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

Abstract

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.

Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones

“…Thus RIRS became a common endourologic procedure for the treatment of renal stones with high success rates. [1][2][3][4][5][6] The RIRS procedure can be considered as a safe method due to rarely occurence of major complications as classified according to Satava III or Clavien III-V criteria. [7,8] Only a limited number of studies so far have investigated the complications developed after RIRS, and they only presented some severe complications of the procedure.…”

“…[1][2][3][4][5][6] Retrograde intrarenal surgery can be considered as a quite safe method because major complications rarely occur after the procedure. [7] However, only a limited number of studies have investigated the complications after RIRS.…”

Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones

“…Use of RIRS has increased with technical improvements, including miniaturisation of endoscope, improved deflection mechanism and enhanced optical quality. [1] Conventionally, fluoroscopy is used for initial ureteral access, assistance in reaching the stone and monitoring the placement of stents and wires. [2,3] The risk of radiation exposure has become a clinical concern for both patients and urologists with the widespread use of endoscopic treatment.…”

Categorizing Intraoperative Complications of Retrograde Intrarenal Surgery

“…Advances in technology have resulted in the instruments being smaller and improving the deflection mechanism, making surgery easier and more successful [4,5]. RIRS is therefore becoming a more common procedure worldwide with stone-free rates of 69.7-97% [6,7,8,9], and although it is considered a minimal invasive procedure, it can still result in a number of complications.…”