Practical_Ureteroscopy Đinh Thị Hảo .ppt

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1. Practical Ureteroscopy
Ronald S. Sutherland MD, FACS, FAAP
Chairman, Urology
Tripler Army Medical Center, Honolulu, Hawaii
Associate Professor of Surgery
University of Hawaii, John Burns School of Medicine
Presentation in Hue, 2007

2. Introduction
•Semi-rigid ureteroscopy
•Flexible ureteroscopy
•Guidewires
•Lithotripsy
•Baskets
•Stents

3. Semi-rigid Ureteroscopes
•Size 6.9-9.4 Fr
•Working channel 2.1-
5.4 Fr
•Durable

4. Flexible Ureteroscopes
•Optics
•Length
•Size
•Deflection
•Fragile
•Expensive

5. Guidewires
•Size
•Outer covering
•Tips
•Rigidity

6. Lithotripsy
•Rigid scope
–Ultrasonic
–Lithoclast
–Electrohydraulic
–Laser
•Flexible scope
–Electrohydraulic
–Laser

7. Ultrasonic Lithotripsy
•Vibrates at 25,000 Hz
•Probes 2.5-12 Fr
•May generate
significant heat
•Often attached to a
suction device
•Fragmentation rates 69-
100%

8. Lithoclast
•Ballistic energy
•“Jackhammer” effect
•Probes 0.8-2.5mm
•Fragmentation rates 73-
96%
•High rate of stone
migration
•Hard to treat small stone

9. Electrohydraulic Lithotripsy (EHL)
•1.6-5 Fr. probe
•Flexible
•One time use
•Fragmentation rates
67-90%
•Risk of ureteral
perforation
•Stone migration

10. Laser Lithotripsy (Holmium)
•Holmium:YAG
•2140 nm
•Highly absorbed by water
•Causes photothermal
vaporization of stone
•Fragmentation rates 91-100%
•Low rate of stone migration

11. Baskets
•Types
–Zero-tip
–Spiral, helical
–Flat wire
–Multi-stranded
–graspers
•Uses
–Stones
–Foreign objects
–Tissue
–Migrated stents

12. Ureteral Stents
•Types
–Open-ended
–Double-J
–Material
–Coatings
•Uses
–Pre-op
•Relieve obstruction
•Dilate ureter
–Post-op

13. Semi-rigid Ureteroscopy
•Safety wire
•Ureteral access
–Irrigation
–Second guidewire
–Rotation
–Ureteral dilators

14. Semi-rigid Ureteroscopy
•Navigating the
ureter
–Trendelenburg
position
–Second guidewire
–Retrograde
instillation of viscous
lidocaine
–Balloon dilation
•Treatment decisions
–Basket or lithotriptor
–Type of lithotriptor
–Stent ?

15. Flexible Ureteroscopy
•Safety wire
•Working wire
•Ureteral access
–Irrigation
–Rotation
–Ureteral access sheath
–Ureteral dilators

16. Flexible Ureteroscopy
•Passive deflection

17. Flexible Ureteroscopy
•Multiple calyceal examination

18. Flexible Ureteroscopy
•Treatment decisions
–Basket or lithotripsy
–Type of lithotripsy
–Stent ?