Ureteroscopy
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Ureteroscopy is defined as upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract. Indications for ureteroscopy have broadened from diagnostic endoscopy to various minimally invasive therapies. Technological advancements have led to broader indications while minimizing peri-operative complications resulting in efficacious access to the upper tract.
See image below.
Endoscopic lithotripsy, treatment of upper urinary tract urothelial malignancies, stricture incisions, and ureteropelvic junction obstruction repair are all current treatments facilitated by contemporary ureteroscopic techniques. Because the application of ureteroscopic procedures has evolved from a diagnostic tool to a facilitator in complex therapeutic interventions, a proportional increase in the rate and severity of complications would be expected. However, with improved instrumentation and evolution of surgical technique, the complication rate associated with ureteropyeloscopy has actually decreased significantly.
The progression from cystoscopy to upper urinary tract endoscopy was natural, with pediatric cystoscopes being used as the first rigid rod-lens ureteroscopes. Relatively large rod-lens endoscopes, averaging 12F (3F = 1 mm) in diameter, combined with ultrasonic and electrohydraulic lithotripsy probes became the first commonly accepted ureteroscopic equipment combination used to treat distal ureteral calculi.
Ureteroscopic treatment of calculi and, in particular, distal ureteral stones was the first common application of upper urinary tract endoscopy. Early in this evolution, smaller and more precise instrumentation was obviously found to cause less trauma to normal tissues. Rigid ureteroscopes progressed from rod-lens imaging to fiberoptic imaging with outer-diameter miniaturization. The narrow and delicate distal ureter once required vigorous balloon dilation for ureteroscopic access; however, by 1989, the fiberoptic-based rigid endoscopes were small enough (averaging 7F in diameter) for frequent placement in the distal ureter under direct vision. The small rigid ureteroscopes combined with both laser and pneumatic lithotriptors are currently used to treat distal ureteral calculi in both university and community settings.
Flexible ureteroscopy was an attractive alternative to rigid ureteroscopy in that the more proximal ureter and intrarenal collecting system were theoretically more easily accessible with this type of instrument. The application of flexible ureteroscopy was first reported by Marshall in 1964. [1] He described the passage of a 9F endoscope manufactured by American Cystoscope Makers (Pelham Manor, NY) into the ureter to visualize an impacted ureteral calculus. These first flexible ureteroscopes were not capable of being directed and did not have a working channel, thus permitting only the most primitive diagnostic maneuvers. The subsequent addition of a cystoscopically placed “guide tube” facilitated placement of the first flexible ureteroscopes. In addition, irrigant then could be passed through the guide tube to displace the ureteral mucosa and debris from the distal endoscopic lens.
In the early 1980s, Bagley, Huffman, and Lyon began work at the University of Chicago to develop an improved flexible fiberoptic ureteropyeloscope. [2] Three major design changes improved the potential of the flexible ureteroscope. First, the addition of a working channel allowed irrigant and endoscopic accessories to be passed directly through the endoscope rather than through an operating sheath. Second, active tip deflection allowed the endoscope to be directed or steered to areas of interest. Finally, by altering the stiffness (ie, based on durometer measurements) of the endoscope shaft, the actively deflecting portion could be combined with passive buckling of the endoscope (ie, secondary deflection), which facilitated lower-pole intrarenal access as depicted below.
The first steerable, actively deflectable, flexible ureteropyeloscopes were equipped with relatively large fiberoptic bundles for imaging and illumination. The addition of the working channel and a cable-and-pulley system used for active tip deflection required on outer diameter of 3.6 mm. By the late 1980s, optical fiber miniaturization and improved geometrical pixel packing produced a smaller fiberoptic bundle and thus, a smaller-diameter endoscope. Flexible ureteroscope specifications in 1990 included a 10F outer diameter, a standard 3.6F working channel, and unidirectional active tip deflection. Guide tubes were no longer required as direct guidewire endoscope placement became mainstream. Intramural ureteral dilation was often required for placement of this flexible ureteroscope into the upper urinary tract. These endoscopes allowed inspection of the entire intrarenal collecting system and became part of the standard evaluation of filling defects within the upper urinary tract defined on contrast-enhanced imaging studies and pyelograms.
