Ureteroscopy
FLEXIBLE VS. SEMIRIGID
Semi-rigid distal tip is 4.9-7.5 Fr and the shaft graduates to 8.0-9.5Fr. Flexible ureteroscopes range in size from 5.2-8.7F at the tip and gradually increase in size more proximally. The working channel is 3.6fr.
POST URETEROSCOPY OBSTRUCTION
One retrospective study of 241 patients who had undergone URS and found that silent obstruction developed in 2.9% of the patients. (1) Another study that imaged patients with US/Xray (no CT) in 268 patients who had undergone URS for ureteral stones reported 95% overall success rate with URS and ureteral symptomatic strictures were observed in 0.7% cases when imaged by US or XRAY (not CT). (2) Other studies have shown ureteral stricture occurs in 0.5-4% of cases. (7) A prospective study of high grade ureteral injuries after access sheath placement found <2% had ureteral stricture afterwards. (8)
COST OF URETEROSCOPY
A study of 655 uses of ureteroscopy uses found average of 21 cases per repair at ~$7521 per repair resulting in $355 repair costs per procedure and 11days out of service for repair. This was from use over a guidewire (88% of cases); a laser fiber (70%), ureteral sheath (13.4%). Mean procedure time was 40 minutes. The most common reasons for ureteroscope repair were cloudy lens (16 repairs) and broken optic fibers (9 repairs). (3)
DISPOSABLE vs. NON-DISPOSABLE
A prospective, head to head study included 150 cases using disposable (LithoVue) vs. reusable ureteroscopes. Total disposable cases were significantly shorter (54.1 vs. 65.5min) and also disposable stone cases (57.3 vs. 70.3min). Scope failure occurred in 4.4% of LithoVue cases and 7.7% of reusable cases (p=0.27). (4)
URETERAL PERFORATION
Occurs in 4% of cases. Stop procedure and place stent for 2-6wks. Avulsion occurs in <1% of cases. (5,6,7)
UROSEPSIS
In one study 462 patients were evaluated and there was 17x risk of urosepsis if positive preop urine culture that was treated, and a higher rate of urosepsis if no preoperative stent was used. (9)
Semi-rigid distal tip is 4.9-7.5 Fr and the shaft graduates to 8.0-9.5Fr. Flexible ureteroscopes range in size from 5.2-8.7F at the tip and gradually increase in size more proximally. The working channel is 3.6fr.
POST URETEROSCOPY OBSTRUCTION
One retrospective study of 241 patients who had undergone URS and found that silent obstruction developed in 2.9% of the patients. (1) Another study that imaged patients with US/Xray (no CT) in 268 patients who had undergone URS for ureteral stones reported 95% overall success rate with URS and ureteral symptomatic strictures were observed in 0.7% cases when imaged by US or XRAY (not CT). (2) Other studies have shown ureteral stricture occurs in 0.5-4% of cases. (7) A prospective study of high grade ureteral injuries after access sheath placement found <2% had ureteral stricture afterwards. (8)
COST OF URETEROSCOPY
A study of 655 uses of ureteroscopy uses found average of 21 cases per repair at ~$7521 per repair resulting in $355 repair costs per procedure and 11days out of service for repair. This was from use over a guidewire (88% of cases); a laser fiber (70%), ureteral sheath (13.4%). Mean procedure time was 40 minutes. The most common reasons for ureteroscope repair were cloudy lens (16 repairs) and broken optic fibers (9 repairs). (3)
DISPOSABLE vs. NON-DISPOSABLE
A prospective, head to head study included 150 cases using disposable (LithoVue) vs. reusable ureteroscopes. Total disposable cases were significantly shorter (54.1 vs. 65.5min) and also disposable stone cases (57.3 vs. 70.3min). Scope failure occurred in 4.4% of LithoVue cases and 7.7% of reusable cases (p=0.27). (4)
URETERAL PERFORATION
Occurs in 4% of cases. Stop procedure and place stent for 2-6wks. Avulsion occurs in <1% of cases. (5,6,7)
UROSEPSIS
In one study 462 patients were evaluated and there was 17x risk of urosepsis if positive preop urine culture that was treated, and a higher rate of urosepsis if no preoperative stent was used. (9)
- Weizer AZ, Auge BK, Silverstein AD, Delvecchio FC, Brizuela RM, Dahm P, et al. Routine postoperative imaging is important after ureteroscopic stone manipulation. J Urol. 2002;168:46–50.
- Karadag MA, Tefekli A, Altunrende F, Tepeler A, Baykal M, Muslumanoglu AY. Is routine radiological surveillance mandatory after uncomplicated ureteroscopic stone removal? J Endourol. 2008;22:261–6.
- Kramolowsky, Eugene, et al. "Cost analysis of flexible ureteroscope repairs: evaluation of 655 procedures in a community-based practice." Journal of endourology 30.3 (2016): 254-256.
- Usawachintachit, Manint, et al. "A prospective case–control study comparing LithoVue, a single-use, flexible disposable ureteroscope, with flexible, reusable fiber-optic ureteroscopes." Journal of endourology 31.5 (2017): 468-475.
- Matlaga BR, Krambeck AE, Lingeman JE. Surgical Management of Upper Urinary Tract Calculi. Chapter 54, Vol 2 In: Wein AJ, Kavoussi LR, Partin AW and Peters CA, eds. Campbell Walsh-Urology, 11th Edition. Philadelphia, WB Saunders Elsevier; 2016.
- Semins MJ and Matlaga BR: Complications of ureteroscopy. AUA Update Series 2008; vol 27, lesson 27.
- AUA Core Curriculum. Accessed October 21, 2018.
- Stern, Karen L., et al. “A Prospective Study Analyzing the Association Between High-Grade Ureteral Access Sheath Injuries and the Formation of Ureteral Strictures.” Urology, vol. 128, 2019, pp. 38–41.
- Blackmur, James P., et al. "Analysis of factors' association with risk of postoperative urosepsis in patients undergoing ureteroscopy for treatment of stone disease." Journal of endourology 30.9 (2016): 963-969.