Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond
Patrick Juliebø-Jones1,2,3, Etienne Xavier Keller3,4, Vincent De Coninck3,5
1Department of Urology, Haukeland University Hospital, Bergen, Norway.
Frontiers in Surgery
|October 2, 2023
Summary
This review examines current debates in ureteroscopy (URS) for urinary stone disease, evaluating single-use scopes, laser lithotripsy, and surgical techniques to guide clinical practice.
Area of Science:
- Urology
- Minimally Invasive Surgery
Background:
- Ureteroscopy (URS) is a common procedure for urinary stone disease.
- Advancements in URS technology have introduced new techniques and tools.
- Several aspects of URS practice remain subjects of ongoing clinical debate.
Purpose of the Study:
- To review and evaluate contemporary controversies in ureteroscopy.
- To provide evidence-based conclusions on debated topics in URS.
Main Methods:
- Literature review of current URS technologies and techniques.
- Analysis of clinical outcomes and expert opinions on debated issues.
- Synthesis of information to guide clinical decision-making.
Main Results:
- Discussion on the utility of single-use ureteroscopes.
- Comparison of laser lithotripsy settings and fragmentation techniques (basketing vs. dusting).
- Evaluation of ureteral access sheath use, safety guidewires, and fluoroscopy-free URS.
Conclusions:
- Provides a balanced perspective on current URS debates.
- Offers guidance for clinicians on optimizing ureteroscopy practice.
- Highlights areas for future research in ureteroscopy.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
8
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
8
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
31
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
31
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
41
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
41
01:24Imaging Studies II: Ultrasonography
14
IntroductionUltrasonography, or renal ultrasound, is a noninvasive medical imaging technique that uses high-frequency sound waves to visualize the kidneys, ureters, bladder, and surrounding tissues.Indications for Urinary System UltrasonographyUrinary system ultrasonography is indicated in various clinical scenarios, such as:Kidney Stones (Urolithiasis): To detect and monitor the size and presence of kidney or urinary tract stones.Hydronephrosis: To assess the dilation of the renal pelvis and...
14
01:28Imaging Studies I: Kidney, Ureter, and Bladder Studies
11
Kidney, Ureter, and Bladder (KUB) StudiesKidney, Ureter, and Bladder (KUB) studies are standard diagnostic imaging procedures used to assess the anatomy of the urinary system. They are commonly utilized for patients experiencing abdominal pain or urinary symptoms. By using a simple X-ray of the abdomen, KUB studies can reveal structural and pathological abnormalities within the kidneys, ureters, and bladder. These studies are particularly valuable in diagnosing kidney stones, urinary...
11
01:30Urinary Tract Calculi III: Medical Management
9
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
9