Ureteroscopy with and without safety guide wire: should the safety wire still be mandatory?

BACKGROUND AND
PURPOSE: Although the evidence is sparse, most urologists advise the insertion of a safety guide wire (SGW) alongside the ureteroscope whenever performing ureteroscopy (URS). The aim of the study was to compare the results of ureteroscopic treatment for ureteral stones at the Oslo University Hospital (OUH), where the SGW is routinely used, with the results at the Haukeland University Hospital (HUH), where the SGW is routinely omitted. The primary goal was to evaluate the success rates of passing the ureteroscope through the orifice, the ability to access the ureteral stone, and the ability to place a ureteral stent when needed after the endoscopy. The secondary goals were to compare the perioperative complication rates and stone-free rates at the two hospitals.
MATERIALS AND METHODS: A retrospective review of 500 URS for ureteral calculi at each of the two hospitals, during 2004-2010, was performed. Relevant data were extracted from the medical records. The exact chi-squared, Mann-Whitney U, and independent-samples t-tests were used comparing the results at the two hospitals.
RESULTS: An SGW was used in 480 (96.2%) of the URS procedures at OUH and in 7 (1.4%) at HUH. No significant differences were found between the two hospitals in the success rates of passing the ureteroscope through the orifice, in the ability to access the ureteral calculus, or in the ability to place a ureteral stent when needed after the endoscopy. There were no significant differences in the number of intraoperative complications, but postendoscopic ureteral stenosis occurred more often at OUH (3.4%) than at HUH (1.2%), p=0.039. The overall stone-free rate was higher at HUH (85.9%) compared to OUH (77.1%), p=0.001.
CONCLUSION: No superior results were found at the hospital with the routine use of an SGW. It may be questioned if the SGW still should be considered mandatory.