Sky is no limit for ureteroscopy: extending the indications and special circumstances

To critically review and synthesize data of ureteroscopy (URS) in different circumstances that all urologists may encounter during everyday clinical practice, such as pregnancy, obesity, bleeding diathesis, renal stones larger than 2 cm, calyceal diverticula, and kidney malformations. According to PRISMA guidelines, a systematic literature review was performed to identify articles published between 1990 and December 2013 that reported different indications and special circumstances for URS. Articles were separated into the following categories: pregnancy, obesity, bleeding diathesis, stones larger than 2 cm in diameter, calyceal diverticula, and kidney malformations. We used a narrative synthesis for the analyses of the studies, including a description of the characteristics and main outcomes reported in the articles. Records identified through database searching were 1396; at the end of study selection, articles included were 57. The majority of these are retrospective studies and involve small cohorts of patients. There does not exist a consensus about important parameters in ureterorenoscopy like stone size, stone free status and complication rate. Ureteroscopy is effective and reliable tool capable of treating the majority of stones even in the most complicated clinical scenarios and will have more fundamental roles in endourology. The lack of definitive conclusions is due to the great heterogeneity in collecting study's results; multicentric randomized trials that define in advance the parameters to be studied should be encouraged.