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World Journal of Urology

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01-11-2019 | Urothelial Cancer | Topic Paper

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

Authors: Etienne Xavier Keller, Steeve Doizi, Luca Villa, Olivier Traxer

Published in: World Journal of Urology | Issue 11/2019

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.

Munoz JJ, Ellison LM (2000) Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol 164(5):1523–1525CrossRefPubMed

Visser O, Adolfsson J, Rossi S, Verne J, Gatta G, Maffezzini M, Franks KN, RARECARE working group (2012) Incidence and survival of rare urogenital cancers in Europe. Eur J Cancer 48(4):456–464. https://doi.org/10.1016/j.ejca.2011.10.031 CrossRefPubMed

Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W, Spiess PE, Lotan Y, Ye D, Fernandez MI, Kikuchi E, Chade DC, Babjuk M, Grollman AP, Thalmann GN (2017) Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 35(3):379–387. https://doi.org/10.1007/s00345-016-1928-x CrossRefPubMed

Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Gontero P, van Rhijn BWG, Mostafid AH, Palou J, Shariat SF (2018) European association of urology guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol 73(1):111–122. https://doi.org/10.1016/j.eururo.2017.07.036 CrossRefPubMed

Roupret M, Babjuk M, Burger M, Compérat E, Cowan NC, Gontero P, Mostafid AH, Palou J, van Rhijn BWG, Shariat SF, Sylvester RJ, Zigeuner R (2019) EAU guidelines on upper urinary tract urothelial cell carcinoma. https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/. Accessed 2 Feb 2019

Giusti G, Proietti S, Villa L, Cloutier J, Rosso M, Gadda GM, Doizi S, Suardi N, Montorsi F, Gaboardi F, Traxer O (2016) Current standard technique for modern flexible ureteroscopy: tips and tricks. Eur Urol 70(1):188–194. https://doi.org/10.1016/j.eururo.2016.03.035 CrossRefPubMed

Zelenko N, Coll D, Rosenfeld AT, Smith RC (2004) Normal ureter size on unenhanced helical CT. AJR Am J Roentgenol 182(4):1039–1041. https://doi.org/10.2214/ajr.182.4.1821039 CrossRefPubMed

Dragos L, Martis SM, Somani B, Bres-Niewada E, Sener TE, Buttice S, Wiseman OJ, Iacoboaie CT, Doizi S, Traxer O (2018) “Torque” Abilities of reusable and single-use flexible ureterorenoscopes: a novel in vitro evaluation of twelve scopes. J Urol 199(4S):e476–e477

Johnson GB, Portela D, Grasso M (2006) Advanced ureteroscopy: wireless and sheathless. J Endourol 20(8):552–555. https://doi.org/10.1089/end.2006.20.552 CrossRefPubMed

10.

Hudson RG, Conlin MJ, Bagley DH (2005) Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope. BJU Int 95(7):1043–1044. https://doi.org/10.1111/j.1464-410X.2005.05462.x CrossRefPubMed

11.

Hubosky SG, Healy KA, Grasso M, Bagley DH (2014) Accessing the difficult ureter and the importance of ureteroscope miniaturization: history is repeating itself. Urology 84(4):740–742. https://doi.org/10.1016/j.urology.2014.06.029 CrossRefPubMed

12.

Ng YH, Somani BK, Dennison A, Kata SG, Nabi G, Brown S (2010) Irrigant flow and intrarenal pressure during flexible ureteroscopy: the effect of different access sheaths, working channel instruments, and hydrostatic pressure. J Endourol 24(12):1915–1920. https://doi.org/10.1089/end.2010.0188 CrossRefPubMed

13.

Sener TE, Cloutier J, Villa L, Marson F, Butticè S, Doizi S, Traxer O (2016) Can we provide low intrarenal pressures with good irrigation flow by decreasing the size of ureteral access sheaths? J Endourol 30(1):49–55. https://doi.org/10.1089/end.2015.0387 CrossRefPubMed

14.

De Coninck V, Keller EX, Rodriguez-Monsalve M, Audouin M, Doizi S, Traxer O (2018) Systematic review on ureteral access sheaths: facts and myths. BJU Int. https://doi.org/10.1111/bju.14389 CrossRefPubMed

15.

Proietti S, Dragos L, Somani BK, Buttice S, Talso M, Emiliani E, Baghdadi M, Giusti G, Traxer O (2017) In vitro comparison of maximum pressure developed by irrigation systems in a kidney model. J Endourol. https://doi.org/10.1089/end.2017.0005 CrossRefPubMed

16.

Lama DJ, Safiullah S, Patel RM, Lee TK, Balani JP, Zhang L, Okhunov Z, Margulis V, Savage SJ, Uchio E, Landman J (2018) Multi-institutional evaluation of upper urinary tract biopsy using backloaded cup biopsy forceps, a nitinol basket, and standard cup biopsy forceps. Urology 117:89–94. https://doi.org/10.1016/j.urology.2018.03.040 CrossRefPubMed

17.

Thomsen HS, Dorph S, Olsen S (1981) Pyelorenal backflow in normal and ischemic rabbit kidneys. Invest Radiol 16(3):206–214CrossRefPubMed

18.

Keller EX, De Coninck V, Traxer O (2019) Next generation fiberoptic and digital ureteroscopes. Urol Clin N Am. https://doi.org/10.1016/j.ucl.2018.12.001 CrossRef

19.

Hopkins HH (1954) A flexible fibrescope, using static scanning. Nature 173(4392):39–41. https://doi.org/10.1038/173039b0 CrossRef

20.

Goddard JC (2018) A series of fortunate events: harold hopkins. JCU 11(1_suppl):4–8. https://doi.org/10.1177/2051415818775309 CrossRef

21.

Tan YH, Preminger GM (2004) Advances in video and imaging in ureteroscopy. Urol Clin N Am 31(1):33–42. https://doi.org/10.1016/S0094-0143(03)00103-4 CrossRef

22.

Abdelshehid C, Ahlering MT, Chou D, Park HK, Basillote J, Lee D, Kim I, Eichel L, Protsenko D, Wong B, McDougall E, Clayman RV (2005) Comparison of flexible ureteroscopes: deflection, irrigant flow and optical characteristics. J Urol 173(6):2017–2021. https://doi.org/10.1097/01.ju.0000158139.65771.0a CrossRefPubMed

23.

Talso M, Proietti S, Emiliani E, Gallioli A, Dragos L, Orosa A, Servian P, Barreiro A, Giusti G, Montanari E, Somani B, Traxer O (2018) Comparison of flexible ureterorenoscope quality of vision: an in vitro study. J Endourol 32(6):523–528. https://doi.org/10.1089/end.2017.0838 CrossRefPubMed

24.

Binbay M, Yuruk E, Akman T, Ozgor F, Seyrek M, Ozkuvanci U, Berberoglu Y, Muslumanoglu AY (2010) Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol 24(12):1929–1934. https://doi.org/10.1089/end.2010.0211 CrossRefPubMed

25.

Somani BK, Al-Qahtani SM, de Medina SD, Traxer O (2013) Outcomes of flexible ureterorenoscopy and laser fragmentation for renal stones: comparison between digital and conventional ureteroscope. Urology 82(5):1017–1019. https://doi.org/10.1016/j.urology.2013.07.017 CrossRefPubMed

26.

Usawachintachit M, Isaacson DS, Taguchi K, Tzou DT, Hsi RS, Sherer BA, Stoller ML, Chi T (2017) A prospective case-control study comparing LithoVue, a single-use, flexible disposable ureteroscope, with flexible, reusable fiber-optic ureteroscopes. J Endourol 31(5):468–475. https://doi.org/10.1089/end.2017.0027 CrossRefPubMedPubMedCentral

27.

Mandalapu RS, Remzi M, de Reijke TM, Margulis V, Palou J, Kapoor A, Yossepowitch O, Coleman J, Traxer O, Anderson JK, Catto J, de la Rosette J, O’Brien T, Zlotta A, Matin SF (2017) Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma. World J Urol 35(3):355–365. https://doi.org/10.1007/s00345-016-1859-6 CrossRefPubMed

28.

