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More and more studies are conducted to analyze the effectiveness of flexible ureteroscopy in urinary stone management. Through this work, we hope to demonstrate the clinical efficacy and economic competitiveness of this technique.Methods: We followed 214 patients undergoing flexible USCO by the same surgeon between April 2012 and September 2014. A series of data were collected from each patient. A statistical study has subsequently been performed in order to analyze the obtained results. Finally, we compared our results with those of the literature concerning the flexible USCO, but also with those concerning other treatment techniques such as extracorporeal shockwave lithotripsy and percutaneous nephrolithotomy.Results: For stones measuring less than 10 mm, flexible USCO's stone free rate is 92%, against 74% and 86-100% for ESWL and PCNL respectively. For bigger stones, measuring more than 10 mm, the success rate drops to 74% for the soft USCO, 56% for CEA and remains unchanged for the PNL. While literature shows a higher onset of residual stone fragments when a J stent is placed before surgery, the results of our study were not significant because our sample of patients were too small. ln our study, the SFRS for flexible USCO was not significant for kidney stones. ln the lower calyx, our SFRS was 87% while it is lower than 65% for the LEC. ln the ureter our SFRS for flexible U5CO was 89%, while it is 88% for the LEC and 95% for PCNL.The rate of complications is 20% and 1% for the PCNL and ESWL respectively, while it is 2.5% for flexible USCO. From an economic point of view, in Saint Luc, between 2012 and 2015, an endoscope had a lifetime of 250 procedures. The laser fiber has been used 35 times on average. An access sheath has been used in 6 of 10 cases. A basket has been used in 15% of procedures. These results allow us to calculate depreciation of the ureteroscopy to 125 € per procedure. The price of the laser fiber was three times smaller and the use of disposable material was two times smaller. Objectif : De plus en plus d'études sont réalisées afin d'étudier l'efficacité de l'urétéroscopie souple dans la prise en charge des calculs. Par ce travail, nous espérons démontrer l'efficacité-et la compétitivité clinique et économîque de cette technique.Méthodes : Nous avons suivi 214 patients ayant subit une urétéroscopie (USCO) souple par le même opérateur entre Avril 2012 et Septembre 2014. Toute une série de données ont été récoltées chez chacun de ces patients. Une étude statistique a par la suite été réalisée afin de pouvoir analyser les résultats recueillis. Enfin, nous avons comparé nos résultats à ceux de la littérature, concernant l'USCO souple, mais aussi par rapport aux autres techniques de traitements des lithiases rénales que sont la lithotritie extracorporelle (LEC) et la néphrolithotomie percutanée (NLPC).Résultats : Pour les calculs de moins de 10 mm, le "stone free rate" de l'USCO souple est de 92%, contre 74% et 86-100% pour la LEC et la NLPC respectivement. Tandis que lorsqu'il s'agit de calculs supérieurs à 10 mm le taux de réussite tombe à 74% pour l'USCO souple, et à 56% pour la LEC, et demeure inchangé pour la NLPC. Alors que la littérature montre un taux de fragments résiduels significatifs (SFRS) plus élevé en cas de présence d'une sonde JJ en préopératoire, les résultats de notre étude n'ont pas été significatifs dû à un échantillon de patients trop petit. Quant au taux de SFRS en fonction de la localisation, nous nous sommes retrouvés avec un taux de SFRS non significatif (NS) au niveau du rein pour l'USCO souple. Tandis qu'au niveau du calice inférieur, nous avons obtenu un taux de SFRS de 87%, contre moins de 65% pour la LEC ; et enfin pour le SFRS au niveau de l'uretère, nous avons eu un taux de 89% pour l'USCO souple, 88% pour la LEC et 95% pour la NLPC.Les complications, sont de 20% et 1% pour la NLPC et la LEC respectivement, et de 2,5% pour l'USCO souple.D'un point de vue économique, à Saint Luc, entre 2012 et 2015, un seul endoscope permet de réaliser environ 250 procédures. De son côté la fibre laser est utilisée 35 fois en moyenne. On utilise une gaine d'accès 6 fois sur 10, et un panier dans 15% des procédures.Tout ceci nous permet de calculer un amortissement de l'urétéroscope à 125 € par procédure. Le prix de la fibre laser est divisé par trois. Et l'utilisation de matériel disposable est ainsi diminuée de moitié.Conclusion : L'USCO souple présente un taux de SFRS non inférieur, voire même supérieur à la LEC et est plus efficace que celle-ci dans le traitement des lithiases au niveau du calice inférieur. Avec un taux de complications bien moindre que la NLPC, l'USCO souple semble être une très bonne alternative au traitement des lithiases et est aussi efficace que ces autres deux techniques. Sur le plan économique, nous parvenons à réduire le prix d'une procédure à une valeur égale à celle remboursée par l'INAMI. Il ne s'agit donc pas d'une procédure rentable sur le plan économique.

Ureteroscopy --- Retrospective Studies --- Prospective Studies --- Urinary Calculi

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The landscape of minimally invasive urological intervention is changing. A lot of new innovations and technological developments have happened over the last 3 decades. Laparoscopy and robotic surgery have revolutionised kidney and prostate cancer treatment, with more minimally invasive procedures now being carried out than ever before. At the same time, technological advancements and the use of laser have changed the face of endourology. Several new innovative treatments are now commonplace for benign prostate enlargement (BPE). Management of prostate cancer now involves procedures such as robotic prostatectomy, brachytherapy, radiotherapy, cryotherapy and HIFU. Robotic partial nephrectomy and cryotherapy have changed the face of renal cancer. En-bloc resection of bladder cancer is challenging the traditional management of non-muscle invasive bladder cancer and becoming commonplace, while robotic cystectomy is also gaining popularity for muscle invasive bladder cancer. Newer surgical intervention related to BPE includes laser (holmium, thulium and green light), water-based treatment (Rezum, Aquablation) and other minimally invasive procedures such as prostate artery embolisation (PAE) and Urolift. Endourological procedures have incorporated newer laser types and settings such as moses technology, disposable ureteroscopes (URS) and minimisation of percutaneous nephrolithotomy (PCNL) instruments. All these technological innovations and improvements have led to shorter hospital stay, reduced cost, potential reduction in complications and improvement in the quality of life (QoL).

