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Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Preoperative imaging includes either an IVU or non-contrast CT scan. A nephroscope is inserted and the urologist may attempt to endoscopically grasp and remove smaller kidney stones directly. Larger stones are broken up with an ultrasonic or electrohydraulic probe, or a holmium laser lithotripter. The holmium laser has the advantage of being usable on all types of calculi. A catheter is placed to drain the urinary system through the bladder and a nephrostomy tube is placed in the incision in the back to carry fluid from the kidney into a drainage bag. The catheter is removed after 24 hours. The nephrostomy tube is usually removed while the patient is still in the hospital, but may be left in after the patient is discharged.
Concomitant Treatment of Ureteropelvic Junction Obstruction Complicated by Renal Calculi with Laparoscopic Pyeloplasty and Pyelolithotomy via 19.5F Rigid Nephroscope: A Report of 12 Cases
Published in Journal of Investigative Surgery, 2022
Lizhe An, Liulin Xiong, Liang Chen, Xiongjun Ye, Xiaobo Huang
The Toldt line was incised, then kidney and dilated renal pelvis were exposed. Dissociation of obstruction site and upper ureter was conducted, the kidney would be fully dissociated to allow the rigid nephroscopy to reach all calyces in some situations. For placement of the 19.5 F nephroscope, an 15 mm-long incision was performed on the anterior wall of renal pelvis, the incision was eventually incorporated into the final pyeloplasty incision. The cutting edge of the renal pelvis was held by one clamp introduced through Trocar C, to keep the collecting system distended, helping to gain a better space and visualization. Subsequently, the 19.5 F nephroscope (RICHARD WOLF GmbH, Knittlingen, Germany) with irrigation was introduced through Trocar B into the renal pelvis and a separate camera, monitor and light source were used. The bigger stones were extracted with endoscopic grasper or stone basket and were placed into the specimen retrieval bag which was removed out of abdominal cavity at the end of the procedure (Figure 2). For those multiple smaller stones (Figure 4), extraction via grasper or basket could be time consuming, standard ultrasonic probe was introduced through nephroscope to suction out stones. Sometimes stone was partly staghorn or too big to be extracted out through small incision, this kind of stone could be fragmented and suctioned out by standard ultrasonic probe, or could be fragmented by pneumatic lithotripsy and extracted by basket or grasper if the stone was extremely hard. During the procedure, the irrigation fluid in abdominal cavity was sucked off through assistant Trocar D. In the end, examination of kidney was conducted by laparoscopic ultrasound probe to find residual stones (Figure 3).
Modified tubeless minimally invasive percutaneous nephrolithotomy for management of renal stones in children: A single-centre experience
Published in Arab Journal of Urology, 2019
Ahmed Sebaey, Ashraf Abdelaal, Alaa Elshaer, Hisham Alazaby, Wael Kadeel, Tarek Soliman, Ehab Elbarky
Placement of an external 5-F ureteric stent below the renal pelvis after the mini-PCNL without a JJ stent, modified tubeless mini-PCNL would provide adequate drainage of the kidney and minimise postoperative discomfort without complications and the possibility of a second-look nephroscopy [6].