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Antegrade flexible ureteroscopy for bilateral ureteral stones in a patient with severe hip joint ankylosis.

Kim BS, Lee JN, Choi JY, Park YK, Kim TH - Korean J Urol (2010)

Bottom Line: In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval.Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy.This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT
In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.

No MeSH data available.


Related in: MedlinePlus

Postoperative plain film checked 2 weeks after the operation when both double-J stents were removed.
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Figure 4: Postoperative plain film checked 2 weeks after the operation when both double-J stents were removed.

Mentions: When the patient's condition became stable, we decided to perform elective surgical management to remove the bilateral ureteral stones rather than SWL because of the relatively large size of the stones. However, the patient could not be placed in the dorsal lithotomy or low lithotomy position to perform a retrograde ureteroscopy because of the severe hip joint ankylosis. In this situation, we decided to perform antegrade flexible ureteroscopy through a percutaneous trans-renal route to approach the ureteral stones. Before the start of the procedure, while the patient was under general anesthesia, the patient was placed in the prone position with appropriate padding and prepared and draped in a sterile fashion. A 0.035 inch guidewire was placed under fluoroscopic guidance through the nephrostomy tube. The tract was dilated by using coaxial telescopic dilators to 14 F and a second 0.035 inch safety guidewire was placed. A 12/14 F ureteral access sheath (Applied Medical, Rancho Santa Margarita, CA, USA) was placed to allow for optimal visualization and safe introduction of the flexible ureteroscope (Fig. 3). A 7.2 F flexible ureteroscope and a 200 µ laser fiber were used for lithotripsy. We used a holmium laser machine set at an energy of 1 J and a rate of 15 Hz. The fragmented stones were passed down to the bladder by irrigation and a flexible ureteroscope was advanced to the ureteral orifice to confirm that all stone fragments were removed from the ureter. Following lithotripsy, a double-J stent was placed through an antegrade route and the same procedure was performed on the contralateral side simultaneously. Stone fragments in the bladder were evacuated by manual bladder irrigation through a 20 F Foley catheter. The stones were composed of mixtures of calcium oxalate and calcium carbonate apatite. Both double-J stents were removed through the retrograde approach by using a flexible cystoscope 2 weeks after the procedure. No residual fragments were found in the postoperative study (Fig. 4).


Antegrade flexible ureteroscopy for bilateral ureteral stones in a patient with severe hip joint ankylosis.

Kim BS, Lee JN, Choi JY, Park YK, Kim TH - Korean J Urol (2010)

Postoperative plain film checked 2 weeks after the operation when both double-J stents were removed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2991580&req=5

Figure 4: Postoperative plain film checked 2 weeks after the operation when both double-J stents were removed.
Mentions: When the patient's condition became stable, we decided to perform elective surgical management to remove the bilateral ureteral stones rather than SWL because of the relatively large size of the stones. However, the patient could not be placed in the dorsal lithotomy or low lithotomy position to perform a retrograde ureteroscopy because of the severe hip joint ankylosis. In this situation, we decided to perform antegrade flexible ureteroscopy through a percutaneous trans-renal route to approach the ureteral stones. Before the start of the procedure, while the patient was under general anesthesia, the patient was placed in the prone position with appropriate padding and prepared and draped in a sterile fashion. A 0.035 inch guidewire was placed under fluoroscopic guidance through the nephrostomy tube. The tract was dilated by using coaxial telescopic dilators to 14 F and a second 0.035 inch safety guidewire was placed. A 12/14 F ureteral access sheath (Applied Medical, Rancho Santa Margarita, CA, USA) was placed to allow for optimal visualization and safe introduction of the flexible ureteroscope (Fig. 3). A 7.2 F flexible ureteroscope and a 200 µ laser fiber were used for lithotripsy. We used a holmium laser machine set at an energy of 1 J and a rate of 15 Hz. The fragmented stones were passed down to the bladder by irrigation and a flexible ureteroscope was advanced to the ureteral orifice to confirm that all stone fragments were removed from the ureter. Following lithotripsy, a double-J stent was placed through an antegrade route and the same procedure was performed on the contralateral side simultaneously. Stone fragments in the bladder were evacuated by manual bladder irrigation through a 20 F Foley catheter. The stones were composed of mixtures of calcium oxalate and calcium carbonate apatite. Both double-J stents were removed through the retrograde approach by using a flexible cystoscope 2 weeks after the procedure. No residual fragments were found in the postoperative study (Fig. 4).

Bottom Line: In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval.Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy.This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT
In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.

No MeSH data available.


Related in: MedlinePlus