Expanding role of flexible nephroscopy in the upper urinary tract.

Flexible nephroscopy has become an important diagnostic and therapeutic modality for urologists. We have applied the flexible nephroscope in four clinical settings: as an adjunct to rigid instruments during primary percutaneous nephrolithotomy (PCNL); in a second-look procedure to remove residual renal calculi; as the primary endoscope to treat renal calculi; and to diagnose and treat other upper urinary tract pathology. The most common application of flexible nephroscopy in our experience has been during primary PCNL after the bulk of the stone burden has been removed with the rigid nephroscope. Liberal use of the flexible endoscope in these settings may increase the stone-free rate and decrease the need for additional access tracts and procedures. In addition, patients with conduit urinary diversions may be managed using flexible nephroscopy to diagnose and treat upper tract tumors.