Ureteral stent encrustation in an HIV patient treated with disposable flexible ureteroscope: a case report.

Human immunodeficiency virus prevalence was increasing worldwide. Medication-associated urinary calculi are very commonly caused by medications used to treat HIV-positive patients. We present a case of an HIV-positive 39-year-old male with ureteral stent encrustation and kidney stone. Ureterolithotripsy using a disposable flexible ureteroscope is performed. The postoperative evolution was favorable. The disposable flexible ureteroscope is effective in the treatment of HIV combined with ureteral stent encrustation.

Effect of esketamine on the ED50 of propofol for successful insertion of ureteroscope in elderly male patients: a randomized controlled trial.

BACKGROUND: Propofol is effective and used as a kind of routine anesthetics in procedure sedative anesthesia (PSA) for ureteroscopy. However, respiratory depression and unconscious physical activity always occur during propofol-based PSA, especially in elderly patients. Esketamine has sedative and analgesic effects but without risk of cardiorespiratory depression. The purpose of this study is to investigate whether esketamine can reduce the propofol median effective dose (ED50) for successful ureteroscope insertion in elderly male patients. MATERIALS AND METHODS: 49 elderly male patients undergoing elective rigid ureteroscopy were randomly divided into two groups: SK Group (0.25 mg/kg esketamine+propofol) and SF Group (0.1 µg/kg sufentanil+propofol). Patients in both two groups received propofol with initial bolus dose of 1.5 mg/kg after sufentanil or esketamine was administered intravenously. The effective dose of propofol was assessed by a modified Dixon's up-and-down method and then was adjusted with 0.1 mg/kg according to the previous patient response. Patients' response to ureteroscope insertion was classified as "movement" or "no movement". The primary outcome was the ED50 of propofol for successful ureteroscope insertion with esketamine or sufentanil. The secondary outcomes were the induction time, adverse events such as hemodynamic changes, hypoxemia and body movement were also measured. RESULT: 49 patients were enrolled and completed this study. The ED50 of propofol for successful ureteroscope insertion in SK Group was 1.356 ± 0.11 mg/kg, which was decreased compared with that in SF Group, 1.442 ± 0.08 mg/kg (P = 0.003). The induction time in SK Group was significantly shorter than in SF Group (P = 0.001). In SK Group, more stable hemodynamic variables were observed than in SF Group. The incidence of AEs between the two groups was not significantly different. CONCLUSION: The ED50 of propofol with esketamine administration for ureteroscope insertion in elderly male patients is 1.356 ± 0.11 mg/kg, significantly decreased in comparsion with sufentanil. TRIAL REGISTRATION: Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .

The Effect of Reusable Flexible Ureteroscope Aging on the Efficacy and Safety of Retrograde Intrarenal Surgery.

Purpose: Reusable flexible ureteroscopes may lose their mechanical functionality through overuse, which is known as "aging of the flexible ureteroscope." Although mechanical deterioration has been shown in several studies, the data about the effect of this situation on the efficacy and safety of retrograde intrarenal surgery (RIRS) are missing. The aim of our study was to evaluate the effect of the aging of flexible ureteroscopes on the efficacy and safety of RIRS. Methods: Patients who had undergone RIRS between 2017 and 2021 at a single center were retrospectively included in the study. Serial surgeries were performed using the same reusable flexible ureteroscope (Storz X2) until it was broken or malfunctioned because of the aging process. Group 1 was formed by the first 10 cases on whom the flexible ureteroscopes were used, representing the youngest period of the instruments, whereas group 2 was composed of the last 10 cases on whom the flexible ureteroscopes were used, representing the oldest phase of the instruments. The operative and postoperative data-including the operation time, hospitalization time, intraoperative complications, postoperative complications, and stone-free rates-were compared between the two groups. Results: A total of five flexible ureteroscopes were included in the study. The number of cases for each flexible ureteroscope ranged between 87 and 133, with a median number of 107 cases. The demographic and clinical properties of patients in both groups were similar. The operation time, lasering time, and total laser pulse were similar between the groups. The stone-free rates in group 1 and group 2 were 82.0% and 78.0%, respectively (p = 0.304). The complication rates were also similar between the groups (p = 0.591). Conclusion: The aging of reusable flexible ureteroscopes did not negatively affect the efficacy and safety of RIRS. Therefore, surgeons may use the reusable types of flexible ureteroscopes until they are totally broken.

Clinical efficacy analysis of tip­flexible suctioning ureteral access sheath combined with disposable flexible ureteroscope to treat 2-4 cm renal stones.

PURPOSE: This study aims to evaluate the clinical efficacy of using a tip­flexible suctioning ureteral access sheath (TFS-UAS) in combination with a traditional ureteral access sheath (T-UAS) and a disposable flexible ureteroscope (DFU) for treating large renal stones (2-4 cm in diameter). METHODS: We retrospectively collected clinical data from 238 patients who underwent retrograde intrarenal surgery (RIRS) at Ganzhou People's Hospital between January 2019 and October 2023. The study included 238 patients who met the inclusion criteria, with 125 in the observation group using TFS-UAS and 113 in the control group using T-UAS. We compared differences in the stone-free rate (SFR), complication rates, surgery duration, and average hospital stay between the two groups. RESULTS: All 238 surgeries were successfully completed. The stone-free rates for the observation group at the first and thirtieth day post-surgery were 87.20% and 95.20%, respectively, whereas for the control group, the rates were 73.45% and 85.84%, showing statistically significant differences (P < 0.05). The overall complication rates were 1.6% for the observation group and 14.16% for the control group, also statistically significant (P < 0.001). The surgical times for stone removal were (101.17 ± 25.64) minutes for the observation group and (86.23 ± 20.35) minutes for the control group, with significant differences (P < 0.05). CONCLUSION: Compared to T-UAS, combining TFS-UAS with DFU for treating renal stones of 2-4 cm diameter, although more time-consuming, resulted in higher SFRs and improved safety.

First worldwide report on safety and efficacy of using small 7.5 Fr scope for pediatric ureteroscopy: prospective pilot series from Europe.

Introduction: Although pediatric urolithiasis remains relatively uncommon, its global prevalence is on the rise. Technological advances have led to miniaturization of instruments especially in the form of single use scopes. As the evidence on the use of small single use ureteroscopes in children is scarce, we have conducted a pilot two-center study to analyze the outcomes of pediatric patients treated with the Pusen 7.5 Fr single use scopes at our institutions. Material and methods: This study included consecutive pediatric patients with urinary stones treated with the small Pusen 7.5 Fr single use ureteroscope. The study was conducted at two large European tertiary endourology centers that specialize in pediatric kidney stone management. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone free rate (SFR), operating time, and complications. Results: In this pilot study, 26 patients were included with a median age of 12 years (7.0-16.0) and a male to female ratio of 14:12. The mean cumulative stone size was 15.15 mm (SD ±11.1) and multiple stones were present in 9 (34.6%) patients. Pre-operative stent, access sheath and post-operative stent usage was done in 12 (46.2%), 23 (88.5%) and 13 (50%) patients respectively. The median operative time was 47 minutes (IQR: 40.0-63.8). Following the initial procedure 24 (92.3%) patients were stone free, while no intra or postoperative complications were observed. Conclusions: Our study demonstrates that the use of the small 7.5 single use ureteroscope is safe and efficient for the treatment of urinary stones in pediatric patients with high stone-free rates and no complications noted in our series. While this might become a standard of care in future, to confirm and validate our findings further studies with larger cohorts are warranted.

Cumulative sum analysis of the learning curve for retrograde intrarenal stone surgery in newbie surgeons.

INTRODUCTION: This study investigated the learning curve of retrograde intrarenal surgery (RIRS) in patients with medium-sized stones using cumulative sum analysis (CUSUM) to evaluate the competence and proficiency of three new surgeons during their first RIRS procedures. MATERIALS AND METHODS: We conducted a retrospective review of 227 patients from 2019 to 2022 at a single institution. The patients were divided into four groups based on the operating surgeon: tutor surgeon (85 patients), newbie surgeon A (21 patients), newbie surgeon B (85 patients), and newbie surgeon C (36 patients). Patients had one or multiple stones with the largest stone diameter fell within the range of 10-30 mm. Fragmentation efficacy was calculated as "removed stone volume (mm3) divided by operative time (minutes)." CUSUM analysis monitored changes in fragmentation efficacy and validated surgical outcomes. RESULTS: No statistically significant differences were observed in the total stone volume, maximum stone size, or total operation time between the three newbie surgeons and the tutor surgeon. The mean fragmentation efficacy value was comparable among the newbie surgeons, but significantly different from that of the tutor surgeon. The minimum acceptable fragmentation efficacy level was set at 25.12 mL/min, based on the tutor's average value. The CUSUM curves for the three surgeons initially remained relatively flat until Cases 12-15, after which they increased and eventually plateaued. Stone-free rates and postoperative complications did not differ significantly among the surgeons. CONCLUSION: Learning curve analysis for the three newbie surgeons indicated that approximately 12-15 cases were required to reach a plateau.

Initial Experience and Clinical Assessment of the Karl Storz FLEX-XC1 Single-Use Flexible Ureteroscope.

INTRODUCTION: The Karl Storz FLEX-XC1 is a novel single-use flexible ureteroscope that uses the same videographics platform as its reusable digital counterpart. We evaluated the technical performance of the FLEX-XC1 in its initial clinical use. METHODS: We reviewed a series of consecutive ureteroscopy procedures performed by 2 endourologists using the FLEX-XC1 for indications for which we typically use a single-use device: total stone burden > 15 mm or > 10 mm in the lower pole, anticipated case duration > 60 minutes, bilateral procedure, or upper tract urothelial cancer procedures. We assessed device tip deflection, intraoperative mechanical failure, and clinical outcomes for each case. Surgeons rated visual clarity, image quality, and maneuverability on a 1 to 5 Likert scale. RESULTS: Of 29 procedures using FLEX-XC1, 27 (93%) were successfully completed. Preoperative upward deflection was < 270° in 6 (21%) cases, and downward deflection was < 270° in 9 (31%) cases. Three types of intraoperative malfunctions occurred: rotational twisting of deflectable tip (4 cases, 13%), device not advancing through distal ureter (1 case, 3%), and working channel not accommodating a 365-µm laser (1 case, 3%). Visual clarity, image quality, and maneuverability were rated as 5 "very good" or 4 "good" in 100%, 100%, and 97% of cases, respectively. No device-specific or general 30-day complications were observed. CONCLUSIONS: The FLEX-XC1 showed comparable image quality and maneuverability to reusable digital devices. We observed incomplete deflection in up to 31% of cases and mechanical failure in 2 cases. The FLEX-XC1 may be advantageous in prolonged cases where maintaining visual clarity is paramount.

Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis.

Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [-5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons' preference.

In vitro comparison of simulated intrapelvic pressure in an artificial kidney model during retrograde intrarenal surgery among various single-use ureteroscopes.

OBJECTIVES: This study compares intrapelvic pressure (IPP) during retrograde intrarenal surgery with various single-use flexible ureteroscopes (f-URS) in an artificial kidney model. METHODS: We created an artificial kidney model with a pressure sensor using a bladder evacuation device. The model was completely closed and the only backflow was on the side of the ureteroscope inside the ureteral access sheath (UAS). We tested five single-use f-URSs (LithoVue, Wiscope, PU3022A, PU3033A, and AXIS) with six different types of UAS (9.5/11.5-14/16 Fr). Using the automatic irrigation system, 30 s of irrigation was performed at various pressures (40-180 mmHg) and steady-state IPP was recorded. IPP was compared between the five single-use f-URSs. IPP cutoff value was determined at 30 mmHg. The diameter of the endoscope tip and the curved and shaft parts were also measured and recorded. RESULTS: The diameters of all parts were significantly different between single-use f-URSs. The maximum IPP tended to be higher in ureteroscopes with larger diameters of the proximal parts (curved part/shaft part). In LithoVue and Uscope PU3022A f-URSs, the maximum IPP did not exceed 30 mmHg when UAS ≥12/14 Fr was used. In AXIS and Wiscope f-URSs, it did not exceed the cutoff value when the UAS ≥11/13 Fr was used. In Uscope PU3033A f-URS, it did not exceed 30 mmHg when the UAS ≥10/12 Fr was used. CONCLUSIONS: Maximum IPP tended to be higher in f-URSs with larger diameters of the proximal part and the appropriate size of the UAS differed between various single-use f-URSs.

Clinical Application of Ureteroscope-Assisted Laparoscopic Surgery for Prostatic Utricle in Children.