Dragos LB, Somani BK, Sener ET, Buttice S, Proietti S, Ploumidis A, Iacoboaie CT, Doizi S, Traxer O (2017) Which flexible ureteroscopes (digital vs. fiber-optic) can easily reach the difficult lower pole calices and have better end-tip deflection: in vitro study on K-box. A PETRA evaluation. J Endourol 31(7):630–637. https://doi.org/10.1089/end.2017.0109 CrossRefPubMed

29.

Gono K (2015) Narrow band imaging: technology basis and research and development history. Clin Endosc 48(6):476–480. https://doi.org/10.5946/ce.2015.48.6.476 CrossRefPubMedPubMedCentral

30.

Faber DJ, Mik EG, Aalders MC, van Leeuwen TG (2003) Light absorption of (oxy-)hemoglobin assessed by spectroscopic optical coherence tomography. Opt Lett 28(16):1436–1438CrossRefPubMed

31.

Traxer O, Geavlete B, de Medina SG, Sibony M, Al-Qahtani SM (2011) Narrow-band imaging digital flexible ureteroscopy in detection of upper urinary tract transitional-cell carcinoma: initial experience. J Endourol 25(1):19–23. https://doi.org/10.1089/end.2009.0593 CrossRefPubMed

32.

Jocham D, Stepp H, Waidelich R (2008) Photodynamic diagnosis in urology: state-of-the-art. Eur Urol 53(6):1138–1148. https://doi.org/10.1016/j.eururo.2007.11.048 CrossRefPubMed

33.

Somani BK, Moseley H, Eljamel MS, Nabi G, Kata SG (2010) Photodynamic diagnosis (PDD) for upper urinary tract transitional cell carcinoma (UT-TCC): evolution of a new technique. Photodiagn Photodyn Ther 7(1):39–43. https://doi.org/10.1016/j.pdpdt.2009.12.005 CrossRef

34.

Kata SG, Nabi G, Eljamel S, Chlosta P, Moseley H, Aboumarzouk OM (2014) Photodynamic diagnostic ureterorenoscopy with orally administered 5-aminolaevulinic acid as photosensitiser: how I do it. Urol Int 93(4):384–388. https://doi.org/10.1159/000360228 CrossRefPubMed

35.

Osman E, Alnaib Z, Kumar N (2017) Photodynamic diagnosis in upper urinary tract urothelial carcinoma: a systematic review. Arab J Urol 15(2):100–109. https://doi.org/10.1016/j.aju.2017.01.003 CrossRefPubMedPubMedCentral

36.

Kata SG, Aboumarzouk OM, Zreik A, Somani B, Ahmad S, Nabi G, Buist R, Goodman C, Chlosta P, Golabek T, Moseley H (2016) Photodynamic diagnostic ureterorenoscopy: a valuable tool in the detection of upper urinary tract tumour. Photodiagn Photodyn Ther 13:255–260. https://doi.org/10.1016/j.pdpdt.2015.08.002 CrossRef

37.

Emiliani E, Talso M, Baghdadi M, Barreiro A, Orosa A, Servian P, Gavrilov P, Proietti S, Traxer O (2017) Evaluation of the Spies (TM) modalities image quality. Int Br J Urol 43(3):476–480. https://doi.org/10.1590/S1677-5538.IBJU.2016.0324 CrossRef

38.

Kamphuis GM, de Bruin DM, Brandt MJ, Knoll T, Conort P, Lapini A, Dominguez-Escrig JL, de la Rosette JJ (2016) Comparing image perception of bladder tumors in four different storz professional image enhancement system modalities using the iSPIES App. J Endourol 30(5):602–608. https://doi.org/10.1089/end.2015.0687 CrossRefPubMed

39.

Gregory E, Simmons D, Weinburg JJ (1988) Care and sterilisation of endourologic instruments. Urol Clin N Am 15(3):541–546

40.

