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Most patients with calyceal diverticula stones are asymptomatic, but some patients experience fever and low back pain. Here we report a case of calyceal diverticula stones treated by ureteroscopic management. A 41-year-old woman with backache visited a local doctor. She was diagnosed with a urinary tract infection, and prescribed an antibiotic. Her symptoms began to improve, but the ultrasonography showed she had a left renal cystic lesion, so she visited our hospital. Abdominal contrast-enhanced computed tomography (CT) showing in-flow of a contrast agent into the left renal calyceal diverticula located stones in the upper pole. We performed ureteroscopic management of the calyceal diverticula stones in two stages. First, we expanded the neck of the calyceal diverticula by indwelling the ureteral stent at the calyceal diverticula. Then, using a ureteral dilator, we expanded the neck of the calyceal diverticula further and removed the stones in the calyceal diverticula. Treatment with ureteroscopic management was possible due to the location of the calyceal diverticula stones and the success rate was increased by performing the treatment in two stages.

BACKGROUND Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes. Currently, known removal methods are either ineffective or will cause additional damage to the patient in a secondary operation. Ureteroscopy and the holmium laser have been used in various surgical techniques in urology, and in theory, they are expected to be a good strategy for solving the problem of tissue incarceration. CASE SUMMARY Four patients diagnosed with difficult removal of an abdominal drainage tube following abdominal surgery are reported. All patients underwent surgery to remove the incarcerated greater omentum in the drainage tube using a holmium laser and a ureteroscope, and a new 16-F drain was then placed in the abdominal or pelvic cavity. The efficacy of this technique was evaluated by intraoperative conditions, success rate, and operating time; safety was evaluated by perioperative conditions and the probability of postoperative complications. All four operations went smoothly, and the drains were successfully removed in all patients. The average operating time was 24.5 min. Intraoperatively, the average irrigation volume was 892.0 mL, the average drainage volume was 638.5 mL, and no bleeding or damage to surrounding tissues was observed. Postoperatively, the average drainage volume was 32.8 mL and the new drains were removed within 36 h. All patients were able to get out of bed and move around within 12 h. Their visual analogue pain scores were all below 3. The average follow-up duration was 12.5 mo and no complications such as fever or bleeding were noted. CONCLUSION Ureteroscopic holmium laser surgery is an effective, safe and minimally invasive technique for removing drains where the greater omentum is incarcerated in the abdominal drain.

INTRODUCTION Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)? METHOD Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected. RESULTS The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney

Objectives The objective of this study was to identify, map and review scope-related and user-related parameters used to evaluate the quality of flexible ureterorenoscopes. Thereby identifying key items and variability in grading systems. Methods A literature search of four databases (MEDLINE [Ovid], EMBASE [Ovid], Web of Science, Google scholar and the Cochrane Library) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines encompassing articles published up to August 2020. A total of 2386 articles were screened. Results A total of 48 articles were included in this systematic scoping review. All studies had a prospective design. Five key items in the assessment of flexible ureterorenoscopy were distinguished: 'Manoeuvrability' (87.5%), 'Optics' (64.6%), 'Irrigation' (56.3%), 'Handling' (39.6%) and 'Durability' (35.4%). After regrouping, every key item could be divided into specific subcategories. However, the quality assessment showed a wide variation in denomination, method of measurement, circumstances of measurement, tools used during measurements, number of measurements performed, number of observers, and units of outcomes. Conclusion The research field regarding quality assessment of ureterorenoscopes is heterogeneous. In this systematic scoping review we identified five key parameters: Manoeuvrability, Optics, Irrigation, Handling and Durability, used to grade flexible ureterorenoscopes. However, within these categories we found a wide variety in terms of method of measurements. A standardised, uniform grading tool is required to assess and compare the quality of flexible ureterorenoscopes in the future.

