Flexible Ureteroscopy: Wireless and Sheathless

No-touch ureteroscopy, also termed “wireless and sheathless” ureteroscopy, is an advanced ureteroscopic technique that minimizes incidental trauma from a wire or dilators. Direct access to the upper urinary tract with a flexible ureteroscope allows pristine inspection of the upper ureter and renal calyceal system. Improvements in the mechanics of flexible ureteroscopes, including smaller tip diameter, exaggerated tip deflection, and a larger deflecting radius allowed for the intubation of the ureteral orifice and the complete upper urinary tract inspection to be performed solely with a flexible endoscope, commonly without the assistance of a potentially traumatic guide wire. With the safety and efficacy of this technique in diagnostic applications, the indications for no-touch ureteroscopy have expanded to include a variety of therapeutic indications including tumor therapy and endoscopic lithotripsy. Herein, a review of the current techniques and results associated with wireless and sheathless flexible ureteroscopy will be presented.