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Modified Access Sheath for Continuous Flow Ureteroscopic Lithotripsy: A Preliminary Report of a Novel Concept and Technique.
J Endourol. 2016 09; 30(9):992-6.JE

Abstract

OBJECTIVE

To improve the safety and efficacy of ureteroscopic lithotripsy for the treatment of ureteral stone, we made a simple modification to the standard ureteral access sheath (mUAS) and developed a novel technique to overcome the deficiencies of the current procedure.

MATERIALS AND METHODS

We added an oblique suction-evacuation port with pressure regulating mechanism to the UAS to allow active egress of irrigation fluid and stone fragments. A pressure vent was placed on the egress port. Continuous negative pressure aspiration was connected to the egress port, whereas the continuous irrigation was delivered through the endoscope with a pressure pump. Stone fragmentation was performed using a holmium-YAG laser through a semirigid ureteroscope. Tiny stone fragments were evacuated in the space between the sheath and the scope. When larger fragments came into the sheath that were too large to exit between the scope and the sheath, the scope was withdrawn to just proximal to the bifurcation of the oblique port. This opened up an unimpeded egress channel for the larger fragments. We attempted this procedure in 104 consecutive patients.

RESULTS

Seventy-four patients had effective insertion of mUAS. Seven patients failed semirigid ureteroscopy despite effective placement of mUAS. Patient with effective semirigid ureteroscopic lithotripsy had 100% immediate stone clearance and no observed stone retropulsion. Patients who failed semirigid ureteroscopy were converted to flexible ureteroscopy. Five patients had completed stone clearance. The overall immediate stone-free rate was 97.3% and 100% at 1-month follow-up. Complications included two fevers and one minor ureteral false passage.

CONCLUSIONS

Our modification of UAS has reduced stone retropulsion, improved stone clearance, improved visual field, and probably reduced the intraluminal pressure.

Authors+Show Affiliations

1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangdong Key Laboratory of Urology, Guangzhou, China .2 Department of Urology, People's Hospital of Huantai County , Zibo, China .1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangdong Key Laboratory of Urology, Guangzhou, China .3 The First People's Hospital of Xiaoshan District , Hangzhou, China .

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27443243

Citation

Zeng, Guohua, et al. "Modified Access Sheath for Continuous Flow Ureteroscopic Lithotripsy: a Preliminary Report of a Novel Concept and Technique." Journal of Endourology, vol. 30, no. 9, 2016, pp. 992-6.
Zeng G, Wang D, Zhang T, et al. Modified Access Sheath for Continuous Flow Ureteroscopic Lithotripsy: A Preliminary Report of a Novel Concept and Technique. J Endourol. 2016;30(9):992-6.
Zeng, G., Wang, D., Zhang, T., & Wan, S. P. (2016). Modified Access Sheath for Continuous Flow Ureteroscopic Lithotripsy: A Preliminary Report of a Novel Concept and Technique. Journal of Endourology, 30(9), 992-6. https://doi.org/10.1089/end.2016.0411
Zeng G, et al. Modified Access Sheath for Continuous Flow Ureteroscopic Lithotripsy: a Preliminary Report of a Novel Concept and Technique. J Endourol. 2016;30(9):992-6. PubMed PMID: 27443243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified Access Sheath for Continuous Flow Ureteroscopic Lithotripsy: A Preliminary Report of a Novel Concept and Technique. AU - Zeng,Guohua, AU - Wang,Dong, AU - Zhang,Tao, AU - Wan,Shaw P, Y1 - 2016/08/24/ PY - 2016/7/23/entrez PY - 2016/7/23/pubmed PY - 2017/7/29/medline SP - 992 EP - 6 JF - Journal of endourology JO - J. Endourol. VL - 30 IS - 9 N2 - OBJECTIVE: To improve the safety and efficacy of ureteroscopic lithotripsy for the treatment of ureteral stone, we made a simple modification to the standard ureteral access sheath (mUAS) and developed a novel technique to overcome the deficiencies of the current procedure. MATERIALS AND METHODS: We added an oblique suction-evacuation port with pressure regulating mechanism to the UAS to allow active egress of irrigation fluid and stone fragments. A pressure vent was placed on the egress port. Continuous negative pressure aspiration was connected to the egress port, whereas the continuous irrigation was delivered through the endoscope with a pressure pump. Stone fragmentation was performed using a holmium-YAG laser through a semirigid ureteroscope. Tiny stone fragments were evacuated in the space between the sheath and the scope. When larger fragments came into the sheath that were too large to exit between the scope and the sheath, the scope was withdrawn to just proximal to the bifurcation of the oblique port. This opened up an unimpeded egress channel for the larger fragments. We attempted this procedure in 104 consecutive patients. RESULTS: Seventy-four patients had effective insertion of mUAS. Seven patients failed semirigid ureteroscopy despite effective placement of mUAS. Patient with effective semirigid ureteroscopic lithotripsy had 100% immediate stone clearance and no observed stone retropulsion. Patients who failed semirigid ureteroscopy were converted to flexible ureteroscopy. Five patients had completed stone clearance. The overall immediate stone-free rate was 97.3% and 100% at 1-month follow-up. Complications included two fevers and one minor ureteral false passage. CONCLUSIONS: Our modification of UAS has reduced stone retropulsion, improved stone clearance, improved visual field, and probably reduced the intraluminal pressure. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/27443243/Modified_Access_Sheath_for_Continuous_Flow_Ureteroscopic_Lithotripsy:_A_Preliminary_Report_of_a_Novel_Concept_and_Technique_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2016.0411?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -