View WOC from NURSING at Airlangga University. Makalah Neurogenic ; Airlangga University; NURSING – Summer. Looking for Documents about Makalah Urolithiasis? Makalah Dan Asuhan Keperawatan UROLITHIASISmakalah pbl 20 urolithiasis-kasus Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial.

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If this is unsuccessful, one can consider using a stiff wire, rather than the standard guide wire, to aid sheath makalha. Which ureteral access sheath is compatible with your flexible ureteroscope? In this paper we provide a summary of placing ureteric access sheath, flexible ureteroscopy, intra renal stone fragmentation and retrieval, maintaining visual clarity and biopsy of ureteric and urolithiasiw tumours.

These can migrate into the ureter and be tricky to reposition. Correct adjustment of these factors aids vision and results in successfully completed procedures.

If one pulls back on the device, the graspers may slip and offer a degraded specimen.


In addition, the presence of an access sheath will result in lower intra-renal pressure, and allow better irrigation, both of which are valuable in cases of TCC, which, unlike stones, bleed with compromised views under low irrigation flow rates. Published online Nov Once tumor specimens are taken and still in the grasper, consider pushing the biopsy device forward to gently avulse the biopsy.

When initially placing the ureteroscope, we would advocate having it free of all attachments irrigation channel, light and camera leadsenabling smoother passage. The second technique utilises single use biopsy devices. Of course, it is important not to leave the distal end too short! Some newer access sheaths enable a single wire to be used for placement and results in the wire being situated outside the sheath after placement [ 4 ].

If considering leaving a stent, good preoperative counselling of the patient is vital.


Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy

Improved optical characteristics translate to improved clinical outcomes with significant improvements in mean operative time, flexible ureterorenoscopy time and efficiency of stone fragmentation [ 89 ]. The interpole, not well seen on the images 3a-c is filled with contrast via the scope to confirm it has been visualised. By pulling back the wire slightly under fluoroscopy monitoring the renal endthe stent can then be advanced.

Reusable laser fibres can result in small microfractures, which then contribute to flexible ureterorenoscope damage. We do not advocate the use of ureteric balloons to dilate the ureter to aid sheath placement nor the use of other ureteric dilators.

Then, try repeating access sheath placement with both the sheath and inner component.

One can consider using a double-tipped hydrophilic wire, thereby irolithiasis damage to the fragile working channel of the flexible ureteroscope.

It is best to visualise and ensure its position in the bladder before sending the patient to recovery — if there is any doubt from the final fluoroscopic image, it is best to be sure by passing the cystoscope and having a look! When the procedure is completed, withdraw the ureteroscope and access sheath together with the tip of the ureteroscope placed just at the end of the sheath, watching the ureteric mucosa move past.

Change tack, pass the flexible scope over the stone wire and perform your flexible ureteroscopy without a sheath see below or simply stent the patient and come back another day. If this should occur, gradual step-wise withdrawal of the wire, under close fluoroscopic control, is needed to straighten the wire, and then retry the insertion with particular attention to the sheath crossing the ureteric orifice and lowermost ureter see Figure 1.

Do ureteric stent extraction strings affect stent-related quality of uroltihiasis or complications after ureteroscopy for urolithiasis: We advocate performing an initial semi-rigid ureteroscopy before placement of the access sheath. Corresponding author Bhaskar K. The scope is placed in the next calyces down, in the lateral part malalah the lower pole. This makaalh has been cited by other articles in PMC.


Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy

The access sheath has been withdrawn to the urethra. Ureteric and renal tumors Diagnostic ureterorenoscopy and biopsy has been recommended for cases of upper tract tumors [ 310 ]. Maintaining the scope straight as the uroltihiasis fibre is passed reduces the risk of working channel damage, avoiding costly repairs.

The working guide wire has been withdrawn slightly, such that the coiled loop is of smaller diameter.

Wire problems in bladder for access sheath insertion. Once the lower third has been successfully traversed, the image intensifier can be moved to the proximal ureter to allow makalag positioning of the tip of the sheath in the upper ureter.

Makalah Urolithiasis Documents –

Consider the use of a ureteric catheter or tethered stent if feasible, for short-term drainage. Simple hand held pump urloithiasis can be used and will help increase irrigant flow. Finally, regardless of the circumstances leading to stent placement, it is important to ensure that an appropriate postoperative plan is in place to track and remove the stent.

The stone has been identified in the lower pole, and is grasped in a basket to prepare for relocation. They urolitthiasis best used judiciously as they transiently increase intra-renal pressure. Patients will need to be aware that they might have some pain or discomfort postoperatively.

The stone has been successfully broken into small pieces.