The Experts below are selected from a list of 885 Experts worldwide ranked by ideXlab platform
Olivier Traxer - One of the best experts on this subject based on the ideXlab platform.
-
does working channel position influence the effectiveness of flexible ureteroscopy results from an in vitro study
BJUI, 2020Co-Authors: Luca Villa, Steeve Doizi, Silvia Proietti, Eugenio Ventimiglia, Guido Giusti, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Olivier TraxerAbstract:OBJECTIVE To evaluate whether the position of the working channel affects the effectiveness of flexible ureteroscopy. MATERIALS AND METHODS We compared the Ureteroscopes Flex-X2S and Flex-XC (working channel at the 9 and 3 o'clock positions, respectively) in eight cavities of a K-Box model, simulating the distribution of the right and left intrarenal calyces. In the first and second settings, each cavity contained a 1-cm stone, lying on the bottom and fixed on the anterior sheet covering the box, respectively. In the third setting, the posterior and lateral surface of each cavity was draped with graph paper. Once the flexible Ureteroscope entered each cavity, we measured and compared (i) the proportion of stone surface targeted by the laser (STL) and (ii) the proportion of graph paper burned by the laser (PBL) obtained with the two instruments. RESULTS Higher STLs and PBLs were obtained with the 3 o'clock position than the 9 o'clock position in the right posterior and left anterior cavities (mean ± sd STL 87% ± 15% vs 46% ± 38% and 78% ± 35% vs 43% ± 24%, respectively; P < 0.05), and on the right posterior surfaces of the middle-lower/lower cavities (PBL 72% vs 31% and 77% vs 35%, respectively; P < 0.01) and on the left lateral surface of the lower cavities (PBL 45% vs 25%; P = 0048), respectively. Conversely, the 9 o'clock position provided higher STLs and PBLs than the 3 o'clock position in the left posterior and right anterior cavities (mean ± sd STL 84% ± 20% vs 65% ± 28% and 79% ± 30% vs 44% ± 35%, respectively; P ≤ 0.02), and on the left posterior and right lateral surfaces of the lower cavities (PBL 59% vs 34% and 50% vs 21%, respectively; P ≤ 0.04). CONCLUSIONS The position of the working channel of the flexible Ureteroscope should be considered when planning flexible ureteroscopy, especially when dealing with the lower pole.
-
Which flexible Ureteroscope is the best for upper tract urothelial carcinoma treatment?
World Journal of Urology, 2019Co-Authors: Etienne Xavier Keller, Steeve Doizi, Luca Villa, Olivier TraxerAbstract:PurposeTo present attributes of currently available flexible Ureteroscopes to define the best flexible Ureteroscope for upper tract urothelial carcinoma (UTUC) treatment.Materials and methodsScopus 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.ResultsSmaller 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.ConclusionsMiniaturization, 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.
-
Which flexible Ureteroscope is the best for upper tract urothelial carcinoma treatment
World journal of urology, 2019Co-Authors: Etienne Xavier Keller, Steeve Doizi, Luca Villa, Olivier TraxerAbstract:To present attributes of currently available flexible Ureteroscopes to define the best flexible Ureteroscope for upper tract urothelial carcinoma (UTUC) treatment. 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. 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. 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.
-
Comparison of New Single-Use Digital Flexible Ureteroscope Versus Nondisposable Fiber Optic and Digital Ureteroscope in a Cadaveric Model
Journal of endourology, 2016Co-Authors: Steeve Doizi, Silvia Proietti, Guido Giusti, Laurian Dragos, Wilson R. Molina, Olivier TraxerAbstract:Abstract Purpose: To evaluate LithoVue, the new single-use digital flexible Ureteroscope, in a human cadaveric model and compare it with a nondisposable fiber optic and digital flexible Ureteroscopes. Materials and Methods: LithoVue, a conventional fiber optic, and digital flexible Ureteroscopes were each tested in four renal units of recently deceased female cadavers by three surgeons. The following parameters were analyzed: accessibility to the kidney and navigation of the entire collecting system with and without ureteral access sheath (UAS), lower pole access measuring the deflection of the Ureteroscope with the working channel empty, and with inside two different baskets and laser fibers. A subjective evaluation of maneuverability and visibility was assessed by each surgeon at the end of every procedure. Results: Kidney access into the Renal unit 1 was not possible without UAS for all Ureteroscopes because of noncompliant ureter at the level of sacroiliac joint. The reusable digital Ureteroscope was ...