Medicine --- Surgery --- partial nephrectomy --- single site surgery --- sutureless --- CEUS --- contrast-enhanced ultrasound --- renal ultrasound --- image quality --- small renal mass (3–5) --- kidney stones --- metabolic syndrome --- urolithiasis --- nephrolithiasis --- kidney calculi --- diabetes mellitus --- acute kidney injury --- percutaneous nephrolithotomy --- urology --- artificial intelligence --- machine learning --- urinary incontinence --- kidney stone disease --- fertility --- reproductive urology --- renal cell carcinoma --- hydronephrosis --- urinary reflux --- endourology --- pediatric urology --- prostate cancer --- bladder cancer --- nephrostomy --- quality of life --- survival --- decision making --- ureteroscopy --- laser --- RIRS --- Moses --- holmium --- mineral water --- mineral composition --- drinking water --- still water --- sparkling water --- Ho:YAG laser --- thulium fiber laser --- laser fiber --- lithotripsy --- chronic prostatitis --- chronic pelvic pain syndrome --- extracorporeal shockwave therapy --- ESWT --- NIH-CPSI --- EHS --- IIEF-5 --- QoL --- urosepsis --- laser lithotripsy --- predictor factors --- PCNL --- renal tumour --- AI --- TFL --- partial nephrectomy --- single site surgery --- sutureless --- CEUS --- contrast-enhanced ultrasound --- renal ultrasound --- image quality --- small renal mass (3–5) --- kidney stones --- metabolic syndrome --- urolithiasis --- nephrolithiasis --- kidney calculi --- diabetes mellitus --- acute kidney injury --- percutaneous nephrolithotomy --- urology --- artificial intelligence --- machine learning --- urinary incontinence --- kidney stone disease --- fertility --- reproductive urology --- renal cell carcinoma --- hydronephrosis --- urinary reflux --- endourology --- pediatric urology --- prostate cancer --- bladder cancer --- nephrostomy --- quality of life --- survival --- decision making --- ureteroscopy --- laser --- RIRS --- Moses --- holmium --- mineral water --- mineral composition --- drinking water --- still water --- sparkling water --- Ho:YAG laser --- thulium fiber laser --- laser fiber --- lithotripsy --- chronic prostatitis --- chronic pelvic pain syndrome --- extracorporeal shockwave therapy --- ESWT --- NIH-CPSI --- EHS --- IIEF-5 --- QoL --- urosepsis --- laser lithotripsy --- predictor factors --- PCNL --- renal tumour --- AI --- TFL

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

The landscape of minimally invasive urological intervention is changing. A lot of new innovations and technological developments have happened over the last 3 decades. Laparoscopy and robotic surgery have revolutionised kidney and prostate cancer treatment, with more minimally invasive procedures now being carried out than ever before. At the same time, technological advancements and the use of laser have changed the face of endourology. Several new innovative treatments are now commonplace for benign prostate enlargement (BPE). Management of prostate cancer now involves procedures such as robotic prostatectomy, brachytherapy, radiotherapy, cryotherapy and HIFU. Robotic partial nephrectomy and cryotherapy have changed the face of renal cancer. En-bloc resection of bladder cancer is challenging the traditional management of non-muscle invasive bladder cancer and becoming commonplace, while robotic cystectomy is also gaining popularity for muscle invasive bladder cancer. Newer surgical intervention related to BPE includes laser (holmium, thulium and green light), water-based treatment (Rezum, Aquablation) and other minimally invasive procedures such as prostate artery embolisation (PAE) and Urolift. Endourological procedures have incorporated newer laser types and settings such as moses technology, disposable ureteroscopes (URS) and minimisation of percutaneous nephrolithotomy (PCNL) instruments. All these technological innovations and improvements have led to shorter hospital stay, reduced cost, potential reduction in complications and improvement in the quality of life (QoL).

partial nephrectomy --- single site surgery --- sutureless --- CEUS --- contrast-enhanced ultrasound --- renal ultrasound --- image quality --- small renal mass (3–5) --- kidney stones --- metabolic syndrome --- urolithiasis --- nephrolithiasis --- kidney calculi --- diabetes mellitus --- acute kidney injury --- percutaneous nephrolithotomy --- urology --- artificial intelligence --- machine learning --- urinary incontinence --- kidney stone disease --- fertility --- reproductive urology --- renal cell carcinoma --- hydronephrosis --- urinary reflux --- endourology --- pediatric urology --- prostate cancer --- bladder cancer --- nephrostomy --- quality of life --- survival --- decision making --- ureteroscopy --- laser --- RIRS --- Moses --- holmium --- mineral water --- mineral composition --- drinking water --- still water --- sparkling water --- Ho:YAG laser --- thulium fiber laser --- laser fiber --- lithotripsy --- chronic prostatitis --- chronic pelvic pain syndrome --- extracorporeal shockwave therapy --- ESWT --- NIH-CPSI --- EHS --- IIEF-5 --- QoL --- urosepsis --- laser lithotripsy --- predictor factors --- PCNL --- renal tumour --- AI --- TFL