Research Article
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Comparison of Outcomes Between Disposable and Reusable Flexible Ureteroscopes in the Treatment of Lower Pole Renal Stones

Year 2025, Volume: 17 Issue: 2, 78 - 85, 30.05.2025

Adem Tunçekin , Arda Tongal , Süleyman Sağır , Yasin Aktaş , Erkan Arslan

Abstract

Objective: Kidney stone disease is a significant health problem that substantially affects individuals’ quality of life. Approximately 30% of kidney stones are located in the lower pole, which presents challenges in accessing these stones during retrograde intrarenal surgery. In the surgical treatment of lower pole kidney stones, we aimed to evaluate the efficacy and success rates of single-use and reusable flexible ureterorenoscopes, and to determine the most optimal option based on these findings.
Material and Methods: This study included patients with lower pole kidney stones who underwent retrograde intrarenal surgery. Patients were divided into two groups based on the type of ureterorenoscope used: single-use or reusable. The collected data were compared between the two groups.
Results: A total of 61 patients, including 34 men and 27 women, were included in the study. Thirty-four patients were evaluated in the single-use group, and 27 patients in the reusable group. The median stone size was 78.5 mm² (50.3–127.6) mm² in the reusable group and 125.3 mm² (56.5–201.1) mm² in the single-use group. There was no statistically significant difference between the groups in terms of demographic characteristics, Clavien-Dindo scores, or postoperative complications (p > 0.05). However, vomiting was observed significantly less frequently in the single-use group compared to the reusable group (p < 0.05).
Conclusion: Flexible ureterorenoscopes are commonly used in the surgical management of lower pole kidney stones. When choosing between single-use and reusable flexible ureterorenoscopes, factors such as cost and ease of use should be taken into consideration. To better compare the advantages of each type and obtain more reliable results, larger case series and prospective studies are needed.

Keywords

ureteroscopes urolithiasis kidney stone

Ethical Statement

ethics committee approval from Uşak University Ethics Committee (decision number 01 and date 02.05.2024)

