Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones >2 cm: a bicentric prospective assessment

Abstract

The combined use of semirigid ureteroscopy and an UAS further develops the endoscopic treatment of kidney stones. This is the first series of this kind that confirms high SFRs by CT. The approach has significant advantages: Superior irrigation and outflow enhance both vision and stone clearance, and multiple ureteral passages without putting the ureter at injury risk. These encouraging results make this modality an appealing alternative to percutaneous nephrolithotomy.

Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

“…These studies did not focus on URSL or large stones and were therefore excluded. Seventeen further papers were excluded upon reading the full manuscript, leaving 12 papers [7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Nine commented on average operation time [7, 9-12, 14, 15, 17, 18]. Nine papers commented on use of ureteral access sheath [7,[9][10][11][12][13][14][15]18]. All the papers commented on complications apart from the paper by Hussain et al [8].…”

“…All the papers commented on complications apart from the paper by Hussain et al [8]. Seven papers performed subgroup analysis within the paper [7,9,10,12,15,17,18]. Grasso et al [16] also included one child with a large stone in their study on the basis that the authors felt it would not skew the results.…”

“…Nine of the studies reported on average number of procedures [7,9,10,[12][13][14][15][16]18]. Nine commented on average operation time [7, 9-12, 14, 15, 17, 18].…”

“…The age range was 18-86 years. Five of the studies were from the USA [9][10][11][12][13]16], the rest were individually from France [7], UK [8], Japan [12], India [14], Poland [15], Egypt [17] and Germany [18]. The included studies range from 1998-2013.…”