The introduction of small diameter (< 8F) flexible ureteroscopes in 2001 offered greater active tip deflection and significantly advanced the therapeutic and diagnostic efficacy of ureteroscopy. These endoscopes maintained a standard 3.6F working channel for irrigation and accessory use while offering a greater deflection radius. In addition, the stiff shaft allowed for atraumatic direct endoscope placement often without a guidewire.
In 2014, digital imaging replaced fiberoptics for the small diameter flexible ureteroscope. This addition provides greater clarity with digital enhancement that improves the sensitivity of tumor mapping. The digital imager removes the round “insect eye” appearance of the quartz bundles providing a bright clear rectangular image that has twenty times the resolution of the fiberoptic and can be enhanced to accentuate malignant lesions and other urothelial anomalies. The tiny CMOS chip imager has been incorporated with the now standard specifications of small shaft diameter, exaggerated tip deflection, standard 3.6F working channel, etc. [3] Integrated digital ureteroscopes are lighter, with integrated L.E.D.s at the end of the device. Without the need for an attached camera head and light cord, there are fewer potential points for device failure, and are also ergonomically superior to its predecessor. [4]
Currently, rigid and flexible ureteroscopes average 8F in tip diameter and are commonly passed atraumatically into the upper urinary tract without intramural dilation. These endoscopes are used to diagnose and treat various upper urinary tract disorders including calculi, urothelial malignancies, stricture disease, and bleeding lesions. The addition of laser energy applied through optical quartz fibers passed through the working channel of the endoscope has facilitated these treatments. Specific treatments are discussed further in subsequent sections of this article.
Ureteroscopy is used as a diagnostic tool in situations such as investigating abnormal imaging findings, assessing obstruction or unilateral essential hematuria, or localizing the source of positive urinary cytology results.
Therapeutic uses of ureteroscopy have broadened to include various minimally invasive therapies. Endoscopic lithotripsy (treating stones), treatment of upper urinary tract urothelial malignancies, stricture incisions, and ureteropelvic junction obstruction repair are all current treatments facilitated by contemporary ureteroscopic techniques.
Ureteroscopy is a routine procedure performed by urologists. The most common indication is to treat upper urinary tract calculi, particularly those that are either unsuitable for extracorporeal shockwave lithotripsy or are refractory to that form of treatment. Other common indications include evaluation of an abnormal lesion revealed by less invasive imaging tools (eg, intravenous pyelography [IVP], MRI, CT scanning) or localization of the source of positive urine culture or cytology results. Thus, ureteroscopy is often an essential part of the diagnostic algorithm and can also be used to treat the underlying disorder.
Diagnostic indications for ureteropyeloscopy are as follows:
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
Surveillance with known history of urothelial malignancy
Therapeutic indications for ureteropyeloscopy are as follows:
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
The ureter has 3 physiologic narrowings: (1) the ureteropelvic junction, (2) the crossing over the iliac vessels, and (3) the ureterovesical junction. This is crucial in the manifestations of calculus disease. These narrowings may result in ureteral stones becoming trapped and obstructing at these specific levels. For more information about the relevant anatomy, see Ureter Anatomy.
The segments of the ureter in which calculi can become lodged are also natural barriers for the ureteroscope. The intramural ureter is the narrowest segment and can prohibit endoscope passage. Guidewires are frequently passed into the ureteral orifice cystoscopically and are then directed into the renal pelvis with fluoroscopic assistance. Guidewires straighten the ureter and can facilitate (1) dilation of obstructed segments with balloon or graduated dilators, (2) advancement of endoscopes over the wires into the proximal collecting system, and (3) placement of internal stents and drainage catheters.
The intramural ureter once required balloon dilation for endoscope access. Small diameter semirigid ureteroscopes commonly employed in the lower ureter have graduated shafts with an oval or triangular 7.5F tip (see image below). This facilitates direct tip access, and when advanced the intramural segment is also modestly dilated (ie, dilation under direct vision). Use of a working sheath to facilitate passage of the ureteroscope beyond the intramural ureter can be employed when repeated access to the ureter is expected or if the intramural ureter is unusually tight or restrictive. The use of operative sheaths is optional, and is generally not required. Furthermore, recent literature has suggested that the use of such sheaths may have detrimental effects [5] .