Fuselier HA Jr, Mason C (1997) Liquid sterilization versus high level disinfection in the urologic office. Urology 50(3):337–340. https://doi.org/10.1016/S0090-4295(97)00218-5 CrossRefPubMed

41.

McDougall EM, Alberts G, Deal KJ, Nagy JM 3rd (2001) Does the cleaning technique influence the durability of the < 9F flexible ureteroscope? J Endourol 15(6):615–618. https://doi.org/10.1089/089277901750426409 CrossRefPubMed

42.

Sooriakumaran P, Kaba R, Andrews HO, Buchholz NP (2005) Evaluation of the mechanisms of damage to flexible ureteroscopes and suggestions for ureteroscope preservation. Asian J Androl 7(4):433–438. https://doi.org/10.1111/j.1745-7262.2005.00077.x CrossRefPubMed

43.

Monga M, Best S, Venkatesh R, Ames C, Lee C, Kuskowski M, Schwartz S, Vanlangendock R, Skenazy J, Landman J (2006) Durability of flexible ureteroscopes: a randomized, prospective study. J Urol 176(1):137–141. https://doi.org/10.1016/S0022-5347(06)00575-1 CrossRefPubMed

44.

Abraham JB, Abdelshehid CS, Lee HJ, Box GN, Deane LA, Le T, Jellison F, Borin JF, Manipon A, McDougall EM, Clayman RV (2007) Rapid communication: effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde high-level disinfection on durability of new-generation flexible ureteroscopes. J Endourol 21(9):985–992. https://doi.org/10.1089/end.2007.0181 CrossRefPubMed

45.

Semins MJ, George S, Allaf ME, Matlaga BR (2009) Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs. J Endourol 23(6):903–905. https://doi.org/10.1089/end.2008.0489 CrossRefPubMed

46.

Legemate JD, Kamphuis GM, Freund JE, Baard J, Zanetti SP, Catellani M, Oussoren HW, de la Rosette JJ (2018) Durability of flexible ureteroscopes: a prospective evaluation of longevity, the factors that affect it, and damage mechanisms. Eur Urol Focus 1:10. https://doi.org/10.1016/j.euf.2018.03.001 CrossRef

47.

Chang CL, Su LH, Lu CM, Tai FT, Huang YC, Chang KK (2013) Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope. J Hosp Infect 85(2):118–124. https://doi.org/10.1016/j.jhin.2013.06.010 CrossRefPubMed

48.

Ofstead CL, Heymann OL, Quick MR, Johnson EA, Eiland JE, Wetzler HP (2017) The effectiveness of sterilization for flexible ureteroscopes: a real-world study. Am J Infect Control 45(8):888–895. https://doi.org/10.1016/j.ajic.2017.03.016 CrossRefPubMed

49.

Emiliani E, Traxer O (2017) Single use and disposable flexible ureteroscopes. Curr Opin Urol 27(2):176–181. https://doi.org/10.1097/MOU.0000000000000371 CrossRefPubMed

50.

Proietti S, Somani B, Sofer M, Pietropaolo A, Rosso M, Saitta G, Gaboardi F, Traxer O, Giusti G (2017) The “Body Mass Index” of flexible ureteroscopes. J Endourol 31(10):1090–1095. https://doi.org/10.1089/end.2017.0438 CrossRefPubMed

51.

Ludwig WW, Lee G, Ziemba JB, Ko JS, Matlaga BR (2017) Evaluating the ergonomics of flexible ureteroscopy. J Endourol 31(10):1062–1066. https://doi.org/10.1089/end.2017.0378 CrossRefPubMed

52.

Proietti S, Dragos L, Molina W, Doizi S, Giusti G, Traxer O (2016) Comparison of new single-use digital flexible ureteroscope versus nondisposable fiber optic and digital ureteroscope in a cadaveric model. J Endourol 30(6):655–659. https://doi.org/10.1089/end.2016.0051 CrossRefPubMedPubMedCentral

Title: Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?
Authors: Etienne Xavier Keller
Steeve Doizi
Luca Villa
Olivier Traxer
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Urothelial Cancer
Urothelial Cancer
Published in: World Journal of Urology / Issue 11/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02675-0

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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