BERKELEY, CA (UroToday.com) - As novel digital ureteroscopes have been developed, flexible ureteroscopy (fURS) has progressed from an awkward diagnostic procedure with limited visualization to a complex surgical intervention allowing access to the entire collecting system.[1]
We reviewed the current literature regarding the flexible ureteroscopic management of upper tract pathologies and reported that fURS is indicated in treating renal stones less than 15 mm, that do not respond to shock wave lithotripsy (SWL). It is an attractive option for treating renal and ureteral stones in the same patient, in a single session. The retrograde endoscopic treatment of lower calyceal calculi represents the latest result of technological advancement in the field of endourology. It is indicated in obese individuals, patients on anticoagulation, concomitant ureteral calculi, and bilateral occurrence. Although percutaneous nephrolithotripsy is the first-line treatment for renal stones larger than 2 cm, its major complication rate is not negligible and less invasive approaches, such as fURS, are under evaluation. In many challenging stone cases such as kidney stones in prepubertal children, in pregnancy, urinary diversions, morbidly obese patients, pelvic kidneys, polycystic kidney disease, horseshoe kidneys, caliceal diverticula, and lower-pole stones, fURS is now considered by many endourologists as the first-line treatment.
Except for urolithiasis, fURS contributes to the diagnosis and treatment of urothelial cancer. Novel techniques, such as narrow band imaging, can increase the diagnostic accuracy of fURS. Other indications for fURS include the evaluation of benign hematuria, the management of ureteropelvic junction stenosis, and of caliceal diverticulum. Future perspectives include the development of virtual and robotic fURS. Lastly, the research into new flexible scopes, fibres, and economical, long-lasting endoscopic tools will be the future challenge.
Reference:
- Bach C, Nesar S, Kumar P, et al. The new digital flexible ureteroscopes: 'size does matter'-increased ureteric access sheath use! Urol Int. 2012;89(4):408-11.
Written by:
Athanasios Papatsoris, MD, MSc, PhD, FEBU, FES and Kemal Sarica, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece
Flexible ureterorenoscopic management of upper tract pathologies - Abstract
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