Death of the Safety Guidewire

The safety guidewire has been an integral tool in endourologic percutaneous and ureteroscopic procedures for the last three decades, providing access to the collecting system or ureter in the event of loss of renal contact or ureteral perforation, respectively. However, recent advances in endourologic techniques and instrumentation have obviated the need of routine safety guidewire placement. Today the establishment of a "through-and-through" flank to urethral meatus guidewire eliminates the need of an additional guidewire during percutaneous procedures. Likewise, the availability of smaller flexible ureteroscopes, as well as modern ureteral access sheaths, has reduced the necessity of safety guidewire placement in ureteroscopic procedures. Herein, we trace the historical development of the safety guidewire concept, review recent advances in technologies that have obsoleted the safety guidewire, and evaluate recent data suggesting that continued use of a safety guidewire during ureteroscopic procedures may indeed be counterproductive.