title: Current Standard Technique for Modern Flexible Ureteroscopy: Tips and Tricks.
abstract: Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity.
  
  
  
  To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety.
  
  
  
  A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed.
  
  
  
  Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes.
  
  
  
  Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed.
  
  
  
  The mean overall stone size was 16.5 ± 7.9mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature.
  
  
  
  The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi.
  
  
  
  Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.
authors.affiliation: Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy. Electronic address: info@guidogiusti.it.
authors.forename: Guido
authors.initials: G
authors.lastname: Giusti
authors.affiliation: Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy; Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Proietti
authors.affiliation: Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Luca
authors.initials: L
authors.lastname: Villa
authors.affiliation: Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cloutier
authors.affiliation: Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rosso
authors.affiliation: Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy.
authors.forename: Giulio Maria
authors.initials: GM
authors.lastname: Gadda
authors.affiliation: Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Steeve
authors.initials: S
authors.lastname: Doizi
authors.affiliation: Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Gaboardi
authors.affiliation: Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D017602:Lithotripsy, Laser / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards
keywords: Complications; Flexible ureteroscopy; Renal stones; Stone-free rate; Surgical technique; Tips and tricks