Current Standard Technique for Modern Flexible Ureteroscopy: Tips and Tricks

Guido Giusti, Silvia Proietti, Luca Villa, Jonathan Cloutier, Marco Rosso, Giulio Maria Gadda, Steeve Doizi, Nazareno Suardi, Francesco Montorsi, Franco Gaboardi, Olivier Traxer

Research output: Contribution to journalArticlepeer-review


Background Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. Objective To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. Design, setting, and participants A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. Surgical procedure Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. Outcome measurements and statistical analysis Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations The mean overall stone size was 16.5 ± 7.9 mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5 min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. Conclusions The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. Patient summary Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.
Original languageEnglish
Pages (from-to)188 - 194
Number of pages7
JournalEuropean Urology
Issue number1
Publication statusPublished - Jul 1 2016


  • Complications
  • Flexible ureteroscopy
  • Renal stones
  • Stone-free rate
  • Surgical technique
  • Tips and tricks

ASJC Scopus subject areas

  • Urology


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