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Flexible ureteroscopy update: indications, instrumentation and technical advances

Retrograde ureteroscopy has recently gained a broadened indication for use from diagnostic to a variety of complex minimally invasive therapies. This

review aims to look at the recent advances in the instrumentation and accessories, the widened indications of its use, surgical techniques and complications.

With minimization of ureteroscopic instruments manufacturers are challenged to develop new, smaller and sturdier instruments that all will also survive the

rigors of surgical therapy.

Ureteroscopy is defined as retrograde instrumentation performed with an endoscope passed through the lower urinary tract directly into the ureter and

calyceal system.[1] With the addition of actively deflectable, flexible endoscopes the indications for ureteral access sheath have broadened from diagnostic to a variety of complex minimally invasive therapies. Current

ureteroscopic treatments include intracorporeal lithotripsy (by far the most common), treatment of upper urinary tract urothelial malignancies, incising

strictures, evaluation of ureteral trauma, and repairing ureteropelvic junction obstructions.[2,3] With improved instrumentation and incorporation of

technologies such as a large endoscope working channel and active tip deflection, the evolution of surgical techniques have broadened while the complications

noted with ureteropyeloscopy have actually decreased significantly.