Operative ureteral access sheaths have, in general, a relatively large outer diameter ranging from 12F to 16F, often significantly greater than the normal diameter of the ureteral lumen with the obvious risk of wall trauma during insertion. Traxer and colleagues in Paris recently underscored this concern by evaluating ureters immediately after sheath removal. [5] Ureteral trauma with wall damage was found in almost one-half of patients (46.5%), with high grade full thickness injury identified in 13.3%. Similar findings were confirmed by Guzelburc et al with low-grade injuries found in 41.5% of patients, [6] and a meta-analysis by Huang et al demonstrated a higher incidence of post-operative complications with the use of ureteral access sheaths (OR 1.46), including persistent post-operative hematuria, increased need for post-operative ureteral stents and ureteral strictures. [7] These high rates of trauma are exponentially greater than noted in series where small diameter endoscopes were placed directly into the ureter, thus questioning the long term risk of subsequent stricture disease associated with routine operative sheath use. For these reasons access sheaths should be employed judiciously.
As the fiberoptic-based rigid ureteroscope continues proximally past the ureteral orifice, it then is inhibited by the natural curvature of the ureter as it crosses the iliac vessels, psoas muscle, and the ureteropelvic junction. If the ureter is dilated, the rigid endoscope may be safely passed proximally. If not, then conversion to an actively deflectable flexible endoscope is indicated.
Flexible ureteroscopes are passed into the upper urinary tract with a wireless technique or over a guidewire. The flexible ureteroscope is a particularly useful instrument, especially when a rigid endoscope cannot be placed safely into the more proximal ureter or if intrarenal inspection is required. In these cases, endoscope tip deflection is essential to completely inspect the calyces.
Lower pole intrarenal access performed with a flexible ureteroscope can be challenging and may require both active tip and passive shaft deflection. Design improvements of the small diameter flexible ureteroscopes include two-way logical or “intuitive” active endoscope tip deflection (i.e. thumb lever down causes tip to go down and vice versa), a large radius of deflection, and incorporation of a standard passive secondary deflecting segment of the more proximal shaft (which buckles to produce greater deflectability for the most dependent lower pole intrarenal access).
To place the tip of the endoscope into the lower pole, the instrument must first be actively deflected and then advanced to allow the proximal shaft to buckle as depicted below. This maneuver, termed secondary deflection, was historically required in 60% of traditional flexible ureteroscopies for a complete inspection. The increased active deflection offered by new-generation flexible ureteroscopes significantly decreases the need for secondary deflection and enhances the surgeon’s ability to inspect all aspects of the renal collecting system.
Diagnostic ureteroscopy has few contraindications. Untreated urinary tract infection, endoscopy without appropriate antibiotic coverage, and uncorrected bleeding diathesis are relative contraindications.
Contraindications to therapeutic ureteroscopy (eg, lithotripsy, endopyelotomy, tumor therapy) are more numerous and can mirror those associated with the corresponding more invasive open surgical intervention. In general, the major contraindications are related to untreated infections and uncorrected bleeding diathesis prior to therapeutic endoscopy.
Marshall VF. Fiber Optics in Urology. J Urol. 1964 Jan. 91:110-4. [Medline].
Bagley DH, Huffman JL, Lyon ES. Combined rigid and flexible ureteropyeloscopy. J Urol. 1983 Aug. 130(2):243-4. [Medline].
Grasso M, Fishman AI, Alexander B. Ureteropyeloscopic Management of Upper Urinary Tract Calculi. Grasso M and Goldfarb D. Urinary Stones – Medical and Surgical Management. 1. USA: Wiley Blackwell; 2014. 243-263/20.
Gridley CM, Knudsen BE. Digital ureteroscopes: technology update. Res Rep Urol. 2017. 9:19-25. [Medline].
Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013 Feb. 189(2):580-4. [Medline].
Guzelburc V, Guven S, Boz MY, Erkurt B, Soytas M, Altay B, et al. Intraoperative Evaluation of Ureteral Access Sheath-Related Injuries Using Post-Ureteroscopic Lesion Scale. J Laparoendosc Adv Surg Tech A. 2016 Jan. 26 (1):23-6. [Medline].
Huang J, Zhao Z, AlSmadi JK, Liang X, Zhong F, Zeng T, et al. Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis. PLoS One. 2018. 13 (2):e0193600. [Medline].