Purpose: To investigate the use of ureteroscope-assisted laparoscopic surgery (UALS) in treating symptomatic prostatic utricle (PU) in children. Materials and Methods: Data on surgically treated cases of PU at the Department of Urology in Hunan Children's Hospital between September 2014 and September 2022 were retrospectively collected and analyzed. The diagnosis was confirmed by cystourethroscopy followed by ureteroscopy, and PU was excised by ureteroscope-assisted laparoscopy. Results: A total of 21 patients with PU were enrolled in this study. The median age of the patients at surgery was 8.1 (4.6-11.5) years. Karyotyping was available for 15 children: 13 (86.7%) were 46XY, 1 (6.7%) was 45X/46XY, and 1 (6.7%) was 45X/46XY/47XYY. The median length of the PU was 5.0 (4.1-7.1) cm. Nineteen patients underwent only ureteroscope-assisted laparoscopic excision, whereas 2 also had a perineal incision. All excisions were successfully performed. The median intraoperative blood loss was 25.0 (20.0-37.5) mL. The median hospital stay and follow-up durations were 18.0 (14.5-25.0) days and 24.0 (13.5-49.0) months, respectively. The patients reported no postoperative clinical symptoms. Conclusion: UALS allows for accurate patient positioning and thorough exposure of the anatomical structures, and it is a safe, effective, and minimally invasive treatment for PU in children.

A Novel Hydrodynamic Design Greatly Improves the Debris Clearance Rate of Flexible Ureteroscopy.

Objectives: To introduce a novel hydrodynamic design for a flexible ureteroscope that can increase stone debris clearance. Methods: Based on hydrodynamics, the new design allowed the ureteroscope to have six water jets. Fluid gushed from the six jets and would ultimately converge into an eddy. The safety and stone debris clearance efficiency were tested in a 3D-printed kidney model. Stone fragments between 0.5 and 1 mm were used to mimic the debris. A ureteroscope already approved for marketing was used as a control. Results: The new design did not change the local renal pressure and did not raise the whole renal pressure under irrigation at 80 or 100 mL/min but slightly raised it under irrigation at 120 mL/min. The pressures in the 2 g stone clearance procedures were 26.0, 33.1, and 37.5 cmH2O for the new design and 25.1, 30.2, and 39.3 cmH2O for the current design; in the 4 g stone clearance procedures, the pressures were 30.1, 37.2, and 40.0 cmH2O for the new design and 26.9, 30.8, and 39.8 cmH2O for the current design, all under conditions of 80, 100, and 120 mL/min irrigation, respectively. The new design significantly improved the stone clearance rate by ∼10-fold. It effectively cleared 2 and 4 g stones within 900 seconds under the three irrigation rates. In contrast, the current design cleared <10% of the stone debris in all tests. Conclusion: The new hydrodynamic design significantly improved the stone debris clearance rate without causing obviously increased renal pressure, and the improvement was maintained under different irrigation pressures and stone burdens.

Application of Micro-Percutaneous Nephrolithotomy (Micro-PCNL) combined with FURL in 1-2 cm symptomatic, refractory lower calyceal stones.

Objective: To investigate the safety and efficacy of Micro-Percutaneous Nephrolithotomy (Micro-PCNL) combined with flexible ureteroscopic lithotomy (FURL) in the treatment of 1-2 cm symptomatic, refractory lower calyceal stones. Methods: A retrospective analysis was performed concerning the clinical data of 28 patients with 1-2 cm symptomatic, refractory lower calyceal stones. When there was a difficulty in performing FURL in Affiliated Hospital of Hebei University from January 2019 to February 2022, ultrasound-guided F4.8 visual puncture was performed on the lower calyceal stone,with a holmium laser was then used to treat the remaining stones, followed by drainage using a flexible ureteroscopic sheath and postoperative indwelling of the ureteral stent without a nephrostomy tube. The surgery time, intraoperative bleeding and stone-free rate(SFR) were recorded, and the VAS score was used to evaluate the patients' pain status. Results: The surgery was completed successfully in an average of 43.46 ± 10.04 minutes, and the puncture time was 3.46 ± 0.69 minutes. The SFR was 85.71%(24/28) and 92.86%(26/28) at one day and 30 days after surgery, respectively. Two patients with residual stones greater than 0.6 cm in size underwent extracorporeal shock wave lithotripsy four weeks after surgery. Patients were followed up for three months after surgery, and the SFR was revised to 96.43%(27/28). In addition, the VAS scores of all patients decreased significantly from before to after surgery, and the difference was statistically significant(p< 0.05). Conclusion: Micro-Percutaneous Nephrolithotomy (Micro-PCNL) combined with FURL is safe and effective in the treatment of 1-2 cm symptomatic, refractory lower calyceal stones.

