Is the 4.5-F ureteroscope (Ultra-Thin) an alternative in the management of ureteric and renal pelvic stones?

Role and Efficacy of Percutaneous 4.5-Fr Semi-Rigid Ureteroscope While Creating Through-And-Through Guidewire Passage During Minimally Invasive Endoscopic Combined Intrarenal Surgery in the Supine Position; Retrospective Study at a Single Institution

OBJECTIVE

This study was performed to evaluate the efficacy of using a percutaneous 4.5-Fr semi-rigid ureteroscope (4.5-rURS) and preoperative clinical factors in the performance of the through-and-through guidewire technique (T&TGW) under the guidance of retrograde flexible ureteroscope (fURS)-assisted fluoroscopy during minimally invasive endoscopic combined intrarenal surgery (mini-ECIRS).

METHODS

In total, 123 patients who underwent mini-ECIRS with percutaneous 4.5-rURS assistance for large kidney stones in the flank-free modified Valdivia position were retrospectively evaluated. The primary outcome was the achievement rate of T&TGW, defined as percutaneous insertion of a guidewire that passed down the ureter and exited outside the external urethral meatus. The secondary outcome was the rate of percutaneous 4.5-rURS assistance required to successfully perform T&TGW.

RESULTS

The stone-free rate was 81.2%, including no residual fragments in 72.3% of patients. T&TGW was successful in 119 (96.6%) patients, which was necessary using retrograde fURS-assisted fluoroscopic guidance in 61 (49.5%) patients, whereas 4.5-rURS assistance was required in 58 (47.1%) patients. Guidewire migration under the renal pelvis mucosa was found in 10 (8.1%) patients. Preoperative factors associated with failed T&TGW using retrograde fURS-assisted fluoroscopic guidance were the puncture site in the lower calyx (odds ratio, 0.125; confidence interval, 0.043-0.364; p = 0.001) and the presence of preoperative hydronephrosis in the renal calyx of the puncture site (odds ratio, 0.261; confidence interval, 0.093-0.730; p = 0.011).

CONCLUSION

Percutaneous 4.5-rURS assistance facilitated successful T&TGW in cases of failed access under retrograde fURS-assisted fluoroscopic guidance in supine mini-ECIRS and a useful option to find a migrated guidewire in the wrong direction.

Micro-URS Experience in the Treatment of Distal Ureteral Stones in Preschool-Aged Children

Objective: The incidence of urolithiasis in the paediatric population is rising, leading to a progressive shift towards minimally invasive management strategies. This study evaluated the efficacy and safety of using micro-ureteroscopy (micro-URS) to treat distal ureteral stones in preschool-aged paediatric patients. Methods: A retrospective analysis was conducted on 57 children (aged 6-72 months), all of whom had undergone micro-URS treatment for distal ureteral stones between September 2022 and April 2024. Patient demographics, along with perioperative and postoperative outcomes, were assessed. Stone fragmentation was achieved using a 4.85 Fr micro-ureteroscope and a 200 μm Ho:YAG laser fibre. Postoperative complications were graded according to the Clavien-Dindo classification system, and stone-free status was confirmed for each patient at their one-month follow-up appointment. Results: The mean patient age was 44.2 months, and the median stone size was 9.4 mm (range: 6-24 mm). Stone-free status was confirmed in all patients at their one-month follow-up appointment. In 22.8% of cases, reintervention was required to address minor complications, including haematuria (n = 6), urinary tract infections (n = 4), and stone migration (n = 3). No major intraoperative complications were observed. A total of 41 patients (71.9%) required a double-J stent to treat intraoperative oedema or stone impaction. The mean operative time was 28.6 min, and the mean hospitalisation duration was 19.7 h. Conclusions: Micro-URS achieved a 100% stone-free rate with minimal complications, establishing it as a safe and highly effective option for treating distal ureteral stones in preschool-aged children. These findings show that micro-URS offers advantages over Shock Wave Lithotripsy (SWL) in paediatric urolithiasis management, supporting it as a first-line treatment modality. Further prospective, randomised studies are needed to validate these results.

The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications

PURPOSE

To assess the safety and effectiveness of the 4.5/6.5 Fr ureteroscopic laser lithotripsy (URSL) under topical intraurethral anesthesia (TIUA) compared to spinal anesthesia (SA).

METHODS

A retrospective study was conducted on 47 (TIUA: SA = 23:24) patients receiving 4.5/6.5 Fr URSL from July 2022 to September 2022. For the TIUA group, atropine, pethidine, and phloroglucinol were used apart from lidocaine. In the SA group, patients received lidocaine and bupivacaine. We compare the two groups including stone-free rate (SFR), procedure time, anesthesia time, overall operative time, hospital stay, anesthesia failure, intraoperative pain, need for additional analgesia, cost, and complications.

RESULTS

The conversion rate in the TIUA group was 4.35% (1/23). SFR was 100% in both groups. Surgical waiting time and anesthesia time were longer in the SA group (P < 0.001). There were no statistical differences in operational time and intraoperative pain. Patients developed grade 0-1 ureteral injuries. Post-surgical time out of bed was noticeably faster in the TIUA group (P < 0.001). The post-operative complication rate including vomiting and back pain was lower in the TIUA group (P = 0.005).

CONCLUSION

TIUA had an equal surgical success rate and controlled patients' intraoperative pain as SA. It was superior in terms of TIUA's patient admission, waiting time for surgery, anesthesia time, post-operative time out of bed, low complications, and costs, especially for females.