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Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?

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Abstract

Purpose

To present attributes of currently available flexible ureteroscopes to define the best flexible ureteroscope for upper tract urothelial carcinoma (UTUC) treatment.

Materials and methods

Scopus and Medline databases were searched for articles relating to performance of flexible ureteroscopes. A consensus for final inclusion of articles judged to be relevant for UTUC treatment was reached between the authors. Instrument characteristics were extracted from manufacturers’ product brochures.

Results

Smaller cross-sectional size of instruments is associated with increased probability for successful primary access to the upper urinary tract. The smallest flexible ureteroscopes are fiberoptic scopes. Smaller ureteroscopes also allow comparatively increased irrigation flow at constant intrarenal pressure. Digital flexible ureteroscopes achieve superior image quality compared to their fiberoptic counterparts, at the price of lower end-deflection ability. Image enhancement technologies such as narrow-band imaging (NBI), photodynamic diagnosis (PDD) and Image 1-S (formerly SPIES) are based on subjective image interpretation by the operator. NBI and PDD significantly increase tumor detection rate. The highest subjective image quality score of the Image 1-S technology is reached by the “Clara + Chroma” mode. Single-use ureteroscopes offer potential advantages over reusable scopes, including sterility, absence of contamination, immediate availability and exemption of previous instrument wear.

Conclusions

Miniaturization, digital image caption and image enhancement technologies seem to be the major determinants defining the best flexible ureteroscope for UTUC treatment. The impact of further factors, such as distal tip design, torque, working channel position, risk of contamination, as well as upcoming technological innovations should be evaluated in randomized controlled trials.

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Authors and Affiliations

  1. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Etienne Xavier Keller

  2. Sorbonne Université, Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, 4 Rue de la Chine, 75020, Paris, France

    Etienne Xavier Keller, Steeve Doizi & Olivier Traxer

  3. Sorbonne Université, Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC n°20), Hôpital Tenon, 75020, Paris, France

    Etienne Xavier Keller, Steeve Doizi & Olivier Traxer

  4. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Luca Villa

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  1. Etienne Xavier Keller
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  2. Steeve Doizi
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  3. Luca Villa
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  4. Olivier Traxer
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Contributions

EXK: project development, data collection, data analysis and manuscript writing. SD: data analysis and manuscript editing. LV: data analysis and manuscript editing. OT: project development, data analysis and manuscript editing.

Corresponding author

Correspondence to Olivier Traxer.

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Conflict of interest

Prof. Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS, Boston Scientific and IPG Medical. Dr. Steeve Doizi is a consultant for Coloplast. Dr. Etienne Xavier Keller is supported by a Travel Grant from the University Hospital Zurich and by a grant from the Kurt and Senta Herrmann Foundation.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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No informed consents were necessary for this study, since no research directly involving human participants and/or animals was performed in this study.

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Keller, E.X., Doizi, S., Villa, L. et al. Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?. World J Urol 37, 2325–2333 (2019). https://doi.org/10.1007/s00345-019-02675-0

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