Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania.
Nat Rev Urol. 2014 Jul;11(7):373-82. doi: 10.1038/nrurol.2014.118. Epub 2014 Jun 3.
Substantial advances in ureteroscopy have resulted in the incorporation of this procedure into routine urological practice in many centres worldwide. Subsequently, an abundance of clinical data and technological progression have enabled the development of novel solutions that have increased the efficacy of ureteroscopy, and reduced associated morbidity and costs. In addition the indications for this retrograde approach have been expanded, and pyelocalyceal diverticulum, infundibular stenosis, urolithiasis in pregnant women or in patients with urinary diversions, as well as upper urinary tract tumours can now be managed using this methodology. New endoscopes are continuously developed, with different manufacturers choosing various technical solutions to further increase the efficacy and safety-and sometimes decrease costs-of ureteroscopy, including miniaturization, inclusion of digital optical systems and dual working channels, and the introduction of disposable apparatus. The holmium laser, currently the most-versatile energy source available, enables tissue incision, tumour ablation, and intracorporeal lithotripsy. Modern ancillary instruments are diverse, flexible, and durable, and novel devices used in daily clinical practice can minimize ascendant migration of stone fragments and, therefore, decrease the failure rate of the retrograde ureteroscopic approach. However, the peak of ureteroscopy evolution seems to remain distant, with further improvement of endoscopes and ancillary instruments, and robot-assisted ureteroscopy representing only some of the areas in which future developments are possible.
输尿管镜技术的显著进步使得该技术在全球许多中心已常规应用于泌尿外科临床实践中。随之而来的是大量的临床数据和技术进步，使新的解决方案得以开发，提高了输尿管镜的疗效，并降低了相关的发病率和成本。此外，该逆行方法的适应证也有所扩大，肾盂旁囊肿、漏斗部狭窄、妊娠妇女或尿路改道患者的尿石症以及上尿路肿瘤均可采用该方法治疗。新型的输尿管镜不断开发，不同的制造商选择了各种技术解决方案，以进一步提高输尿管镜的疗效和安全性，有时还可以降低成本，包括小型化、数字化光学系统和双工作通道的应用，以及一次性仪器的引入。钬激光是目前应用最广泛的多功能能量源，可用于组织切割、肿瘤消融和腔内碎石。现代辅助器械种类繁多，灵活耐用，而在日常临床实践中使用的新型器械可以最大限度地减少结石碎片的逆行迁移，从而降低逆行输尿管镜治疗的失败率。然而，输尿管镜技术的发展似乎仍有很长的路要走，未来的发展方向可能还包括进一步改进内窥镜和辅助器械，以及机器人辅助输尿管镜技术。
