Current Standard Technique for Modern Flexible Ureteroscopy: Tips and Tricks

Background: Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. Objective: To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. Design, setting, and participants: A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. Surgical procedure: Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. Outcome measurements and statistical analysis: Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations: The mean overall stone size was 16.5 ± 7.9. mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5. min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. Conclusions: The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. Patient summary: Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available. Flexible ureteroscopy is a safe and effective procedure for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status in the case of large calculi. Both the modern highly technological armamentarium and surgical know-how should be available.