Antegrade Removal Research Articles

Ретророградная интраренальная хирургия заболеваний почек

Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures.To study the results of RIRS in patients with nephrolithiasis and various renal disorders.A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+/-15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done.RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+/-10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (n=7) and repeated RIRS (n=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+/-16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+/-8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 +/- 20.5 minutes) and there were no complications.RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.

Transfistula cholangioscopy: clarification of the diagnosis and antegrade removal of residual bile duct stones

Aim. To demonstrate our own experience of performing transfistula cholangioscopy and removing bile duct stones.Materials and Methods. From 2017 to 2019, 230 patients with functioning external biliary drains underwent antegrade transfistula cholangioscopy. Preliminary dilatation and straightening of the fistulous tract were required in 37 patients.Results. Bile duct stones were detected in 158 (68.7%) patients. During transfistula cholangioscopy, stones were removed from all patients. In 68 cases with large choledocholithiasis, it was necessary to perform contact lithotripsy. To this end, staged treatment and two hospitalizations were required in five cases. Adequate transfistular access to the bile ducts was formed during the first hospital stay; during the second, after hardening of the access walls, the stones were removed. The overall complication rate was 3.8%, including grade III–IV complications (1.9%) according to the Clavien–Dindo classification. Mortality was 0.4%.Conclusion. Transfistula cholangioscopy increases the reliability of stone detection in the bile ducts, permits removing them without mandatory dissection of the major duodenal papilla, and creates favorable conditions for a more accurate assessment of its functional state. When patients with functioning biliary drains and unresolved bile duct diseases are placed in a specialized medical center, they can be provided with high-quality care. Additionally, it creates rational conditions for the use of the highly effective methods of endobiliary diagnosis and treatment.

Antegrade Therapy for Management of Choledocholithiasis through Endoscopic Ultrasound-Guided Hepaticogastrostomy in a Patient with Surgically Altered Gastrointestinal Anatomy

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a technique used to access the biliary tree in patients with surgically altered anatomy. Additionally, development of EUS-HG fistula permits intraductal therapy, thereby preventing patients from requiring surgery or percutaneous transhepatic biliary drainage (PTBD), thus decreasing morbidity. This clinical vignette describes an 83-year-old man with a history of gangrenous cholecystitis requiring cholecystectomy, partial gastrectomy, and Roux-en-Y gastrojejunostomy who presented to an outside hospital with abdominal pain and fever and found to have cholangitis and choledocholithiasis. He underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures at an outside hospital which were unsuccessful due to an inaccessible major papilla in the setting of the patient's surgically altered anatomy. On arrival to Wake Forest, the patient underwent EUS-HG with successful biliary drainage and resolution of cholangitis. He returned for ERCP three months later with balloon sphincteroplasty, cholangioscopy, and electrohydraulic lithotripsy (EHL) performed through the existing metal stent (hepaticogastrostomy), resulting in stone fragmentation and antegrade removal with balloon sweeps. Repeat cholangioscopy post-EHL and balloon sweeps showed complete duct clearance with no residual stones. The hepaticogastrostomy stent was subsequently removed, and the patient recovered without any complications.

Correction: A case of severe hepatolithiasis after hepaticojejunostomy with Roux-en-Y reconstruction treated by endoscopic ultrasound-guided transhepatic antegrade stone removal.

Correction: A case of severe hepatolithiasis after hepaticojejunostomy with Roux-en-Y reconstruction treated by endoscopic ultrasound-guided transhepatic antegrade stone removal.

Percutaneous antegrade removal of foreign bodies in the urinary tract: a 20-year, single-center experience.

While removing urinary tract foreign bodies is mostly performed through retrograde cystoscopy, antegrade removal using interventional procedures is reported less frequently. To evaluate the safety and effectiveness of percutaneous antegrade removal of urinary tract foreign bodies. A total of 14 consecutive patients (age range 9-80 years) who percutaneous antegrade removal of urinary tract foreign bodies between January 2001 and March 2020 were reviewed. Detailed removal procedures and complications were reviewed retrospectively. Types of foreign bodies were sheared percutaneous nephrostomy (PCN) catheters (n = 5), sheared double J stents (n = 3), migrated ureteral catheters (n = 3), embolization coils (n = 2), and a 0.018-inch guide wire (n = 1). The mean and median indwelling times (range 0-306 days) of the foreign bodies were 58.3 and 1.5 days, respectively. Computed tomography (CT) scans were conducted in six patients, and the extent and nature of the foreign bodies were well-visualized on CT scans. The removal access was new PCN access (n = 8), the tract missing PCN catheter (n = 3), pre-existing PCN access (n = 2), and percutaneous dissection (n = 1). The removal success rate was 92.9% (13/14) with either a simple (n = 8) or modified (n = 4; combination of a snare and guide wire is used) snare technique or a direct forceps grasp (n = 1). The mean procedure time for successful cases was 14.2 min (range 7-25 min). Procedure-related hematoma with (n = 2) or without (n = 1) renal pelvis injury occurred in three patients, which were all self-limited within one week. Percutaneous antegrade removal is safe and effective for urinary tract foreign bodies.

