Abstract
Ureteroscopes have undergone a significant evolutionary course in terms of both concept and design. The earliest flexible ureteroscopes were used only for diagnostic purposes. With subsequent addition of working channels, ureteroscopes were used in a more active and therapeutic role. Limitations of semirigid ureteroscopes revealed that an ureteroscope with an articulating/deflecting nature would be required for navigation of more proximal renal and otherwise tortuous anatomy. With smaller caliber and combined deflective mechanisms, currently available flexible ureteroscopes can now generally be advanced into all portions of the kidney and its associated calcyceal anatomy for treatment of a number of pathologies.
A thorough understanding of the construction of the flexible ureteroscope is critical in understanding how to properly use these instruments, in terms of understanding their capabilities, limitations, optimization of use, and their care, as these instruments, due to their small caliber and fragile nature, are prone to damage.
Critical elements for successful construction of modern-day working flexible ureteroscopes include ability to acquire and transmit an image, ability to transmit or produce light sufficient for imaging, functional working channels for use of ancillary devices, adequate channel capacity for irrigation, ability to have active control maneuverability of the scope, and small shaft caliber. Though digital flexible ureteroscopes have a different operative paradigm in terms of optics and image production, many mechanical and structural features of these ureteroscopes remain quite similar to their fiberoptic counterparts.
Despite widespread use, there has been concern that fiberoptic ureteroscopes tend to have a grainy image, water may leak into the lens, and fibers may burn out and fracture, resulting in loss of image quality. The key paradigm change with digital flexible ureteroscopes is the “chip on the tip design,” where an image is picked up, at times processed, and then transmitted by a digital sensor, and sent to a proximal point a single wire, where further processing and transmission take place. This arrangement bypasses the fragile optical fiber system of conventional fiberoptic flexible ureteroscopes.
Though fiberoptic ureteroscopes are being replaced with their digital counterparts, a thorough understanding of these earlier ureteroscopes is important in that studies of these ureteroscopes reveal a number of issues that impact the use and durability of ureteroscopes in a large number of ways. It is likely that such findings will also facilitate improvements in digital flexible ureteroscopes.
Many parameters of flexible ureteroscopes have been compared in a variety of fashions. Review of these investigations lends further understanding into the features and limitations of these ureteroscopes, in terms of working parameters (optical/mechanical) and overall durability. There are few all-inclusive direct comparison studies. Durability studies are of importance in that costs of damage and maintenance factor significantly into overall cost of ureteroscopy. As digital ureteroscopes have only more relatively recently been introduced into more regular use, data regarding outcome with them, using a number of assessment parameters, will be forthcoming in the near future.
Though experience to date with digital flexible ureteroscopes is limited, they have been received quite favorably. They have notably improved image quality, a brighter image, are lightweight, and likely cause less operator-related fatigue. Digital ureteroscopes carry the immediate promise of better optics and visualization, but only further experience will dictate to what degree they address other shortcomings that exist beyond those of optics, namely, in terms of working channel parameters, reliable/user-friendly deflective mechanisms, and durability.
Keywords
- Laser Fiber
- Complementary Metal Oxide Semiconductor
- Small Caliber
- Flexible Ureteroscopes
- Ureteral Access Sheath
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Young HH, Mckay RW. Congenital valvular obstruction of the prostatic urethra. Surg Gynecol Obstet. 1929;48:509.
Marshall VF. Fiberoptics in urology. J Urol. 1964;91:110–4.
Aso Y, Takayasu H, Ohta N, Tajima A. Flexible ureterorenoscopy. Urol Clin North Am. 1988;15:329–38.
Parkin J, Keeley Jr FX, Timoney AG. Flexible ureteroscope: a user’s guide. BJU Int. 2002;90:640–3.
El-Hakim A, Tan BJ, Smith AD. Ureteroscopy: technical aspects. In: Stoller ML, Meng MV, editors. Urinary stone disease. Totowa: Humana press; 2007. p. 589–607.
Grasso M, Bagley D. Small diameter, actively deflectable, flexible ureteropyleoscopy. J Urol. 1998;160(5):1648–53.
Johnston WK. Epochs in endourology: the birth of fiber optics from “light guiding”. J Endourol. 2004;18(5):425–6.
Hecht J. City of lights: the story of fiberoptics. New York: Oxford University Press; 1999. p. 13–27. 60–75.
Colladon D. On the reflections of a ray of light inside a parabolic liquid stream. Compt Rend. 1842;15:800.
Babinet J. Note on the transmission of light by sinous channels. Compt Rend. 1842;15:802.
Tyndall J. On some phenomena connected with the motion of liquids. Proc R Inst Great Britain. 1854;1:446.
Hirschowitz BI, Curtiss LE, Peters CW, et al. Demonstration of a new gastroscope, the fiberscope. Gastroenterology. 1958;35:50.
Chiu KY, Cai Y, Marcovich R, et al. Comparison of the mechanical, flow, and optical properties of contemporary flexible ureteroscopes. Urology. 2003;62(5):800–4.
Andonian S, Okeke Z, Smith AD. Digital ureteroscopy: the next step. J Endourol. 2008;22(4):603–5.
Sidorov DN, Kokaram AC. Suppression of moiré patterns via spectral analysis. In: Jay Kuo C-C, editors. Visual communications and image processing. Proceedings of the society of Photographic Instrumentation Engineers. vol. 4671; 2002. p. 895.
