Background: Flexible ureterorenoscopy (fURS) has become a
cornerstone in the minimally invasive management of renal stone disease.
Continuous technological evolution over the past decades has expanded its
indications, improved procedural safety, and enhanced stone-free outcomes. This
review synthesises recent innovations that have reshaped contemporary fURS
practice.
Objective: To critically appraise key technological and
procedural advances in flexible ureterorenoscopy, with emphasis on scope
design, laser lithotripsy, adjunctive instrumentation, and emerging guidance
and robotic systems, and to evaluate their clinical impact on renal stone
management.
Methods: A narrative review was conducted based on
historical milestones, recent clinical studies, systematic reviews, and
meta-analyses addressing innovations in fURS. Developments in digital and
single-use ureteroscopes, laser technologies, ureteral access sheaths,
irrigation and pressure-control systems, image guidance, and robotic assistance
were analysed with respect to efficacy, safety, and workflow implications.
Results: Major advancements include the transition to
high-definition digital “chip-on-tip” ureteroscopes, the widespread adoption of
single-use disposable scopes, and enhanced deflection mechanisms that improve
access to complex calyceal anatomy. Laser innovations, particularly thulium
fibre lasers and pulse-modulated holmium systems, have increased fragmentation
efficiency while reducing retropulsion and operative time. Suction-enabled and
pressure-controlled ureteral access sheaths have improved stone clearance and
reduced infectious complications. Emerging technologies such as augmented
reality navigation and robotic-assisted fURS have demonstrated stone-free rates
comparable to those of conventional techniques while significantly improving
surgeon ergonomics.
Conclusion: Technological innovation has transformed fURS
into a highly effective, safe, and versatile modality for the treatment of
renal stones. Ongoing integration of advanced lasers, innovative
instrumentation, image guidance, and robotics is likely to refine outcomes
further, personalise treatment strategies, and establish new benchmarks in
endourological care.
Author(s) Details
Rajan Ravichandran
Department of Urology & Renal Transplantation, Sri
Ramachandra Institute of Higher Education & Research, Chennai, India.
Roshan Reddy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Velmurugan
Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH6
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