title: The new digital flexible ureteroscopes: 'size does matter'--increased ureteric access sheath use!
abstract: OBJECTIVE
  To evaluate whether the use of sheaths to access the ureter has increased after the introduction of new digital ureterorenoscopes in patients undergoing flexible ureteroscopy.
  
  
  METHODS
  140 patients with kidney stones were randomised to be scoped with either an old-generation fibre-optic flexible ureteroscope (DUR-8, Elite, ACMI; distal tip diameter = 6.75 Fr) or a new-generation digital LCD flexible ureteroscope (Invisio D-URD flexible ureteroscope; distal tip diameter = 8.7 Fr). We recorded the necessity to use a sheath to access the ureter, sheath-related and postoperative complications, and whether or not a JJ stent was left behind.
  
  
  RESULTS
  157 (80 fibre-optic and 77 digital) ureterorenoscopies were performed. Ureteral access sheaths were used significantly more frequently with digital scopes (p = 0.00174). Two patients in the digital scope group had a small distal ureteric perforation from the introducer sheath compared with none in the fibre-optic scope group.
  
  
  CONCLUSIONS
  A statistically significant increase in sheath use was observed in the new-generation digital flexible ureteroscopy group. Despite the improvement in image quality, better durability and improved stone clearance, there are some potential drawbacks of these scopes. The increased distal tip diameter can result in increased use of ureteric access sheaths and this may increase morbidity and expense.
authors.affiliation: Endourology & Stone Services, Barts and the London NHS Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Bach
authors.forename: S
authors.initials: S
authors.lastname: Nesar
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: A
authors.initials: A
authors.lastname: Goyal
authors.forename: S
authors.initials: S
authors.lastname: Kachrilas
authors.forename: A
authors.initials: A
authors.lastname: Papatsoris
authors.forename: J
authors.initials: J
authors.lastname: Masood
authors.forename: N
authors.initials: N
authors.lastname: Buchholz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014513:Ureter; D020709:Ureteroscopes