References

  • 1. Florido C, Herren JL, Pandhi MB, Niemeyer MM. Emergent Percutaneous Nephrostomy for Pyonephrosis: A Primer for the On-Call Interventional Radiologist. Semin Intervent Radiol. 2020;37(1):74-84. doi:10.1055/s-0039-3401842
  • 2. Zul Khairul Azwadi I, Norhayati MN, Abdullah MS. Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis. Sci Rep. 2021 Mar 23;11(1):6613. doi: 10.1038/s41598-021-86136-y.
  • 3. Balasubramanian A, Metcalfe MJ, Wagenheim G, Xiao L, Papadopoulos J, Navai N, Davis JW, Karam JA, Kamat AM, Wood CG, Dinney CP, Matin SF. Salvage topical therapy for upper tract urothelial carcinoma. World J Urol. 2018 Dec;36(12):2027-2034. doi: 10.1007/s00345-018-2349-9
  • 4. Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol. 1997 Sep-Oct;8(5):769-74. doi: 10.1016/s1051-0443(97)70658-4
  • 5. Young M, Leslie SW. Percutaneous Nephrostomy. 2021 Aug 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
  • 6. Dyer RB, Regan JD, Kavanagh PV, Khatod EG, Chen MY, Zagoria RJ. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics. 2002 May-Jun;22(3):503-25. doi: 10.1148/radiographics.22.3.g02ma19503.
  • 7. ACR–SIR–SPR Practice Parameter for the Performance of Percutaneous Nephrostomy Res. 20 – 2016 Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Percutaneous-Nephros.pdf Accessed February 10 2022
  • 8. Valji, K., Maroney, T.P. Vascular and Interventional Radiology. Shock, 1999,12 (5).
  • 9. GOODWIN WE, CASEY WC, WOOLF W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955 Mar 12;157(11):891-4.
  • 10. Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol. 2004;45(2):184–8.
  • 11. Efesoy O, Saylam B, Bozlu M, Çayan S, Akbay E. The results of ultrasound-guided percutaneous nephrostomy tube placement for obstructive uropathy: A single-centre 10-year experience. Turk J Urol. 2018 Jul;44(4):329-334. doi: 10.5152/tud.2018.25205.
  • 12. Pabon-Ramos WM, Dariushnia SR, Walker TG, d'Othée BJ, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B; Society of InterventionalRadiologyStandards of PracticeCommittee. QualityImprovementGuidelinesforPercutaneousNephrostomy. J VascIntervRadiol. 2016 Mar;27(3):410-4. doi: 10.1016/j.jvir.2015.11.045.
  • 13. Yoo MJ, Bridwell RE, Inman BL, Henderson JD, Long B. Approach to nephrostomy tubes in the emergency department. Am J Emerg Med. 2021 Dec; 50:592-596. doi: 10.1016/j.ajem.2021.09.034.
  • 14. Ali SM, Mehmood K, Faiq SM, Ali B, Naqvi SA, Rizvi AU. Frequency of complications in image guided percutaneous nephrostomy. J Pak Med Assoc. 2013 Jul;63(7):816-20.
  • 15. Kehinde EO, Newland CJ, Terry TR, Watkin EM, Butt Z. Percutaneous nephrostomies. Br J Urol. 1993 Jun;71(6):664-6. doi: 10.1111/j.1464-410x.1993.tb16061.x.
  • 16. Sood, G., A. Sood, A. Jindal, et al. Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases. Int braz j urol 2006 32(3): p.281–286.
  • 17. Bird VG, Fallon B, Winfield HN. Practice patterns in the treatment of large renal stones. J Endourol/Endourol Soc. 2003; 17:355–363.
  • 18. Lee CL, Anderson JK, Monga M. Residency training in percutaneous renal access: does it affect urological practice? J Urol. 2004 Feb;171(2 Pt 1):592-5. doi: 10.1097/01.ju.0000104849.25168.6d.
  • 19. Cobb KD, Gomella PT, DiBianco JM, Batter TH, Eisner BH, Mufarrij PW. Are Emergently Placed Nephrostomy Tubes Suitable for Subsequent Percutaneous Endoscopic Renal Surgery? Urology. 2019 Apr; 126:45-48. doi: 10.1016/j.urology.2019.01.006.
  • 20. Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure. Int J Clin Oncol. 2019 Mar;24(3):306-312. doi: 10.1007/s10147-018-1348-6.
  • 21. Prentice J, Amer T, Tasleem A, Aboumarzouk O. Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review. J R Soc Med. 2018 Apr;111(4):125-135. doi: 10.1177/0141076818766725.
  • 22. Folkard SS, Banerjee S, Menzies-Wilson R, Reason J, Psallidas E, Clissold E, Al-Mushatat A, Chaudhri S, Green JSA. Percutaneous nephrostomy in obstructing pelvic malignancy does not facilitate further oncological treatment. Int Urol Nephrol. 2020 Sep;52(9):1625-1628. doi: 10.1007/s11255-020-02466-2.
  • 23. Wong LM, Cleeve LK, Milner AD, Pitman AG. Malignant ureteral obstruction: outcomes after intervention. Have things changed? J Urol. 2007 Jul;178(1):178-83; discussion 183. doi: 10.1016/j.juro.2007.03.026.
  • 24. Garg G, Bansal N, Singh M, Sankhwar SN. Role of Percutaneous Nephrostomy in Bladder Carcinoma with Obstructive Uropathy: A Story Revisited. Indian J Palliat Care. 2019 Jan-Mar;25(1):53-56. doi: 10.4103/IJPC.IJPC_102_18.
  • 25. Noegroho BS, Kurniawan AP, Wijayanti Z, Mustafa A. Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients. Asian Pac J Cancer Prev. 2021 Apr 1;22(4):1211-1216. doi: 10.31557/APJCP.2021.22.4.1211.
  • 26. Chalmers N, Jones K, Drinkwater K, Uberoi R, Tawn J. The UK nephrostomy audit. Can a voluntary registry produce robust performance data? Clin Radiol. 2008 Aug;63(8):888-94. doi: 10.1016/j.crad.2007.10.021.
  • 27. Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Ceylan Y, Ors B, Minareci S. Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines. Urology. 2013 Jun;81(6):1161-7. doi: 10.1016/j.urology.2013.02.038.
  • 28. Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol. 2004 Mar;59(3):255-61. doi: 10.1016/j.crad.2003.10.021.
  • 29. Krohmer, S. J., Pillai, A. K., Guevara, C. J., Bones, B. L., &Dickey, K. W. (2018). Image-GuidedNephrostomyInterventions: How toRecognize, Avoid, orGetOut of Trouble. Techniques in vascularandinterventionalradiology, 21(4), 261–266. https://doi.org/10.1053/j.tvir.2018.07.008.
  • 30. Montvilas P, Solvig J, Johansen TE. Single-centre review of radiologically guided percutaneous nephrostomy using "mixed" technique: success and complication rates. Eur J Radiol. 2011 Nov;80(2):553-8. doi: 10.1016/j.ejrad.2011.01.109.
  • 31. Carrafiello G, Laganà D, Mangini M, Lumia D, Recaldini C, Bacuzzi A, Marconi A, Mira A, Cuffari S, Fugazzola C. Complications of percutaneous nephrostomy in the treatment of malignant ureteral obstructions: single-centre review. Radiol Med. 2006 Jun;111(4):562-71. English, Italian. doi: 10.1007/s11547-006-0051-2.

