Rigid Ureteroscope Research Articles

Simple aid to ureteroscopy.

Initial experience with the rigid ureteroscope showed that despite ureteral dilation and guide wire followers, introduction of the ureteroscope can be difficult due to bladder mucosa catching on the instrument. A simple, cheap disposable device using a modified ureteric catheter is presented that overcomes this problem.

Use of the ureteroscope in ureteral calculus manipulation.

The success rate of endoscopic manipulation of ureteral calculi is uncertain. The uncertainty arises because of selection procedures. A common reported figure is 50%, but this figure varies according to the selection procedure followed and the selection procedure depends on the anticipated difficulty of manipulation. The outcome of endoscopic manipulation performed as an initial procedure in a series of patients whose ureteral calculi required operative intervention is presented. A total of 33 calculi were successfully extracted by manipulation, including five in the upper ureter. The method failed to extract three calculi of which two were in the upper ureter. The success of this approach is attributed to the use of the rigid ureteroscope and the Meagher ureteral dilator, and to x-ray control.

Ureteroscopy with Rigid Instruments in the Management of Distal Ureteral Disease

The ureter is accessible to direct vision for diagnosis and treatment because it is pliable and attached firmly to the bladder. Instrumentation is in the process of development. A generally applicable technique for rigid ureteroscopy within the distal ureter and examples of use in patients with stricture, transitional cell carcinoma and calculi are reported.

Transurethral Ureteroscopic Retrieval of Ureteric Stones

Summary— This report documents our initial experience in the transurethral retrieval of ureteric stones using the rigid ureteroscope. Ten patients are included. Half of the stones were located in the lower one-third of the ureter and half in the upper two-thirds. They varied in size from 5 to 10 mm in diameter. Seven were successfully extracted at the first attempt using stone baskets under direct vision. Of the remaining 3, one was retrieved at a second ureteroscopy, one was fragmented and subsequently passed and one required percutaneous nephroscopy for its removal from the renal pelvis. It is concluded that transurethral ureteroscopy offers a safe alternative to both open ureterolithotomy and blind manipulation.

Ultrasonic and electrohydraulic lithotripsy of ureteral calculi

Ultrasonic lithotripsy of ureteral calculi has been accomplished using a fine flexible ultrasonic probe under direct visual control through a 9-F rigid ureteroscope. Electrohydraulic ureterolithotripsy was performed by passing a 5-F catheter-electrode cystoscopically under fluoroscopic control. Case reports are presented. It is concluded that ultrasonic ureterolithotripsy, using the technique described, is a feasible and safe method. Although stone fragmentation by electrohydraulic ureterolithotripsy is possible, the danger of ureteral injury and urinary extravasation is appreciable.

Transurethral ureteroscopic retrieval of ureteric stones.

This report documents our initial experience in the transurethral retrieval of ureteric stones using the rigid ureteroscope. Ten patients are included. Half of the stones were located in the lower one-third of the ureter and half in the upper two-thirds. They varied in size from 5 to 10 mm in diameter. Seven were successfully extracted at the first attempt using stone baskets under direct vision. Of the remaining 3, one was retrieved at a second ureteroscopy, one was fragmented and subsequently passed and one required percutaneous nephroscopy for its removal from the renal pelvis. It is concluded that transurethral ureteroscopy offers a safe alternative to both open ureterolithotomy and blind manipulation.

Treatment of distal ureteral calculi using rigid ureteroscope

Rigid transurethral ureteroscopy has been utilized on sixteen occasions for the treatment of distal ureteral calculi. This resulted in successful stone removal and avoidance of an open operation in 69 per cent of the cases. The advantages of this type of treatment are that it enables endoscopic access to a surgically difficult portion of the ureter and allows direct visualization during basket manipulation of ureteral calculi.

LITOTRIPSI LASER HOLMIUM YAG UNTUK TERAPI BATU URETER

Objective: To assess the efficacy of pulsed holmium:YAG laser lithotripsy for ureteral stone therapy. Material and method: Ninety-one patients (70 males and 21 females) with age range 20 – 76 years underwent 93 ureteroscopic procedures for 101 ureteral stones. A preoperative diagnosis was established by ultrasound scanning and intravenous urography. An 8 F rigid Karl-Storz ureteroscope was used for a holmium:YAG laser (OmniPulse MaxTM 80 watt Holmium Laser System Model 1210-VHP, Trimedyne,Inc. Irvine CA, USA) as energy source for laser lithotripsy. The stone localization was mostly at the lower third of the ureter. The mean stone size was 9,6 mm, mean duration of procedure was 48,1 minutes, and the mean hospital stay was 2,1 days. Results: The overall stone clearance rate was 95,6% with the best results for stones in the middle third of the ureter (100%). At follow up we noted two patients with residual stones and two patients with a perforation of the ureteral wall. Conclusion: The Holmium:YAG laser is effective for ureteral stone treatment with a high success rate. Special attention and care should be afforded in impacted ureteral stones.

The outcome of pneumatic lithotripsy for the management of ureteric calculi

Various methods have been adopted for the removal of ureteric calculi around the world. Ureteroscopic pneumatic lithotripsy has been used to treat ureteric calculi for more than a decade. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic device amongst many others. Moreover, ureteroscopy has become the method of choice for the quickest way of rendering patients stone-free. To determine successful stone fragmentation by ureteroscopic pneumatic lithotripsy in the management of ureteric calculi as well as intra-operative and post-operative complications related to it. A prospective and descriptive study. The study was conducted in Section of Urology, Department of Surgery, B&B Teaching Hospital, Kathmandu University. The data was collected from April 2005 to April 2006. Ninety-two consecutive patients having ninety-five ureteric stones were treated with intracorporeal pneumatic lithotripsy over a period of one year. The size, side, number and site of stones along with the results of preoperative routine investigations were noted in the patients. The pneumatic lithotripter was introduced through a 10 or 8 Fr rigid ureteroscope (Karl Storz) to break the stone/s. Successful stone fragmentation, lithotripsy time, intra-operative and post-operative complications and duration of hospital stay were recorded. Complete stone fragmentation was achieved in about 80 % of cases. The mean lithotripsy time was 17.66 minutes. About 76% of patients were stone-free at one week follow-up after the procedure, 92% by the end of eight weeks while 100% stone-free status was achieved by the end of 12 weeks. The mean hospital stay was 1.82 days and complications (both significant and minor) occurred in 51 % of cases. However, majority of them were minor and successfully managed. Intra-operative pneumatic lithotripsy is a minimally invasive, effective and rapid procedure for the management of ureteric calculi. Though it can give rise to considerable complications, they are mainly minor. Moreover, both complications and failure rates can be reduced if patients with ureteric calculi are properly selected. It seems to be a good alternative in patients where extracorporeal shockwave lithotripsy is unsuccessful or not indicated and in patients who need early stone removal.