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Withdraw of the ureteroscope causes fragmented ureter stones to disperse.
Int Braz J Urol. 2013 Sep-Oct; 39(5):756-7; discussion 757.IB

Abstract

INTRODUCTION

Ureteroscopy has improved from the first use of ureteroscope in the 1970' s. Although the success rate increased in the last years, new treatment techniques are being developed for impacted and large proximal ureter stones (2). Pneumatic lithotripsy has high efficiency with low complication rates. However, in case of steinstrasse and large (> 1 cm) ureter stones, fragmented small stones may obstruct insertion of a ureteroscope after initial lithotripsy. In order to triumph over this issue, multiple ureteroscopic passages and manipulations needed for extraction of these small stones by forceps or basket catheters. The overall incidence of stricture was found upto 14.2% when the fragments were removed with a grasping forceps or a basket. We present our technique to disperse small fragmented stones in order to contact non-fragmented rest stone.

MATERIALS AND METHODS

Ureteral lithotripsy was performed with an 8-9.8F semirigid ureteroscope using a pneumatic lithotripter (Swiss LithoClast, EMS, Nyon, Switzerland). The stone was fragmented into small pieces as small as 2-3 mm. by pneumatic lithotripter. Eventually, these fragmented stones interfered with vision and the lithotripter to get in touch with the rest stone. After fragmenting distal part of the large stone, the ureteroscope was pulled back out of ureter. While pulling back, the operating channel was closed and irrigation fluid was flowing in order not to decrease pressure behind the stones. Simultaneously, a person tilted the operating table to about 30 in reverse Trendelenburg position. When the ureteroscope was out of ureteral orifice, the operating channel was opened and irrigation fluid was stopped. This maneuver aided decreasing pressure in the bladder more rapidly in addition to feeding tube. Stone dust and antegrade fluid flow were easily seen out of the ureteral orifice. Ureteroscope was re-inserted after 30-60 seconds. While reaching the rest of the stone, small stone dust was seen at first. Bigger stones were approximately 3-5 cm distal to the original place of the stone. When the non-fragmented rest stone appeared, there were no blocking fragmented stones. Insertion of the ureteroscope was easy and we could go on with the lithotripsy procedure.

CONCLUSIONS

In comparison to standard position, tilting and rapid decrease in pressure by pulling back the ureteroscope made gravity and negative pressure more effective.

Authors+Show Affiliations

Urology II Clinics, Kartal Teaching and Research Hospital, Istanbul, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

24267120

Citation

Canguven, Onder, et al. "Withdraw of the Ureteroscope Causes Fragmented Ureter Stones to Disperse." International Braz J Urol : Official Journal of the Brazilian Society of Urology, vol. 39, no. 5, 2013, pp. 756-7; discussion 757.
Canguven O, Boz M, Bulbul M, et al. Withdraw of the ureteroscope causes fragmented ureter stones to disperse. Int Braz J Urol. 2013;39(5):756-7; discussion 757.
Canguven, O., Boz, M., Bulbul, M., Selimoglu, A., & Albayrak, S. (2013). Withdraw of the ureteroscope causes fragmented ureter stones to disperse. International Braz J Urol : Official Journal of the Brazilian Society of Urology, 39(5), 756-7; discussion 757. https://doi.org/10.1590/S1677-5538.IBJU.2013.05.21
Canguven O, et al. Withdraw of the Ureteroscope Causes Fragmented Ureter Stones to Disperse. Int Braz J Urol. 2013 Sep-Oct;39(5):756-7; discussion 757. PubMed PMID: 24267120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Withdraw of the ureteroscope causes fragmented ureter stones to disperse. AU - Canguven,Onder, AU - Boz,Mustafa, AU - Bulbul,Mustafa, AU - Selimoglu,Ahmet, AU - Albayrak,Selami, PY - 2013/03/20/received PY - 2013/06/15/accepted PY - 2013/11/26/entrez PY - 2013/11/26/pubmed PY - 2014/4/22/medline SP - 756-7; discussion 757 JF - International braz j urol : official journal of the Brazilian Society of Urology JO - Int Braz J Urol VL - 39 IS - 5 N2 - INTRODUCTION: Ureteroscopy has improved from the first use of ureteroscope in the 1970' s. Although the success rate increased in the last years, new treatment techniques are being developed for impacted and large proximal ureter stones (2). Pneumatic lithotripsy has high efficiency with low complication rates. However, in case of steinstrasse and large (> 1 cm) ureter stones, fragmented small stones may obstruct insertion of a ureteroscope after initial lithotripsy. In order to triumph over this issue, multiple ureteroscopic passages and manipulations needed for extraction of these small stones by forceps or basket catheters. The overall incidence of stricture was found upto 14.2% when the fragments were removed with a grasping forceps or a basket. We present our technique to disperse small fragmented stones in order to contact non-fragmented rest stone. MATERIALS AND METHODS: Ureteral lithotripsy was performed with an 8-9.8F semirigid ureteroscope using a pneumatic lithotripter (Swiss LithoClast, EMS, Nyon, Switzerland). The stone was fragmented into small pieces as small as 2-3 mm. by pneumatic lithotripter. Eventually, these fragmented stones interfered with vision and the lithotripter to get in touch with the rest stone. After fragmenting distal part of the large stone, the ureteroscope was pulled back out of ureter. While pulling back, the operating channel was closed and irrigation fluid was flowing in order not to decrease pressure behind the stones. Simultaneously, a person tilted the operating table to about 30 in reverse Trendelenburg position. When the ureteroscope was out of ureteral orifice, the operating channel was opened and irrigation fluid was stopped. This maneuver aided decreasing pressure in the bladder more rapidly in addition to feeding tube. Stone dust and antegrade fluid flow were easily seen out of the ureteral orifice. Ureteroscope was re-inserted after 30-60 seconds. While reaching the rest of the stone, small stone dust was seen at first. Bigger stones were approximately 3-5 cm distal to the original place of the stone. When the non-fragmented rest stone appeared, there were no blocking fragmented stones. Insertion of the ureteroscope was easy and we could go on with the lithotripsy procedure. CONCLUSIONS: In comparison to standard position, tilting and rapid decrease in pressure by pulling back the ureteroscope made gravity and negative pressure more effective. SN - 1677-6119 UR - https://www.unboundmedicine.com/medline/citation/24267120/Withdraw_of_the_ureteroscope_causes_fragmented_ureter_stones_to_disperse_ L2 - http://www.brazjurol.com.br/september_october_2013/Video_Canguven_756_757.htm DB - PRIME DP - Unbound Medicine ER -