Hudson RG, Conlin MJ, Bagley DH. Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope. BJU Int. 2005;95:1043–4.
Bach T, Geavlete B, Hermann TRW, et al. Working tools in flexible ureterorenoscopy-influence on flow and deflection: what does matter? J Endourol. 2008;22(8):1639–43.
Natalin RA, Landman J. Where next for the endoscope? Nat Rev Urol. 2009;6:622–8.
Boyle WS, Smith GS. Charge coupled semiconductor devices. Bell Syst Tech J. 1970;49:587–93.
Damerell CJS, Farley FJM, Gillman AR, et al. Charge-coupled devices or particle detection with high spatial resolution. Nucl Instrum Methods. 1981;185:33–42.
Golden JP, Ligler FS. A comparison of imaging methods for use in an array biosensor. Biosens Bioelectron. 2002;17:719–25.
Nagele U, Horstmann M, Hennenlotter J, et al. Size does matter: 1.5 Fr stone baskets almost double irrigation flow during flexible ureteroscopy compared to 1.9 Fr stone baskets. Urol Res. 2006;34:389–92.
Bach T, Netsch C, Herrmann TRW, et al. Objective assessment of working tool impact on irrigation flow and visibility in flexible ureterorenoscopes. J Endourol. 2011;25(7):1125–9.
Kruck S, Anastasiadis AG, Gakis G, et al. Flow matters: irrigation flow differs in flexible ureteroscopes of the newest generation. Urol Res. 2011;39(6):483–6.
Haberman KH, Ortiz-Alvarado O, Chotikawanich E, et al. A dual-channel flexible ureteroscope: evaluation of deflection, flow, illumination, and optics. J Endourol. 2011;25(9):1411–4.
Monga M, Weiland D, Pedro RN, et al. Intrarenal manipulation of flexible ureteroscopes: a comparative study. BJU Int. 2007;100:157–9.
Ankem MK, Lowry PS, Slovick RW, et al. Clinical utility of dual active deflection flexible ureteroscope during upper tract ureteropyeloscopy. Urology. 2004;64:430–4.
Sung JC, Springhart WP, Marguet CG, et al. Location and etiology of flexible and semirigid ureteroscope damage. Urology. 2005;66(5):958–63.
Afane JS, Olweny EO, Bercowsky E, et al. Flexible ureteroscopes: a single center evaluation of the durability and function of the new ureteroscopes smaller than 9Fr. J Urol. 2000;164:1164–8.
User HM, Hua V, Blunt LW, et al. Performance and durability of leading flexible ureteroscopes. J Endourol. 2004;18:735–8.
Monga M, Best S, Venkatesh R, Ame C, et al. Durability of flexible ureteroscopes: a randomized prospective study. J Urol. 2006;176:137–41.
Carey RI, Gomez CS, Maurici G, et al. Frequency of ureteroscope damage at a tertiary care center. J Urol. 2006;176:607–10.
Traxer O, Dubosq F, Jamali K, et al. New-generation flexible ureteroscopes are more durable than previous ones. Urology. 2006;68(2):276–9.
Knudsen B, Miyaoka R, Shah K, et al. Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional trial. Urology. 2010;75(3):534–8.
Al-Qahtani SM, Geavlette BP, de Medina GS, et al. The new Olympus digital flexible ureteroscope (URF-V): initial experience. Urol Ann. 2011;3(3):133–7.
Pietrow PK, Auge BK, Delvecchio FC, et al. Techniques to maximize flexible ureteroscopy longetevity. Urology. 2002;60(5):784–8.
Busby JE, Low RK. Ureteroscopic treatment of renal calculi. Urol Clin North Am. 2004;31:89–98.
Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol. 2001;165:789–93.
Seto C, Ishiura Y, Egawa M. Durability of working channel in flexible ureteroscopes when inserting ureteroscopic devices. J Endourol. 2006;20:223–6.
Chew BH. Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional trial. Editorial reply. Urology. 2010;75(3):538.
Benito J, Abraham A, Corollas S, et al. Effects of Steris 1TM sterilization and Cidex® ortho-phthalaldehyde high-level disinfection on durability of new generation Flexible ureteroscopes. J Endourol. 2007;21(9):985–92.
Healy KA, Pak RW, Cleary RC, et al. Hand problems among endourologists. J Endourol. 2011;25:1915–20.
Ingram JN, Kording KP, Howard IS, et al. The statistics of natural hand movements. Exp Brain Res. 2008;188:223–36.
Pearlman JL, Roach SS, Valero-Cuevas FJ, et al. The fundamental thumb-tip force vectors produced by the muscle of the thumb. J Orthop Res. 2004;22:306–12.
Humphreys M, Miller NL, Williams JC, et al. A new world revealed: early experience with digital ureteroscopy. J Urol. 2008;179:970–5.
Castellanos JAC. SolidFlex™—the fourth generation in endoscopy. Arch Esp Urol. 2009;62(7):573–9.
Bansal H, Swain S, Sharma GK, et al. Polyscope: a new era in flexible ureteroscopy. J Endourol. 2011;25(2):317–21.
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Bird, V.G. (2013). Flexible Ureteroscopes: Fiberoptic and Digital. In: Monga, M. (eds) Ureteroscopy. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-206-3_9
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