-
MP51-03 COMPARISON OF A NEW SINGLE-USE DIGITAL FLEXIBLE Ureteroscope (LITHOVUE TM) TO A NON-DISPOSABLE FIBRE-OPTIC FLEXIBLE Ureteroscope IN A LIVE PORCINE MODEL
The Journal of Urology, 2016Co-Authors: Oliver Wiseman, Olivier Traxer, Guido Giusti, Francis X. Keeley, Michael E. Lipkin, Glenn M PremingerAbstract:INTRODUCTION AND OBJECTIVES: LithoVue TM is a new single use digital flexible Ureteroscope. The aim of this study was to evaluate it compared to a standard fibre-optic flexible Ureteroscope, with respect to image quality and maneuverability within a live porcine renal collecting system. METHODS: Flexible ureteroscopy was performed in three anaesthetised pigs by six experienced endourologists using fluoroscopic guidance and standard techniques with the Boston Scientific LithoVue TM disposable digital flexible Ureteroscope and compared to an Olympus P5 TM fiber optic flexible Ureteroscope. Each operator operated on one kidney, and attempted to access all areas of the collecting system either by accessing the kidney over a wire of via and access sheath or both. Passage of a 1.9Fr Escape TM or 1.9 or 3 Fr Fr Zero-tip TM basket and a 200 micron TracTip TM or Flexiva TM laser fibre was undertaken, and effect on deflection and visibility noted. Users were asked standard questions on completion, and also rated image quality of the LithoVue TM system compared to the P5. RESULTS: All operators were able to access all areas of the collecting system, and complete the schedule of tasks including passage of the basket and laser fibre through the Ureteroscope. Ureteroscope set up and use, access and navigation, image quality, field of view, depth of field, and lithotripsy compatibility were all rated as clinically acceptable. All operators answered the statement 0 The user was able to access, visualize, diagnose, and aid on the treatment of stones and conditions in the kidney, ureter and bladder better thanks or equal to the standard of care amongst current flexible Ureteroscopes0 positively. When asked to compare the image quality of the LithoVue TM to the P5 , on a scale of 1 to 7, where 1 is superior P5 TM performance, 4 is similar performance, and 7 is superior LithoVue TM performance, operators gave a median score of 7, with a mean score of 6.86. CONCLUSIONS: The LithoVue TM single-use digital flexible Ureteroscope gives excellent views of the collecting system when compared to a P5 TM fibre-optic Ureteroscope and is able to access all calyces in a porcine model, without significant loss of deflection or visibility with passage of a laser fibre or 1.9Fr basket. Further studies in humans are needed to determine the clinical utility of this new Ureteroscope.
Manoj Monga - One of the best experts on this subject based on the ideXlab platform.
-
a dual channel flexible Ureteroscope evaluation of deflection flow illumination and optics
Journal of Endourology, 2011Co-Authors: Ken Haberman, Ekkarin Chotikawanich, Manoj Monga, Omar OrtizalvaradoAbstract:Abstract Background and Purpose: Despite the evolution and progressive improvements of Ureteroscopes, problems related to visibility and maneuverability can still hinder the goals of surgical intervention. We evaluate the attributes of a dual-channel flexible Ureteroscope compared with a single-channel device and discuss the implications for expanded techniques afforded by this new technology. Materials and Methods: In vitro measurements of active deflection, irrigant flow through the working channel, luminescence, and optical resolution were performed between the single-channel Wolf Viper and the dual-channel Wolf Cobra Ureteroscopes. Characteristics were obtained with the working channels both empty and with combinations of a 200 μ holmium aser fiber, 3.0F biopsy forceps, and 1.5F, 2.4F, and 2.8F nitinol basket. Luminescence from each scope was measured using a commercial luminometer. Three blinded physicians rated the optical resolution captured electronically using a standard test image. Results: The ...
