Flexible ureteroscope has revolutionised the management of renal stones. Ureteral Access Sheath (UAS) is commonly used for easy access of the Pelvicalyceal system. This helps in easy passage of the scope and enable drainage of irrigants out of the kidney helping to reduce the intra renal pressure.
For introduction of the UAS, we have to dilate the ureter or pre-stent it. This is associated with our apprehension of injuries to ureter either by trauma or ischaemia. Both eventually result in ureteric strictures which is a nightmare. This brings in the question- Are we going back to the old days when we had only large ureteroscopes? We were doing the same exercises in those days and facing poor outcomes. In the modern era of flexible ureteroscopy, Our limitation is not the availability of small scopes but our dependency on Ureteral Access Sheath for performing the procedure.
With simple techniques we can perform sheathless RIRS which is safe and easy to perform. In this video I am discussing the basic steps of sheathless RIRS.
Dr Vinod K V, Kerala