Abstract：Flexible ureteroscopy is one of the minimally invasive instruments commonly used in urology. With the increasing popularity of this technology, there are also many controversial issues. This article will discuss several controversial aspects from decision-making of operation mode, the selection of surgical instruments, preoperative preparation and intraoperative operation.
[1] DOIZI S, TRAXER O.Flexible ureteroscopy: technique, tips and tricks. Urolithiasis, 2018,46(1):47-58. [2] TISELIUS HG, ACKERMANN D, ALKEN P, et al.Guidelines on urolithiasis. Eur Urol, 2001,40(4):362-371. [3] TÜRK C, PETŘÍK A, SARICA K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol, 2016,69(3):475-482. [4] ZHANG Y, WU Y, LI J, et al.Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery for the treatment of lower calyceal calculi of 2-3 cm in patients with solitary kidney. Urology, 2018,115:65-70. [5] GAO X, PENG Y, SHI X, et al.Safety and efficacy of retrograde intrarenal surgery for renal stones in patients with a solitary kidney: a single-center experience. J Endourol, 2014,28(11):1290-1294. [6] WESTERMAN ME, SCALES JA, SHARMA V, et al.The effect of anticoagulation on bleeding-related complications following ureteroscopy. Urology, 2017,100:45-52. [7] HYAMS ES, SHAH O.Percutaneous nephrostolithotomy versus flexible ureteroscopy/Holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009,182(3):1012-1017. [8] PAN J, CHEN Q, XUE W, et al.RIRS versus mPCNL for single renal stone of 2-3 cm:clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis, 2013,41(1):73-78. [9] SHI X, PENG Y, LI X, et al.Propensity Score-Matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy for large stones in patients with a solitary kidney. J Endourol, 2018,32(3):198-204. [10] JI C, GAN W, GUO H, et al.A prospective trial on ureteral stenting combined with secondary ureteroscopy after an initial failed procedure. Urol Res, 2012,40(5):593-598. [11] MOGILEVKIN Y, SOFER M, MARGEL D, et al.Predicting an effective ureteral access sheath insertion: a bicenter prospective study. J Endourol, 2014,28(12):1414-1417. [12] TRAXER O, THOMAS A.Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol, 2013,189(2):580-584. [13] ASSIMOS D, CRISCI A, CULKIN D, et al.Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int, 2016,117(4):648-654. [14] ERKURT B, CASKURLU T, ATIS G, et al.Treatment of renal stones with flexible ureteroscopy in preschool age children. Urolithiasis, 2014,42(3):241-245. [15] KARTAL I, CAKICI MC, SELMI V, et al.Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of stones in horseshoe kidney;what are the advantages and disadvantages compared to each other? Cent European J Urol, 2019,72(2):156-162. [16] YANG H, YAO X, TANG C, et al.Flexible ureterorenoscopy management of calyceal diverticular calculi. Urol J, 2019,16(1):12-15. [17] SCOTLAND KB, RUDNICK B, KELLY AH, et al.Retrograde ureteroscopic management of large renal calculi: a single institutional experience and concise literature review. J Endourol, 2018,32(7):603-607. [18] LAMB AD, VOWLER SL, JOHNSTON R, et al.Meta-analysis showing the beneficial effect of alpha-blockers on ureteric stent discomfort. BJU Int, 2011,108(11):1894-1902. [19] SCARNECIU I, LUPU S, PRICOP C, et al.Morbidity and impact on quality of Life in patients with indwelling ureteral stents: A 10-year clinical experience. Pak J Med Sci, 2015,31(3):522-526. [20] GEAVLETE P, MULTESCU R, GEAVLETE B.Pushing the boundaries of ureteroscopy: current status and future perspectives. Nat Rev Urol, 2014,11(7):373-382. [21] MARSHALL VF.FIBER OPTICS IN UROLOGY. J Urol, 1964,91:110-114. [22] TAKAYASU H, ASO Y.Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol, 1974,112(2):176-178. [23] ASO Y, OHTAWARA Y, FUKUTA K, et al.Operative fiberoptic nephroureteroscopy: removal of upper ureteral and renal calculi. J Urol, 1987,137(4):629-632. [24] HUMPHREYS MR, MILLER NL, Williams JJ, et al.A New World revealed:early experience with digital ureteroscopy. J Urol, 2008,179(3):970-975. [25] GONO K.Narrow band imaging: technology basis and research and development history. Clin Endosc, 2015,48(6):476-480. [26] KAMPHUIS GM, DE BRUIN DM, BRANDT MJ, et al.Comparing image perception of bladder tumors in four different storz professional image enhancement system modalities using the iSPIES App. J Endourol, 2016,30(5):602-608. [27] SOMANI BK, MOSELEY H, ELJAMEL MS, et al.Photodynamic diagnosis(PDD)for upper urinary tract transitional cell carcinoma (UT-TCC): evolution of a new technique. Photodiagnosis Photodyn Ther, 2010,7(1):39-43. [28] BINBAY M, YURUK E, AKMAN T, et al.Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol, 2010,24(12):1929-1934. [29] ABBOTT JE, SUR RL.Ureterorenoscopy: current technology and future outlook. Minerva Urol Nefrol, 2016,68(6):479-495. [30] DRAGOS LB, SOMANI BK, SENER ET, et al.Which flexible ureteroscopes (digital vs. Fiber-Optic) can easily reach the difficult lower Pole calices and have better End-Tip deflection: in vitro study on K-Box. A Petra evaluation. J Endourol, 2017,31(7):630-637. [31] PROIETTI S, DRAGOS L, MOLINA W, et al.Comparison of new single-use digital flexible ureteroscope versus nondisposable fiber optic and digital ureteroscope in a cadaveric model. J Endourol, 2016,30(6):655-659. [32] MOORE B, PROIETTI S, GIUSTI G, et al.Single-use ureteroscopes. Urol Clin North Am, 2019,46(2):165-174. [33] OFSTEAD CL, HEYMANN OL, QUICK MR, et al.The effectiveness of sterilization for flexible ureteroscopes: A real-world study. Am J Infect Control, 2017,45(8):888-895. [34] HENNESSEY DB, FOJECKI GL, PAPA NP, et al. Single-use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis. BJU Int, 2018,121 Suppl 3:55-61. [35] DEININGER S, HABERSTOCK L, KRUCK S, et al.Single-use versus reusable ureterorenoscopes for retrograde intrarenal surgery(RIRS): systematic comparative analysis of physical and optical properties in three different devices. World J Urol, 2018,36(12):2059-2063. [36] DAVIS NF, MCGRATH S, QUINLAN M, et al.Carbon footprint in flexible ureteroscopy: a comparative study on the environmental impact of reusable and single-use ureteroscopes. J Endourol, 2018,32(3):214-217. [37] ZHONG W, LETO G, WANG L, et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol, 2015,29(1):25-28. [38] MARCHINI GS, TORRICELLI FC, BATAGELLO CA, et al.A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices. Int Braz J Urol, 2019,45(4):658-670. [39] SANGUEDOLCE F, LIATSIKOS E, VERZE P, et al.Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis. Urolithiasis, 2014,42(4):329-334. [40] DELVECCHIO FC, AUGE BK, BRIZUELA RM, et al.Assessment of stricture formation with the ureteral access sheath. Urology, 2003,61(3):518-522. [41] HUMPHREYS MR, SHAH OD, MONGA M, et al.Dusting versus Basketing during Ureteroscopy-Which Technique is More Efficacious?A Prospective Multicenter Trial from the EDGE Research Consortium. J Urol, 2018,199(5):1272-1276. [42] EL HAMED AMA, ELMOGHAZY H, ALDAHSHOURY M, et al.Single session vs two sessions of flexible ureterosopy(FURS)for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied? Turk J Urol, 2017,43(2):158-161. [43] ITO H, KURODA S, KAWAHARA T, et al.Preoperative factors predicting spontaneous clearance of residual stone fragments after flexible ureteroscopy. Int J Urol, 2015,22(4):372-377. [44] SCHATLOFF O, LINDNER U, RAMON J, et al.Randomized trial of stone fragment active retrieval versus spontaneous passage during Holmium laser lithotripsy for ureteral stones. J Urol, 2010,183(3):1031-1035.
