Skip to main content
SpringerLink
Log in

Technische Innovationen in der endoskopischen Steintherapie

Technical innovations in endourological stone therapy

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die endoskopische Steintherapie unterliegt einer rasanten technischen Entwicklung. Im Bereich der Ureterorenoskopie haben flexible Ureterorenoskope mit einer Flexion von 270° den Zugang zum gesamten Harntrakt inklusive der unteren Kelchgruppen ermöglicht. In früherer Zeit noch mit dem Makel hoher Reparaturkosten behaftet, weisen die flexiblen Ureterorenoskope der neueren Generation eine deutlich bessere Haltbarkeit und eine geringere Reparaturanfälligkeit als die Instrumente der Vorgängergenerationen auf. Die Verbesserung und Weiterentwicklung von Zusatzgeräten wie den Access Sheaths vereinfacht die Eingriffe, reduziert Komplikationen und erhöht die Steinfreiheitsrate. Ähnliches zeichnet sich auch bei der perkutanen Nephrolitholapaxie ab. Auch hier geht der Trend hin zu miniaturisierten Instrumenten wie zum Beispiel bei der Mini-PCNL. Dabei werden vor allen Dingen in Kombination mit der tubeless PCNL, also dem Verzicht auf die postoperative Einlage einer Nephrostomie und dem Verschluss des Arbeitskanals mittels Gewebekleber, bei gleicher Erfolgsrate geringere Komplikationen und eine verkürzte Hospitalisation erreicht.

Abstract

Endoscopic stone management is a field of consistent technical innovation. For ureterorenoscopy, flexible scopes capable of 270° deflection have allowed access to the complete urinary tract, including the lower-pole renal calculi. To counter the flaw of high repair costs, new-generation flexible ureterorenoscopes feature significantly greater durability and a less frequent need for repair. The development and improvement of auxiliary instruments such as access sheaths has facilitated the procedures, reduced complications, and improved the stone-free rates. A similar trend is seen for percutaneous nephrolitholapaxy (PCNL). Development is directed at miniaturised instruments such as the mini-PCNL. Especially in combination with a tubeless procedure in which a routine nephrostomy after PCNL is omitted and the nephrostomy tract is closed using hemostyptic sealant, similar success rates are achieved, with fewer complications and shorter hospital stays.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Afane JS, Olweny EO, Bercowsky E et al. (2000) Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr. J Urol 164: 1164–1168

    Article  PubMed  CAS  Google Scholar 

  2. Auge BK, Pietrow PK, Lallas CD et al. (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18: 33–36

    Article  PubMed  Google Scholar 

  3. Chow GK, Patterson DE, Blute ML, Segura JW (2003) Ureteroscopy: effect of technology and technique on clinical practice. J Urol 170: 99–102

    Article  PubMed  Google Scholar 

  4. Desai MR, Kukreja RA, Desai MM et al. (2004) A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol 172: 565–567

    Article  PubMed  Google Scholar 

  5. Giusti G, Piccinelli A, Taverna G et al. (2007) Miniperc? No, thank you! Eur Urol 51: 810–814

    Article  PubMed  Google Scholar 

  6. Humphreys MR, Miller NL, Williams JC Jr et al. (2008) A new world revealed: early experience with digital ureteroscopy. J Urol 18: 18

    Google Scholar 

  7. Jackman SV, Hedican SP, Peters CA, Docimo SG (1998) Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 52: 697–701

    Article  PubMed  CAS  Google Scholar 

  8. Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165: 789–793

    Article  PubMed  CAS  Google Scholar 

  9. L’Esperance JO, Ekeruo WO, Scales CD Jr et al. (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66: 252–255

    Article  Google Scholar 

  10. Lahme S, Bichler KH, Strohmaier WL, Gotz T (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40: 619–624

    Article  PubMed  CAS  Google Scholar 

  11. McDougall EM, Alberts G, Deal KJ, Nagy JM 3rd (2001) Does the cleaning technique influence the durability of the <9F flexible ureteroscope? J Endourol 15: 615–618

    Article  PubMed  CAS  Google Scholar 

  12. Michel MS, Honeck P, Alken P (in press) Conventional high pressure vs. newly developed continuous-flow ureterorenoscope: urodynamic pressure evaluation of the renal pelvis and flow capacity. J Endourol

  13. Michel MS, Knoll T, Ptaschnyk T et al. (2002) Flexible ureterorenoscopy for the treatment of lower pole calyx stones: influence of different lithotripsy probes and stone extraction tools on scope deflection and irrigation flow. Eur Urol 41: 312–316; discussion 316–317

    Article  PubMed  Google Scholar 

  14. Nagele U, Horstmann M, Hennenlotter J et al. (2006) Size does matter: 1.5 Fr. stone baskets almost double irrigation flow during flexible ureteroscopy compared to 1.9 Fr. stone baskets. Urol Res 34: 389–392

    Article  PubMed  Google Scholar 

  15. Nagele U, Horstmann M, Sievert KD et al. (2007) A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy: an in-vitro pressure-measurement and microscopic study. J Endourol 21: 1113–1116

    Article  PubMed  Google Scholar 

  16. Rana AM, Mithani S (2007) Tubeless percutaneous nephrolithotomy: call of the day. J Endourol 21: 169–172

    Article  PubMed  Google Scholar 

  17. Rehman J, Monga M, Landman J et al. (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61: 713–718

    Article  PubMed  Google Scholar 

  18. Shah HN, Hegde S, Shah JN et al. (2006) A prospective, randomized trial evaluating the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. J Urol 176: 2488–2492

    Article  PubMed  CAS  Google Scholar 

  19. Shah HN, Kausik VB, Hegde SS et al. (2005) Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports. BJU Int 96: 879–883

    Article  PubMed  Google Scholar 

  20. Stern JM, Yiee J, Park S (2007) Safety and efficacy of ureteral access sheaths. J Endourol 21: 119–123

    Article  PubMed  Google Scholar 

  21. Sung YM, Choo SW, Jeon SS et al. (2006) The“mini-perc” technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath: 3-year results in 72 patients. Korean J Radiol 7: 50–56

    Article  PubMed  Google Scholar 

  22. Tefekli A, Altunrende F, Tepeler K et al. (2007) Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. Int Urol Nephrol 39: 57–63; Epub 2006 Dec 2014

    Article  PubMed  Google Scholar 

  23. Traxer O, Dubosq F, Jamali K et al. (2006) New-generation flexible ureterorenoscopes are more durable than previous ones. Urology 68: 276–279; discussion 280–281

    Article  PubMed  Google Scholar 

  24. Uribe CA, Eichel L, Khonsari S et al. (2005) What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol 19: 312–317

    Article  PubMed  Google Scholar 

  25. Wendt-Nordahl G, Trojan L, Alken P et al. (2007) Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol 21: 1439–1444

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Urologische Universitätsklinik Mannheim, Theodor-Kutzer-Ufer 1–3, 68135, Mannheim, Deutschland

    P. Honeck & M.S. Michel

  2. Urologische Klinik, Universitätsklinik Tübingen, Tübingen, Deutschland

    U. Nagele

Authors
  1. P. Honeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Nagele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M.S. Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Honeck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Honeck, P., Nagele, U. & Michel, M. Technische Innovationen in der endoskopischen Steintherapie. Urologe 47, 587–590 (2008). https://doi.org/10.1007/s00120-008-1735-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-008-1735-0

Schlüsselwörter

Keywords

Search

Navigation