Changing Trends in the Use of Ureteroscopic Instruments from 1996 to 2008

Abstract

Purpose: Despite ongoing advances in the field of endourology, there are few reports describing specific changes adopted by urologists that have come as a result. We investigated the progression of single surgeon's clinical practice over a 12-year period, noting differences in ureteroscopes, ancillary equipment, and indications for surgery over that time. Methods: The records of 1181 patients undergoing ureteroscopy by a single surgeon were reviewed. Consecutive patients from the years 1996 (n = 200), 1998 (n = 179), 2000 (n = 198), 2002 (n = 127), 2004 (n = 137), 2006 (n = 200), and 2008 (n = 140) were included in the study. Patients remained grouped by the year of their procedure for comparison. Compared variables included the indication for surgery, type of anesthesia, method of ureteral dilation and stabilization, specific ureteroscopes used, type and number of working instruments employed, and the method of postprocedure ureteral drainage. Results: A change favoring smaller, more flexible ureteroscopes was seen. An increase in the percentage of surgeries performed for upper tract tumors paralleled decreasing trends in urolithiasis and ureteropelvic junction obstruction surgery. A divergence in the devices used for calculi and upper tract tumors was seen. Conclusions: Over the past 12 years, technological advancements in the field of endourologic surgery have resulted in shifting clinical practice for endourologists, with trends favoring smaller, actively flexible ureteroscopes, intrarenal surgery, and nitinol basket use.