Flexible Ureteroscopy: Global User Experience Using Disposable Devices.

INTRODUCTION: Renal stone treatment through flexible ureteroscopy is widely established and successful. Ureteroscopes can broadly be classified into reusable and single-use disposable devices, each with their own advantages. Disposable scopes are cheaper to buy, maintain, and dispose of but may have a greater environmental impact and long-term cost. To establish the collective views of urologists, we conducted a multicentre, global study to demonstrate users' experience with single-use flexible ureteroscopes.  Methods: An online nine-question survey was distributed to urologists globally through email and social media platforms. Questions focused on user grade, experience, location, general opinion, advantages, disadvantages, and estimated cost of a single-use flexible ureteroscope. All responses were collated over a three-day period and analysed using descriptive statistics. RESULTS: A total of 69 responses were received; the majority of responses were from the UK (75%), and most were consultants (64%). Two-thirds of those surveyed had used a single-use scope on a patient, and 95% of them stated they enjoyed using it, citing excellent vision and reduced need for maintenance. The majority (52%) stated that widespread adoption of disposable scopes was limited due to their prohibitive expense, with an average, sterling-converted responder-estimated cost of £991 (£100-£6000) per reusable scope. CONCLUSION: Most urologists enjoyed using disposable scopes, finding them comparable or better than reusable devices. However, the initial cost can be prohibitive in certain centres. The potential environmental impact is a further concern as this remains largely unknown for now. In the meantime, it is likely that stone units will continue to use a combination of single-use and reusable scopes, considering their individual needs and budgets as well as local availability and price.

Challenges of Retrograde Ureteroscopic Procedures in Overweight Patients.

BACKGROUND: Obesity and urolithiasis are both prevalent conditions that have an impact on the healthcare system. The ureteric diameter and accessibility play a crucial role in the management of urolithiasis in both overweight and normal weight patients. Studies have shown that obesity can lead to changes in ureter diameter where excessive body fat can exert pressure on the kidneys, causing them to enlarge in size and this enlargement can result in a compression of the adjacent structures, including the ureter. The aim of this study is to assess the incidence of intraoperative challenges faced during retrograde ureteroscopic procedures in overweight patients with ureteric and renal calculi. METHODS: We retrospectively reviewed patients who underwent retrograde ureteroscopic surgery (RURS) for urolithiasis from 1st January 2021 until 30th August 2023. The outcome and any complications were documented and compared with the patient's Body Mass Index (BMI). All patients who undergo RURS in our facility have to have a Non-Contrast CT scan prior to surgery. Procedural success was determined by the ability to obtain access to the stone site intraoperatively and stone-free status in kidney, ureter, and bladder (KUB) X-ray post-operatively. Post-operative complications were recorded up to two weeks post-operatively and classified according to the Calvein Dindo Classification. RESULTS: Our total sample size was 146 patients out of which 75 were overweight and 71 were normal weight patients. In 34 (45%) of overweight patients' access to the ureter was restricted due to a narrow ureteric orifice with ureteroscopy not successful; on the contrary 13 (18%) of normal weight patients faced this same issue. This was statistically significant with a p-value of .004. The stone clearance rates were 91% and 95% in overweight and normal weight patients respectively, which is higher in normal weight patients however this difference was not found to be a statistically significant finding (p-value .028). Overweight patients had 12% Grade I and 8% Grade II complications whereas normal weight patients had 11% Grade I complications and 1.4% Grade II with no higher-grade complications. CONCLUSION: Retrograde ureteroscopic procedures are a safe treatment modality for patients with urolithiasis in both overweight and normal weight populations. They are shown to have similar success rates between both populations once ureteric access is obtained. However, access failure rates are shown to be slightly higher in overweight patients. Hence, further preoperative patient counselling and technical considerations should be undertaken.

Initial experience of comparison between two slimmest single-use flexible ureteroscopes: Indoscope Sleek (Bioradmedisys™) Versus Uscope PU3033A (Pusen™): A single-center prospective study.

