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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Be aware that these wires can cause intra-renal bleeding if forced too hard or pushed through the urothelium. 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 pelvicalyceal tumours.

When the laser fibre is inserted, ensure that the ureterorenoscope is straight in a non-deflected, neutral position — one of the advantages of having an additional wire in the kidney is maintaining a straight ureterorenoscope. This will also reduce torque and pressure on the flexible scope. National Center for Biotechnology InformationU. They are best used judiciously as they transiently increase intra-renal pressure.

If the stent is not moving, use fluoroscopy to check the wire placement in the collecting system. As with most forms of surgery, meticulous preoperative planning will lead to a more successful outcome.

Makalah Urolithiasis Documents –

They facilitate multiple passages of the ureterorenoscope, reduce intra-renal pressure and help improve irrigation flow [ 1 ]. When initially placing the ureteroscope, we would advocate having it free of all attachments irrigation channel, mkaalah and camera leadsenabling smoother passage.

This reduces the chance of mucosal trauma, therefore reducing the risk of unnecessary biopsy. It is best to visualise and ensure its position in the bladder before sending the patient makalab 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!

The aim is to keep the ureteroscope as straight as possible while fragmenting, reducing the risk of damage to the flexible ureterorenoscope see Figure 3.


,akalah review our privacy policy. Improved optical characteristics translate to improved clinical outcomes with significant improvements in mean operative time, flexible ureterorenoscopy time and efficiency of stone fragmentation [ 89 ].


Problems might arise with guide wire placement, but hopefully the tips discussed earlier will aid this. The decision to leave a safety wire outside an access sheath is one of personal preference.

Vision is key to achieving good fragmentation and stone-free rates, particularly in the kidney. Although these might be an option in very particular circumstances, in most cases involving an unfavourable ureter, it urloithiasis usually preferable to place a stent and return for the definitive operation at a later date The decision to leave a safety wire outside an access sheath is one of personal preference.

Correct adjustment of these factors aids vision and results in successfully completed procedures.

By pulling back the wire slightly under fluoroscopy monitoring the renal endthe stent can then be advanced. The access sheath has been withdrawn to the urethra.

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

With minor bleeding, increasing the irrigation for a few minutes may help improve the view. Azi Samsudin 11 St. Then, try repeating access sheath placement with both the sheath and inner component.

Copyright by Polish Urological Association. The ureterorenoscope is deflected into the lower medial calyx. Once the access sheath of the desired size and length has been chosen, pass kakalah sheath over the guidewire using the Seldinger technique. Any ureteric injury can then be noted and stented accordingly. Irrigant flow and intrarenal pressure during flexible ureteroscopy: Ensure that the wire does not kink, hrolithiasis coil in the bladder, which will make advancement of the sheath impossible.

The sheath passage should be monitored with pulsed fluoroscopy during ureteric passage, preventing possible buckling in the bladder or to identify early resistance and failure to progress. This article has been cited by other articles in PMC. Despite the majority of cases being relatively straightforward, many potential confounding factors can affect the success rates of these procedures. A straight safety wire is present, but the working wire, over which the access sheath is being passed, is substantially coiled in the bladder.


If this is unsuccessful, one can consider using a stiff wire, rather than the standard guide wire, to aid sheath placement. Ureteral stenting and urinary stone management: Selective urine cytology is an important aspect of this procedure. Somani2 Jake Patterson3 Ben R. Is a safety wire necessary during routine flexible ureteroscopy?

Placing a ureteric access sheath The use of ureteric access sheaths prior to flexible ureterorenoscopy can be both a surgical preference and case-specific. A pre-instrumented ureteric sample is preferable.

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

It pays to be careful when avulsing tissue as perforation of the collecting system may occur. If you are still unable to place the sheath, discretion is much better than valour. If one tries to envisage the potential problems preoperatively, appropriate solutions can be considered beforehand. The upper middle calyx will be visualised where the safety wire is located as the scope is moved to the upper lateral calyx.

The stone has been successfully broken into small pieces. 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 ].

The second technique utilises single use biopsy devices. The use of routine makalzh sheaths for biopsies and laser fragmentation of tumours urolithiasiz discouraged, as any minor trauma of the ureter may theoretically result in tumor seeding, but this might be necessary in selected cases where multiple passes need to be made for biopsy from the pelvicalyceal system.

Diagnostic ureterorenoscopy and biopsy has been recommended for cases of upper tract tumors [ 310 ]. Basket relocation of lower pole stone.