Johnson GB, Portela D, Grasso M. Advanced ureteroscopy: wireless and sheathless. J Endourol. 2006 Aug. 20(8):552-5. [Medline].
Aboumarzouk OM, Kata SG, Keeley FX, Nabi G. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev. 2011 Dec 7. 12:CD006029. [Medline].
Freton L, Peyronnet B, Arnaud A, et al. Extracorporeal shockwave lithotripsy versus flexible ureteroscopy for the management of upper tract urinary stones in children. J Endourol. 2016 Nov 8. [Medline].
Prattley S, Voss J, Cheung S, Geraghty R, Jones P, Somani BK. Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature. Int Braz J Urol. 2018 Mar 9. 44:[Medline].
Chen GL, Bagley DH. Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management. J Endourol. 2001 May. 15(4):399-404; discussion 409. [Medline].
Lee D, Trabulsi E, McGinnis D, Strup S, Gomella LG, Bagley D. Totally endoscopic management of upper tract transitional-cell carcinoma. J Endourol. 2002 Feb. 16(1):37-41. [Medline].
Blute ML, Segura JW, Patterson DE. Ureteroscopy. J Urol. 1988 Mar. 139(3):510-2. [Medline].
Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. 2000 Nov. 27(4):623-31. [Medline].
Jiang H, Wu Z, Ding Q, Zhang Y. Ureteroscopic treatment of ureteral calculi with holmium: YAG laser lithotripsy. J Endourol. 2007 Feb. 21(2):151-4. [Medline].
Huynh M, Telfer S, Pautler S, Denstedt J, Razvi H. Retained Digital Flexible Ureteroscopes. J Endourol Case Rep. 2017. 3 (1):24-27. [Medline].
Abdel-Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol. 1992 Dec. 148(6):1788-92. [Medline].
Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol. 1997 Jan. 157(1):28-32. [Medline].
Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi. J Urol. 1998 Aug. 160(2):346-51. [Medline].
Cohen J, Cohen S, Grasso M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int. 2013 Mar. 111(3 Pt B):E127-31. [Medline].
El-Anany FG, Hammouda HM, Maghraby HA, Elakkad MA. Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi. BJU Int. 2001 Dec. 88(9):850-3. [Medline].
Ricchiuti DJ, Smaldone MC, Jacobs BL, Smaldone AM, Jackman SV, Averch TD. Staged retrograde endoscopic lithotripsy as alternative to PCNL in select patients with large renal calculi. J Endourol. 2007 Dec. 21(12):1421-4. [Medline].
Breda A, Ogunyemi O, Leppert JT, Lam JS, Schulam PG. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater–is this the new frontier?. J Urol. 2008 Mar. 179(3):981-4. [Medline].
Riley JM, Stearman L, Troxel S. Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol. 2009 Sep. 23(9):1395-8. [Medline].
Hyams ES, Munver R, Bird VG, Uberoi J, Shah O. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol. 2010 Oct. 24(10):1583-8. [Medline].
Takazawa R, Kitayama S, Tsujii T. Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater. Int J Urol. 2012 Mar. 19(3):264-7. [Medline].
Bagley D. Active versus passive deflection in flexible ureteroscopy. J Endourol. 1987. 1:15.
Bagley DH. Intrarenal access with the flexible ureteropyeloscope: effects of active and passive tip deflection. J Endourol. 1993 Jun. 7(3):221-4. [Medline].
Bagley DH. Removal of upper urinary tract calculi with flexible ureteropyeloscopy. Urology. 1990 May. 35(5):412-6. [Medline].
Bagley DH. Ureteral endoscopy with passively deflectable, irrigating flexible ureteroscopes. Urology. 1987 Feb. 29(2):170-3. [Medline].
Bagley DH, Allen J. Flexible ureteropyeloscopy in the diagnosis of benign essential hematuria. J Urol. 1990 Mar. 143(3):549-53. [Medline].
Bagley DH, Huffman JL, Lyon ES. Flexible ureteropyeloscopy: diagnosis and treatment in the upper urinary tract. J Urol. 1987 Aug. 138(2):280-5. [Medline].
Bagley DH, Liu JB, Goldberg BB, Grasso M. Endopyelotomy: importance of crossing vessels demonstrated by endoluminal ultrasonography. J Endourol. 1995 Dec. 9(6):465-7. [Medline].