-
V2002 THE COBRA DUAL-CHANNEL FLEXIBLE Ureteroscope: NOVEL FUNCTION, NOVEL APPLICATIONS
The Journal of Urology, 2010Co-Authors: Omar Ortiz-alvarado, Ken Haberman, Ekkarin Chotikawanich, Manoj MongaAbstract:Abstract Introduction: Ureteroscopes have evolved from purely diagnostic tools to key instruments in the management of stone disease and other pathology of the upper urinary tract. Despite these advances, problems related to visibility and maneuverability can hinder the goals of surgical intervention. In this study, we evaluate the capabilities of a modern dual-channel flexible Ureteroscope and demonstrate novel techniques afforded by this technology. Using the Cobra dual-channel flexible Ureteroscope (Richard Wolf), we performed patient-based case studies of stone basketing and laser lithotripsy in addition to laser excision and extraction of an upper tract renal lesion. A similar simulation-based scenario of stone basketing and fragmentation is also demonstrated. Materials and Methods: The dual-channel scope has two separate 3.3F channels. One is designed as a traditional working channel; the second provides a wheel-based laser advancement device and the option for simultaneous suction or additional flo...
-
lateral deflection to release a stone a simple method
Journal of Endourology, 2007Co-Authors: Derek Weiland, Kari Hendlin, Benjamin K Canales, Stephen Lukasewycz, Manoj MongaAbstract:We describe and demonstrate a simple method to release a stone from a basket that emphasizes the importance of lateral deflection of the Ureteroscope while opening and advancing the basket. This technique works well with semirigid and flexible Ureteroscopes and all stone baskets, although some difficulty may be encountered with flat-wire baskets.
-
independent analysis of olympus flexible Ureteroscope repairs
Urology, 2007Co-Authors: Benjamin K Canales, Joseph M Gleason, Nathan Hicks, Manoj MongaAbstract:OBJECTIVES To conduct a systematic review of repairs of Olympus flexible Ureteroscopes using an independent database to compare and contrast with the published data obtained from Ureteroscope manufacturers. METHODS The repair data from 2000 to 2004 were extracted from a computer database obtained through Precision Endoscopy of America, an independent endoscope repair company. All endoscopes submitted for repair underwent a detailed 16 to 32-point inspection using a set protocol for each endoscope make and model, as determined by the manufacturer. RESULTS A total of 341 repairs were performed on the Olympus URF-P (4%), URF-P2 (47%), and URF-P3 (47%) flexible Ureteroscopes. The distal segment was the most common repair site requiring repair (30%), with 87% of these repairs requiring replacement of the bending rubber. The repairs also included the deflection apparatus (14%) and hand control segment (9%) and image-related repairs (9%). The between-group assessment showed a statistically significant decrease in deflection apparatus repairs for the URF-P2 (20%) compared with the URF-P3 (7%; P <0.001, chi-square = 11.96). CONCLUSIONS The results of our study have shown that the loss of deflection is less common with the newer Olympus Ureteroscopes. The distal deflection tip, specifically the outer bending rubber, is the most common site of damage to Olympus flexible Ureteroscopes. Improvements in form and function of the distal tip should decrease the maintenance expenses and increase Ureteroscope longevity.
-
The fractured flexible Ureteroscope with locked deflection.
The Journal of urology, 2004Co-Authors: J. Kyle Anderson, Ann Lavers, John C. Hulbert, Manoj MongaAbstract:With technological advances in flexible Ureteroscopes upper urinary tract endoscopy has become the standard for diagnosis and treatment of select upper tract stones and urothelial cancers. While flexible scopes have greatly expanded endourological patient care, they require frequent repair. Common malfunctions include loss of deflection, broken optical fibers and working channel damage.1 Fortunately, when these malfunctions occur it is possible to modify or abort a procedure with little risk of complication. We report a case of Ureteroscope malfunction in which the Ureteroscope locked in a kinked position within the renal pelvis.