Large meta-analyses demonstrated that ureteral access sheaths (UAS) have specific complications during and after flexible ureteroscopy (fURS). The present study focused on the technical aspects, advantages, drawbacks, and limitations of the latest “no-touch” technique (NTT) in the flexible ureteroscopic therapeutic approach of renal stones. A total of 288 patients with a single pyelocaliceal stone (largest diameter between 11 and 29 mm) underwent fURS: 144 using the 12/14 Fr UAS (group 1) and 144 without UAS (group 2). For NTT, we used four types of ureteroscopes: Olympus URF-V2 (8.5 Fr) – 33 cases, Storz Flex X2 (8.4 Fr) – 60 cases, single-use PUSEN PU 3022 (9.5 Fr) – 37 cases, and single-use PUSEN – PU 3033A (7.5 Fr) – 14 cases. For group 1, we used the Olympus URF–V2 ureteroscope in 44 cases, the Storz Flex X2 in 58 cases, and the single-use PUSEN PU 3022 in 42 cases. We compared the operative time, hospitalization periods, and complications. Successful access sheath insertion was noted in 83.3% of cases from group 1, and successful ureteroscope insertion was noted in 90.9% of cases from group 2. The average operative time was slightly higher in group 1 vs. group 2 (47 vs. 39 min). Stone-free rates (SFRs) were overall lower in group 2 (76.3% vs. 86.8%) at 1 month. At 3 months, we did not find a significant difference between these two groups. Superficial mucosal ureteral wall lesions were found in 38.8% of patients from group 1 and 4.1% from group 2. Hospitalization periods were longer in group 1 vs. group 2 (21 vs. 29 hours, respectively). The single-use 7.5 Fr ureteroscope should receive a special mention: the insertion was simple, we did not encounter any mucosal ureteral wall lesions, and all patients were discharged on the same day. Despite the clear advantages of routine UAS usage, there are many adverse events for the patient. Larger diameter sheaths involve a greater risk of ureteral wall injury. NTT seems to improve peri- and postoperative safety while preserving therapeutic efficiency. The new 7.5 Fr ureteroscopes appear to optimize surgical efficiency and diminish complications in the flexible ureteroscopic treatment of renal stones.

Introduction: The advent of single-use disposable flexible ureteroscopes allows for rapid prototyping of novel endoscopes. In this regard, we sought to develop a female-specific ureteroscope, with ...

Announced in 1855, the Désormeaux endoscope articulated a scope expansion in medical utility of the uréthroscope initially presented to the Académie de médecine in late 1853. The former epochal term was never formally claimed, and although evidencing creative thinking by Désormeaux himself, production was a poorly acknowledged but seemingly close collaboration with two leading Parisian instrument makers: Maison Chevalier for the optical parts and Maison Charrière for the accessory catheter.

Introduction: Elevated intrarenal pressure (IRP) during flexible ureterorenoscopy (FURS) is a predictor of postoperative complications. The aim of this study is to evaluate IRP during FURS in a por...

Endoscopes are used for diagnosis and minimally invasive treatment of the interior regions of the body. The visual fields of endoscopes, especially angioscopes, are often obscured due to the contamination with biological fluids. To avoid the biological fouling, the lubricant liquid infused slippery surfaces with excellent antifouling property have been proposed and fabricated by previous work. Although the slippery surfaces can be transparent, the transmittance is not comparable with bare glass lens, which limits their optical applications. In contrast, nano-structured surfaces, which could eliminate reflection, exhibit excellent transmittance (~98.5%) and antireflection properties for lens applications. However, the nano-structures with large specific surface area increase biofouling, which induces vision loss and hemocompatibility problems in vivo. Herein, we develop an ultra-transparent and antifouling slippery surface on nano-structure glass. It is achieved by infusing lubricant oil on the fluorinated glass surface with semi-hexagonal nanoholes. This semi-hexagonal nanohole structures on the one hand stabilize the lubricant phase by capillary force, on the other hand effectively eliminate reflection. Our ultra-transparent slippery surface exhibits excellent hemocompatibility and antifouling property, as well as the stable transmittance even after being immersed into the whole blood for multiple cycles. This novel functional surface provides new opportunities in design of endoscopes, especially angioscopes, and offers enormous potential for disease diagnosis and treatment.