Bagley DH, Rivas D. Upper urinary tract filling defects: flexible ureteroscopic diagnosis. J Urol. 1990 Jun. 143(6):1196-200. [Medline].
Berci G. Instrumentation: flexible fiber endoscopes. Berci G, ed. Endoscopy. New York, NY: Appleton-Century-Crofts; 1976.
Bierkens AF, Hendrikx AJ, De La Rosette JJ, Stultiens GN, Beerlage HP, Arends AJ, et al. Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol. 1998 Jan. 81(1):31-5. [Medline].
Conlin M, Bagley DH. Incisional treatment of ureteral strictures. Smith AD, Lingeman JE, Bagley DH, Preminger GM, Clayman RV, Badlani GH, Jordan GH, Kavoussi LV, Segura JW, eds. Smith’s Textbook of Endourology. St Louis, Mo: Quality Medical Publishing; 1996. Vol 1: 497-505.
Conlin MJ, Bagley DH. Ureteroscopic endopyelotomy at a single setting. J Urol. 1998 Mar. 159(3):727-31. [Medline].
Denstedt JD, Clayman RV. Electrohydraulic lithotripsy of renal and ureteral calculi. J Urol. 1990 Jan. 143(1):13-7. [Medline].
Elbahnasy AM, Shalhav AL, Hoenig DM, Elashry OM, Smith DS, McDougall EM, et al. Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol. 1998 Mar. 159(3):676-82. [Medline].
Erhard M, Salwen J, Bagley DH. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol. 1996 Jan. 155(1):38-42. [Medline].
Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol. 1998 Apr. 159(4):1139-43. [Medline].
Goodman TM. Ureteroscopy with pediatric cystoscope in adults. Urology. 1977 Apr. 9(4):394. [Medline].
Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology. 1996 Aug. 48(2):199-206. [Medline].
Grasso M. Resecting upper-tract urothelial Ca by ureteroscopy. Contemp Urol. 1993 Dec. 5(12):52-9. [Medline].
Grasso M. Flexible Fiberoptic Ureteropyeloscopy. Smith AD, Lingeman JE, Bagley DH, Preminger GM, Clayman RV, Badlani GH, Jordan GH, Kavoussi LV, Segura JW, eds. Smith’s Textbook of Endourology. St Louis, Mo: Quality Medical Publishing; 1996. Vol 1: 443-54.
Grasso M, Bagley D. A 7.5/8.2 F actively deflectable, flexible ureteroscope: a new device for both diagnostic and therapeutic upper urinary tract endoscopy. Urology. 1994 Apr. 43(4):435-41. [Medline].
Grasso M, Bagley D. Small diameter, actively deflectable, flexible ureteropyeloscopy. J Urol. 1998 Nov. 160(5):1648-53; discussion 1653-4. [Medline].
Grasso M, Bagley DH. Flexible ureteroscopic lithotripsy using pulsed-dye laser. J Endourol. 1990. 4:155.
Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol. 1999 Dec. 162(6):1904-8. [Medline].
Grasso M, Fraiman M, Levine M. Ureteropyeloscopic diagnosis and treatment of upper urinary tract urothelial malignancies. Urology. 1999 Aug. 54(2):240-6. [Medline].
Grasso M, Lang G, Loisides P, Bagley D, Taylor F. Endoscopic management of the symptomatic caliceal diverticular calculus. J Urol. 1995 Jun. 153(6):1878-81. [Medline].
Grasso M, Liu JB, Goldberg B, Bagley DH. Submucosal calculi: endoscopic and intraluminal sonographic diagnosis and treatment options. J Urol. 1995 May. 153(5):1384-9. [Medline].
Grasso M, Loisides P, Beaghler M, Bagley D. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology. 1995 Mar. 45(3):363-71. [Medline].
Grotas A, Grasso M. Endoluminal sonographic imaging of upper urinary tract: three-dimensional reconstruction. J Endourol. 2001 Jun. 15(5):485-8. [Medline].
Hudson RG, Conlin MJ, Bagley DH. Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope. BJU Int. 2005 May. 95(7):1043-4. [Medline].
