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Highlights for the webinar on flexible ureteroscopes for urolithiasis by IAU
PUSEN
PUSEN Global
2021-03-06

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The webinar on flexible ureteroscopes for the treatment of upper urinary tract calculi conducted by the International Urolithiasis Union (IAU) was successfully concluded on March 6th.

IAU is one of the largest international academic & professional organizations in the field of urolithiasis in the world at present, and it was founded by Prof. Zhangqun Ye, Prof. GuohuaZeng, and Prof. Kemal Sarica in 2012.



Not only did China's top urology experts participate in this webinar, but also many urology experts from Britain, Greece, Denmark, Turkey and other countries participated. Also, there were academic lectures and lively discussions on hot and difficult issues in the field of flexible ureteroscope lithotripsy.

It is well known that flexible ureteroscopy(fURS) is widely used, and its indications are as follows :

Diagnostic indications:

  • Abnormal imaging findings - Filling defect

  • Obstruction - Determination of etiology

  • Unilateral essential hematuria

  • Localizing source of positive urinary cytology results, culture results, or other test results

  • Evaluation of Ureteral injury

Therapeutic indications:

  • Endoscopic lithotripsy

  • Retrograde endopyelotomy

  • Incision of ureteral strictures

  • Improvement of calyceal drainage

  • Treatment of calyceal diverticular lesions

  • Treatment of malignant urothelial tumors

  • Treatment of benign tumors and bleeding lesions

 

As early as 1998, Grasso and colleagues reported the outcomes of large renal stone patients receiving retrograde ureteropyeloscopic treatment with an overall stone free rate(SFR) of 93.0% and complication rate of 5.9%. Subsequent publications supported this primary result and Prof. Athanasios Papateoris demonstrated similar successful management with a series of successful cases of PU3022A in the treatment of large stones through video. With advantageous bending performance, superior imagequality, stone clearance rate and ease of use, PU3022A, an innovative and intelligent single–use flexible endoscope, is highly praised by urologists.

 





Advanced Urology & Best Urologists & PUSEN




Single use flexible ureteroscopy: Applications and realities- in which cases and why?

In recent years, single-use fURS have been developed to overcome some disadvantages of the reusable scopes. These include the purchase and repair costs of reusable devices and issues relating to sterility, including the risk that complete sterilization procedures will reduce the scope's lifespan.


Indications for Single Use are as follows:

  • High-risk of damage, infection

  • Larger stones

  • Complex, infected stones

  • Stents, nephrostomies

  • Difficult to reach calyces

  • More bends with a laser fibre ( Conduit, medial lower polecalyx)






The role of fURS for the management of large stones in 2021

Staged fURS is a practical option for kidney stones 20 to 40mm. Miniaturized percutaneous nephrolithotomy(mini PNL)combined with fURS should be considered to be a preferred option for stones larger than 40mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm,URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status.

 



Complications-Ureteroscope

The complication rate of fURS treatment for urolithiasis was reported in the range of 7 -15%, and major complication occurred 0-2%.

Failure to Access:

  • Placement a ureteral stent and allow for passive ureteral dilation over 1-2 weeks with an attempt at repeat ureteroscopy thereafter.

Infection and Fever:

  • Negative preoperative culture-Preoperative Antibiotics

  • Low intrarenal pressure

  • Usage of 12/14F UAS

  • Sort Duration

  • Perioperative antibiotic prophylaxis

  • Bleeding:Optimal Technique - Carefull use of laser

 




Flexible ureteroscopic stone management in children

  • Urine culture, up to date USS imaging

  • Antibiotic prophylaxis

  • Cystoscopy and safety wire insertion

  • Semirigid URS (4.5F) over a working guidewire

  • Access sheath (9.5F)/ Flexible Ureteroscopy (7.5F)

  • Keep irrigation pressure and operative time low

  • Post op overnight ureteric catheter (or no stent)

 




Role of RIRS in endoscopic combinedstone management: What are the proposed advantages?

Indications for endoscopic combined intra renal surgery (ECIRS)

  • Borderline cases in which RIRS may be enough

  • Complex calculi: avoiding multiple punctures

  • Calculi in parallel calyces

  • Simultaneous ureteral and renal calculi

  • Ureteral/renal calculi & strictures in urinary diversions

  • Massive incrustations/stones on stents

  • Cases in which endovision guidance of puncture and dilatation are desirable

 




Robotic Assisted Flexible Ureterorenoscopy ( RA-FURS)

  • Ergonomics of the surgeon during the procedure!!

  • Performance of long lasting procedures in “large complex”and “multiple stones” without getting tired and loosing necessary attention!!

  • Ease of endoscopic combined approaches in a practicle and team work manner

  • Use the “flexible scope” always in a straight, unbended position will certainly improve its life.

  • Enabling the control of “laser fiber” in an automatic but precisely manipulated fashion

  • Management of large (< 25 mm) and multiple stones in apracticle and successful manner.

 




How to improve stone-free following RIRS

Stone-free rates for RIRS varied widely in different-size stone, were reported in the range of 43.4-100%.

Interventions for promoting the stone free after RIRS:

  • Basketing

  • RIRS with suction UAS

Interventions for promoting the stone free after RIRS:

  • High fluid intake

  • More physical activity

  • Medical expulsive therapy

  • External physical vibration lithecbole (EPVL)

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