Worldwide flexible ureteroscopy practice uncovered
Reviewed by Hamid Abboudi

While guidelines recommend flexible ureteroscopy (fURS) for treating renal stones <1.5cm, considerable differences exist among urologists in the technique, use, and indications of fURS. In 2014, the Endourology Society set out to explore the differences in the fURS technique and practice among endourologists using an anonymous online assessment. The survey contained 36 questions divided into six domains to capture demographic information, level of surgeon experience, indications, surgical technique, postoperative stent management and tracking, and post surgical follow-up. There was a response from 414 of 2000 members (20.7%). Responses from 44 countries were received. Respondents considered fURS to be first-line therapy for patients with renal stones <2cm and lower pole calculi. A minority (11.3%) preferred fURS as a primary treatment modality for renal stones >2cm; likely to increase in the future as scope and laser technology advances. Basket displacement for lower pole stones was routinely performed by 55.8%. Ureteral access sheaths (UAS) were performed for every case by 58.3%. This appears to reflect paucity in the evidence of whether UAS lead to higher stone-free rates (SFR). Interestingly, 66% of respondents dusted rather than fragmented. Criteria for determining stone-free rate was defined as zero fragments or residual fragment (RF) <1, <2, <3 and <4mm by 30.9%, 8.9%, 31.5%, 15.8% and 11.2% of respondents, respectively. Other notable findings: only 38% placed working and / or safety wires, 75% used abdominal radiograph, renal ultrasound or a combination of both to follow up patients postoperatively and 41% utilised high power laser (>100W). fURS is increasingly being utilised for larger stones; with advancements in techniques current guidelines are likely to be stretched. With great variations in practice, it would seem there is scope to further investigate the controversies that exist. 

Contemporary practice patterns of flexible ureteroscopy for treating renal stones: Results of a worldwide survey. Dauw C, Simeon L, Alruwaily A, et al.
JOURNAL OF ENDOUROLOGY
2015;29(11):1221-30.