Johnson GB, Fraiman M, Grasso M. Broadening experience with the retrograde endoscopic management of upper urinary tract urothelial malignancies. BJU Int. 2005 Mar. 95 Suppl 2:110-3. [Medline].
Johnson GB, Grasso M. Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes. BJU Int. 2004 Jan. 93(1):109-14. [Medline].
Keeley FX Jr, Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol. 1997 May. 157(5):1560-5. [Medline].
Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997 Jan. 157(1):33-7. [Medline].
Kumon H, Tsugawa M, Matsumura Y, Ohmori H. Endoscopic diagnosis and treatment of chronic unilateral hematuria of uncertain etiology. J Urol. 1990 Mar. 143(3):554-8. [Medline].
Lam JS, Gupta M. Ureteroscopic management of upper tract transitional cell carcinoma. Urol Clin North Am. 2004 Feb. 31(1):115-28. [Medline].
Liu JB, Bagley DH, Conlin MJ, Merton DA, Alexander AA, Goldberg BB. Endoluminal sonographic evaluation of ureteral and renal pelvic neoplasms. J Ultrasound Med. 1997 Aug. 16(8):515-21; quiz 523-4. [Medline].
Lyon ES, Banno JJ, Schoenberg HW. Transurethral ureteroscopy in men using juvenile cystoscopy equipment. J Urol. 1979 Aug. 122(2):152-3. [Medline].
McMurtry JM, Clayman RV, Preminger GM. Endourological diagnosis and treatment of essential hematuria. J Endourol. 1987. 1:145.
Preminger GM, Kennedy TJ. Ureteral stone extraction utilizing non-deflectable flexible fiberoptic ureteroscopes. J Endourol. 1987. 1:31.
Razdan S, Johannes J, Cox M, Bagley DH. Current practice patterns in urologic management of upper-tract transitional-cell carcinoma. J Endourol. 2005 Apr. 19(3):366-71. [Medline].
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel. J Urol. 1994 Jun. 151(6):1648-51. [Medline].
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. 1997 Nov. 158(5):1915-21. [Medline].
Soderdahl DW, Fabrizio MD, Rahman NU, Jarrett TW, Bagley DH. Endoscopic treatment of upper tract transitional cell carcinoma. Urol Oncol. 2005 Mar-Apr. 23(2):114-22. [Medline].
Stoller ML, Wolf JS Jr, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: an outcome assessment. J Urol. 1992 May. 147(5):1238-42. [Medline].
Streem SB, Pontes JE, Novick AC, Montie JE. Ureteropyeloscopy in the evaluation of upper tract filling defects. J Urol. 1986 Aug. 136(2):383-5. [Medline].
Suh RS, Faerber GJ, Wolf JS Jr. Predictive factors for applicability and success with endoscopic treatment of upper tract urothelial carcinoma. J Urol. 2003 Dec. 170(6 Pt 1):2209-16. [Medline].
Takagi T, Go T, Takayasu H, Aso Y, Hioki R. Small-caliber fiberscope for visualization of the urinary tract, biliary tract, and spinal canal. Surgery. 1968 Dec. 64(6):1033-8. [Medline].
Tawfiek ER, Liu JB, Bagley DH. Ureteroscopic treatment of ureteropelvic junction obstruction. J Urol. 1998 Nov. 160(5):1643-6; discussion 1646-7. [Medline].
Teichman JM, Champion PC, Wollin TA, Denstedt JD. Holmium:YAG lithotripsy of uric acid calculi. J Urol. 1998 Dec. 160(6 Pt 1):2130-2. [Medline].
Wollin TA, Teichman JM, Rogenes VJ, Razvi HA, Denstedt JD, Grasso M. Holmium:YAG lithotripsy in children. J Urol. 1999 Nov. 162(5):1717-20. [Medline].
Bus MT, de Bruin DM, Faber DJ, Kamphuis GM, Zondervan PJ, Laguna Pes MP, et al. Optical diagnostics for upper urinary tract urothelial cancer: technology, thresholds, and clinical applications. J Endourol. 2015 Feb. 29 (2):113-23. [Medline].
Hao YC, Xiao CL, Liu K, Liu YQ, Ma LL. [Application of narrow-band imaging flexible ureteroscopy in the diagnosis, treatment and follow-up of upper tract urothelial carcinomas]. Zhonghua Wai Ke Za Zhi. 2018 Mar 1. 56 (3):222-226. [Medline].
