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Analgesia-free flexible ureteroscopic treatment and laser lithotripsy for removal of a large urinary stone: a case report.

Wilhelm K, Frankenschmidt A, Miernik A - J Med Case Rep (2015)

Bottom Line: No analgesia is needed with this procedure and it can be performed in an out-patient setting.The described clinical case highlights the difficulties of treating this high-incidence problem in patients with continent urinary diversions.Our presented technique is of particular interest to urologists and family doctors, and could improve the treatment of such patients by lowering the morbidity of the intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Medical Center, Hugstetterstr. 55, D-79106, Freiburg, Germany. Konrad.wilhelm@uniklinik-freiburg.de.

ABSTRACT

Introduction: Urinary stone formation is a frequent complication after continent urinary tract diversion and can require complex surgical management. Therapy options include open, percutaneous, transurethral, or transstomal stone fragmentation and extraction. The transstomal approach is considered to be one of the more complex treatment modalities. The patient's individual anatomy, minor stoma diameter, and the existing continence mechanism in the majority of cases cause substantial technical challenges for the surgeon. We present here what we believe to be the first description of an analgesia-free flexible endoscopic removal of a large pouch stone in an out-patient care setting. Additionally, we provide a brief overview of competing techniques.

Case presentation: A 30-year-old Caucasian woman with a history of lower urinary tract reconstruction with an ileal pouch and a continent umbilical stoma was admitted to our department with pouch urolithiasis in the urinary reservoir. We employed a minimally invasive approach to extract the stone using flexible ureteroscopy via a modified access sheath and laser lithotripsy. No analgesia is needed with this procedure and it can be performed in an out-patient setting.

Conclusion: The described clinical case highlights the difficulties of treating this high-incidence problem in patients with continent urinary diversions. Our presented technique is of particular interest to urologists and family doctors, and could improve the treatment of such patients by lowering the morbidity of the intervention.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view demonstrating the instruments used for transstomal stone lithotripsy showing a modified ureteral access sheath (a) and a conventional flexible ureteroscope (b)
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Fig2: Intraoperative view demonstrating the instruments used for transstomal stone lithotripsy showing a modified ureteral access sheath (a) and a conventional flexible ureteroscope (b)

Mentions: The treatment was performed with our patient in the supine position without general or local anesthetics. Her paraumbilical region was disinfected and covered with sterile surgical draping. The MS was lubricated and a hydrophilic guide wire inserted. For stoma protection against extensive endoscopic manipulation, a standard 12/14F ureteral access sheath (UAS) was shortened to 15cm length and gently placed over the wire. After insertion of the flexible ureteroscope, calculus disintegration was performed using a holmium laser system with thin fibers (274μm) in dusting mode (0.6J, 15Hz, short pulse length). Larger fragments were removed using an NGage open-tip extractor (Cook Medical, Bloomington, IN, USA). The remaining material was washed out using a 10F catheter attached to a 50ml syringe. Potential laser-related lesions and/or rest fragments were excluded by endoscopy (Figs. 2 and 3). After removal of the UAS, a standard latex 14F urethral catheter was inserted using a guide wire, and left in situ for 4 days.Fig. 2


Analgesia-free flexible ureteroscopic treatment and laser lithotripsy for removal of a large urinary stone: a case report.

Wilhelm K, Frankenschmidt A, Miernik A - J Med Case Rep (2015)

Intraoperative view demonstrating the instruments used for transstomal stone lithotripsy showing a modified ureteral access sheath (a) and a conventional flexible ureteroscope (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4592559&req=5

Fig2: Intraoperative view demonstrating the instruments used for transstomal stone lithotripsy showing a modified ureteral access sheath (a) and a conventional flexible ureteroscope (b)
Mentions: The treatment was performed with our patient in the supine position without general or local anesthetics. Her paraumbilical region was disinfected and covered with sterile surgical draping. The MS was lubricated and a hydrophilic guide wire inserted. For stoma protection against extensive endoscopic manipulation, a standard 12/14F ureteral access sheath (UAS) was shortened to 15cm length and gently placed over the wire. After insertion of the flexible ureteroscope, calculus disintegration was performed using a holmium laser system with thin fibers (274μm) in dusting mode (0.6J, 15Hz, short pulse length). Larger fragments were removed using an NGage open-tip extractor (Cook Medical, Bloomington, IN, USA). The remaining material was washed out using a 10F catheter attached to a 50ml syringe. Potential laser-related lesions and/or rest fragments were excluded by endoscopy (Figs. 2 and 3). After removal of the UAS, a standard latex 14F urethral catheter was inserted using a guide wire, and left in situ for 4 days.Fig. 2

Bottom Line: No analgesia is needed with this procedure and it can be performed in an out-patient setting.The described clinical case highlights the difficulties of treating this high-incidence problem in patients with continent urinary diversions.Our presented technique is of particular interest to urologists and family doctors, and could improve the treatment of such patients by lowering the morbidity of the intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Medical Center, Hugstetterstr. 55, D-79106, Freiburg, Germany. Konrad.wilhelm@uniklinik-freiburg.de.

ABSTRACT

Introduction: Urinary stone formation is a frequent complication after continent urinary tract diversion and can require complex surgical management. Therapy options include open, percutaneous, transurethral, or transstomal stone fragmentation and extraction. The transstomal approach is considered to be one of the more complex treatment modalities. The patient's individual anatomy, minor stoma diameter, and the existing continence mechanism in the majority of cases cause substantial technical challenges for the surgeon. We present here what we believe to be the first description of an analgesia-free flexible endoscopic removal of a large pouch stone in an out-patient care setting. Additionally, we provide a brief overview of competing techniques.

Case presentation: A 30-year-old Caucasian woman with a history of lower urinary tract reconstruction with an ileal pouch and a continent umbilical stoma was admitted to our department with pouch urolithiasis in the urinary reservoir. We employed a minimally invasive approach to extract the stone using flexible ureteroscopy via a modified access sheath and laser lithotripsy. No analgesia is needed with this procedure and it can be performed in an out-patient setting.

Conclusion: The described clinical case highlights the difficulties of treating this high-incidence problem in patients with continent urinary diversions. Our presented technique is of particular interest to urologists and family doctors, and could improve the treatment of such patients by lowering the morbidity of the intervention.

No MeSH data available.


Related in: MedlinePlus