Is It Worth Upgrading Your Flexible Ureterorenoscope? A Clinical Analysis

The new generation semiflexible ureterorenoscopes (URS) offer an improved deflection of 270 in both directions and a stiffer sheath. It is postulated that stone access and removal are facilitated compared to the conventional devices. In our study, we aimed to determine the difference in efficacy of stone treatment comparing the new and the conventional flexible URS. A total of 90 patients with upper urinary tract stones were included into a retrospective study. 29 cases were treated with the last generation flexible URS (11274 AA, Karl Storz Endoscopy, Germany) between 01/2000 and 07/2003 and 61 cases were treated with the new flexible URS (Flex-X, Karl Storz Endoscopy. Germany) between 12/2005 and 05/2007. The patients underwent standard clinical and radiological work-up before the procedure. Patients' and stone characteristics, stone free rate and complications were compared between the two groups. Treatment success was defined as complete stone removal or insignificant residual fragments <4mm requiring no further intervention. Stone access was possible in 97% and 100% for the conventional and new URS group. Immediate treatment success was 38% for the conventional versus 70% for the new flexible scope (p=0.0032). For the subgroup of lower pole stones mean stone size was 6.6 mm (conventional scope, 16 patients) versus 5.3 trim (new scope, 51 patients). Stone access was possible in 94% versus 100% and treatment success was 31% versus 69% (p=0.0004) for the old compared to the new scope. No major complications were observed. Minor complications were comparable in both groups. Our study suggests an advantage of the new flexible ureterorenoscopes compared to their predecessors. They offer an increased stone free rate especially in the treatment of lower pole stones

Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors?

New generation flexible ureterorenoscopes offer an improved deflection mechanism and a stiffer sheath compared to their predecessors. We aimed to determine if these improvements in design lead to a higher efficacy in the treatment of nephrolithiasis. Ninety patients with upper urinary tract calculi were included into a retrospective analysis. Twenty-nine cases were treated with the conventional flexible ureterorenoscope (11274 AA, Karl Storz Endoscopy, Germany) and 61 cases were treated with the new generation device (Flex-X, Karl Storz Endoscopy). Patients' and stone characteristics, intraoperative data, treatment success and complications were retrieved from the charts and compared between the two groups. Preoperative data were comparable in both groups. Whereas stone access was also comparable (97 vs. 100%; n.s.), immediate treatment success was significantly higher for the new flexible scope (70 vs. 38%; p = 0.003). For the subgroup of lower pole stones, stone access was possible in 94 versus 100% (n.s.) and treatment success was 31 versus 69% (p = 0.0004) for the conventional and the new generation device, respectively. No major complications were observed, minor complications were comparable in both groups. Our study suggests an advantage of the new generation flexible ureterorenoscopes compared to their predecessors. They offer an increased stone free rate especially in the treatment of lower pole stones. It seems therefore advisable to switch to the latest generation flexible devices

Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

To describe the differences in the treatment and the outcomes of renal stones treated with flexible ureteroscopy (URS) either with or without the support of a ureteral access sheath (UAS). The Clinical Research Office of the Endourological Society URS Global Study involved the collection of prospective data from consecutive patients treated with URS at centers around the world over a 1-year period. Baseline characteristics, stone location, treatment details, postoperative outcomes and complications were recorded. Inverse-probability-weighted regression adjustment (IPWRA) analyses were conducted on outcome from patients treated with or without the use of a UAS to determine the impact on stone-free rates (SFRs). Of 2239 patients treated with flexible URS, 1494 (67 %) patients were treated with the use of a UAS and 745 (33 %) without a UAS. The IPWRA analyses conducted on 1827 patients with complete data and based on treatment and outcome models showed that if URS procedures were performed without the use of an UAS, the average stone-free rate would be 0.504 compared with 0.753 with a UAS. This average treatment effect of 0.248 was not significant (P = 0.604). Using IPWRA analysis on only the treated population in the estimations revealed no significant difference between using and not using a UAS (31 %; ATET: 0.311; P = 0.523). The study showed no difference in SFR when a UAS was used or not. Whereas UAS did not increase the risk of ureteral damage or bleeding, postoperative infectious complications were reduce