Is a Safety Guide Wire Necessary for Transurethral Lithotripsy using Semi-Rigid Ureteroscope? Results from a Prospective Randomized Controlled Trial Semirigid Ureteroscopy with and without Safety Guide Wire
1 January 2020
Background: Experts recommend us to keep a safety guidewire during the process of upper urinary tract endoscopy, though there is a lack of high-level evidence to support the efficacy and safety of this opinion. This study conducted to compare the outcome of ureteral stone breakage in the presence or absence of safety guidewire.
Materials and methods: Patients candidate for endoscopic breakage of ureteral stone using a semi-rigid ureteroscope, were randomly assigned in two groups based on keeping a safety guidewire (group1) or removing the guidewire (group2) before the process of breaking ureteral stone by lithoclast. Demographic factors, history of previous stone treatment, kidney function, stone location, symptoms duration and severity were recorded for each patient. Primary outcomes include success rate of stone treatment and secondary outcomes include number of attempts to enter to ureter, success rate of ureteral entry, success rate of stone achievement, stone migration rate and success rate of ureteral stent insertion.
The recorded data were entered to the SPSS software and descriptive statistical analysis including power calculation and non-inferiority design for the primary and secondary outcomes, was performed. P-value less than 0.05 was considered significant.
Results: From January 2016 till May 2018, 320 patients were randomized with 160 patients in each arm. Considering the cases who were missed due to follow-up loss, there were 153 patients in group 1 and 147 patients in group 2 at the end of the study. Baseline data were equally distributed in both groups. Based on the initial analysis, the studied variables had no significant difference between two groups; though, according to the subgroup analysis of patients with proximal ureter stones, patients in Group 1 had higher rates of ureteral injury comparing to the patients in Group 2 (p=0.03).
Conclusion: According to our findings, keeping the safety guidewire through the process of endoscopic stone breakage (stone size: less than 1.5Cm) seems to add no significant benefit to the procedure outcome, while it increases the ureteral injuries in the proximal ureter stones, but not in mid or distal ureter stones.
- Ureteroscopy, Safety Guide Wire, Randomized Controlled Trial
How to Cite
2. Erbin A, Ucpinar B, Cubuk A, Yazici O, Uysal H, Savun M, et al. The Impact of Sheath Size in Miniaturized Percutaneous Nephrolithotomy in Adult Patients; A matched-pair Analysis. Urology journal. 2019;16(6):536-40.
3. Gucuk A, Yilmaz B, Gucuk S, Uyeturk U. Are Stone Density and Location Useful Parameters That Can Determine the Endourological Surgical Technique for Kidney Stones That are Smaller than 2 cm? A Prospective Randomized Controlled Trial. Urology journal. 2019;16(3):236-41.
4. Sprunger JK, Herrell SD, 3rd. Techniques of ureteroscopy. The Urologic clinics of North America. 2004;31(1):61-9.
5. Rukin NJ, Somani BK, Patterson J, Grey BR, Finch W, McClinton S, et al. Tips and tricks of ureteroscopy: consensus statement Part I. Basic ureteroscopy. Central European Journal of urology. 2015;68(4):439-46.
6. Molina WRJ, Pessoa RR, Silva RDD, Gustafson D, Nogueira L, Meller A. Is a safety guidewire needed for retrograde ureteroscopy? Revista da Associacao Medica Brasileira (1992). 2017;63(8):717-21.
7. Senocak C, Ozcan C, Sahin T, Yilmaz G, Ozyuvali E, Sarikaya S, et al. Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy. Urology journal. 2018;15(4):158-63.
8. Sarica S, Akkoc Y, Karapolat H, Aktug H. Comparison of the use of conventional, hydrophilic, and gel-lubricated catheters concerning urethral microtrauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study. European journal of physical and rehabilitation medicine. 2010;46(4):473-9.
9. Ulvik Ø, Wentzel-Larsen T, Ulvik NM. A safety guidewire influences the pushing and pulling forces needed to move the ureteroscope in the ureter: a clinical randomized, crossover study. Journal of endourology. 2013;27(7):850-5.
10. Whitehurst LA, Somani BK. Semi-rigid ureteroscopy: indications, tips, and tricks. Urolithiasis. 2018;46(1):39-45.
11. Muslumanoglu AY, Fuglsig S, Frattini A, Labate G, Nadler RB, Martov A, et al. Risks and Benefits of Postoperative Double-J Stent Placement After Ureteroscopy: Results from the Clinical Research Office of Endourological Society Ureteroscopy Global Study. Journal of endourology. 2017;31(5):446-51.
12. Ye T, Yi Y. Sample size calculations in clinical research, third edition, by Shein-Chung Chow, Jun Shao, Hansheng Wang, and Yuliya Lokhnygina: Chapman & Hall/CRC Biostatistics Series, New York, Taylor & Francis, 2017, 510 pp., $99.95 (hardback), ISBN: 978-1-138-74098-3. Statistical Theory and Related Fields. 2017;1:1-2.
13. Ulvik O, Ulvik NM. Diversity in urologists' personal preferences in the ureteroscopic management of ureteral calculi in Norway. Scandinavian journal of urology. 2013;47(2):126-30.
14. Dickstein RJ, Kreshover JE, Babayan RK, Wang DS. Is a safety wire necessary during routine flexible ureteroscopy? Journal of endourology. 2010;24(10):1589-92.
15. Eandi JA, Hu B, Low RK. Evaluation of the impact and need for use of a safety guidewire during ureteroscopy. Journal of endourology. 2008;22(8):1653-8.
16. Johnson GB, Portela D, Grasso M. Advanced ureteroscopy: wireless and sheathless. Journal of endourology. 2006;20(8):552-5.
17. Bratslavsky G, Moran ME. Current trends in ureteroscopy. The Urologic clinics of North America. 2004;31(1):181-7, xi.
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