Removal of proximally migrated double J ureteric stent through a percutaneous nephrostomy route in an infant

Proximal migration of double J-stent (DJ stent) can be a reason for failure of its cystoscopic removal. Antegrade percutaneous nephrostomic removal of the stent can be done in such cases. Although the technique is described in adults and older children, the technique requires some modification when used in infants because of smaller calibre of pelvicalyceal system. Here we describe a case of a 6 month old male child who was treated by robotic assisted pyeloplasty for left sided ureteropelvic junction obstruction followed by placement of DJ stent. Cystoscopic removal of the stent 6 weeks after surgery was not possible due to proximal migration of the stent. Hence, antegrade percutaneous nephrostomic removal of the stent was performed using micro-snare. Certain novel technical modifications, like advancement of a diagnostic angiographic catheter in pelvicalyceal system, has been used in this case to reduce the risk of urothelial injury. Thus, antegrade removal of DJ stent with few technical modifications can be used safely in infants for removal of proximally migrated stents.

Antegrade removal of biliary stones by use of a hepaticogastrostomy in a patient with altered anatomy.

Antegrade removal of biliary stones by use of a hepaticogastrostomy in a patient with altered anatomy.

Clinical Utility of the Modified Snare Technique for Percutaneous Antegrade Removal of Double J Ureteral Stents.

Although a snare is the commonly used device for antegrade double J (DJ) stent removal, there are some cases in which DJ stent removal using only a snare is particularly difficult. In the present study, an unfavorable positioning of the proximal DJ stent tip and tip embeddedness were significantly associated with a simple snare technique failure; thus, present the modified snare technique to overcome the simple snare technique failure. By applying these 2 techniques together, we can increase the overall technical success rate up to 97% (196/202). The modified snare technique is safe and effective in cases of simple snare technique failure.

A Novel Technique for the Removal of an Intramedullary Femoral Guidewire Lodged in the Femoral Canal

Intramedullary nails are currently the most commonly used device for the fixation of intertrochanteric hip fractures. An initial threaded guidewire is used for localizing the site of entry and determining the final position of the fixation device. Hardware failure with guidewire breakage can complicate the procedure and lead to unplanned challenges for the surgeon. Predisposing mechanical properties of the hardware, along with technical surgical errors may lead to inadvertent breakage or migration of guidewires. The authors report a case of initial threaded starting guidewire migration into the femoral intramedullary canal with subsequent impaction into the distal femoral subchondral bone after advancement of the proximal femoral canal reamer. A method for antegrade removal of a lodged intramedullary guidewire through the distal femoral condyles is described. A set of key technical points to avoid this complication are also provided. Although guidewire migration during hip fracture surgery is a rare occurrence, it is important to recognize the technical measures that can be used to prevent this potentially devastating complication. Surgeons should be familiar with several different techniques for extraction of such hardware surrounding the hip, as there is no universally successful method.

Long-term complications of JJ stent and its management: A 5 years review.

Objectives:To assess the long term complications of JJ stent, the management of complications and the role of endoscopic approach to manage these complications.Materials and Methods:Nineteen patients with indwelling JJ stent for a duration of more than 6 months were included in this study. Patients were assessed with X-ray KUB, USG KUB, blood urea, creatinine and DTPA renogram. Data were analyzed by Microsoft excel 2007.Results:Out of 19 patients 12 (63.16%) were male and 7 (36.84%) were female. The mean age was 39.78 ± 13.69 years., Mean duration for which the stent was in situ was 29.56 months. The most common complication was broken stent, in 11 cases (57.89%). Other complications were migration in 5 (26.32%), encrustation in 2 (10.52%) and 1 case of (5.26%) stone formation. Eighteen cases were managed by endoscopic approaches. A total of 22 procedures were performed to treat the complications. Eleven cases were managed by a single procedure and 8 patients required multiple procedures. All were managed successfully with no death reported. Post-operative complications were seen in eight cases (42.11%).Conclusions:JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone.

Antegrade Removal of an Incarcerated Intramedullary Femoral Nail Through the Knee

Antegrade Removal of an Incarcerated Intramedullary Femoral Nail Through the Knee

Endoscopic management of lower ureteric stone after ureterosigmoidostomy

Ureterosigmoidostomy is one of the oldest technique for continent urinary diversion. Though less common nowadays, it is still a useful form of urinary diversion; simple to perform, offers good continence with minimal interference with life style. It still has a major role in conditions like ectopia vesicae and post-radical cystectomy for bladder carcinoma. We present a case of 33 years lady who underwent ureterosigmoidostomy at the age of 10 years for ectopia vesicae and later developed left pyonephrosis due to distal ureteric calculus. Left sided PCN was done and successful antegrade endoscopic removal of calculus relieved her symptoms.

