TL;DR: The access sheath is potentially protective against pyelovenous and pyelolymphatic backflow, with clinical implications for the ureteroscopic management of upper-tract transitional cell carcinoma, struvite stones, or calculi associated with urinary tract infection.
Abstract: Background and Purpose: New-generation flexible ureteroscopes allow the management of proximal ureteral and intrarenal pathology with high success rates, including complete removal of ureteral and renal calculi. One problem is that the irrigation pressures generated within the collecting system can be significantly elevated, as evidenced by pyelovenous and pyelolymphatic backflow seen during retrograde pyelography. We sought to determine if the ureteral access sheath (UAS) can offer protection from high intrarenal pressures attained during routine ureteroscopic stone surgery. Patients and Methods: Five patients (average age 72.6 years) evaluated in the emergency department for obstructing calculi underwent percutaneous nephrostomy (PCN) tube placement to decompress their collecting systems. The indications for PCN tube placement were obstructive renal failure (N = 1), urosepsis (N = 2), and obstruction with uncontrolled pain and elevated white blood cell counts (N = 2). Flexible ureteroscopy was subsequen...
TL;DR: Two Volumes: BASIC PRINCIPLES: Optics of Flexible and Rigid Endoscopes: Physical Principles and Complications, and Basic Laparoscopy: Patient Prepara Tion and Operating Room Setup.
Abstract: Two Volumes: BASIC PRINCIPLES: Optics of Flexible and Rigid Endoscopes: Physical Principles. Care and Sterilization of Instruments. How to Protect Yourself and Others from Radiation. Video Imaging and Documentation. Intracorporeal Lithotriptors. Lasers. Monopolar and Bipolar Electrosurgery and Associated Problems. Sedoanalgesia: an Adjunct to Modern Endourology. Informed Consent and Related Legal Issues in Laparoscopic Surgery. Patient Instructions and Nursing Care. Equipment, Instrumentation, And Operating Room Setup: Role of the Urology Nursing Team PERCUTANEOUS SURGERY: Surgical Anatomy of the Kidney. Assessment of Function in Kidney Obstruction. Percutaneous Access. Retrograde Access. Dilation and Maintenance of the Nephrostomy Tract. Nephroscopy. Stone Extraction. Treatment of Ureteral Stones. Chemolysis of Urinary Calculi. Complications of Stone Removal. Treatment of Ureteropelvic Junction Obstruction. Treatment of Caliceal Diverticula and Infundibular Stenosis. Treatment of Renal Cysts. Treatment of Upper Urinary Tract Transitional Cell Carcinoma URETEROSCOPY: Ureteroscopes and Working Instruments. Rigid Ureteroscopes. Flexible Ureteroscopes. Working Instruments. Ureteral Anatomy. Indications for Surgical Intervention. Ureteral Dilation: Indications and Techniques. Access to the Difficult Ureter. Techniques in Rigid Ureteroscopy. Flexible Fiberoptic Ureteropyeloscopy. Treatment of Ureteral Stones. Diagnostic Ureteroscopy. Treatment of Upper Urinary Tract Neoplasms. Ureteral Surgery. Retrograde Endopyelotomy for Ureteropelvic Junction Obstruction. Incisional Treatment of Ureteral Strictures. Postoperative Care. Complications EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY: Shock Wave Physics of Lithotriptors. Lithotripsy Systems. Treatment of Renal Calculi. Treatment of Ureteral Calculi. Nonurologic Applications. Focused Ultrasound. Complications BASIC and PROCEDURAL LAPAROSCOPY: Basic Laparoscopy: Patient Prepara Tion and Operating Room Setup. Instrumentation. Anesthetic Considerations. Physiologic Effects of
TL;DR: Small diameter flexible ureteroscopes are effective for diagnosing and treating upper urinary tract pathology but improved durability is required.
TL;DR: The use of smaller diameter ureteroscopes, better working instruments and more effective lithotriptors allow calculi in all parts of the collecting system to be engaged and treated.
TL;DR: Flexible ureteroscopy will be used increasingly to manage upper urinary tract pathologic findings and being incorporated into common practice can reduce the strain on these fragile 7.5F endoscopes, thereby maximizing their longevity.