Comparison of Optics and Performance of Single Channel and a Novel Dual-channel Fiberoptic Ureteroscope

Lusch, Achim; Okhunov, Zhamshid; Junco, Michael del; Yoon, Renai; Khanipour, Ramtin; Menhadji, Ashleigh; Landman, Jaime

doi:10.1016/j.urology.2014.09.032

Cited by 17 publications

(3 citation statements)

References 10 publications

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“…Such data has been previously reported and is a good reference for those embarking on flexible ureteroscopy or looking to move to using digital scopes [ 15 ]. Flow and pressure characteristics may also be different in newer ureteroscopes with separate instrument and irrigation channels rather than those with a single channel [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

Wright

Williams

Somani

et al. 2015

CEJU

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IntroductionFlexible ureterorenoscopy is becoming a first-line treatment for many intrarenal stones. Ureteric access sheaths are commonly used to aid access, stone removal and reduce intrarenal pressure. We evaluated the effects of two commonly used access sheaths on irrigation flow and intrarenal pressure during flexible ureterorenoscopy. We measured the effect of scope instrumentation on flow and pressure.Material and methodsWe utilized a 10/12F and 12/14F, 35 cm Re-Trace™ access sheath with a FlexX2 scope in a cadaveric porcine kidney. We evaluated the effect of four Nitinol baskets (1.3F, 1.5F, 1.9F, 2.2F), three different 200 µm laser fibres and a hand-held pump. Measurements of irrigation flow and intrarenal pressure were recorded and compared between the different sized access sheaths.ResultsFlow rates varied widely between access sheaths. Without instrumentation, mean flow was 17 mls/min (10/12F access sheath), versus 33 mls/min (12/14F sheath) (p <0.0001). Increasing basket size produced a gradual reduction in flow and pressure in both access sheaths. Reassuringly, pressures were low overall (<40 cm H2O). Pressures were significantly reduced when using the larger 12/14F sheath, with and without all instrumentations (p <0.0001). Hand-held pump devices have a marked effect on flow and pressure in both sheaths; with pressures rising up to 121 cm H2O with a 10/12F sheath, versus 29 cm H2O (12/14F) (p <0.0001).ConclusionsA 12/14F access sheath offered significantly improved irrigation whilst maintaining significantly lower intrarenal pressure, when compared to a 10/12F access sheath in a cadaveric porcine model. Scope instrumentation affects irrigation flow and pressure in both sized sheaths. Furthermore, there should be caution with hand-held pump devices, especially with smaller sized sheaths, as intrarenal pressure can be very high.

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Section: Discussionmentioning

confidence: 99%

Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

Wright

Williams

Somani

et al. 2015

CEJU

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“…Consequently, these ureterorenoscopes have better flow and visibility, particularly when employing instruments in the working channel. However, the large diameter of dual‐channel fURS necessitates a larger‐calibre UAS if an access sheath is desired, which potentially may result in strain‐induced ureteric injuries [ 97 , 98 , 99 ].…”

Section: Guidelinementioning

confidence: 99%

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery

et al. 2022

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To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. Materials and MethodsAfter a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. ResultsA total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. ConclusionThe series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.

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“…However, recent studies have reported that a dedicated irrigation channel, separate from the primary working channel, yields increased irrigation rates over a comparable cross-sectional size, single channel design. [8][9][10] Dual-channel flexible ureteroscopes have been tested in the clinic, motivating movement toward multiple channels. It is therefore a logical next step to introduce more working channels beyond irrigation, for simultaneous insertion of different ureteroscope tools (e.g., optical fibers, guidewires, and stone baskets).…”

Section: Ureteroscope Designsmentioning

confidence: 99%

Miniature ureteroscope distal tip designs for potential use in thulium fiber laser lithotripsy

et al. 2018

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Thulium fiber laser lithotripsy using smaller optical fibers may enable development of miniature ureteroscopes. Two ureteroscope distal tip prototypes were built and characterized. The first design was 4.5-French (Fr) [1.5-mm outer diameter (OD)], five channel tip, housing 200-μm inner diameter (ID) dedicated central channel for insertion of 100-μm core fibers and four surrounding channels, each with 1.5 Fr (510-μm ID) for instrumentation, irrigation, imaging, and illumination, respectively. The second design was 6.0-Fr (2.0-mm OD), three-dimensional printed tip with larger, hemispherical common working channel and separate detection port integrated with ring lighting. Standard instruments, including optical fibers, guidewires, and stone baskets, were inserted through working channels to demonstrate feasibility. Gravitational and manual pump-assisted saline irrigation rates were measured. Luminous intensity distribution curves (LIDCs) were modeled for both ring and conventional lighting designs. Imaging was conducted using 3000, 6000, and 10,000 pixel, miniature, flexible endoscopes with 0.4-, 0.6-, and 0.9-mm OD, to differentiate between urinary stones and ureter wall, for potential clinical application. The multichannel ureteroscope tip with 1.5-Fr working channel yielded a gravitational saline flow rate of 3.9 ± 0.2 mL / min compared to 31.3 ± 0.6 mL / min for standard (3.6 Fr) ureteroscope channel. Manual, pump-assisted irrigation increased flow rate to 32.5 ± 3.0 mL / min. The 6000 pixel, 0.6-mm OD, flexible endoscope provided a balance of clear differentiation between stones and ureter wall and sufficiently small OD. A ring lighting configuration provided more uniform illumination than conventional cross-lighting geometry as demonstrated by LIDCs. With further development, these miniature ureteroscope tip designs may be integrated into a fully functional ureteroscope to permit ureteral access with minimal trauma and improved patient safety and comfort.

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Comparison of Optics and Performance of Single Channel and a Novel Dual-channel Fiberoptic Ureteroscope

Cited by 17 publications

References 10 publications

Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery

Miniature ureteroscope distal tip designs for potential use in thulium fiber laser lithotripsy

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