View WOC from NURSING at Airlangga University. Makalah Neurogenic ; Airlangga University; NURSING – Summer. Looking for Documents about Makalah Urolithiasis? Makalah Dan Asuhan Keperawatan UROLITHIASISmakalah pbl 20 urolithiasis-kasus Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial.

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However, as noted above, it is important to note that larger access sheaths can potentially cause ureteric ischaemia and even direct ureteric trauma including perforation. If unable to pass the access sheath into the UO or much beyond the lower third of the ureter, despite prior normal rigid ureteroscopy, consider using only the inner obturator of the access sheath over your wire, enabling an initial urolithissis dilatation by advancing the obturator to the upper ureter.

The decision to leave a safety wire outside an access sheath is one of personal preference.

Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy

The interpole, not well seen on the images 3a-c is filled with contrast via the scope to confirm it has been visualised. Once the access sheath of the desired size and length has been chosen, pass the sheath over the guidewire using the Seldinger technique. They are best used judiciously as they transiently increase intra-renal pressure. The stone urolithisais been successfully broken into small pieces. When the procedure is completed, withdraw the ureteroscope and access sheath together with the tip of the ureteroscope placed just at the end of the sheath, watching the ureteric mucosa move past.

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Makalah Urolithiasis Documents –

The ureterorenoscope is directed to the upper urplithiasis calyx as the starting point for an anti-clockwise tour of the collecting system. Improved optical characteristics translate to improved clinical outcomes with significant improvements in mean operative time, flexible ureterorenoscopy time and efficiency of stone fragmentation [ 89 ].

The base of the tumor can be snared, and then avulsed with some traction. Traxer O, Thomas A. The scope is placed in the next calyces down, in the lateral part of the lower pole. Furthermore, it can aid the rapid reintroduction of the scope towards the calyx of interest stone or Urolithiasie bearing later in the procedure see Figure 2. Inglis1 and Daron Smith After a diagnostic cystoscopy, a previously saline-filled ureteric catheter can be placed in the ureter to collect selective cytology from one or both ureters relatively quickly.


However, the surgeon must be aware that access sheaths carry a risk of ureteric ischaemia and can lead to ureteric injury [ 2 ].

Is a safety wire necessary during routine flexible ureteroscopy? Ureteroscopy with and without safety guide wire: One biopsy technique is by performing a cold cup technique biopsy, utilising a tip-less stone basket.

In this paper we provide a summary of placing ureteric access sheath, flexible ureteroscopy, intra renal stone fragmentation and retrieval, maintaining visual clarity and biopsy of ureteric and pelvicalyceal tumours.

We do not advocate the use of ureteric balloons to dilate the ureter to aid sheath placement nor the use of other ureteric dilators. Rukin1 Bhaskar K. Then, try repeating access sheath placement with both the sheath and inner component. The use of disposable laser fibres is increasing, and they have been shown to be cost-effective and reduce ureteroscope damage [ 6 ]. Despite the majority of cases being relatively straightforward, many potential confounding factors can affect the success rates of these procedures.

If this is unsuccessful, one can consider using a stiff wire, rather than the standard guide wire, to aid sheath placement. The use of ureteric access sheaths prior to flexible ureterorenoscopy can be both a surgical preference and case-specific.

Consider the use of a ureteric catheter or tethered stent if feasible, for short-term drainage.


It is important to remember that bilateral ureteroscopy may result in bilateral stent insertion. Although these might urolithiqsis an option in very particular circumstances, in most cases involving an unfavourable ureter, it is usually preferable to place a stent and return for the definitive operation at a later date.

This reduces the chance of mucosal trauma, therefore reducing the risk of unnecessary biopsy.

The indications for endoluminal surgery continue to widen, mainly through technological advances, such that this branch of urological practice continues to increase year on year. If you are still unable to place the sheath, discretion is much better than valour.


Deliberate, slow movements will get one around the whole collecting system faster than wild, fast movements.

For safety reasons, one may prefer to use a guidewire in diagnostic cases. Copyright by Polish Urological Association. Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. If you are still unable to pass the flexible scope, stent the ureter with a view to performing a repeat procedure in approximately 2—6 weeks.

Open in a separate window. The scope is advanced into the patient to the upper pole — the presence of makaah safety wire in the upper calyx can aid this both under endoscopic and fluoroscopic control.

Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy

Both calyces can be inspected in turn before moving to urolithisais lowermost calyx. The placement of a ureteric stent, particularly in an emergency setting, such as relieving obstruction in an infected system, can be a daunting task.

Laser fragmentation and basket technique Before performing laser fragmentation in the kidney, consider repositioning the stone into a more favourable position upper calyx or even upper ureter if feasible. Ureteral stenting and urinary stone management: It is best to visualise and ensure its position in the bladder before sending the patient to recovery — if there is any doubt from the final fluoroscopic image, it is best to be sure by passing the cystoscope and having a look!

In such cases, care must be taken to ensure the distal end of jrolithiasis stent is not pushed too high in the ureter. When placing the stent, if one is having difficulty with buckling at the UO, bring the cystoscope closer to the UO and push slowly under vision.

Improving vision in the kidney Vision is key to achieving good fragmentation and stone-free rates, particularly in the kidney. Correct adjustment of these factors aids vision and results in successfully completed procedures. It pays to be maklaah when avulsing tissue as perforation of the collecting system may occur.