Blute, et al. [14]
Abdel-Razzak and Bagley [18]
Harmon, et al. [19]
Grasso [15]
Jiang, et al. [16]
Year
1988
1992
1997
2000
2007
Number of Procedures
346
290
209
1000
697
Minor Complications
(%)
(%)
(%)
(%)
(%)
Colic/pain
—
9.0
3.5
4.2
—
Fever
6.2
6.9
2.0
1.3
—
False passage
0.9
—
—
0.4
0.4
Hematuria
Minor
Prolonged
0.5
0.3
2.1
1.0
0
0
0.8
0.2
Extravasation
0.6
1.0
—
—
—
UTI
—
1.0
—
1.7
—
Pyelonephritis
—
—
—
1.0
—
Major Complications
(%)
(%)
(%)
(%)
(%)
Major perforation
4.6
1.7
1.0
0
0.3
Stricture
1.4
0.7
0.5
0.4
0.3
Avulsion
0.6
0
0
0
0
Urinoma
0.6
—
0
0
—
Urosepsis
0.3
0
0
0
—
CVA
—
—
0.5
0.1
—
DVT
—
—
—
0.1
—
MI
—
—
—
0.1
—
Segment
Number of Cases
Mean Diameter,
mm (range, mm)
Success Rate,
First-Stage Treatment
and Second -Stage Treatment
Proximal third
75
11.3 (30-5)
95% and 96%
Middle third
45
10.7 (60-5)
98% and 100%
Distal third
91
10.3 (50-4)
99% and 100%
Totals
211
97% and 99%
Location
Number of Cases
Mean Diameter,
mm (range, mm)
Success Rate, Treatment
and Multistage Treatment
Upper pole
58
10.6 (35-4)
90% and 97%
Middle pole
30
11.1 (23-4)
90% and 93%
Lower pole
103
14.8 (40-3)
79% and 85%
Renal pelvic
37
20.5 (60-6)
78% and 95%
Totals
228
81% and 90%
STUDY
Date
Number of Patients
Mean Stone Diameter (mm)
Mean number of procedures
Stone Free (%)
Complications number (%)
Grasso et al. [20]
1998
51
24.9
1.3
93
3 (3)
El-Anany et al. [22]
2001
30
>20
1
77
3 (10)
Ricchiuti et al. [23]
2007
23
30.9
1.4
74
0 (0)
Breda et al. [24]
2008
15
22
2.3
93
3 (9)
Riley et al. [25]
2009
22
30
1.8
91
4 (10)
Hyams et al. [26]
2010
120
24
1.2
83
8 (6)
Takazawa et al. [27]
2011
20
31
1.4
90
3 (5)
Cohen et al. [21]
2012
145
29
1.6
87
5 (2)
Michael Grasso, III, MD Professor and Vice Chairman, Department of Urology, New York Medical College; Director, Living Related Kidney Transplantation, Westchester Medical Center; Director of Endourology, Lenox Hill Hospital
Michael Grasso, III, MD is a member of the following medical societies: American Medical Association, American Urological Association, Endourological Society, International Society of Urology, Medical Society of the State of New York, National Kidney Foundation, Society of Laparoendoscopic Surgeons
Disclosure: Received consulting fee from Karl Storz Endoscopy for consulting.
Bobby S Alexander, MD Fellow in Endourology, Lenox Hill Hospital, Long Island Jewish Medical Center
Bobby S Alexander, MD is a member of the following medical societies: American Medical Association, American Urological Association, Endourological Society, Phi Beta Kappa, Golden Key International Honour Society
Disclosure: Nothing to disclose.
Paul Pyo, MD Staff Physician, Department of Urology, New York Medical College
Disclosure: Nothing to disclose.
G Blake Johnson, MD Consulting Staff, Middleton Urology Associates
G Blake Johnson, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association
Disclosure: Nothing to disclose.
Wayne L DeBeatham, MD Fellow in Endourology, Department of Surgery, Phelps Memorial Hospital
Wayne L DeBeatham, MD is a member of the following medical societies: American College of Surgeons, National Medical Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical; Olympus.
Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association
Disclosure: Nothing to disclose.
Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership
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