Nephroscopes

A nephroscope is an endoscopic instrument designed to visualize the interior of the kidney and to facilitate intrarenal procedures, most commonly through a percutaneous approach known as percutaneous nephrolithotomy (PCNL). It is inserted through a small tract created in the flank to access the renal collecting system. Nephroscopes can be rigid or flexible; rigid models are common in PCNL for direct visualization of calyces, while flexible nephroscopes permit navigation to complex intrarenal anatomy.

Design features typically include a tubular body with an optical channel for viewing, one or more working channels for instruments, and irrigation ports to clear the field of view. Viewing optics may be zero- or angled (for example 0° or 30°), with illumination supplied from an external light source. Some systems integrate video capability and radiopaque markers for navigation.

Indications primarily involve treatment of renal stones, especially large, complex, or multiple calculi that are difficult to manage with other endoscopic methods. Nephroscopes may also be used for diagnostic nephroscopy to inspect the renal pelvis and calyces during other renal procedures.

Procedure overview: after anesthesia, a percutaneous tract is created under image guidance (ultrasound or fluoroscopy). The nephroscope is advanced into the renal collecting system, stones are visualized and fragmented using lithotripsy devices or laser fibers, and fragments are retrieved through the working channel. Irrigation maintains visibility and field clarity.

Complications can include bleeding, infection, injury to renal tissue, urine leakage, or damage to surrounding structures. When performed by experienced surgeons, PCNL with nephroscope access achieves high stone-free rates for large stones and remains a cornerstone of intrarenal endoscopic surgery.