Antegrade ureteroscopy for impacted lower ureteral calculus: A salvage procedure for failed retrograde ureteroscopy (original) (raw)
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The Journal of Urology, 2007
We describe our innovative technique for the treatment of large calculi (greater than 1.5 cm) of the proximal ureter. Materials and Methods: Between 2003 and 2005 we positioned an 8Ch pyelostomy in 25 patients diagnosed with impacted calculi of the proximal ureter greater than 1.5 cm on ultrasound, direct x-ray of the abdomen, and/or computerized tomography and subsequent retrograde pyelography. After 30 days all patients underwent combined treatment in the Valdivia supine position, including positioning a 0.035-inch guidewire through the pyelostomy into the ureter up to above the calculus, pyelostomy removal and insertion onto the guide of a 7Ch balloon occlusion catheter, which was inflated in the ureter immediately above the calculus. Ureteral lithotripsy was done with an 8.5 to 11.5Ch ureteroscope (Wolf, Dudley, Massachusetts) with a 6Ch operating channel and a Calcusplit® ballistic probe, alternating high antegrade pressure by the balloon catheter and retrograde pressure using the ureteroscope, as required. After lithotripsy and fragment dislocation the ureteroscope was retracted with rapid flow antegrade irrigation. At the end of the procedure after antegrade contrast medium followup the balloon catheter was retracted as far as the pelvis as a nephrostomy. We analyzed operative time, the number of postoperative recovery days, the incidence of complications during and after surgery, and the stone-free rate immediately, after 5 days and after 1 month. Results: Average calculus size was 1.7 cm. Ten patients presented with multiple ureteral bending upon diagnosis, which was no longer found at surgery with a consequent lack of difficult ureteroscope feeding. Significant edema downstream of the calculus was present in all cases. High pressure irrigation, a rigid ballistic probe and retrieving forceps enabled the dislocation of even larger fragments from the original calculous site in all cases. Antegrade high pressure irrigation after lithotripsy enabled the complete clearance of calcareous fragments as far as the bladder without the need for ancillary maneuvers. We observed no cases of calcareous fragment push-back. No retroperitoneal extravasation, or pyelolymphatic or pyelovenous backflow was observed. Average procedure time was 33 minutes. The renal-ureteral stone-free rate was 100% at the end of the procedure and all calcareous fragments were in the bladder. We did not observe any ureteral lesions. In no case was there onset of fever. Average postoperative hospitalization was 2 days. Followup with contrast material after 5 days showed a renal-ureteral stone-free rate of 100% and a bladder stone-free rate of 84%. The nephrostomy was removed at an average of 5.5 days. Conclusions: Compared to the techniques described in the medical literature our method appears to have certain advantages, including a mini-invasive approach to the renal pelvis compared to that of percutaneous nephrolithotomy with protection of the renal parenchyma from high pressure, rigid ureteroscope use, which provides a high level of maneuverability and low operating costs, ballistic probe use, which provides lower costs and higher speeds than the laser, and balloon catheter use, which removes the risk of push-back and enables push-down of the fragments without any further ancillary maneuvers. The balloon catheter also enables contrast medium followup and immediate postoperative drainage. The speed of the procedure and the ability to adjust antegrade or retrograde flow with variable pressure and direction make this technique highly suitable for the complete resolution of large, impacted calculi of the proximal ureter.
Journal of Endourology Case Reports, 2019
Background: Retrograde intrarenal surgery (RIRS) has become the preferred treatment option for selected renal stones <20 mm. However, laser fragmentation of stones often results in residual small fragments that may prompt subsequent stone events. We describe a simple technique to facilitate removal of these fragments. Case Presentation: A 68-year-old woman underwent elective RIRS for a 13 mm right renal pelvic stone. After laser fragmentation of the stone there were numerous <2 mm fragments too small to allow removal by a standard retrieval basket (i.e., NCircle Ò and NCompass Ò Nitinol Stone Extractors, Cook Medical, Bloomington, IN). A smaller ureteral access sheath (UAS) was advanced into the kidney within the preexisting larger UAS and, using a connecting piece from a Foley catheter, stone fragments were suctioned out through the smaller sheath. Stone-free status was corroborated endoscopically and with postoperative CT. Conclusion: Stone fragments were flushed from the kidney using a simple irrigation technique through a coaxial UAS.
Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi
International Braz J Urol, 2006
Introduction: This work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. Materials and Methods: From March 1997 to May 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. Twenty-eight patients were female and 14 were male. The stone size ranged from 5 to 20 mm. The ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9. Results: Considering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). As for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). In the mid ureter, 1 ureteral avulsion was verified. In 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). Of 8 patients who had perforation, 6 developed strictures. The overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. Conclusions: Ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. Ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. Ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.
Arab journal of urology, 2013
To analyse and compare the effect of stone site and size, method of lithotripsy, and level of experience on the results and complications of semi-rigid ureteroscopy for ureteric and renal pelvic stones. Between April 2010 and May 2011, 90 patients underwent 95 ureteroscopies, using 7.5- and 9-F semi-rigid ureteroscopes, with or without pneumatic or laser lithotripsy. The peri-operative findings were analysed and compared. The mean (SD) longest diameter of the stones was 11.8 (4.5) mm. Laser lithotripsy was used in 32 cases and pneumatic lithotripsy in 26. There were complications in 35 procedures in the form of colicky pain (2%), haematuria (1%), stone migration (7%), equipment failure (5%), access failure (8%), mucosal injury (7%), fever (2%) and extravasation (3%).The calculi were successfully retrieved in 75 patients (83%). The success rate was 95%, 77%, 85%, and 53% in the lower, middle, upper ureter and renal pelvis, respectively. Upper ureteric stones can be managed safely wit...
Urology, 2005
Objectives. To compare the safety and cost-effectiveness of ureterorenoscopic holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy (URSL) with extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones. Methods. This investigation assessed 220 patients with upper ureteral stones. Those in the ESWL group were treated on an outpatient basis using the Medispec Econolith 2000 (Medispec, Germantown, Md) under intravenous sedation. URSL was performed with a 6/7.5F semirigid tapered ureterorenoscope and holmium: YAG laser under spinal anesthesia on an inpatient basis. A successful outcome was defined as the patient being stone free on radiography 1 month after treatment. The stone size, success rate, postoperative complications, and cost were evaluated in each group. Results. A total of 220 patients were enrolled in this study. Hematuria and flank pain were the most common complaints in each group. The mean stone burden Ϯ SD was 58.7 Ϯ 3.1 mm 2 in the ESWL group and 108.4 Ϯ 10.0 mm 2 in the URSL group (P ϭ 0.000). The accessibility of the semirigid ureterorenoscope for upper ureteral stones was 98.1% (101 of 103), and the stone-free rate achieved after one treatment was 83.2% (84 of 101). The initial stone-free rate of in situ ESWL was 63.9% (76 of 119). Significantly, the initial stone-free rate of the URSL group was superior to that of the ESWL group (P ϭ 0.001). The average cost in the URSL group appeared to be lower than that in the ESWL group (P ϭ 0.000). Conclusions. The results of this study have demonstrated that URSL achieved excellent results for upper ureter calculi. In terms of cost and effectiveness, this procedure should be the first-line therapy for proximal ureter stones. UROLOGY 65: 1075-1079, 2005.
Renal Ureteroscopy Treatment of Kidney and Bladder Stones
— The high incidence of urinary stones ranges from 20-40 years with a M / F ratio of 3: 1 The advent of extracorporeal shock wave lithotripsy associated with improved optical endoscopic have significantly reduced morbidity representing the gold standard for the treatment of urinary stones purpose of the study is to detect, by implementing an analysis of the physical and clinical parameters, the technique and complications of the procedure, the factors that can predict what the potential cases of high morbidity. Materials and methods From January 2000 to December 2014 were performed at the Surgical Clinic III of the University of Catania Policlnico 134 ureterorenoscopy procedures (URS) .the review covered the medical records considering the age, BMI, medical history, treatments and the stone free rate of URS the indication for therapeutic purposes has been carried out in the ureter and kidney stones of size handling <15mm, placement of ureteral catheter, ureteral stenosis, treatment of high urinary tract neoplasms. (Figure 9) .the procedure took an anesthesia care to spontaneous breathing, with cardiac monitoring. Discussion The development of complications in an investigation conducted is slightly higher than the detected case studies, (14%) in the absence of ureteral injury. the survey carried out has a therapeutic success in the first two years stood at 70% reaching the 90% at the end of the period observed, then the use of both general and spinal anesthesia promotes muscle paralysis avoiding potential injuries. With fast deployment anesthetics. Conclusion :The URS is a safe and reliable reality in the treatment of ureteral pathology. the analysis of clinical cases allows to state as the stretch pelvic ureter is easier to deal with both flexible semirigid uretroscopi that becomes essential when a complication arises stop take the appropriate therapeutic options in order to avoid the transformation into major complications.