Glenn M Preminger - One of the best experts on this subject based on the ideXlab platform.
-
Evaluation of a Novel Single-Use Flexible Ureteroscope.
Journal of endourology, 2017Co-Authors: Joanne Dale, Adam G. Kaplan, Daniela Radvak, Richard Shin, Anika Ackerman, Tony Chen, Charles D. Scales, Michael N. Ferrandino, Walter Neal Simmons, Glenn M PremingerAbstract:Abstract Introduction: A novel single-use flexible Ureteroscope promises the optical characteristics and maneuverability of a reusable fourth-generation flexible Ureteroscope. In this study, the LithoVue Single-Use Digital flexible Ureteroscope was directly compared with contemporary reusable flexible Ureteroscopes, with regard to optics, deflection, and irrigation flow. Methods: Three flexible Ureteroscopes such as the LithoVue (Single Use; Boston Scientific), Flex-Xc (Karl Storz, Germany), and Cobra (Richard Wolf, Germany) were assessed in vitro for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field. Ureteroscope deflection was tested with an empty channel followed by placement of a 200 μm laser fiber and a 1.9F wire basket, a 2.0F nanoelectric pulse lithotripsy (NPL) probe, and a 2.4F NPL probe. Ureteroscope irrigation flow was measured using normal saline at 100 cm, with an empty channel followed by a 200 μm laser fiber, a 1.9F wire basket and a 2....
-
MP51-03 COMPARISON OF A NEW SINGLE-USE DIGITAL FLEXIBLE Ureteroscope (LITHOVUE TM) TO A NON-DISPOSABLE FIBRE-OPTIC FLEXIBLE Ureteroscope IN A LIVE PORCINE MODEL
The Journal of Urology, 2016Co-Authors: Oliver Wiseman, Olivier Traxer, Guido Giusti, Francis X. Keeley, Michael E. Lipkin, Glenn M PremingerAbstract:INTRODUCTION AND OBJECTIVES: LithoVue TM is a new single use digital flexible Ureteroscope. The aim of this study was to evaluate it compared to a standard fibre-optic flexible Ureteroscope, with respect to image quality and maneuverability within a live porcine renal collecting system. METHODS: Flexible ureteroscopy was performed in three anaesthetised pigs by six experienced endourologists using fluoroscopic guidance and standard techniques with the Boston Scientific LithoVue TM disposable digital flexible Ureteroscope and compared to an Olympus P5 TM fiber optic flexible Ureteroscope. Each operator operated on one kidney, and attempted to access all areas of the collecting system either by accessing the kidney over a wire of via and access sheath or both. Passage of a 1.9Fr Escape TM or 1.9 or 3 Fr Fr Zero-tip TM basket and a 200 micron TracTip TM or Flexiva TM laser fibre was undertaken, and effect on deflection and visibility noted. Users were asked standard questions on completion, and also rated image quality of the LithoVue TM system compared to the P5. RESULTS: All operators were able to access all areas of the collecting system, and complete the schedule of tasks including passage of the basket and laser fibre through the Ureteroscope. Ureteroscope set up and use, access and navigation, image quality, field of view, depth of field, and lithotripsy compatibility were all rated as clinically acceptable. All operators answered the statement 0 The user was able to access, visualize, diagnose, and aid on the treatment of stones and conditions in the kidney, ureter and bladder better thanks or equal to the standard of care amongst current flexible Ureteroscopes0 positively. When asked to compare the image quality of the LithoVue TM to the P5 , on a scale of 1 to 7, where 1 is superior P5 TM performance, 4 is similar performance, and 7 is superior LithoVue TM performance, operators gave a median score of 7, with a mean score of 6.86. CONCLUSIONS: The LithoVue TM single-use digital flexible Ureteroscope gives excellent views of the collecting system when compared to a P5 TM fibre-optic Ureteroscope and is able to access all calyces in a porcine model, without significant loss of deflection or visibility with passage of a laser fibre or 1.9Fr basket. Further studies in humans are needed to determine the clinical utility of this new Ureteroscope.