Alt Kutup Böbrek Taşlarının Tedavisinde Tek Kullanımlık ve Yeniden Kullanılabilir Üreteroskopların Sonuçlarının Karşılaştırılması

Year 2025, Volume: 17 Issue: 2, 78 - 85, 30.05.2025

Adem Tunçekin , Arda Tongal , Süleyman Sağır , Yasin Aktaş , Erkan Arslan

Abstract

Amaç: Böbrek taşı hastalığı, önemli bir sağlık sorunu olup bireylerin yaşam kalitesini büyük ölçüde etkiler. Böbrek taşlarının yaklaşık %30’u alt kutupta yer alır ve bu durum retrograd intrarenal cerrahi sırasında taşlara erişimde zorluklara neden olur. Alt kutup böbrek taşlarının cerrahi tedavisinde tek kullanımlık ve yeniden kullanılabilir üreterorenoskopların etkinliğini ve başarı oranlarını değerlendirmeyi; bu bulgulara dayanarak en iyi seçeneği belirlemeyi amaçladık.
Gereç ve Yöntemler: Çalışmamıza, esnek üreterorenoskopi kullanılarak retrograd intrarenal cerrahi ile tedavi edilen alt kutup böbrek taşı olan hastalar dahil edildi. Hastalar, kullanılan üreterorenoskop tipine göre tek kullanımlık veya yeniden kullanılabilir esnek üreterorenoskop gruplarına ayrıldı. Elde edilen veriler bu iki grup arasında karşılaştırıldı.
Bulgular: Çalışmamıza 34 erkek ve 27 kadın olmak üzere toplam 61 hasta dahil edildi. Tek kullanımlık grupta 34 hasta ve yeniden kullanılabilir grupta ise 27 hasta değerlendirildi. Yeniden kullanılabilir grupta ortanca taş boyutu 78.5 mm² (50.3–127.6) mm², tek kullanımlık grupta ise 125.3 mm² (56.5–201.1) mm² olarak bulundu. Gruplar arasında demografik özellikler, Clavien-Dindo skorları veya postoperatif komplikasyonlar açısından istatistiksel olarak anlamlı bir fark gözlenmedi (p>0,05). Tek kullanımlık grupta kusma, yeniden kullanılabilir gruba göre anlamlı ölçüde daha az sıklıkta gözlendi (p<0,05).
Sonuç: Alt kutup böbrek taşlarının cerrahisinde esnek üreterorenoskoplar yaygın olarak kullanılır. Tek kullanımlık ve yeniden kullanılabilir esnek üreterorenoskoplar arasında seçim yaparken, maliyet ve kullanım kolaylığı dikkate alınmalıdır. Her iki üreterorenoskop tipinin avantajlarını karşılaştırmak ve daha güvenilir sonuçlar elde etmek için daha büyük serilere ve prospektif çalışmalara gereksinim duyulmaktadır.

Keywords

ÜRETEROSKOPLAR ÜROLİTİYAZİS BÖBREK TAŞI

Ethical Statement

Ethics approval was obtained from Uşak University ethics committee with the decision number 367-367-01 on 02.05.2024.

