Illumination matters Part III: Impact of light obstruction on illuminance from flexible ureteroscopes — a comparative PEARLS analysis
By
Jia-Lun Kwok
Eugenio Ventimiglia
Vincent De Coninck
Alba Sierra
Frédéric Panthier
Mariela Corrales
Yazeed Barghouthy
Vineet Gauhar
Benedikt Kranzbühler
Florian Alexander Schmid
Cédric Poyet
Daniel Eberli
Olivier Traxer
Etienne Xavier Keller
March 23, 2024
Clinical Scorecard: The Role of Light Obstruction in Flexible Ureteroscopes: A Comparative PEARLS Analysis on Illuminance Effects, Part III
At a Glance
Category Detail
Condition Renal stones requiring ureteroscopy Key Mechanisms Partial obstruction of ureteroscope light source by collecting system structures (e.g., calyceal neck) affecting background illuminance Target Population Patients undergoing flexible ureteroscopy for renal stone management Care Setting Operating room during ureteroscopic procedures
Key Highlights
Image quality in ureteroscopy is influenced by illuminance intensity and obstruction from anatomical structures. Partial light obstruction by calyceal neck or soft tissue can reduce background illuminance impacting visualization. A 3D-printed obstructive kidney calyx model was used to simulate and measure illuminance effects in saline. Guideline-Based Recommendations
Diagnosis
Consider potential light obstruction when assessing ureteroscopic image quality during renal stone interventions. Management
Use flexible ureteroscopes with optimized light sources and adjustable brightness settings to mitigate effects of partial obstruction. Perform ureteroscopy in saline to replicate clinical conditions affecting illumination. Monitoring & Follow-up
Monitor background illuminance during ureteroscopy to ensure adequate visualization, especially in difficult-to-reach calyces. Risks
Reduced illuminance due to partial obstruction may impair visualization, potentially affecting diagnostic and therapeutic accuracy. Patient & Prescribing Data
Patients undergoing flexible ureteroscopy for renal stone treatment
Selection of ureteroscope and light source with adjustable brightness can improve visualization in obstructed calyceal anatomy.
Clinical Best Practices
Use manual mode for light brightness adjustment to maintain consistent illumination during ureteroscopy. Position ureteroscope carefully to minimize light obstruction by anatomical structures. Employ new or well-maintained fiber-optic cables and light sources to ensure optimal illuminance. Replicate clinical conditions (e.g., saline environment) during device testing to better predict in vivo performance. References