PURPOSE: A single-use digital flexible ureteroscope (fURS) has become a cost-effective alternative option to reusable fURS. The requirement of large-diameter access sheath for passage of 9.5 Fr single-use fURS has not always achieved in the first attempt in all cases leading to stage stone clearance. Recently, two slimmest single-use digital disposable fURSs have been introduced by Bioradmedisys™ and Pusen™ to mitigate the accessibility problem, without or with small size access sheath. Primary objective was to compare in vivo performance and surgical outcomes with two single-use fURS: 7.5Fr Indoscope (Bioradmedisys™, Pune, India) and 7.5Fr Uscope PU3033A (Pusen, Zhuhai, China). METHODS: 60 patients undergoing Retrograde Intrarenal Surgery (RIRS) with < 2 cm renal stones were prospectively randomized into: Group A (30 patients) for Indoscope and Group B (30 patients) for Uscope PU3033A. Pre-operative, intra-operative, and post-operative parameters were evaluated. In vivo visibility and maneuverability were rated on 5-point Likert scale by the operating surgeon. At one-month stone clearance was assessed with ultrasound and X-ray KUB. Data were analyzed using SPSS 23.0. RESULTS: Patient demographics and stone characteristics were comparable in both groups. Indoscope had significantly higher visibility (p < 0.05) than Uscope; however, the maneuverability scores were comparable between both the groups (p > 0.05). 28 patients in group A and 26 patients in group B achieved complete stone clearance (p = 0.38). Scope failure was observed in 1 case of group B (p = 0.31). CONCLUSION: We conclude that 7.5Fr Indoscope has better vision than 7.5Fr Uscope and the rest of in vivo performances were comparable with similar outcomes and complications among both scopes.

Laparoscopy and ureteroscopy cooperative surgery for high burden stones in solitary kidney and ureter in one stage: A case report.

Treatment of kidney and ureter multiple calculi is a difficult procedure in urology. It is especially difficult to eliminate the high burden stones in a one-stage operation. When a patient has had only one kidney since he/she was born (a condition termed 'solitary kidney'), the conservation of the renal function is especially important. A series of combined surgery techniques have been developed, including endoscopic combined intrarenal surgery, extracorporeal shock wave lithotripsy sandwich therapy and laparoscopy-assisted percutaneous nephrolithotomy, but not laparoscopy or endoscopy cooperative surgery. The present study described the case of a patient with a solitary kidney and ureter who developed multiple calculi. This condition led to hydronephrosis and severe anuria for 3 days. Urinary ultrasound indicated hydronephrosis of the left kidney and several stones were detected. The maximum renal stone was sized ~2.7x0.8 cm. In addition, a maximally sized stone of 2.9x0.9 cm was found in the left upper ureter. The patient had only one kidney, the right kidney was absent. Laboratory examinations revealed severe renal dysfunction. A percutaneous nephrostomy was immediately performed on the left kidney. Laparoscopy, flexible ureteroscopy, rigid ureteroscopy and ureteroscope pneumatic lithotripsy were used to eliminate all the stones in one stage. The patient recovered well and was discharged on the eighth day post-surgery. The present case report highlighted that the conservation of kidney function is critical in the treatment of anuria lasting for 3 days in a patient with calculus. When the situation arises, laparoscopy combined with ureteroscopy cooperative surgery was shown to be a good choice for one-stage clearance of complex stones in patients with a solitary kidney and ureter.

Single-use versus conventional reusable flexible ureteroscopes - an evaluation of the functional parameters.

The purpose of single-use flexible ureteroscopes (su-fURS) was to overcome the limitations of conventional reusable ureteroscopes in terms of maneuverability and maintenance. We aimed to perform a systematic literature review on available su-fURS performance versus conventional reusable fURS focusing on clinical data. A systematic research using Pubmed was performed evaluating single-use fURS and reusable fURS in urinary tract stone disease, including prospective assessments and case series. This review aimed to provide an overview of single-use and disposable flexible ureteroscopes and to examine and compare their capabilities (deflection, irrigation, optical properties). We included 11 studies, where the single-use fURS were compared to the reusable fURS. The studies with single-use ureteroscopes included data on LithoVue (Boston Scientific), The Uscope UE3022 (Pusen, Zhuhai, China), NeoFlex-Flexible, (Neoscope Inc San Jose, CA), 23 YC-FR-A (Shaogang). For reusable ureteroscopes, data were included on three models, two digital (Karl Storz Flex-XC and Olympus URF-Vo) and one fiber optic (Wolf-Cobra). There were no significant differences in stone-free rate, procedure duration, or functional capabilities between single-use fURS and reusable fURS. The systematic literature review analyzed operative time, functional capabilities, stone-free rates, and postoperative complications of the ureteroscopes, and a special chapter about renal abnormalities to emphasize that they are a good choice having a high proportion of stone-free rates and few risks, particularly in treating difficult-to-access calculi. Single-use fURS demonstrate a comparable efficacy with reusable fURS in resolving renal lithiasis. Further studies on clinical efficacy are needed to determine whether single-use fURS will reliably replace its reusable counterpart.