Introduction: Flexible ureteroscopy is a commonly performed urologic procedure for visualization and treatment of the upper urinary tracts. Traditionally, ureteroscopy has been performed with reusable scopes, which have large initial purchasing costs. LithoVue was the first widely adopted single-use flexible ureteroscope clinically available in 2016 and has caused reevaluation of this paradigm. Areas covered: This review is an objective assessment of the LithoVue single-use ureteroscope based on available studies at the time of publication. The authors searched major databases for papers that included the term 'LithoVue' and included relevant papers. The state of the market, technical specifications, results from clinical studies and cost analyses, and competitors are discussed. Expert opinion: The LithoVue single-use flexible ureteroscope has comparable clinical performance to existing reusable ureteroscopes based on available data. Direct clinical comparisons to competing single-use ureteroscopes, many of which are relatively new, are limited. In numerous pre-clinical studies LithoVue performed favorably compared to available competitors. Cost analyses suggest that benefit of single-use ureteroscopes is institution-specific, and will likely be favorable at a low volume of cases and with high local costs for repairs of reusable scopes.

To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones.We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small ( 0.6 mm), medium (0.6 to 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones 4 mm in diameter on non-contrast computed tomography (NCCT).The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively; p 0.001).Our findings that gaps 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.

The use of ureteral access sheaths (UAS) is common practice during routine flexible ureteroscopy procedures. However, debates and concerns continue amongst endourologists on routine UAS placement. UAS placement allows for multiple passages of the ureteroscope, decreases intrarenal pressure, and may improve stone-free rates. However, concerns for the UAS's effectiveness in these claimed benefits and complications related to UAS placement has been documented and investigated by many. In this review, we will discuss the controversies surrounding the placement of UAS during ureteroscopy.

Cystic dilatation of Cowper’s glands, also known as a syringocele, is a well-known condition of childhood, with increased recognition as a rare presentation of urinary tract symptoms in adults. Surgical techniques for its treatment vary, with several described in the literature. However, consensus on optimal treatment is unclear. We present a rare case of a Cowper’s gland syringocele successfully treated with laser deroofing with a previously undescribed method using a rigid ureteroscope, and we also review techniques in the literature. Level of evidence: Level 5.

This lecture is dedicated to increasing stone free rate (SFR) in patients with staghorn renal stones by using a multimodal approach. Percutaneous nephrolithotomy (PCNL) is the "gold standard" for the treatment of this group of patients. Depending on a stone size and complexity, SFR for PCNL varies from 55 to 98%. Due to low SFR, which is a main criterion for the effective procedure, various approaches currently are being suggested. In this lecture, we highlighted the following approaches: multi-access PCNL, a use of a ureteroscope in case of antegrade stone migration, a use of flexible instruments, ureterorenoscopy in combination with PCNL. Various lithotripsy techniques are briefly described. The advantage of ultrasound-guided puncture of the kidney is also discussed.

Objectives: Ureteroscopy is one of the commonest procedures performed to manage urolithiasis. Flexible ureteroscopy has been traditionally based on reusable, fiber-optic ureteroscopes. Technology advancements permitted the development of single-use scopes with digital image. The aim of this study is to compare efficacy and safety between a reusable, fiberoptic ureteroscope with a single-use, digital scope. Patients and methods: We collected data based on chart review from a prospectively collected database on a tertiary, high-volume hospital in Greece. Baseline, perioperative and postoperative data were gathered and analyzed. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a = 0.05. Results: 40 patients underwent flexible ureteroscopy with a single- use digital scope, while 37 with the reusable scope. The two groups were matched regarding baseline characteristics and stone-related parameters. After data analysis, a shorter operative time in favor of single-use flexible ureteroscope was detected (45 vs 65 min, p = 0.001), while safety was also in favor of this type of scope with a significantly higher immediate stonefree rate (70% vs 43%, p = 0.005). Overall complications did not differ between the two groups, although a lower sepsis rate was detected in patients treated with single-use scope. Conclusions: Our findings indicate that single-use, digital ureteroscopes are a viable alternative for flexible ureteroscopy and management of urolithiasis, especially in centers with deficient facilities for sterilization and ensured funds for more expensive reusable scopes.

An endoilluminator is a surgical tool used to supply light for surgeons inside the body. Also known as a chandelier endo illuminator or chandelier probe, in vitreoretinal surgical treatment this kind of surgical lighting tool can assist surgeons better see their operating field and improve visualization of challenges that can also occur. The foremost objective of the challenge is the usage of endo illuminator mild for eye surgery to limit the complexity of dealing with eye surgery.

To compare the range of reach of our newly designed omni-directional ureteroscope (URF-Y0016), compared to the commonly used URF-P6, FlexX2s, and LithoVue™ scopes, in the upper, middle, and lower calyces in an ex-vivo pyelocaliceal model.We fabricated a three-dimensional pyelocaliceal model of the upper, middle, and lower pole calyces using urethane and acrylic resin. The inner surface of the dome of each calyx was engraved with reference lines along eight directions, set at 10° of latitude from the top to the base of the dome, and at angles of 0-90°, to precisely determine the range of reach of each scope. The main feature of the URF-Y0016 scope is the omni-directional bending of the tip of the flexible ureteroscope, with the control of these four directions integrated into a handgun-type control unit with a joystick. The range of reach within each calyx was measured by four expert surgeons.The URF-Y0016 scope provided a greater range of reach along all directions in the lower pole calyx compared to URF-P6, FlexX2s, and LithoVue™ scopes (p 0.001), particularly along the anterior-posterior direction in the lower lobe calyx. However, the URF-Y0016 scope did not influence the improvement of reach range in the upper and middle pole calyx compared to URF-P6, FlexX2s, and LithoVue™ scopes (p = 0.08, p = 0.296).The novel design of the URF-Y0016 could improve treatment outcomes for calyceal stones in the lower pole in practice.

BACKGROUND & OBJECTIVE: To compare transurethral cystolithoclasty with ureteroscope over open vesicolithotomy in pediatric male patients. METHODOLOGY: Study comprises of hundred pediatric male patients, divided into two equal groups of 50 each, labeled as Group-A and Group-B. All the patients having stones less than 20mm size (average 14mm) were included. Group-A patients were treated with transurethral cystolithoclasty by using ureteroscope and pneumatic lithoclast assisted with the help of Dormia basket. Group-B patients were treated with open vesicolithotomy.RESULTS: All hundred male pediatric patients were between the ages of 1-15 years (mean age 8 years). Hospital stay was 2-3 days (average 2.5 days) in Group-A patients and 3-5 days (average 4 days) in Group-B patients. In Group-A3 (6%) patients had urinary tract infection, 1(2%) had urethral injury and 2(4%) had residual stone post-operatively. While Group-B4 (8%) suffered from urinary tract infection, 1(2%) had wound infection, 1(2%) had hematuria, and 2(4%) had fever. Retention of urine was 1(2%) in each Group. CONCLUSION: Transurethral cystolithoclasty is a much better way of treating vesical calculus in pediatric male patients because it is a procedure with short hospital stay, minimal invasion, no scar and less complication. KEYWORDS: Bladder Calculus, Comparison, Cystolithoclasty, Ureteroscope, Pneumatic Lithoclast, Dormia basket, Vesicolithotomy.

Flexible ureteroscopy is an important therapeutic and diagnostic procedure and has seen rapid rise in its utilisation in recent years. There have been numerous developments in flexible ureteroscope (fURS) technology but scope fragility, and the associated high maintenance costs, remains a concern. A comprehensive Medline search for related publications from the last 20 years was undertaken to identify common causes of fURS damage and ascertain practices to minimise this. Flexible ureteroscopy can be due to intraoperative causes (loss of the deflection mechanism, damage to the working channel due and fibreoptic bundle injury) and non-operative damage which occur during cleaning, sterilisation and handling of the fURS. The review summarises the available literature to help highlight common mechanisms of scope damage, and outlines evidence-based measures to reduce the risk of damage and maximise durability. Scope fragility remains a problem with significant associated cost implications. In a culture of rising fURS use and reducing re-imbursement for endourologists, prolonging the longevity of the fURS is imperative for maintaining profitability. There are simple and inexpensive practices which can be immediately adopted to maximise fURS use and reduce the need for repairs.