Supporting Institution

There are no financial conflicts of interest to disclose.

References

  • 1. Florido C, Herren JL, Pandhi MB, Niemeyer MM. Emergent Percutaneous Nephrostomy for Pyonephrosis: A Primer for the On-Call Interventional Radiologist. Semin Intervent Radiol. 2020;37(1):74-84. doi:10.1055/s-0039-3401842
  • 2. Zul Khairul Azwadi I, Norhayati MN, Abdullah MS. Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis. Sci Rep. 2021 Mar 23;11(1):6613. doi: 10.1038/s41598-021-86136-y.
  • 3. Balasubramanian A, Metcalfe MJ, Wagenheim G, Xiao L, Papadopoulos J, Navai N, Davis JW, Karam JA, Kamat AM, Wood CG, Dinney CP, Matin SF. Salvage topical therapy for upper tract urothelial carcinoma. World J Urol. 2018 Dec;36(12):2027-2034. doi: 10.1007/s00345-018-2349-9
  • 4. Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol. 1997 Sep-Oct;8(5):769-74. doi: 10.1016/s1051-0443(97)70658-4
  • 5. Young M, Leslie SW. Percutaneous Nephrostomy. 2021 Aug 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
  • 6. Dyer RB, Regan JD, Kavanagh PV, Khatod EG, Chen MY, Zagoria RJ. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics. 2002 May-Jun;22(3):503-25. doi: 10.1148/radiographics.22.3.g02ma19503.
  • 7. ACR–SIR–SPR Practice Parameter for the Performance of Percutaneous Nephrostomy Res. 20 – 2016 Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Percutaneous-Nephros.pdf Accessed February 10 2022
  • 8. Valji, K., Maroney, T.P. Vascular and Interventional Radiology. Shock, 1999,12 (5).
  • 9. GOODWIN WE, CASEY WC, WOOLF W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955 Mar 12;157(11):891-4.
  • 10. Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol. 2004;45(2):184–8.
  • 11. Efesoy O, Saylam B, Bozlu M, Çayan S, Akbay E. The results of ultrasound-guided percutaneous nephrostomy tube placement for obstructive uropathy: A single-centre 10-year experience. Turk J Urol. 2018 Jul;44(4):329-334. doi: 10.5152/tud.2018.25205.
  • 12. Pabon-Ramos WM, Dariushnia SR, Walker TG, d'Othée BJ, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B; Society of InterventionalRadiologyStandards of PracticeCommittee. QualityImprovementGuidelinesforPercutaneousNephrostomy. J VascIntervRadiol. 2016 Mar;27(3):410-4. doi: 10.1016/j.jvir.2015.11.045.
  • 13. Yoo MJ, Bridwell RE, Inman BL, Henderson JD, Long B. Approach to nephrostomy tubes in the emergency department. Am J Emerg Med. 2021 Dec; 50:592-596. doi: 10.1016/j.ajem.2021.09.034.
  • 14. Ali SM, Mehmood K, Faiq SM, Ali B, Naqvi SA, Rizvi AU. Frequency of complications in image guided percutaneous nephrostomy. J Pak Med Assoc. 2013 Jul;63(7):816-20.
  • 15. Kehinde EO, Newland CJ, Terry TR, Watkin EM, Butt Z. Percutaneous nephrostomies. Br J Urol. 1993 Jun;71(6):664-6. doi: 10.1111/j.1464-410x.1993.tb16061.x.
  • 16. Sood, G., A. Sood, A. Jindal, et al. Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases. Int braz j urol 2006 32(3): p.281–286.
  • 17. Bird VG, Fallon B, Winfield HN. Practice patterns in the treatment of large renal stones. J Endourol/Endourol Soc. 2003; 17:355–363.
  • 18. Lee CL, Anderson JK, Monga M. Residency training in percutaneous renal access: does it affect urological practice? J Urol. 2004 Feb;171(2 Pt 1):592-5. doi: 10.1097/01.ju.0000104849.25168.6d.
  • 19. Cobb KD, Gomella PT, DiBianco JM, Batter TH, Eisner BH, Mufarrij PW. Are Emergently Placed Nephrostomy Tubes Suitable for Subsequent Percutaneous Endoscopic Renal Surgery? Urology. 2019 Apr; 126:45-48. doi: 10.1016/j.urology.2019.01.006.