-
The Digital Flexible Ureteroscope: In Vitro Assessment of Optical Characteristics
Journal of endourology, 2011Co-Authors: Dorit E. Zilberman, Michael N. Ferrandino, Walter Neal Simmons, Michael E. Lipkin, John G. Mancini, Maria E. Raymundo, Pei Zhong, Glenn M PremingerAbstract:Abstract Introduction: Recent advances in endoscope design have placed the charged coupled device chip on the tip of the endoscope. The image is instantly digitalized and converted into an electrical signal for transmission. Digital technology was first introduced into flexible cystoscopes/nephroscopes and subsequently into rigid and flexible Ureteroscopes. Herein, we assess the image characteristics and advantages of a new generation of digital flexible Ureteroscopes. Methods: The Olympus URF-V flexible digital Ureteroscope and the Olympus URF-P3 fiberoptic Ureteroscope were assessed in vitro for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field. Results: The digital Ureteroscope had a higher resolution at 3, 5, 10, and 20 mm (25.2 lines/mm vs. 8.0, 14.1 vs. 5.0, 6.3 vs. 2.8, and 3.2 vs. 1.3), respectively. Distortion with the digital flexible Ureteroscope was lower, though not statistically significant. Color representation was better with the digit...
-
location and etiology of flexible and semirigid Ureteroscope damage
Urology, 2005Co-Authors: Jeffrey C Sung, David M. Albala, Patrick W Springhart, Charles G Marguet, James O Lesperance, Yeh H Tan, Glenn M PremingerAbstract:Abstract Objectives To perform an analysis of currently available manufacturer data regarding the character of Ureteroscope damage. The high costs associated with the repair of flexible and semirigid Ureteroscopes are well documented. Increased knowledge of the etiology of Ureteroscope damage should aid urologists in prolonging the lives of these delicate instruments. Methods We requested data from the four major Ureteroscope manufacturers (ACMI, Olympus America, Karl Storz, and Richard Wolf) on the types, speculated causes, costs, and frequency of Ureteroscope damage. The results were tabulated in a blinded fashion and analyzed for trends. We then formulated guidelines that could be applied by practicing urologists. Results For both flexible and semirigid Ureteroscopes, the frequency of repair increased with decreasing Ureteroscope diameter and increasing instrument length. The cost of the repair was generally greater for flexible Ureteroscopes (mean $4597) than for semirigid Ureteroscopes (mean $2437). The major causes of flexible Ureteroscope damage were working channel damage from laser burn or instrument passage and extreme scope deflection with an indwelling instrument. The primary reasons for semirigid Ureteroscope repair included overtorquing and improper handling in the operating room and during sterile processing. Conclusions Urologists can minimize the repair costs of flexible and semirigid Ureteroscopes by taking precautions to eliminate laser fiber-induced damage and by avoiding overdeflection. Improved storage and handling of these instruments is also necessary. Although small-diameter Ureteroscopes are favorable because of their increased mobility and ease of passage, physician and staff awareness of their increased fragility is vital in maximizing the longevity of these commonly used instruments.
