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Urolithiasis pp 473-480 | Cite as

Tricks for Successful Ureteroscopy

  • Zhong WuEmail author
  • Chen-Chen Feng
Chapter

Abstract

Ureteral calculus is a common condition in urological practice. Ureteroscopic laser lithotripsy is currently widely used as the first-line therapy for stones reaching indicated size. Successful lithotripsy needs not only adept maneuver techniques but swift decision making as well. In this chapter, the author shares his experience with some of the tricks that could help fresh practitioners manage ureteroscopy faster and with fewer complications. As choice of correct equipment is crucial, this chapter lists the various ureteroscopes, guidewires, and ureteral access sheaths that are helpful in difficult cases. Then, the tips for gaining access into the ureteral orifice with a semirigid ureteroscope are delineated, as these are maneuvers to guarantee safe practice whenever resistance is encountered during passage of the ureteroscope. Lithotripsy is then described in detail to ensure maximum clearance at the first attempt. Furthermore, step-by-step maneuvers of flexible ureteroscopy are described, as these instruments are increasingly used in the minimally invasive therapy for stones in the renal pelvis and calyx. Finally, decisions on stent placement are discussed based on experience of the author’s, as well as other, institutes.

Keywords

Ureteroscopy Ureteroscope Ureteral calculi Renal calculi Lithotripsy Laser Stone occlusion Stone retropulsion Guidewire Ureteral stent 

Supplementary material

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References

  1. 1.
    Wu JP. Wujieping urology. 1st ed. Jinan: Shandong Science and Technology Press; 2004. p. 743.Google Scholar
  2. 2.
    Jiang H, Wu Z, Ding Q. Ureteroscopy and holmium: YAG laser lithotripsy as emergency treatment for acute renal failure caused by impacted ureteral calculi. Urology. 2008;72(3):504–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Shvarts O, Perry KT, Goff B, Schulam PG. Improved functional deflection with a dual-deflection flexible ureteroscope. J Endourol. 2004;18(2):141–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Ankem MK, Lowry PS, Slovick RW, Munoz del Rio A, Nakada SY. Clinical utility of dual active deflection flexible ureteroscope during upper tract ureteropyeloscopy. Urology. 2004;64(3):430–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Jiang H, Wu Z, Ding Q, Zhang Y. Ureteroscopic treatment of ureteral calculi with holmium: YAG laser lithotripsy. J Endourol. 2007;21(2):151–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Feng C, Ding Q, Jiang H, Gao P, Wen H, Gu B, et al. Use of NTrap during ureteroscopic holmium: YAG laser lithotripsy of upper ureteral calculi. Minim Invasive Ther Allied Technol. 2012;21(2):78–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Binbay M, Tepeler A, Singh A, Akman T, Tekinaslan E, Sarilar O, et al. Evaluation of pneumatic versus holmium: YAG laser lithotripsy for impacted ureteral stones. Int Urol Nephrol. 2011;43(4):989–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Denstedt JD, Zheng W. Intracorporeal lithotripsy. Update on technology. Urol Clin North Am. 2000;27:301–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Wu Z, Feng C, Ding Q, Jiang H, Zhang Y. Ureteroscopic holmium: YAG laser endopyelotomy is effective in distinctive ureteropelvic junction obstructions. Videosurg Other Miniinvasive Tech. 2011;6(3):144–9. doi: 10.5114/wiitm.2011.24692.CrossRefGoogle Scholar
  10. 10.
    Farahat YA, Elbahnasy AE, Elashry OM. A randomized prospective controlled study for assessment of different ureteral occlusion devices in prevention of stone migration during pneumatic lithotripsy. Urology. 2011;77(1):30–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Dickstein RJ, Kreshover JE, Babayan RK, Wang DS. Is a safety wire necessary during routine flexible ureteroscopy? J Endourol. 2010;24(10):1589–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Clayman RV, Elbers J, Miller RP, Williamson J, McKeel D, Wassynger W. Percutaneous nephrostomy: assessment of renal damage associated with semi-rigid (24 F) and balloon (36 F) dilation. J Urol. 1987;138(1):203–6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Department of UrologyHuashan Hospital, Fudan UniversityShanghaiPeople’s Republic of China

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