Flexible URS

™ Flexible scopes with calibers of 6.5-9 Fr can be introduced into the upper urinary tract without prior ureter dilation.

™ While flexible scopes are used proximal from the iliac vessel crossing by many urologist in the United States, we recommend the use of semirigid scopes inside the ureter whenever possible. However, for the passage of difficult anatomy such as strictures, kinking or ureter wall edema, a flexible scope may be necessary.

™ Most flexible scopes have an active, bilateral deflection mechanism at the tip and a passive deflection mechanism proximally of the tip. Recently, a scope with two separate active deflection mechanisms has been introduced.

□ Fig. 12.4. Tip of semirigid ureteroscope with separate working/irrigation channel

™ While most standard flexible scopes have maximal deflection angles of 120°-180° (□ Fig. 12.5), a new generation of flexible ureterorenoscopes have bilateral deflections >270° [12] (□ Fig. 12.6).

™ A second advantage of such new-generation endoscopes is a stiffer shaft, that improves durability and controllability

Flexibele Ureterorenoscoop
□ Fig. 12.6. Modern generation flexible ureterorenoscope with bilateral 270° maximal tip deflection

□ Fig. 12.4. Tip of semirigid ureteroscope with separate working/irrigation channel

□ Fig. 12.5. Maximal tip deflection of standard flexible ureterorenoscope with 170° (left) and a modern semiflexible scope with 325° down movement (right)
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