Death of the Safety Guidewire

Abstract

The safety guidewire has been an integral tool in endourologic percutaneous and ureteroscopic procedures for the last three decades, providing access to the collecting system or ureter in the event of loss of renal contact or ureteral perforation, respectively. However, recent advances in endourologic techniques and instrumentation have obviated the need of routine safety guidewire placement. Today the establishment of a "through-and-through" flank to urethral meatus guidewire eliminates the need of an additional guidewire during percutaneous procedures. Likewise, the availability of smaller flexible ureteroscopes, as well as modern ureteral access sheaths, has reduced the necessity of safety guidewire placement in ureteroscopic procedures. Herein, we trace the historical development of the safety guidewire concept, review recent advances in technologies that have obsoleted the safety guidewire, and evaluate recent data suggesting that continued use of a safety guidewire during ureteroscopic procedures may indeed be counterproductive.

Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey

“…A study by Western Endourological stone consortium showed that the risks for FURS damage were significantly decreased when using a safety guidewire [19]. Currently; and with increased use of UAS; there are some reports of FURS without a safety guidewire [20, 21]. In the present study, it was observed that 13% of high-volume surgeons did not use a safety guidewire compared to 6% of the other group.…”

Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis

“…At this point, a guidewire can be placed into the renal cavities under fluoroscopic guidance. Although not mandatory, the use of a safety guidewire is highly advised as it ensures access to the collecting system and facilitates the insertion of a stent in case of ureteric or collecting system injury such as ureteral perforation or excessive bleeding [22] , [23] , [24] .…”

Flexible ureteroscopy: technique, tips and tricks

“…Although the feasibility of performing fURS without a working or safety guidewire and without intraoperative complications has been reported, we suggest the use of a safety guidewire as it is still useful and does not add any morbidity. Moreover, the use of a safety guidewire ensures access to the collecting system and facilitates the insertion of a stent in case of ureteric or collecting system injury such as ureteral perforation or excessive bleeding [14][15][16][17][18]. Alternatively, the procedure may start with a first-look semirigid ureteroscopy, always using a safety guidewire, which has the advantage of passively dilating the whole ureter in order to choose the most appropriate ureteral access sheath (UAS) size [19].…”