Percutaneous Antegrade Removal of Double J Ureteral Stents via a 9-F Nephrostomy Route

To evaluate the safety and clinical efficacy of an antegrade approach in the removal of double J ureteral stents via preexisting nondilated nephrostomy routes under fluoroscopic guidance. Under fluoroscopic guidance and local anesthesia, antegrade removal of 39 ureteral stents in 27 patients was attempted by using a snare or basket. Indications for percutaneous stent removal included the presence of a preexisting nephrostomy route (n = 8), a surgical history resulting in an inaccessible retrograde route (n = 8), urethral stricture (n = 5), upward stent migration (n = 2), inability to obtain a lithotomy position (n = 1), fragmentation of the proximal stent (n = 1), and inability to find the ureteral orifice with a cystoscope (n = 2). Thirty-seven of the 39 stents (95%) were successfully removed by using a snare or basket. Two stents (5.1%) could not be removed with a snare or basket because they were embedded against the renal calyx or pelvis. There were no major complications. Blood clot formation or laceration or tract leakage of the pelvicalyceal system occurred in six and two patients, respectively, all of which resolved spontaneously. Percutaneous antegrade removal of double J ureteral stents with a snare or basket via a nondilated nephrostomy route is effective without major complications in patients with an available nephrostomy route or an inaccessible retrograde option.

Impacted Upper-Ureteral Calculi >1 cm: Blind Access and Totally Tubeless Percutaneous Antegrade Removal or Retrograde Approach?

To compare blind access and totally tubeless percutaneous antegrade removal and pneumatic transurethral ureterolithotripsy for the management of impacted upper-ureteral calculi >1 cm. Seventy patients (41 male, 29 female) with impacted upper-ureteral calculi >1 cm were selected in randomized order for pneumatic transurethral ureterolithotripsy (35 patients) or blind access and totally tubeless percutaneous nephrolithotomy (PCNL) (35 patients). Ultrasonography and intravenous urography were performed for all patients before surgery. After operation, plain films and ultrasonography were done. In the PCNL group, blind access was achieved from the lumbar notch area in all 35 patients, but in 3 patients, the exposure was not optimal for approaching the ureteropelvic junction (UPJ). So we injected contrast material into the collecting system, and, under fluoroscopic control, another access was achieved. In 33 patients (94.3%), intact removal of the stones was performed. In the other two patients, we fragmented the stones with the Swiss Lithoclast by an antegrade approach. The success rate thus was 100%. The mean operative time was 38 minutes (range 25-48 minutes). In the transurethral lithotripsy group, 12 stones (34.2%) migrated upward to the pelvis of kidney, and 5 stones (14.2%) fragmented incompletely. In these cases, a double- J stent was inserted, and SWL was performed. In follow-up, plain films and ultrasonography showed complete clearance in these patients. Eighteen calculi (51.4%) fragmented completely with the Lithoclast. The mean operative time in this group was 34 minutes (range 20-58 minutes). In the presence of moderate to severe hydronephrosis, blind access and totally tubeless PCNL is an effective option for large, impacted upper-ureteral calculi. Flexible ureteroscopy with laser lithotripsy is expensive and not readily available. Pneumatic transurethral ureterolithotripsy has a back-pressure effect and pushes back the calculi to the kidney. Thus, this procedure does not have satisfactory results in the management of these calculi.

Re: Goel et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: Still the treatment of choice in developing countries. J Endourol 2005;19:54–57

Re: Goel et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: Still the treatment of choice in developing countries. J Endourol 2005;19:54–57

V931: A New Instrument for Antegrade Removal of Difficult Upper Tract Stones

V931: A New Instrument for Antegrade Removal of Difficult Upper Tract Stones

Percutaneous Antegrade Removal of Impacted Upper-Ureteral Calculi: Still the Treatment of Choice in Developing Countries

To assess the safety and efficacy of antegrade percutaneous nephrolithotomy (PCNL) of large impacted proximal-ureteral calculi. Between July 1998 and October 2003, a total of 66 patients (43 male and 23 female; mean age 37.5 years) underwent PCNL for impacted proximal-ureteral calculi. The inclusion criteria were calculi >15 mm that were densely impacted and located between the ureteropelvic junction and the lower border of the 4th lumbar vertebra. The mean drop in hemoglobin, operating time, analgesic requirement, and hospital stay were assessed. Sixty-five patients (98.5%) had complete calculus clearance in a single session through a single tract. The mean operating time and hospital stay were 47 minutes and 46 hours, respectively. The mean analgesic requirement was 65 mg of pethidine (meperidine). The mean follow-up was 14 months. There were no significant postoperative complications. Antegrade PCNL is a safe and effective option for large, impacted proximal-ureteral calculi.

A New Procedure for Revision for Fracture of the Stem in Total Hip Replacement

A new system for antegrade removal of fractured femoral stems, the Anspach Extractor III®, is described. A conical hole is made in the fracture surface of the stem with a high speed drill. An extractor rod is then fixed into the hole with a malleable sleeve. We have used the system in eight cases of a broken Charnley stem and removed the distal hip in 6 cases without problems. 2 cases were unsuccessful and needed femoral fenestration for retrograde removal.This system is easy to use and we have found it to shorten operation time in case of broken stem revision.