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Small diameter, actively deflectable, flexible ureteropyeloscopy

M Grasso1, D Bagley

  • 1Department of Urology, New York University, New York, USA.

The Journal of Urology
|October 23, 1998
PubMed
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Small diameter, actively deflectable, flexible ureteroscopy (flexible ureteropyeloscopy) enhances minimally invasive treatments for kidney stones and tumors. This technique offers broad therapeutic applications despite increased instrument fragility.

Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Endourology

Background:

  • Advancements in flexible ureteropyeloscopy aim to improve access and treatment capabilities within the urinary tract.
  • Small-diameter, actively deflectable instruments are crucial for complex intrarenal procedures.

Purpose of the Study:

  • To study and develop ureteroscopic techniques and instrumentation for small-diameter, actively deflectable, flexible ureteropyeloscopy.
  • To evaluate the efficacy and safety of these new instruments in a clinical setting.

Main Methods:

  • Flexible ureteropyeloscopy was performed in 492 patients across two university centers.
  • Endoscope development focused on specific criteria: ≤8F tip diameter, ≥3.6F working channel, and active tip deflection.
  • Complementary accessories were developed for lithotripsy, urothelial lesion management, and stricture treatment.

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Main Results:

  • 584 procedures were completed using small-diameter, actively deflectable, flexible ureteroscopes.
  • 94% of cases achieved access to the entire intrarenal collecting system, with 60% requiring secondary deflection for lower pole access.
  • Successful treatment rates for ureteral and intrarenal calculi were 97% and 79%, respectively, with holmium laser lithotripsy. Treatment of urothelial carcinoma and strictures also showed positive outcomes with a <1% major complication rate.

Conclusions:

  • Small-diameter, actively deflectable, flexible ureteropyeloscopy enables diverse minimally invasive endoscopic therapies.
  • The technique broadens the scope of ureteroscopic treatment to include intrarenal lesions, offering ease of use.
  • While instrument fragility is a consideration, the benefits in therapeutic range and efficacy are significant.