-
ureteroscopic management of renal calculi in anomalous kidneys
Urology, 2005Co-Authors: Alon Z. Weizer, Brian R Matlaga, Patrick W Springhart, Yeh H Tan, Wesley Ekeruo, Dean G Assimos, Glenn M PremingerAbstract:Abstract Objectives To review our experience with ureteroscopy in treating patients with renal calculi in anomalous kidneys and to evaluate the efficacy of this approach. Methods Eight patients with renal calculi in anomalous kidneys who were managed by ureteroscopic procedures were identified. Demographic information, preoperative stone burden, operative information (Ureteroscope size, lithotrite used, instruments used, duration of surgery, complications, stenting), follow-up imaging, and complications were obtained from the medical record. This information was analyzed to determine the most frequently used instruments and stone-free rates. Results Our cohort consisted of 4 patients with horseshoe kidneys (HSK) and 4 patients with pelvic kidneys (PK) (6 male, 2 female, mean age, 50.6 years). The average preoperative stone burden of the 11 treated calculi was 1.4 cm, with 5 stones located in the renal pelvis, 2 in the upper pole, and 4 in lower pole calyces. A 7.5F flexible Ureteroscope, holmium laser lithotripsy, and nitinol baskets and graspers were used in all patients. Six patients had complete clearance of the stone on postoperative imaging (75% HSK, 75% PK), with 88% of patients asymptomatic after their procedure. No patients required additional surgical intervention. Conclusions Flexible ureteroscopy with holmium laser lithotripsy and the use of nitinol baskets and graspers provides a reasonable alternative to shock wave lithotripsy in the management of patients harboring renal calculi in anomalous kidneys. In addition, ureteroscopy can be considered a primary option for managing select patients with symptomatic stones in PKs before a percutaneous surgical approach.
Ralph V Clayman - One of the best experts on this subject based on the ideXlab platform.
-
Evaluation of a Novel Female Gender Flexible Ureteroscope: Comparison of Flow and Deflection to a Standard Flexible Ureteroscope
Journal of endourology, 2021Co-Authors: Rajiv Karani, Jaime Landman, Raphael B Arada, Maged Ayad, Lillian Xie, Andrew Brevik, Akhil Peta, Pengbo Jiang, Roshan M. Patel, Ralph V ClaymanAbstract:Introduction: The advent of single-use disposable flexible Ureteroscopes allows for rapid prototyping of novel endoscopes. In this regard, we sought to develop a female-specific Ureteroscope, with ...
-
rapid communication effects of steris 1 sterilization and cidex ortho phthalaldehyde high level disinfection on durability of new generation flexible Ureteroscopes
Journal of Endourology, 2007Co-Authors: Jose Benito A Abraham, Leslie A. Deane, Corollos S. Abdelshehid, Hak J Lee, Geoffrey N Box, Forrest Jellison, James F Borin, Anthony Manipon, Elspeth M Mcdougall, Ralph V ClaymanAbstract:Background and Purpose: The effects of commonly used reprocessing methods on flexible Ureteroscope longevity have never been examined. We prospectively studied the effects of Steris 1™ sterilization and Cidex® ortho-phthalaldehyde (OPA) high-level disinfection (HLD) on the image quality, physical structure, and deflective properties of two new flexible Ureteroscopes. Materials and Methods: Two identical “out-of-the-box” Storz 11278AU1 flexible Ureteroscopes (Karl Storz Endoscopy, Tuttlingen, Germany) were sterilized individually using the Steris 1™ system (Steris Mentor, Ohio) or disinfected with Cidex® OPA (Advanced Sterilization Products, J&J, Irvine, CA) for 100 trials followed by a crossover to the other method for another 100 trials over a period of 1 year. After every five trials, optical quality, angle of deflection, and fiber damage were analyzed in the laboratory. Throughout the study, neither of these Ureteroscopes was used clinically. Results: After 100 trials, Ureteroscope 1, which was sterili...
-
bare naked baskets Ureteroscope deflection and flow characteristics with intact and disassembled ureteroscopic nitinol stone baskets
The Journal of Urology, 2002Co-Authors: Jaime Landman, Manoj Monga, Ehab A Elgabry, Jamil Rehman, David I Lee, Sam B Bhayani, Chandru P Sundaram, Ralph V ClaymanAbstract:Purpose: Lower pole renal access during flexible ureterorenoscopy is often limited by the active deflection capabilities of the Ureteroscope. Deterioration in the deflection and flow capabilities of Ureteroscopes occurs with the passage of instrumentation through the working channel. We performed in vitro evaluation of a novel technique using unsheathed nitinol baskets to minimize the deterioration in deflection and maximize the irrigant flow associated with instrument passage through the working channel during flexible ureterorenoscopy.Materials and Methods: Alterations in the irrigant flow and active deflection of 4 Ureteroscopes from different manufacturers were evaluated. Each Ureteroscope was evaluated with an empty working channel, and then with sheathed and unsheathed 2.2, 3 and 3.2Fr (Cook Urological, Inc., Indianapolis, Indiana), 2.4 and 3Fr (Microvasive Urology, Natick, Massachusetts) nitinol baskets in the working channel.Results: With all baskets tested and in all Ureteroscopes the deteriorati...
