Advanced Ureteroscopy: Wireless and Sheathless

BACKGROUND: The introduction of a new generation of flexible ureteroscopes significantly advanced the therapeutic and diagnostic efficacy of the instrument, allowing greater access to all aspects of the upper urinary tract and facilitating wireless ureteroscopy. PATIENTS AND METHODS: Four hundred sixty consecutive upper urinary-tract procedures were performed utilizing the 7.5F actively deflectable, flexible ureteroscope. A prospective database of these procedures was maintained. The indications, access technique, complications, success rate of stone treatment, and access to lower-pole calices were evaluated. The accumulated clinical data were compared with a published database of 1000 consecutive flexible ureteroscopies. RESULTS: A stent was in place or had recently been in place in 108 of the procedures (24%). Of the remaining 352 flexible ureteroscopic procedures, only 11% (52) required any form of ureteral dilation to facilitate ureteral access. Two hundred twenty seven procedures were performed in which no guidewire was required to place the flexible endoscope in the upper urinary tract (i.e., "wireless" ureteroscopy). CONCLUSION: Wireless no-touch flexible ureteroscopy with the new flexible instruments is a feasible and safe technique for diagnostic and therapeutic procedures in most patients, irrespective of the location of the pathology, including the distal ureter. These ureteroscopes, with their exaggerated deflection, are ushering in a new era of endoscopic treatment of the upper urinary tract. Greater instrument deflectability and control can lead to shorter procedures and fewer treatment failures.