Ureteroscope

Everything there is to know about a ureteroscope

Ureteroscopes are special endoscopes used by urologists and nephrologists for various reasons, including the breakdown of kidney stones, urinary obstruction, and diagnostic attempts. The procedure of inserting an endoscope inside the urethra is referred to as ureteroscopy, which has very-well defined indications and contraindications. This article will discuss the ureteroscope's mechanism of action, indications, and market leaders.

How does a ureteroscope work?

To understand the function of a ureteroscope, we first need to tackle down some basic anatomy. 

  • The urinary system is a complex entity that houses several organs, including the kidneys, bladder, ureters, and urethra.
  • This system is responsible for blood filtration to get rid of toxins and surplus substances for optimized body function.
  • When the blood gets filtered via the kidneys, urine is produced, which then travels down the ureters to be drained in the bladder.
  • Once the bladder is relatively full, neurological signals are sent to your brain to alert you that it's time for micturition.
  • When you urinate, the sphincter around the lower portion of the bladder relaxes, and urine passes through the urethra.

In summary, it is a pathway that starts from the kidneys and ends in the urethra.

A small tube is equipped with a full HD camera, and a bright light gets inserted through the urethra during ureteroscopy. Once the ureteroscope reaches the bladder, the physician continues up to one of the ureters. Typically, a contrast injection is performed to highlight the affected ureter and kidney's anatomy via imaging techniques (e.g., X-ray). This allows the physician to precisely locate the stone to prepare for the next steps. Once this is completed, the urologist inserts a safety wire to ensure that the ureteroscope reaches the target area. Depending on the location of the stone, a rigid or flexible ureteroscope is indicated. Finally, the doctor can use either shockwave therapy or a stone basket to remove the calculus that's obstructing urinary flow. 

Indications of a ureteroscope

Similar to other endoscopic procedures, a ureteroscope is useful for diagnostic and therapeutic approaches. Here are the most common indications for both cases.

Diagnostic indications

Abnormal findings on imaging tests

Often, people may have symptoms that indicate a problem in the upper urinary tract. In those cases, a few blood tests are needed to rule out infections and inflammatory conditions. Next, imaging tests are conducted (e.g., CT scan, MRI, ultrasound), and if both the urologist and the radiologist cannot decipher the findings on the imaging tests, and the patient still suffers from urinary symptoms, ureteroscopy is needed to visualize any anatomical or functional abnormalities.

Urinary obstruction

As discussed above, the urinary system contains two tiny tubes that can easily get obstructed. Fortunately, the urine passing through the urethra is under high pressure due to powerful bladder muscle contraction, which only leaves one tube that's predisposed to obstruction – the ureter. When the patient complains of slow or absent urine output, it is necessary to locate the obstruction site using a ureteroscope to promptly treat the condition since it can lead to dire consequences. 

Unilateral essential hematuria

Hematuria is a medical term that describes blood found in the urine.

When this sign is suspected of affecting one side of the urinary tract, ureteroscopy might be the only procedure to locate the bleeding site accurately.

Localizing infection site

The most common tests for patients with symptoms affecting the urinary tract are lab studies that analyze bacteria and immune cells in the urine.

When the infection is severe and resistant to antibiotics, ureteroscopy becomes crucial to locate the infection.

Post-trauma ureteral evaluation

Unfortunately, the urethra and ureters are susceptible to severe damage during motor-vehicle accidents, which may even lead to the patient's death in some cases. For this reason, urologists often perform urgent ureteroscopy to evaluate the initial damage and decide the next step (e.g., surgery, therapeutic abstinence).

Therapeutic indications 

Endoscopic lithotripsy

Instead of inserting the ureteroscope to locate the calculus site, endoscopic lithotripsy uses high-frequency shockwaves to destroy the stones, especially those that are large.

Treatment of malignant tumors

The treatment of urothelial cancers can be challenging due to anatomical obstruction, which may indicate the use of ureteroscopes to deliver high-dose of chemotherapy or perform microsurgical procedures to remove the tumor.

Treatment of benign tumors 

Generally speaking, physicians do not treat benign tumors since the risk of surgery exceeds the benefits of ablating the mass. However, just because these tumors are called benign doesn't mean that they can't cause serious problems. Benign tumors can be more dangerous than malignant tumors if they start to compress vital organs and cause symptoms such as hematuria, urinary obstruction, and recurrent infections.

Contraindications of a ureteroscope

There are a few documental contraindications to ureteroscopy, but urologists might not perform this procedure if the following conditions are present:

  • Improper coverage with antibiotics before ureteroscopy
  • Unstable patients
  • Uncorrected bleeding

Market-leading brands

According to reports, the semi-rigid ureteroscope global market share exceeded 756 million dollars in 2017. This number is expected to grow exponentially due to the substantial number of patients who suffer from kidney stones. In a report published by Marketsandmarkets, the global market share of these devices is expected to surpass one billion dollars by as early as 2023.

Here are the key market players:

  • Olympus (Japan)
  • Stryker (US)
  • Boston Scientific (US)
  • KARL STORZ (Switzerland)
  • Richard Wolf (Germany)
  • ELMED Medical Systems (Turkey)
  • Rocamed (France)
  • Maxer Endoscopy (Germany)
  • ProSurg (US)
  • Vimex Endoscopy (Poland)

General specifications

For the general specs, we chose Boston Scientific's ureteroscope called Lithovue.

  • 270˚ deflection in both directions
  • 7.7F tip diameter
  • 9.5F [≤3.23mm] outer diameter
  • 3.6F ID working channel
  • Digital CMOS imager
  • Working distance of 2mm–50mm
  • Light source built into the handle
  • Flexible sheath
  • Integrated camera head
    • no secondary external attachments required
  • Compatible with laser lithotripsy
    • uses existing technologies and familiar surgical tools
  • Mobile cart for portability
  • All-in-one touchscreen PC
    • includes monitor workstation, image processing software

Conclusion 

The ureteroscope has revolutionized the fields of urology and nephrology, allowing physicians to take a direct look at the tubes of the urinary tract. As the incidences of urolithiasis increase every year, the use of these devices is expected to grow, which has already taken place as we see more demand than ever for a ureteroscope. Hopefully, this article helped you understand the value, uses, and market leaders of ureteroscope devices.