  • 20. Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure. Int J Clin Oncol. 2019 Mar;24(3):306-312. doi: 10.1007/s10147-018-1348-6.
  • 21. Prentice J, Amer T, Tasleem A, Aboumarzouk O. Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review. J R Soc Med. 2018 Apr;111(4):125-135. doi: 10.1177/0141076818766725.
  • 22. Folkard SS, Banerjee S, Menzies-Wilson R, Reason J, Psallidas E, Clissold E, Al-Mushatat A, Chaudhri S, Green JSA. Percutaneous nephrostomy in obstructing pelvic malignancy does not facilitate further oncological treatment. Int Urol Nephrol. 2020 Sep;52(9):1625-1628. doi: 10.1007/s11255-020-02466-2.
  • 23. Wong LM, Cleeve LK, Milner AD, Pitman AG. Malignant ureteral obstruction: outcomes after intervention. Have things changed? J Urol. 2007 Jul;178(1):178-83; discussion 183. doi: 10.1016/j.juro.2007.03.026.
  • 24. Garg G, Bansal N, Singh M, Sankhwar SN. Role of Percutaneous Nephrostomy in Bladder Carcinoma with Obstructive Uropathy: A Story Revisited. Indian J Palliat Care. 2019 Jan-Mar;25(1):53-56. doi: 10.4103/IJPC.IJPC_102_18.
  • 25. Noegroho BS, Kurniawan AP, Wijayanti Z, Mustafa A. Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients. Asian Pac J Cancer Prev. 2021 Apr 1;22(4):1211-1216. doi: 10.31557/APJCP.2021.22.4.1211.
  • 26. Chalmers N, Jones K, Drinkwater K, Uberoi R, Tawn J. The UK nephrostomy audit. Can a voluntary registry produce robust performance data? Clin Radiol. 2008 Aug;63(8):888-94. doi: 10.1016/j.crad.2007.10.021.
  • 27. Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Ceylan Y, Ors B, Minareci S. Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines. Urology. 2013 Jun;81(6):1161-7. doi: 10.1016/j.urology.2013.02.038.
  • 28. Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol. 2004 Mar;59(3):255-61. doi: 10.1016/j.crad.2003.10.021.
  • 29. Krohmer, S. J., Pillai, A. K., Guevara, C. J., Bones, B. L., &Dickey, K. W. (2018). Image-GuidedNephrostomyInterventions: How toRecognize, Avoid, orGetOut of Trouble. Techniques in vascularandinterventionalradiology, 21(4), 261–266. https://doi.org/10.1053/j.tvir.2018.07.008.
  • 30. Montvilas P, Solvig J, Johansen TE. Single-centre review of radiologically guided percutaneous nephrostomy using "mixed" technique: success and complication rates. Eur J Radiol. 2011 Nov;80(2):553-8. doi: 10.1016/j.ejrad.2011.01.109.
  • 31. Carrafiello G, Laganà D, Mangini M, Lumia D, Recaldini C, Bacuzzi A, Marconi A, Mira A, Cuffari S, Fugazzola C. Complications of percutaneous nephrostomy in the treatment of malignant ureteral obstructions: single-centre review. Radiol Med. 2006 Jun;111(4):562-71. English, Italian. doi: 10.1007/s11547-006-0051-2.
There are 31 citations in total.

Details

Primary Language English
Subjects Urology
Journal Section Research Articles
Authors

Adem Tunçekin 0000-0001-9951-2556

Arda Tongal 0009-0007-0210-0426

Süleyman Sağır 0000-0001-5300-8071

Yasin Aktaş 0000-0001-5255-3780

Erkan Arslan 0000-0002-3262-2512

Publication Date May 30, 2025
Submission Date February 13, 2025
Acceptance Date May 25, 2025
Published in Issue Year 2025 Volume: 17 Issue: 2

Cite

Vancouver Tunçekin A, Tongal A, Sağır S, Aktaş Y, Arslan E. Comparison of Outcomes Between Disposable and Reusable Flexible Ureteroscopes in the Treatment of Lower Pole Renal Stones. Endourol Bull. 2025;17(2):78-85.
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