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Urinary Symptoms and Investigations
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Ureteroscopy can be performed as both a diagnostic procedure and a therapeutic procedure. A rigid or semi-rigid ure- teroscope can be used in the ureter as far as the renal pelvis but to inspect or operate on the renal pelvis or renal calyces, a flexible ureteroscope is, generally, needed (Figure75.14) . The procedure is most often performed when pathology, commonly stones, strictures or tumours of the ureter, is suspected. The insertion of each of these instruments is facilitated by the use of a guidewire in the ureter and in most cases the ureter is best first outlined with radio-opaque contrast material using an image intensifier.
Urology
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Ureteroscopy via the transurethral route allows an alternative approach to investigate ureteric disease and undertake treatments. The scope is passed transurethrally and navigated into the ureter. It may be used to inspect and biopsy the ureter as well as remove smaller distal stones and place ureteric stents. Patients should have renal function evaluated prior to the procedure.
Infectious Complications of Urologic Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Marc A. Dall’Era, Thomas J. Walsh, John N. Krieger
Ureteroscopy often represents the first-line approach for treating renal and ureteral calculi, as well as diagnosis and treatment of upper tract urothelial tumors. Thus, ureteroscopy has become one of the most common “same day” urologic procedures. In contrast to cystoscopy and other transurethral procedures, there are remarkably few data on the infectious complications of ureteroscopy. Following ureteroscopy, reported UTI rates range from 3.9% to 25%, and use of routine, perioperative, prophylactic antimicrobials is virtually ubiquitous.
Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques
Published in Arab Journal of Urology, 2020
Tarek K. Fathelbab, Amr M. Abdelhamid, Ahmed Z.M. Anwar, Ehab M. Galal, Mamdouh M. El-Hawy, Ahmed H. Abdelgawad, Ehab R. Tawfiek
It is known that the Stone Cone specifically acts as a ‘backstop’ and cannot be used for stone removal. Therefore, fragments of <3 mm may escape and this could explain the higher frequency of stone fragments in Group 1 of our present study. The majority of complications during ureteroscopy are minor with reported rates of 0–15.4% [17]. Ureteric perforation and avulsion are major concerns that should be avoided. In the present study, there was minor mucosal abrasion in nine (12.5%) cases in Group 1 and 12 (13.9%) in Group 2, with no reported major ureteric injuries, documented by retrograde pyelography performed at the end of the manoeuvre. Shabana et al. [16] reported overall ureteric injuries in 9.2% of cases with ureteric perforation occurring in six (1.4%). Conversely, Desai et al. [18] observed minor mucosal abrasion in five (10%) cases, with no major complications.
Is there still a role of balloon dilatation of benign ureteric strictures in 2019?
Published in Scandinavian Journal of Urology, 2020
Wai Loon Yam, Sey Kiat Terence Lim, Keng Sin Ng, Foo Cheong Ng
Our study has several limitations in view of the retrospective/observational nature. The mean stricture length is 11.0 mm for all the patients. This could be due to selection bias where only short strictures are offered balloon dilatation. However, we further analyze that causes of strictures and incidental/non incidental stricture do add to prognosticate the outcome of balloon dilatation in this cohort of short strictures. Secondly, the procedures are performed by a heterogenous group of urologists and interventional radiologists. Furthermore, many of the strictures are encountered only during ureteroscopy and not found on preoperative imaging. Therefore, there is no functional scan performed to assess the severity of obstruction. We recognize that further standardization of technique, size of DJ stent, duration of DJ stent and post-operative follow-up imaging will also help address our limitations.
Relation of postoperative pain medication to return for unplanned care after ureteroscopy
Published in Baylor University Medical Center Proceedings, 2019
Preston A. Milburn, Kim H. Thai, Amr El Mekresh, Patrick S. Lowry, Marawan M. El Tayeb
Pain after ureteroscopy is very common and is often quite distressing for patients. The etiology of such pain is multifactorial and includes spasms of the ureter, stent discomfort, and bladder spasms. Most patients experience lower urinary tract symptoms, and this leads to a demonstrable decrease in quality of life.1,2 As a result, patients are prescribed multiple medications to diminish these symptoms. Many studies have sought to determine the ideal combination to reduce stent discomfort, but most regimens at the authors’ institution include narcotic pain medication.1,3–11 The type of narcotic prescribed depends on surgeon preference; our goal was to determine whether the choice of pain control influenced patients’ return rate for unplanned care.