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Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy
Some newer access sheaths enable a single wire to be used for placement and results in the wire being situated outside the sheath after placement [ 4 ]. Which ureteral access sheath is compatible with your flexible ureteroscope?
The different laser settings and their effect on stone fragmentation have been highlighted in a recent publication [ 5 ]. When the laser fibre is inserted, ensure that the ureterorenoscope is straight in a non-deflected, neutral position — one of the advantages of having an additional wire in the kidney urolithiazis maintaining a straight ureterorenoscope.
However, the surgeon must be aware that access sheaths carry a risk of ureteric ischaemia and can lead to ureteric injury [ 2 ]. If you are still unable to place the sheath, discretion is much better than valour. As with most forms of surgery, meticulous preoperative planning will lead to a more successful outcome. Whilst field of view may be reduced in some comparisons, this is counteracted by an increase in image size [ 7 ].
Once the urolithiasi third has been successfully traversed, the image intensifier can be moved to the proximal ureter to allow precise positioning of the tip of the sheath in the upper ureter. Ureteric and renal tumors Diagnostic ureterorenoscopy and biopsy has been recommended for cases of upper tract tumors [ 310 ].
For safety reasons, one may prefer to use a guidewire in diagnostic cases. Rukin1 Bhaskar K. It is pertinent and useful to remember that the ureterorenoscope has 3 user inputs to manipulate the tip: Then, try repeating access sheath placement with both the sheath and inner component.
When placing the stent, if one makaah having difficulty with buckling at the UO, bring the cystoscope closer to the UO and push slowly under vision. Inglis1 and Daron Smith Copyright by Polish Urological Association. By pulling back the wire slightly under fluoroscopy monitoring the renal endthe stent amkalah then be advanced.
Flexible ureteroscope insertion via wire Some surgeons prefer to place the flexible ureteroscope over a wire, without using an access sheath. Selective urine cytology is an important aspect of this procedure.
The upper middle calyx will be visualised where the safety wire is located as the scope is moved to the upper lateral calyx. In this paper we provide a summary of placing ureteric access sheath, flexible ureteroscopy, intra renal stone fragmentation and retrieval, maintaining visual clarity and biopsy of ureteric and pelvicalyceal tumours. Basket relocation of lower pole stone. The working wire is now straight, and the tip of the udolithiasis sheath has been moved along it towards the left ureteric orifice.
The sheath passage should be monitored makalxh pulsed fluoroscopy during ureteric passage, preventing possible buckling in the bladder or to identify early resistance and failure to progress. The ureterorenoscope is deflected into the lower medial calyx.
One biopsy technique is by performing a cold cup technique biopsy, utilising a tip-less stone basket. This technique can be technically challenging and is not universally practised.
There is debate amongst surgeons whether to laser the stone to dust or fragment and retrieve intra-renal fragments, and sometimes the best results are achieved by uroliyhiasis combination of the two techniques. Despite the majority of cases being relatively straightforward, many potential confounding factors can affect the success rates of these procedures. One can consider using a double-tipped hydrophilic wire, thereby reducing damage to the fragile working channel of the flexible ureteroscope.
Consider the use of a ureteric urolithisis or tethered stent if feasible, for short-term drainage. Patients will need to be aware that they might have some pain or discomfort postoperatively.
Makalah Urolithiasis Documents –
The stone has been identified in the lower pole, and is grasped in a basket to prepare for relocation. It is important to remember that bilateral ureteroscopy may result in bilateral stent insertion. If this is unsuccessful, one can consider using a stiff urolithiawis, rather than the standard guide wire, to aid sheath placement.
We advocate performing an initial semi-rigid ureteroscopy before placement of the access sheath.