Is the safety wire during ureteroscopy mandatory?
Reviewed by Hamid Abboudi

Traditional principles of ureteroscopic training involve the almost religious passage of a safety guide wire (SGW) into the ureter prior to ureteroscopy (URS). The authors compare the clinical outcomes of URS for ureteral stones in two university hospitals with opposite approaches to the use of a SGW. They present results of a retrospective review of 1000 URS for ureteral calculi between two hospitals, where one unit routinely inserts a SGW prior to URS, the other does not. The primary goal was to evaluate the success rates of passing the ureteroscope through the orifice, the ability to access the ureteral stone, and the ability to place a ureteral stent when required. Interestingly no significant differences were found between the two hospitals with respect to the primary outcome measures. The numbers of unsuccessful events during URS were low at both sites. Inexperienced surgeons often rely on the SGW, however in this study a significantly higher number of inexperienced surgeons performed URS without a SGW. There was no significant difference in the rates of intraoperative complications in URS performed by trainees at the two hospitals, suggesting that the SGW may be redundant even in less experienced hands. Unfortunately this is a relatively small sample size and larger prospective studies with higher total numbers of unsuccessful procedures are needed to clarify whether there are clinically relevant differences, particularly in complex cases. Undoubtedly having a SGW in the ureter provides a sense of security to the operating surgeon, that access to the ureter can be maintained at all times in case a stent is required. Furthermore, passage of the orifice remains a challenge in complicated cases and the rotation of the endoscope and various techniques, where guide wires are employed both inside and outside the endoscope, prove useful even to the most experienced of endourologists.

Ureteroscopy with and without safety guide wire: should the safety wire still be mandatory?
Ulvik Ø, Rennesund K, Gjengstø P, et al.
JOURNAL OF ENDOUROLOGY
2013;27(10):1197-202.