Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 3
Our experience with flexible and rigid ureterorenoscopy
- Pages
- 348–353
- DOI
- —
Abstract
Introduction: In this study, the operations performed with flexible ureterorenoskop (f-URS) and rigid ureteroscopy (r-URS) were evaluated retrospectively and the efficacy of f-URS and r-URS for the diagnosis and treatment of ureter and kidney pathologies were assessed. Materials and Methods: Ureteroscopic operations were performed for 154 cases between March 2001 and December 2003. The mean ages of the male and female patients were 41±0.4, 48±0.7 respectively. R-URS was used for 146 cases and f-URS was used for 12 cases. F-URS and r-URS were both used in 4 cases. Karl-Storz-Germany 10 F ureteroscope and Karl-Storz-Germany 7.5 F MVM flexible uretero-reno-fiberscope were used for URS. Swiss-Lithoclast pneumatic lithotripsy system was used for lithotripsy Karl-Storz-Germany splitting forceps and balloon catheters (Uromax-Microvasive-Boston Scientific Cooperation) were used for endopyelotomy procedure. All patients were operated on the Standard lithotomy position. Balloon dilatation was applied for all cases at the educational period. A hydrophilic Guide wire (Glide wire-Microvasive-Boston Scientific Cooperation) was used for insertion of r-URS. When the stone was seen directly a nonhydrophilic guide wire and a stone cone (Microvasive-Boston Scientific Cooperation) passed over the stone. We did not use fluoroscopy routinely. When we did not sure about the passage we passed an open end catheter via guide wire then waited for urine or tested with injection of water. Stone fragments smaller than 2 mm were left off but those bigger than 2 mm were removed by grasper (Triceps-Microvasive-Boston Scientific Cooperation) after stone fragmentation. Double J stents were placed for 39 patients with impacted stones or stones bigger than 1.5 cm. Controls of the patients were assessed by plain films taken 1 mount after the operation and success rate of the procedure was defined. Incision of the ureter reached at the periureteral tissue was applied at the posterolateral side of the ureter by splitting forceps during endopyelotomy. Six French double J stents were placed in the ureter for 2 weeks. Control of the patients with endopyelotomy operation was done by intravenous pyelography (IVP). Mean follow up time was 7.6±1.3 month. Results: Thirty five diagnostic procedures were done for 31 patients and different pathologies were found at 25 procedures (71.4%). Transitional cell carcinoma of pelvis renalis in one case and transitional cell carcinoma of ureter in another case were detected. The diagnoses were confirmed by pathology. Non opaque stones in calices in 4 cases, nonopaque ureteral stones in 11 cases and stricture at uretero-pelvic-junction (UPJ) in 8 cases were detected during the diagnostic URS. URS was used for the treatment of multiple pathologies in 148 cases. 152 stones in 135 cases were fragmented completely and the patients were discharged as stone free. Our success rate was 99% for the treatment of distal ureteral stones, 97 % for mid ureteral stones and 73% for proximal ureteral stones, but our success rate was only 50% for caliseal stones because we used only nitinol basket catheter for stone removal from calices to upper ureter. Endopyelotomy was applied to 6 cases with UPJ stricture. R-URS was used for the treatment of Stone Street in two cases and for removal of ureteral JJ catheter migrated to kidney in one case successfully. F-URS was also used for ureteral catheterization of two patients with ureteral compression by lenfadenopaty. Conclusion: It was seen that rigid and flexible ureterorenoscopes can be used for the diagnosis and treatment of the pathologies of ureter and kidneys effectively and safely.
Özet
Bu çalışmada fleksibıl üreterorenoskop (f-URS) ve rijid üreterorenoskoplar (r-URS) ile yaptığımız operasyonlar retrospektif olarak incelenerek üreter ve böbrek patolojilerinin tanı ve tedavisindeki etkinlikleri değerlendirildi. Mart 2001-Aralık 2003 tarihleri arasında 154 olguda üreteroskopik (URS) girişim yapıldı. Olguların 146’sında r-URS, 12’inde f-URS, dört olguda ise hem r-URS hem f-URS kullanıldı. R-URS olarak Storz 10 F, f-URS olarak Karl-Storz 7.5 F MVM uretero-fiberscope cihazları ile litotripsi için Swiss-Lithoclast pnömatik taş kırma cihazı, endopiyeloplasti için Storz endopiyelotomi makası ve balon kateter kullanıldı. Tanı amaçlı olarak 31 olguda 35 işlem yapıldı ve 25 işlemde (%71,4) patoloji tespit edildi. Bir olguda pelvis renalis tümörü, bir olguda üreter tümörü, dört olguda kalis taşı, 11 olguda nonopak üreter taşı, sekiz olguda üretero pelvik kavşak (UPK) stenozu tespit edildi. Tedavi amaçlı olarak değişik nedenler ile 148 olguda URS kullanıldı. 152 adet taş kırılarak hastalar taşsız olarak taburcu edildi. Distal üreter taşı tedavisinde URS ile %99’luk bir başarı elde edilirken orta üreter taşlarının tedavisinde %97, proksimal üreter taşlarının tedavisinde %73 kalis taşlarının tedavisinde %50 oranında başarı elde edildi. Üreter ve böbrek patolojilerinde tanı ve tedavi için rijid ve fleksibıl üreterorenoskopları başarı ve güven ile kullanılabilir.