Flexible ureteroscopy step by step is easiest to plan from the equipment side: at every stage of the procedure the OR team needs a specific scope, laser, sheath, accessory or irrigation set ready. This article is written for OR nurses, urologists and biomedical engineers who set up the room. It describes what flexible ureteroscopy is, lists the equipment required at each stage and points out where set-up errors usually occur. It is about equipment, not clinical decision-making.
What is flexible ureteroscopy and when is it used
Flexible ureteroscopy, often called retrograde intrarenal surgery (RIRS), uses a slim flexible endoscope passed through the urethra, bladder and ureter into the kidney. It is used for flexible ureteroscopy for kidney stones, for inspecting the upper urinary tract and for treating certain lesions. Laser lithotripsy is the usual energy source for fragmenting stones.
Whether it is the right approach for a given patient is a clinical decision. For the equipment planner, what matters is that the procedure needs a digital or fibre flexible ureteroscope, a laser with fibres, access sheaths, guidewires, baskets, irrigation and a stent set. See our comparison PCNL vs RIRS for how it differs from percutaneous surgery.
Step 1: room set-up, imaging and irrigation
Before the patient arrives, set up the tower with the camera controller and monitor, the light source and the irrigation system. The Richard Wolf flexible sensor endoscopes BOA, COBRA and MAMBA connect to the ENDOCAM Logic 4K controller and support Special Imaging Modes. Check the connection, white balance and that the scope's deflection and image are working.
Prepare irrigation. FLUID CONTROL 2225 is a suction and irrigation pump with a urology discipline selected before the procedure, a large touchscreen and optional fluid-deficit monitoring. Irrigation pressure and flow should follow your surgeons' protocol; ask the manufacturer about the supplied tubing sets.
Step 2: access, guidewire and sheath
Access begins with cystoscopy and a guidewire placed up the ureter, so the room needs a cystoscope, guidewires and contrast if used. An access sheath may be used to protect the ureter and to keep intrarenal pressure low and allow repeated scope passages. Choose the sheath size to suit the scope: BOA has an 8.7 Fr shaft and a 6.6 Fr tip and fits access sheaths of 9.5 Fr or larger.
Match the ureteroscope to the anatomy. COBRA is a two-channel ureterorenoscope with a 3.6 Fr working channel and a 2.4 Fr laser channel and 5.2 Fr distal tip; BOA suits narrow anatomy including paediatric use. For a detailed look at sheaths, see ureteral access sheath guide.
Step 3: laser lithotripsy equipment
For ureteroscopy laser lithotripsy the laser, a sterile fibre and eye protection for the whole team are required. MegaPulse 70+ is a 70 W holmium:YAG laser (2100 nm, pulse energy 0.2 to 5 J, frequency 3 to 60 Hz) with Lithotripsy, Soft Tissue and Expert modes, RFID detection of the sterile fibre and its diameter, a double-pedal footswitch and a blast shield. Settings are chosen by the surgeon; see holmium laser settings.
COBRA's laser channel accepts fibres up to 365 µm and the laser shifter fixes and positions the fibre during stone treatment, so laser lithotripsy and stone extraction can run in parallel. Check fibre connection, test-fire according to the manufacturer's instruction and put up laser safety signage and eyewear for everyone in the room.
Step 4: stone retrieval, stent and wrap-up
After fragmentation, the team may need baskets, graspers and a retrieval set; see ureteroscopy graspers and stone baskets. Laser lithotripsy and stent placement are often combined, so keep a range of stent sizes and a stent-placement set open or immediately available, as the surgeon directs.
Afterwards, scopes need careful handling, leak testing and reprocessing; follow flexible ureteroscope care. Record the equipment used and any problems. Beckfinity can help plan a ureteroscopy set and supply Richard Wolf equipment; contact our specialists for a quotation or consultation.
Frequently asked questions
What is flexible ureteroscopy?
A procedure in which a slim flexible endoscope is passed through the urinary tract to the kidney to inspect it and treat conditions such as stones, usually with a laser.
What laser is used for ureteroscopy?
A holmium:YAG or a thulium fibre laser, chosen by the department. MegaPulse 70+ is a 70 W holmium:YAG laser with a 2100 nm wavelength.
Is an access sheath always used?
Not always. It is a surgeon's choice; if used, it must be compatible with the scope diameter, such as 9.5 Fr or larger for BOA.
What eye protection is needed?
Everyone in the room needs laser safety eyewear matched to the wavelength of the laser in use, following your laser safety policy.
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