Objectives: To assess the effect of irrigation settings and the size of ureteral access sheath (UAS) on the maximal intra-pelvic pressure (IPPmax) during ureteroscopy (URS) in pigs. Materials and Methods: In supine position, three anesthetized female pigs underwent cystoscopy to insert a 6F ureteral catheter in each ureter. Pigs were then turned to prone position to establish a percutaneous access, insert a 10F nephrostomy tube in the kidney, and connect it to a urodynamic device. An 8F semi-rigid ureteroscope or the Flex-X2 Flexible Ureteroscope was used with two irrigation settings: gravity flow and manual pumping using a commercial pump. URS was performed without UAS and with the UAS 9.5/11, 12/14, 14/16 at the ureteropelvic junction and the IPPmax was recorded. Results: Under gravity irrigation, the recorded IPPmax during semi-rigid URS in the distal ureter and the renal pelvis was 0 and 30 cmH2O, respectively. Further, the IPPmax during flexible URS in the renal pelvis without UAS, with UAS 9.5/11.5, with UAS 12/14, and with UAS 14/16 was 23, 6, 2, and 1 cmH2O, respectively. Under manual pumping, the IPPmax during semi-rigid URS in the distal ureter and the renal pelvis was 84 and 105 cmH2O, respectively. Further, the IPPmax during flexible URS in the renal pelvis without UAS, with UAS 9.5/11.5, with UAS 12/14, and with UAS 14/16 was 45, 46, 18, and 1 cmH2O, respectively. Conclusion: Manual pumping can significantly increase the IPPmax to unsafe levels during URS. The UAS can significantly decrease the IPPmax, even under manual pumping. The larger the UAS, the lower the IPPmax. The use of UAS can render URS safer by acting as a safeguard against the consequences of increased IPP, even under forced irrigation.

Introduction Hemothorax is a rare but life-threatening complication following mini-endoscopic combined intrarenal surgery. Herein, we describe a patient with left staghorn kidney stone who presented with hemothorax following mini-endoscopic combined intrarenal surgery under ureteroscope-assisted ultrasound-guided access. Case presentation A 47-year-old woman with left staghorn kidney stone underwent mini-endoscopic combined intrarenal surgery, after which she developed shortness of breath. Chest radiography and computed tomography confirmed left hemothorax. Conservative management and left intercostal chest drainage were performed without improvement. Subsequently, video-assisted thoracoscopic debridement was performed. Conclusion Hemothorax is a severe complication of mini-endoscopic combined intrarenal surgery, which, regardless of accurate access through an ideal renal calyx under ureteroscope-assisted ultrasound-guided access, may lead to pleural injury. Refinement of the surgical technique and management after percutaneous nephrolithotomy is the key to avoiding life-threatening situations.

Staging and treatment of nonmuscle-invasive bladder tumors using transurethral resection of bladder tumors (TURBT) is challenging due to limitations in intravesicular tool dexterity, visualization and risk of bladder wall perforation. Currently, TURBT is achieved via a rigid resectoscope. This dexterity limitation is exacerbated when tumors are located in the bladder neck region. To address these limitations, an endoscopic robotic system called TURBot was developed. The paper presents the design considerations, modeling, and control challenges that were addressed to enable the first robot-assisted in vivo TURBT. The design and control of a slave robot comprised of a multisegment continuum robot capable of deploying a micro snake-like continuum robot for control of an ablation laser, a grasper, and a fiberscope is presented. A strategy for constrained telemanipulation is presented based on the redundancy resolution with varying task dimension that is commensurate with the level of constraint experienced by the robot during transurethral deployment. In addition to evaluation in animals, TURBot resection is compared against manual resection in a mockup user study using a human bladder phantom. The contributions of this paper present key steps that pave the way toward successful clinical robot-assisted TURBT.

