

26. Jiang H, Wu Z, Ding Q et al. Ureteroscopic treatment of ureteral calculi with holmium : YAG laser lithotripsy. J Endourol 2007; 21(2): 151– 154.

27. Preminger GM, Kennedy TJ. Ureteral stone extraction utilizing non‑deflectable flexible fiberoptic ureteroscopes. J Endourol 1987; 1(1): 31– 35.

28. Grasso M, Fishman AI, Cohen J et al. Uretero­scopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15‑year comprehensive review of 160 consecutive patients. BJU Int 2012; 110(11): 1618– 1626. doi: 10.1111/ j.1464‑ 410X.2012.11066.x.

29. Schmeller NT, Hofstetter AG. Laser treatment of ureteral tumors. J Urol 1989; 141(4): 840– 843.

30. Bagley DH, Grasso M 3rd. Ureteroscopic laser treatment of upper urinary tract neoplasms. World J Urol 2010; 28(2): 143– 149. doi: 10.1007/ s00345‑  010‑ 0525‑ 7.

31. Bagley DH, Huffman J, Lyon E et al. Endoscopic ureteropyelostomy: opening the obliterated ureteropelvic junction with nephroscopy and flexible ureteropyeloscopy. J Urol 1985; 133(3): 462– 464.

32. Conlin MJ, Bagley DH. Ureteroscopic endopyelotomy at a single setting. J Urol 1998; 159(3): 727– 731.

33. Nakada SY, Hsu T. Management of upper urinary tract obstruction. In: Wein AJ, Kavoussi LR, Novick AC et al (eds). Campbell‑ Walsh urology. 10. ed. Philadelphia: Elsevier Saunders 2012: 1122– 1168.

34. Conlin MJ. Results of selective management of ureteropelvic junction obstruction. J Endourol 2002; 16(4): 233– 236.

35. Canes D, Berger A, Gettman MT et al. Minimally invasive approaches to ureteropelvic junction obstruction. Urol Clin North Am 2008; 35(3): 425– 439. doi: 10.1016/ j.ucl.2008.05.012.

Labels
Paediatric urologist Urology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#