No-touch ureteroscopy, also termed “wireless and sheathless” ureteroscopy, is an advanced ureteroscopic technique that minimizes incidental trauma from a wire or dilators. Direct access to the upper urinary tract with a flexible ureteroscope allows pristine inspection of the upper ureter and renal calyceal system. Improvements in the mechanics of flexible ureteroscopes, including smaller tip diameter, exaggerated tip deflection, and a larger deflecting radius allowed for the intubation of the ureteral orifice and the complete upper urinary tract inspection to be performed solely with a flexible endoscope, commonly without the assistance of a potentially traumatic guide wire. With the safety and efficacy of this technique in diagnostic applications, the indications for no-touch ureteroscopy have expanded to include a variety of therapeutic indications including tumor therapy and endoscopic lithotripsy. Herein, a review of the current techniques and results associated with wireless and sheathless flexible ureteroscopy will be presented.
Grasso M, Liu JB, Goldberg B, Bagley DH. Submucosal calculi: endoscopic and intraluminal sonographic diagnosis and treatment options. J Urol. 1995;153(5):1384–9.PubMedCrossRefGoogle Scholar
Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm or greater upper urinary tract and minor staghorn calculi. J Urol. 1998;160(2):346–51.PubMedCrossRefGoogle Scholar
Breda A, Ogunyemi O, Leppert JT, Lam JS, Schulam PG. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater—is this the new frontier? J Urol. 2008;179(3):981–4.PubMedCrossRefGoogle Scholar
Ricchiuti DJ, Smaldone MC, Jacobs BL, Smaldone AM, Jackman SV, Averch TD. Staged retrograde endoscopic lithotripsy as alternative to PCNL in select patients with large renal calculi. J Endourol. 2007;21(12):1421–4.PubMedCrossRefGoogle Scholar
Hyams ES, Munver R, Bird VG, Uberoi J, Shah O. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol. 2010;24(10):1583–8.PubMedCrossRefGoogle Scholar