title: [Flexible double active deflection ureterorenoscopy].
abstract: OBJECTIVE
  Secondary deflection of a flexible ureterorenoscope (FUR) is a passive mechanism, which can only be performed under certain anatomical conditions. The objective of this study was to present a new double active deflection FUR and to assess its value based on our initial experience.
  
  
  METHODS
  From October 2002 to February 2003, we performed flexible retrograde ureterorenoscopy in 30 consecutive patients (34 renal units) using a double active deflection FUR (ACMI DUR 8 Elite). Bilateral ureterorenoscopy was performed during the same operating time in four patients. Ureterorenoscopy was diagnostic for 9 patients (macroscopic haematuria, urinary tract tumour), and therapeutic for 21 patients (stones, urinary tract tumour, ureteropelvic junction stenosis with stone). The value of double deflection as well as the efficacy and morbidity of the technique were evaluated.
  
  
  RESULTS
  The main indication for flexible ureterorenoscopy was the treatment of urinary stones (73.6%), followed by the diagnosis of macroscopic haematuria and urinary tract tumours (26.4%). Ureteric dilatation was necessary in 38.3% of cases. The use of active secondary deflection was essential in 20% of cases (7/34) for complete investigation of the pyelocaliceal cavities. Access to the lower calices was not possible in one patient with a left pelvic kidney. 19 patients with urinary stones had no fragments (79.2%) at the end of the operation, while 4 had residual fragments in the lower calices. The global success rate for all operations was 85% (29/34). Two patients developed acute pyelonephritis during the 48 hours after the procedure and another two patients experienced acute renal colic.
  
  
  CONCLUSIONS
  Our study confirms the data of the literature on flexible ureterorenoscopy in terms of indications and efficacy. The URS DUR 8 Elite allowed complete exploration of the pyelocaliceal cavities in more than 97% of cases. The use of active secondary deflection was unnecessary for the majority of patients (80%), but it represents a major technical progress which should be taken into account in the design of future flexible ureterorenoscopes.
authors.affiliation: Service d'Urologie, Hôpital Tenon, 4, rue de la Chine, 75020 Paris. olivier.traxer@tnn.ap-hop-paris.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
authors.forename: Federico
authors.initials: F
authors.lastname: Pasqui
authors.forename: Francis
authors.initials: F
authors.lastname: Dubosq
authors.forename: Kessile
authors.initials: K
authors.lastname: Tchala
authors.forename: Bernard
authors.initials: B
authors.lastname: Gattegno
authors.forename: Philippe
authors.initials: P
authors.lastname: Thibault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020709:Ureteroscopes