Flexible ureteroscopy:Technological advancements,current indications and outcomes in the treatment of urolithiasis

The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies.The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet(YAG)laser lithotripsy.Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones.fURS has proved to be an effective and safe procedure with few contraindications.Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.

Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones

Objectives:The present study compared the safety and efficacy of combined laparoscopic ureterolithotomy(LU)and flexible ureteroscopy with percutaneous nephrolithotomy(PCNL)for removing large impacted upper ureteral stones with concurrent renal stones.Methods:This study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones(group A)or PCNL(group B)for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016.Patient demographics,stone characteristics,and procedure-related parameters including stone-free rate,operation time,hospital stay after surgery,mean decrease in hemoglobin levels,visual analog scale(VAS)score,auxiliary procedure rate,and complication rate were compared between groups A and B.Results:Results of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones.The stone-free rate after a single procedure was 95.7%in group A and 89.7%in group B(p?0.62).The operation time was longer in group A than in group B(112.2±23.3 min versus 96.2±16.4 min,p?0.006).However,no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery(5 days versus 6 days,p?0.06).The decrease in hemoglobin levels was significantly higher in group B than in group A(0.64±0.36 g/dL versus1.44±0.65 g/dL,p<0.0001).The mean VAS scores obtained at 24 hours(2.91±1.08 versus 5.10±1.01,p<0.0001)and 48 hours after the surgery(1.09±0.73 versus 2.28±0.96,p<0.0001)were significantly higher for group B than for group A.Moreover,the auxiliary procedure rate was higher in group B than in group A(6.9%versus 0%).Conclusion:These results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards.Despite the longer operation time,the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications.However,the choice of treatment depends on the preferences of surgeons and patients.

Analysis of the effect of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts

Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of 18 patients,aged from 28 to 62(meanstandard deviation[SD]:46.50±9.14)years,were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage.There were 10 males and eight females.All of the parapelvic renal cysts were unilateral,and two cases were complicated with pyelolithiasis.The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results:All the patients completed the operation successfully in one stage without conversion to open surgery;in two cases,it was difficult to find the cysts during the operation,and the localization was completed by B-ultrasound and percutaneous injection of methylene blue.The mean operative time was 33.89(SD:9.68;range:22-54)min,and the mean hospitalization time was 2.67(SD:0.91;range:2-5)days.Three months and 6 months of follow-up were performed after surgery.The cysts disappeared in 13(72%)cases,and the diameter of the cysts in five(28%)cases decreased by more than 50%.Conclusion:Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple,safe,and effective,and can be used as the first choice for the treatment of parapelvic renal cysts.

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management

Background Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.

Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report

BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic infections and even sepsis.The incidence is extremely low,and it is prevalent in patients with diabetes.We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease(ADPKD).We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARY A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d.She had a history of autosomal dominant polycystic kidney and polycystic liver.She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission.Two months later,she underwent a second-stage flexible ureteroscopy and lithotripsy.Despite postoperative sepsis,she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSION Although EPN is more likely to occur in diabetic patients,for non-diabetic patients with ADPKD and upper urinary tract obstruction,the disease also causes rapid deterioration.Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.

Outcomes of Ureterorenoscopy for Lower Pole Kidney Stones (≤3 cm) to the Omar Bongo Ondimba Army Instruction Hospital

Introduction: The management of kidney stones has benefited from endoscopic techniques, in particular the development of flexible ureteroscopy (ureterorenoscopy). This endoscopic treatment has made it possible to treat many upper urinary tract stones, with satisfactory results and less morbidity. This innovative minimally invasive technique was introduced in our country in 2018. It is not practiced in all health structures. We report our experience. Objectives: The aim of our study was to evaluate the place of flexible ureteroscopy laser, its feasibility, and the results on stones up to 30 mm in size only in the lower calicial group, while assessing the postoperative quality of life. Patients and Methods: We conducted a monocentric observational retrospective study at the Omar Bongo Ondimba Army Training Hospital (OBO ATH) on 22 patients with symptomatic inferior caliciel stones, over a period of January 2019 and December 2020 treated by flexible ureteroscopy laser (FUR-L), once or twice depending on the size of the residual fragments. Results: All the patients had symptomatic urolithiasis, diagnosed on the clinical elements, and confirmed in 77% by urinary computed tomography. The average age was 35.47 years ± 12, with a clear female predominance (64%). All the stones sat in the lower chalice. 66.5% of stones were larger than 10 mm. 75% of patients were “stones free” after one FUR-L session, and 100% after the second session. 10% of patients still had residual pain at 01 month which was absent at 03 month. 18% of postoperative urinary tract infections were treated with antibiotics. 90% of the patients had resumed an activity prior to 1 month. At 1 month and 3 months, 82% and 100% respectively were satisfied with the mode of treatment according to self-questioning. Conclusion: FUR-L remains a therapeutic modality for stones in the lower calicial group, for stones whose diameter is close to 30 mm. A sequential approach should be considered for diameter stone up to 30 mm.

Hysteresis Modeling and Compensation for Distal Shaft Deflection of Flexible Ureteroscope

Flexible ureteroscopy(FURS)has been widely used in the diagnosis and treatment of upper urinarytract diseases.The key operation of FURS is that the surgeon manipulates the distal shaft of flexible ureteroscopeto a specific target for diagnosis and treatment.However,the hysteresis of flexible ureteroscope may be one ofthe most important factors that degrade the manipulation accuracy and the surgeon usually spends a long timenavigating the distal shaft during surgery.In this study,we obtained hysteresis curves of distal shaft deflectionfor the flexible ureteroscope through extensive repeated experiments.Then,two methods based on piecewiselinear approximation and long short-term memory neural network were employed to model the hysteresis curves.On this basis,we proposed two hysteresis compensation strategies for the distal shaft deflection.Finally,wecarried out hysteresis compensation experiments to verify the two proposed compensation strategies.Experimentalresults showed that the hysteresis compensation strategies can significantly improve position accuracy with meancompensation errors of no more than 5°.