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Is a safety guidewire needed for retrograde ureteroscopy?
Rev Assoc Med B ras 2017; 63(8):717-721 717
REVIEW ARTICLE
Is a safety guidewire needed for retrograde ureteroscopy?
Wilson Rica Molina Junior 1, Rodrigo R. Pessoa2, Rodrigo Donalísio da Silva3, Diedra Gustafson4, Leticia Nogueira4, Alex Meller5*
1Associate Professor, University of Colorado, Chief of Endourology Division, Denver Health Medical Center, Denver, CO, USA
2Urology Resident, University of Colorado, Denver, CO, USA
3Assistant Professor of Surgery, Division of Urology, University of Colorado, and Department of Urology, Denver Health Medical Center, Denver, CO, USA
4Reseach Coordinator, University of Colorado, Denver, CO, USA
5Assistant Doctor, Endourology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Summary
Study conducted at Universidade
Federal de São Paulo (Unifesp),
São Paulo, SP, Brazil, and at Denver
Health Medical Center, University of
Colorado, Denver, CO, USA
Article received: May 2017
Accepted for publication: July 2017
*Correspondence:
Departamento de Urologia, Unifesp
Address: Rua Napoleão de Barros, 715,
Vila Clementino
São Paulo, SP – Brazil
Postal code: 04024-002
Introduction: It is generally advised to have a safety guidewire (SGW) present
during ureteroscopy (URS) to manage possible complications. However, it increases
the strenght needed to insert and retract the endoscope during the procedure, and,
currently, there is a lack of solid data supporting the need for SGW in all procedures.
We reviewed the literature about SGW utilization during URS.
Method: A review of the literature was conducted through April 2017 using
PubMed, Ovid, and The Cochrane Library databases to identify relevant studies.
The primary outcome was to report stone-free rates, feasibility, contraindications
to and complications of performing intrarenal retrograde flexible and semi-rigid
URS without the use of a SGW.
Results: Six studies were identified and selected for this review, and overall they
included 1,886 patients where either semi-rigid or flexible URS was performed
without the use of a SGW for the treatment of urinary calculi disease. Only one
study reported stone-free rates with or without SGW at 77.1 and 85.9%, respectively
(p=0.001). None of the studies showed increased rates of complications in the
absence of SGW and one of them showed more post-endoscopic ureteral stenosis
whenever SGW was routinely used. All studies recommended utilization of SGW
in complicated cases, such as ureteral stones associated with significant edema,
ureteral stricture, abnormal anatomy or difficult visualization.
Conclusion: Our review showed a lack of relevant data supporting the use of SGW
during retrograde URS. A well-designed prospective randomized trial is in order.
Keywords: safety guidewire, ureteroscopy, retrograde intrarenal surgery, meta-analysis,
kidney stone, ureteral calculi.
Introduction
Ureteroscopy (URS) has become the standard of care for
treating urolithiasis less than 2 cm, mainly due to the
development of small flexible ureteroscopes, the improve-
ment of laser lithotripsy and the quality of disposable
materials.1 It is generally advised to have a safety guidewire
(SGW) present during URS to allow placement of a ure-
teral stent in order to manage possible complications.2,3
However, there is a lack of solid data to support this long-
standing principle in endourology.
The forces needed to insert and retract the endoscope
during URS with an SGW in place are considerably high-
er when compared with procedures that not involve SGW.4
Although not completely proved, this fact raises the ques-
tion that placement of an SGW could eventually increase
the risk of harming the ureter in some patients.
Moreover, some data advocate that working without
an SGW often facilitates access, scope manipulation and
stone basketing. There is less friction passing the uretero-
scope over than alongside a guidewire and increased torque
to rotate the scope. 5
On the other hand, as patient safety should continue
to be the highest priority, having an SGWduring the entire
procedure may be advised because of the risk of ureteral
injury requiring prompt placement of ureteral stent.6
The following publication aimed to look at SGW
utilization during URS, reviewing the current literature
available for both semi-rigid and flexible URS.
Method
A review of the literature was conducted through April
2017 using PubMed, Ovid and The Cochrane Library