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Review
. 2023 Mar;16(3):372-380.
doi: 10.25122/jml-2023-0005.

Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS)

Bogdan Geavlete  1   2 , Cristian Mareș  2 , Răzvan-Ionuț Popescu  2 , Răzvan Mulțescu  1   2 , Cosmin Ene  2 , Petrișor Geavlete  1   2
Affiliations
Review

Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS)

Bogdan Geavlete et al. J Med Life. 2023 Mar.

Abstract

Flexible ureteroscopy (fURS) is a well-established procedure for treating multiple upper-urinary tract pathologies, particularly renoureteral lithiasis. Endoscopes have undergone significant advancements, including miniaturization, improved optics, and increased maneuverability. In addition, advancements in accessory instruments, such as the performance of laser fibers, guidewires, and extraction probes, have played a significant role in improving the overall performance of flexible ureteroscopy procedures. However, despite these advancements, unique circumstances can make achieving optimum results during flexible ureteroscopy challenging. These include congenital renal anomalies (horseshoe kidneys, ectopic kidneys, rotation anomalies), as well as the unique intrarenal anatomy (infundibulopelvic angle, infundibular length) or the specifications of the endoscope in terms of maneuverability (active and passive deflection). This review explored challenging scenarios during flexible ureteroscopy procedures in the pyelocaliceal system.

Keywords: ectopic kidney; flexible ureteroscopy; horseshoe kidney; passive deflection; renal malformations.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intraoperative images of stone relocation. A – stone located in the inferior calyx; B, C – relocating the stone to the upper calyx; D – laser lithotripsy of the upper calyx.
Figure 2
Figure 2
Graphic representation of active and passive deflection in different situations.
Figure 3
Figure 3
Intraoperative images of active and passive deflection during fURS. A – intraoperative fluoroscopic image; B, C, D – ex. vivo representation of passive deflection).
Figure 4
Figure 4
Examples of in-vitro passive deflection of flexible ureteroscope.
Figure 5
Figure 5
Differences between the 9.5 Fr Pusen (Zhuhai Pusen Medical Technology™) flexible ureteroscope and the new 7.5 Fr ultra-thin flexible ureteroscope.
See this image and copyright information in PMC

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