How Should Be Performed an Optimal Ureterorenoscopy Procedure?

Abstract

Ureterorenoscopy URS is an important part of current urological practice. With increased experience and development of the new generation devices, URS is not only used for the treatment of ureteral stones but also for the diagnosis of ureteral pathologies, treatment of ureteral strictures and tumor ablation. Although URS is not a very common endoscopic procedure, the overall complication rate is 9-25%. In this review, we discuss the indications, optimal surgical conditions, and complications of the URS procedure. Clinical clues that can be used in challenging cases are also provided

Keywords

• Ureterorenoscopy, Ureteral stone, Lithotripsy, Surgical technique

Optimal Bir Üreterorenoskopi İşlemi Nasıl Yapılmalıdır?

Öz

Üreterorenoskopi URS işlemi güncel üroloji pratiğinin önemli bir kısmını oluşturmaktadır. Artmış deneyim ve yeni nesil cihazların geliştirilmesiyle birlikte günümüzde URS sadece üriner sistem taşlarının tedavisinde değil, aynı zamanda üreteral patolojilerin tanısı, darlıkların tedavisi ve tümör ablazyonu için de kullanıma girmiştir. URS her ne kadar çok sık uygulanan bir endoskopik girişim olsa da, URS sonrası genel komplikasyonların oranı %9-25’dir. Bu derlemede URS’nin endikasyonları, optimal koşullarda işlemin nasıl yapılması gerektiği ve komplikasyonları tartışılmış, aynı zamanda zorlu durumlarda uygulanabilecek klinik ipuçları verilmiştir

Anahtar Kelimeler

• Üreterorenoskopi, Üreter taşı, Litotripsi, Cerrahi teknik

References

1. 1. Troy AJ, Anagnostou T, Tolley DA. Flexible upper tract endoscopy. BJU Int 2004;93: 671-9.
2. 2. de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, Preminger G, Traxer O; CROES URS Study Group. The clinical research office of the endourology society ureteroscopy global study: Indications, complications, and outcomes in 11,885 patients. J Endourol 2014;28: 131-9.
3. 3. Ray AA, Ghiculete D, Pace KT, Honey RJ. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology 2010;76: 295–300.
4. 4. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol 2016;69: 468-74.
5. 5. Cybulski PA, Joo H, Honey RJ. Ureteroscopy: anesthetic considerations. Urol Clin North Am 2004;31: 43-7.
6. 6. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf SR Jr; EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi. J Urol 2007;178: 2418-34.
7. 7. Pearle MS, Nadler R, Bercowsky E, Chen C, Dunn M, Figenshau RS, Hoenig DM, McDougall EM, Mutz J, Nakada SY, Shalhav AL, Sundaram C, Wolf JS Jr, Clayman RV. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol 2001;166: 1255-60.
8. 8. Peschel R, Janetschek G, Bartsch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: A prospective randomized study. J Urol 1999;162: 1909-12.

9. 9. Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol 2004;172: 1899-902.
10. 10. Skolarikos A, Gross AJ, Krebs A, Unal D, Bercowsky E, Eltahawy E, Somani B, de la Rosetta J. Outcomes of flexible ureterorenoscopy for solitary renal stones in the CROES URS Global Study. J Urol 2015;194: 137-43.
11. 11. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016;69: 475-82.
12. 12. Menezes P, Dickinson A, Timoney AG. Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones. BJU Int 1999;84: 257-60.
13. 13. Michel MS, Knoll T, Ptaschnyk T, Köhrmann KU, Alken P. Flexible ureterorenoscopy for the treatment of lower pole calyx stones: influence of different lithotripsy probes and stone extraction tools on scope deflection and irrigation flow. Eur Urol 2002;41: 312-6.
14. 14. Lifshitz DA, Lingeman JE. Ureteroscopy as a first-line intervention for ureteral calculi in pregnancy. J Endourol 2002;16: 19-22.
15. 15. Chiu KY, Cai Y, Marcovich R, Smith AD, Lee BR. Are new generation flexible ureteroscopes better than their predecessors? BJU Int 2004;93: 115-9.
16. 16. Tan PK, Tan SM, Consigliere D. Ureteroscopic lithoclast lithotripsy: A cost-effective option. J Endourol 1998;12: 341-4.
17. 17. Kuo RL, Paterson RF, Siqueira TM Jr, Evan AP, McAteer JA, Williams JC Jr, Lingeman JE. In vitro assessment of lithoclast ultra intracorporeal lithotripter. J Endourol 2004;18: 153-6.
18. 18. Auge BK, Lallas CD, Pietrow PK, Zhong P, Preminger GM. In vitro comparison of standard ultrasound and pneumatic lithotrites with a new combination intracorporeal lithotripsy device. Urology 2002;60: 28-32.
19. 19. Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium. YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 2002;167: 31-4.
20. 20. Teichman JM, Rao RD, Rogenes VJ, Harris JM. Ureteroscopic management of ureteral calculi: electrohydraulic versus holmium: YAG lithotripsy. J Urol 1997;158: 1357-61.
21. 21. Jessen JP, Breda A, Brehmer M, Liatsikos EN, Millan Rodriguez F, Osther PJ, Scoffone CM, Knoll T. International Collaboration in Endourology: Multicenter evaluation of prestenting for ureterorenoscopy. J Endourol 2016;30: 268-73.
22. 22. Bagley DH, Kuo RL, Zeltser IS. An update on ureteroscopic instrumentation for the treatment of urolithiasis. Curr Opin Urol 2004;14: 99-106.
23. 23. Vanlangendonck R, Landman J. Ureteral access strategies: Pro-access sheath. Urol Clin North Am 2004;31: 71-81.
24. 24. Abrahams HM, Stoller ML. The argument against the routine use of ureteral access sheaths. Urol Clin North Am 2004;31: 83-7.
25. 25. L’Esperance JO, Ekeruo WO, Scales CD Jr, Marguet CG, Springhart WP, Maloney ME, Albala DM, Preminger GM. Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 2005;66:252-5.
26. 26. Nabi G, Cook J, N’Dow J, McClinton S. Outcomes of stenting after uncomplicated ureteroscopy: Systematic review and meta-analysis. BMJ 2007;334:572.
27. 27. Jeong H, Kwak C, Lee SE. Ureteric stenting after ureteroscopy for ureteric stones: A prospective randomized study assessing symptoms and complications. BJU Int 2004;93: 1032-4.
28. 28. Lamb AD, Vowler SL, Johnston R, Dunn N, Wiseman OJ. Meta-analysis showing the beneficial effect of alphablockers on ureteric stent discomfort. BJU Int 2011;108: 1894-902.
29. 29. Hubert KC, Palmer JS. Passive dilation by ureteral stenting before ureteroscopy: Eliminating the need for active dilation. J Urol 2005;174: 1079-80.
30. 30. Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR, de la Rosetta JJ; CROES Ureteroscopy Global Sudy Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid, proximal, or multiple ureteral locations: The Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 2014;66:102-9.