-
flexible Ureteroscopes a single center evaluation of the durability and function of the new endoscopes smaller than 9fr
The Journal of Urology, 2000Co-Authors: Jose S Afane, Chandru P Sundaram, Elspeth M Mcdougall, Ephrem O Olweny, Eduardo Bercowsky, Matthew D Dunn, Arieh L Shalhav, Ralph V ClaymanAbstract:Purpose: Flexible Ureteroscopes smaller than 9Fr are widely used in endourology. We systematically evaluated the functional durability of these instruments in the clinical setting.Materials and Methods: We performed ureteronephroscopy 92 consecutive times in 84 patients at our hospital using a flexible Storz model 11274AA, ‡ ‡Karl Storz Endoscopy, Tuttlingen, Germany. Circon-ACMI model AUR-7, § §Circon Corp., Santa Barbara, California. Wolf model 7325.172 ∥ ∥Richard Wolf GmbH, Knittlingen, Germany. and Olympus model URF/P3 Ureteroscope ¶ ¶Olympus Optical Co., Melville, New York.. Preoperatively and postoperatively we evaluated all flexible Ureteroscopes for luminosity, irrigant flow at 100 mm. Hg, number of broken image fibers and active deflection range. During the procedure a record was kept of the duration that the endoscope remained in the urinary tract, average irrigation pressure, method of insertion, various devices used within the working channel, need for lower pole access, and surgeon overall im...
-
flexible ureteroscopy washington university experience with the 9 3f and 7 5f flexible Ureteroscopes
The Journal of Urology, 1997Co-Authors: Osama M Elashry, Stephen Y Nakada, Abdelhamid M Elbahnasy, Ralph V ClaymanAbstract:AbstractPurpose: Recent advances in the design of flexible Ureteroscopes have resulted in smaller caliber instruments. We review our experience with the smaller flexible Ureteroscopes, and compare the efficacy and efficiency of the newer 7.5F to the standard 9.3F flexible instruments.Materials and Methods: Between January 1991 and 1995, 69 male and 41 female patients (mean age 57 years, range 16 to 91) underwent 116 retrograde flexible ureteroscopic procedures for a variety of diagnostic and therapeutic indications. A 9.3F Ureteroscope (group 1) was used in 71 patients and a 7.5F instrument (group 2) was used in 39.Results: Patients in group 2 received sedation analgesia significantly more often than those in group 1 (56 versus 35%, p = 0.04). Active dilation of the ureteral orifice was required less often in group 2 (22.5%) than in group 1 (58%, p
Etienne Xavier Keller - One of the best experts on this subject based on the ideXlab platform.
-
Which flexible Ureteroscope is the best for upper tract urothelial carcinoma treatment?
World Journal of Urology, 2019Co-Authors: Etienne Xavier Keller, Steeve Doizi, Luca Villa, Olivier TraxerAbstract:PurposeTo present attributes of currently available flexible Ureteroscopes to define the best flexible Ureteroscope for upper tract urothelial carcinoma (UTUC) treatment.Materials and methodsScopus 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.ResultsSmaller 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.ConclusionsMiniaturization, 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.
-
Which flexible Ureteroscope is the best for upper tract urothelial carcinoma treatment
World journal of urology, 2019Co-Authors: Etienne Xavier Keller, Steeve Doizi, Luca Villa, Olivier TraxerAbstract:To present attributes of currently available flexible Ureteroscopes to define the best flexible Ureteroscope for upper tract urothelial carcinoma (UTUC) treatment. 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. 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. 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.