Author(s): Marchini, Giovanni S; Torricelli, Fabio C; Batagello, Carlos A; Monga, Manoj; Vicentini, Fabio C; Danilovic, Alexandre; Srougi, Miguel; Nahas, William C; Mazzucchi, Eduardo | Abstract: PurposeTo critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes.Materials and methodsA systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included.Results741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive fi nancial costeffective decision model to fl exible ureteroscope acquisition.ConclusionsThe cost-effectiveness of a fl exible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.

Backgrounds/aims Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. Methods We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. Results Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. Conclusions The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

PURPOSE: We assessed the frequency of preoperative and persistent microbial contamination of flexible ureteroscopes after reprocessing and the relation of contamination to cumulative ureteroscope use. MATERIALS AND METHODS: We evaluated the effectiveness of high level disinfection with peracetic acid as well as data on ureteroscope use for 20 new flexible ureteroscopes from December 2015 to December 2017 at a single center. In the operating room pre-use and postuse microbial samples of the ureteroscope shaft and working channel were collected to evaluate microbial contamination after reprocessing. Positive cultures were defined as 30 cfu/ml or greater of skin flora, or 10 cfu/ml or greater of uropathogenic microorganisms. A generalized estimating equation model was used to analyze whether cumulative ureteroscope use was associated with positive pre-use cultures. RESULTS: Microbial samples were collected during 389 procedures. Pre-use ureteroscope cultures were positive in 47 of 389 procedures (12.1%), of which uropathogens were found in 9 of 389 (2.3%) and skin flora in 38 of 389 (9.8%). Urinary tract infection symptoms did not develop in any of the patients who underwent surgery with a uropathogen contaminated ureteroscope. In 1 case the pre-use culture contained the same bacteria type as the prior postuse culture. Cumulative ureteroscope use was not associated with a higher probability of positive cultures. CONCLUSIONS: Microbial contamination of reprocessed ureteroscopes was found in an eighth of all procedures. Notably uropathogenic microorganisms were discovered in a small proportion of all procedures. Persistent ureteroscope contamination with uropathogens was only rarely encountered. Cumulative ureteroscope use was not associated with a higher probability of microbial contamination.

We compared the effect of chemical disinfection (CIDEX® OPA) and low-temperature hydrogen peroxide gas plasma (STERRAD NX) on two brand new digital flexible ureteroscope (DFU) (Flex-Xc) using subjective and objective parameters. Over 11-month period, all flexible ureteroscopic procedures that fulfill the inclusion criteria were done by two brand new flexible ureteroscopes and were prospectively evaluated. Intraoperative data included total operative time, laser power and duration, stone criteria and subjective evaluation of the procedure as well as visibility and maneuverability scores were reported. The end point of the study was when the scope was deemed by the surgeon as unable to perform the procedure; when leak test is positive. A total of 88 patients were randomized either for the first flexible ureteroscope disinfected using Cidex® OPA (n = 59, 67%) or second ureteroscope sterilized with Sterrad NX (n = 29, 33%). Intraoperative, the first DFU was significantly used with a total operative time of approximately 49 h compared to the second one (p

The aim of the present work was to develop a device for semiautomatic manipulation of an optical light guide for laser proctology solving the problem of increasing the accuracy of light guide positioning in low-invasive proctological laser operations using a laser coagulator for the treatment of vascular and oncological diseases. The proposed technical solution increases positioning accuracy by manipulating the optic light guide with a device with two degrees of freedom, firmly attached to the proctoscope, with adjustment of the angle using a lever mechanism and linear semiautomatic movement of the optical light guide using stepper drives. Preclinical and subsequent clinical trials of the device for laser coagulation are planned.

