Is a safety guidewire needed for retrograde ureteroscopy?

Area of Science:

• Urology
• Endourology

Background:

• Safety guidewires (SGW) are commonly used during ureteroscopy (URS) to prevent complications.
• However, their routine necessity is debated due to increased procedural difficulty and limited supporting data.

Purpose of the Study:

• To review the literature on the utilization of SGW during URS.
• To assess stone-free rates, feasibility, and complications associated with performing URS without a SGW.

Main Methods:

• A comprehensive literature search was performed across PubMed, Ovid, and The Cochrane Library up to April 2017.
• Studies focusing on intrarenal retrograde flexible and semi-rigid URS without SGW were selected for analysis.

Main Results:

• Six studies involving 1,886 patients undergoing URS without SGW were reviewed.
• No increased complication rates were observed without SGW; one study noted more ureteral stenosis with routine SGW use.
• Stone-free rates were comparable, with one study showing higher rates without SGW (85.9% vs. 77.1%).

Conclusions:

• Current literature provides insufficient evidence to support the routine use of SGW in all retrograde URS procedures.
• Selective use of SGW is recommended for complicated cases, such as those with ureteral stones, edema, strictures, or difficult anatomy.
• Further high-quality prospective randomized trials are needed to definitively establish the role of SGW in URS.