Readings in endourology: Difficult Cases in Endourology

BERKELEY, CA USA ( - In the recently-released publication, Difficult Cases in Endourology, authors A.M. Al-Kandori et al. note while some groups have proposed that routine use of a safety wire is not necessary, Al-Kandori et al. report the safety wire does not add significantly to the morbidity, and, more importantly, provides emergency access to the urinary tract. The authors cite six areas of difficulty relevant to the devices:

  • inserting the wrong guidewire tip (test you have the floppy end)
  • wire slippage
  • difficulty with wire insertion (for example, J-tip wires are not easy to pass through the ureteric orifice)
  • maintaining a sterile field during endourologic procedures
  • managing bent wire, and,
  • curling wire in the bladder.

In regards to the ureteral access sheath, Al-Kandori et al. indicate using this type of sheath lowers irrigation pressure and reduces operation time, improves ureteral reentry, and improves the longevity of the ureteroscope.


These authors indicated their experience with the ureteral access sheath was more in the context of doing laser lithotripsy for larger stones in the kidney.

M Al-Kandori et al. (eds.) Difficult Cases in Endourology, Springer-Verlag London 2013. Pg. 16-18.



by Karen Roberts, medical editor,



Springer Science+Business Media




email news signup