Flexible nephroscope in calculous surgery.

In difficult operations for multiple, staghorn or recurrent calculi after previous surgical intervention and in cases of chronic nephrostomy intrarenal inspection is facilitated by the use of a new flexible nephroscope. This flexible nephroscope, with its 16F tip, permits localization and removal of stone fragments without trauma. This instrument was used in 30 patients by 9 surgeons. An open surgical procedure was done in 27 patients and nephrostomy was done in 3. In 7 cases intraoperative radiography failed to localize calculi that were identified subsequently by nephroscopy. In all instances the surgeons rated the flexible nephroscope superior to its rigid counterpart. No complications resulted from its use. The flexible nephroscope offers several advantages over the rigid scope: 1) it is atraumatic, 2) it is easily inserted, 3) it offers superior optics, 4) it provides superior visualization and 5) it permits complete intrarenal inspection. Because it allows total intrarenal inspection without trauma or bleeding it should be used before forceps exploration of the kidney.