Clinical Evaluation of Miniature Flexible Scope for Diagnosis of Ureteroscope Working Channel Defects.

Introduction: To evaluate flexible ureteroscope working channels with a 1.06 mm digital borescope (Clarus Medical, Minneapolis, MN) and identify factors contributing to ureteroscope damage over time. Materials and Methods: We performed a single institutional prospective study of patients undergoing stone surgery using a nondisposable flexible ureteroscope. A 1.06 mm borescope was used to evaluate ureteroscopes before and after surgery. Borescope videos were reviewed by two independent researchers to quantify average pre- and postprocedural damage. Results: Twenty-five procedures were performed with pre- and postprocedural borescope assessment between August 2021 and February 2022. All patients received preoperative CT imaging depicting a mean axial stone size of 14.1 ± 8.4 mm and density of 923.4 ± 458.1 HU. Mean operative time was 63.8 ± 34.0 minutes. The average number an instrument passes through the working channel was 2.1 ± 1.6. Laser was used in 11 cases with mean laser time of 18.8 ± 19.7 minutes and mean total energy of 5.8 ± 4.2 KJ. On preoperative assessment, all ureteroscopes had some form of defect (24% shave, 32% pinhole, 96% dents and scratches, and 28% discolorations). During postoperative assessment, 23/25 (92%) ureteroscopes showed additional damage with an average of 3.7 ± 2.8 imperfections acquired after one use. Significant differences were seen in acquired shavings (p = 0.028) and scratches or dents (p = 0.018). Of the 355 imperfections seen on postoperative evaluation, 0.4% were shave, 3% were pinhole, 85.8% were dents and scratches, and 10.8% were discolorations. Conclusion: The Clarus borescope observed defects after the majority of flexible ureteroscopy procedures for nephrolithiasis. Although such disruptions may not immediately render ureteroscopes nonfunctional, they are more common than previously described and could increase maintenance costs. Further studies are needed to investigate the burden of unit damage per procedure to raise operator awareness and reduce preventable ureteroscope imperfections.

Efficacy and feasibility of self-made negative pressure reflux system combined with rigid ureteroscope in the treatment of upper ureteral calculi in exercise-minded patients

Objective: To explore the efficacy and feasibility of self-made negative pressure reflux system combined with rigid ureteroscopy in the treatment of upper ureteral calculi.Methods: The clinical data of 379 Exercise-minded patients with upper ureteral calculi treated in our hospital from January 2018 to August 2022 were analyzed retrospectively. F8.0/9.8STORZ ureteroscope was used to explore the ureteral opening on the affected side, and then the 200μm wavelength holmium laser fiber and F4 ureteral catheter were inserted into the stone incarceration site through the rigid ureteroscope, and the residual stone fragments which were clinically meaningless (the maximum diameter of the stone < 2mm) were completely sucked out by negative pressure reflux system.Results: A total of 379 Exercise-minded patients were included in this study, with a one-time success rate of 97.1% (368/379), aged 26 to 76 years, with an average of (47.5) years. Most of the Exercise-minded patients (63.2%) had low back pain and hematuria before operation. The average diameter of stone was 0.8cm~2.8cm, the mean diameter of the stone was 1.8±1.0 cm.The operation time ranged from 18min to 52min, with an average of (37.86±25.64)min.The average length of hospital stay was (2.7±1.7) days (range, 1-8 days). On the first day after operation, the stone clearance rate was 84.43% (320/379), and the stone clearance rate was 90.77% (344/379) 3 months after operation. Among them, 4 Exercise-minded patients developed fever and 6 Exercise-minded patients had mild urinary fistula or renal pelvis perforation. Stone composition analysis was mainly ammonium phosphate stones and calcium oxalate stones.Conclusion: The treatment of upper ureteral calculi with self-made negative pressure reflux system combined with hard ureteroscope has the advantages of high stone clearance rate, low complications and greatly reducing the utilization rate of soft lens，and had high clinical promotion value. (AU)