Is a safety wire necessary during routine flexible ureteroscopy?

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Flexible ureteroscopy (URS) is increasingly used for treating kidney stones.
• Traditionally, safety guidewires were used during URS to maintain access and manage complications.
• The necessity of safety guidewires in routine URS procedures is being questioned.

Purpose of the Study:

• To evaluate the safety and efficacy of performing flexible URS without a dedicated safety guidewire.
• To determine if omitting a safety guidewire impacts intraoperative complications or outcomes in a large patient cohort.

Main Methods:

• Retrospective review of 305 flexible URS cases with laser lithotripsy performed by a single surgeon.
• Data collected included patient demographics, stone characteristics, operative findings, and postoperative outcomes.
• Analysis focused on renal and ureteropelvic junction (UPJ) stones, categorizing cases as complicated or uncomplicated.

Main Results:

• Flexible URS was performed on 246 patients (305 kidneys); 270 cases were uncomplicated and done without a safety guidewire.
• No intraoperative complications (e.g., lost access, perforation) occurred due to the absence of a safety guidewire in uncomplicated cases.
• Thirty-five cases were complicated, necessitating a safety guidewire due to factors like obstructing ureteral stones, encrusted stents, or difficult access.

Conclusions:

• Routine flexible URS for renal or UPJ stones can be safely performed without a safety guidewire.
• A safety guidewire remains essential for complicated cases involving difficult anatomy, large stone burden, or concomitant ureteral stones.
• Omitting guidewires in uncomplicated cases did not lead to adverse outcomes, suggesting a potential for streamlined procedures.