Most patients with calyceal diverticula stones are asymptomatic, but some patients experience fever and low back pain. Here we report a case of calyceal diverticula stones treated by ureteroscopic management. A 41-year-old woman with backache visited a local doctor. She was diagnosed with a urinary tract infection, and prescribed an antibiotic. Her symptoms began to improve, but the ultrasonography showed she had a left renal cystic lesion, so she visited our hospital. Abdominal contrast-enhanced computed tomography (CT) showing in-flow of a contrast agent into the left renal calyceal diverticula located stones in the upper pole. We performed ureteroscopic management of the calyceal diverticula stones in two stages. First, we expanded the neck of the calyceal diverticula by indwelling the ureteral stent at the calyceal diverticula. Then, using a ureteral dilator, we expanded the neck of the calyceal diverticula further and removed the stones in the calyceal diverticula. Treatment with ureteroscopic management was possible due to the location of the calyceal diverticula stones and the success rate was increased by performing the treatment in two stages.

Background: In recent years, the available evidence revealed that mechanical hysteroscopic tissue removal (mHTR) systems represent a safe and effective alternative to conventional operative resectoscopic hysteroscopy to treat a diverse spectrum of intrauterine pathology including endometrial polyps, uterine myomas, removal of placental remnants and to perform targeted endometrial biopsy under direct visualisation. This innovative technology simultaneously cuts and removes the tissue, allowing one to perform the procedure in a safer, faster and more effective way compared to conventional resectoscopic surgery. Objective: To review currently available scientific evidence concerning the use of mechanical hysteroscopic morcellators and highlight relevant aspects of the technology. Material and Methods: A narrative review was conducted analysing the available literature regarding hysteroscopic tissue removal systems. Main outcome measures: Characteristics of available mHTR systems, procedures they are used for, their performance including safety aspects and their comparison. Results: A total of 7 hysteroscopic morcellators were identified. The diameter of the external sheet ranged from 5.25 to 9.0 mm, optics ranged from 0.8 to 6.3 mm with 0o angle. The cutter device diameter ranged from 2.9 to 4.5 mm most of them with rotation and reciprocation. Conclusion: We conclude that the adoption of mHTR has shown to reduce operating time, simultaneously cutting and suctioning tissue fragments avoiding the need for multiple removal and reinsertions of the device into the uterine cavity as well as reducing the volume of distension media required to complete the procedure compared to using the hysteroscopic resectoscope.

INTRODUCTION AND OBJECTIVE:Ergonomics in flexible ureteroscopy is poorly understood. We sought to assess the effects of different surgeon positions (sitting vs. standing) and ureteroscope types (di...

INTRODUCTION AND OBJECTIVE:Ureteral access sheaths (UAS) are used during ureteroscopy to facilitate passage of the ureteroscope and the extraction of renal and ureteral stone fragments. Larger UAS ...

Objectives The objective of this study was to identify, map and review scope-related and user-related parameters used to evaluate the quality of flexible ureterorenoscopes. Thereby identifying key items and variability in grading systems. Methods A literature search of four databases (MEDLINE [Ovid], EMBASE [Ovid], Web of Science, Google scholar and the Cochrane Library) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines encompassing articles published up to August 2020. A total of 2386 articles were screened. Results A total of 48 articles were included in this systematic scoping review. All studies had a prospective design. Five key items in the assessment of flexible ureterorenoscopy were distinguished: 'Manoeuvrability' (87.5%), 'Optics' (64.6%), 'Irrigation' (56.3%), 'Handling' (39.6%) and 'Durability' (35.4%). After regrouping, every key item could be divided into specific subcategories. However, the quality assessment showed a wide variation in denomination, method of measurement, circumstances of measurement, tools used during measurements, number of measurements performed, number of observers, and units of outcomes. Conclusion The research field regarding quality assessment of ureterorenoscopes is heterogeneous. In this systematic scoping review we identified five key parameters: Manoeuvrability, Optics, Irrigation, Handling and Durability, used to grade flexible ureterorenoscopes. However, within these categories we found a wide variety in terms of method of measurements. A standardised, uniform grading tool is required to assess and compare the quality of flexible ureterorenoscopes in the future.