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Interventional radiology
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
A double-J stent can be placed in the ureter by advancing it over a guidewire with a pusher catheter. A protective nephrostomy tube is probably not necessary unless there is significant bleeding. Occasionally, transurethral removal of a double-J stent is difficult, for example when the lower end of the stent migrates up into the ureter. The stent can then be snared and removed percutaneously, after puncture of the pelvicalyceal system.
Endometriosis
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ceana Nezhat, Pavan Ananth, Dahlia Admon
In rare instances, patients present with acute-onset pain. Deprest et al. describe a case in which a 46-year-old patient with a history of severe endometriosis and left oophorectomy developed an acute abdomen 6 months after maintenance progestin therapy was discontinued [17]. MRI showed a hemorrhagic lesion at the site of obstruction. A double-J stent was placed and progestin therapy was resumed, and the patient's symptoms resolved [17].
Sigmoidoscopy, cystoscopy, and stenting
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Louis J. Vitone, Peter A. Davis, David J. Corless
The instrumentation and stenting of ureters should only be performed by clinicians such as urologists or gynecologic oncologists, since it is easy to damage the ureteric orifices and ureters. Ureteric catheterization and the placement of double J stents are achieved with the 30° telescope. There is a special port for the introduction of the stents, which can be directed toward the ureteric orifices. A floppy-tipped, Teflon-coated guide wire is first placed into the ureteric orifice and advanced under fluoroscopic control into the renal pelvis. The double J stent is slid over the guidewire through the channel of the cystoscope and into the ureter (Figure 6.9). The stent is radio-opaque and its position is monitored by fluoroscopic control. Excessive force used in insertion of the guidewire or stent should be avoided. The proximal and distal ends curl to form a J shape when they are correctly placed in the renal pelvis and bladder, respectively.
Donor kidney lithiasis and back-table endoscopy: a successful combination
Published in Acta Chirurgica Belgica, 2023
Michaël M. E. L. Henderickx, Joyce Baard, Pauline C. Wesselman van Helmond, Ilaria Jansen, Guido M. Kamphuis
Pushkar et al. described 14 cases with back-table endoscopic stone treatment. All were living donors with unilateral, asymptomatic nephrolithiasis between four and ten millimeters who underwent standard donor screening and therefore are comparable with this case [4]. They put the donor kidney on the ice during the back-table treatment. The authors first spatulated the ureter and started the procedure with a semi-rigid URS. They only used a flexible URS if necessary. When the kidney stone was found, they relocated it to the pyelum with a basket or forceps and extracted it via a pyelotomy. Only if a pyelotomy was not feasible, they would use a laser to fragment the stone and extract the pieces through the ureter [4]. Mean operation time in their series was 28 min. A double-J stent was placed for four weeks. The stone-free rate was 93% and no major complications (modified Clavien-Dindo classification ≥3) were recorded [4].
Clinical Features of Endogenous Endophthalmitis Secondary to Minimally Invasive Upper Urinary Tract Calculus Removal
Published in Ocular Immunology and Inflammation, 2022
Bingsheng Lou, Yi Sun, Jialiu Lin, Zhaohui Yuan, Liwen He, Chongde Long, Xiaofeng Lin
ESWL, URL and MPCNL are the minimally invasive procedures to manage urinary calculi. However, complications such as bacteriuria, bacteremia, urinary tract infection, urosepsis, endocarditis and EE still can occur.14,15 The plausible reasons for the EE complication are listed as follows. First, predisposing conditions are important in evaluating patients’ risk. Among the predisposing medical condition assessed in our study, diabetes mellitus, which was found in 7 patients (58%), was the most common condition associated with EE. A number of studies have reported similar findings.16–18 A possible explanation is the dysfunction of blood-retinal barrier permeability caused by diabetes, especially for those with poorly controlled glucose levels. Moreover, elevated urine glucose levels also contribute to the growth of microorganisms. Diabetes has also been reported to be an underlying disease in patients with urinary tract infection due to C. albicans,19 which may probably lead to EE. Second, before crushing stones, occult lower urinary tract latent infections may exist in some patients. Mechanical trauma to the ureter during urological procedures may also be encountered. The regressive ureteral catheter will transfer the microorganisms into the upper urinary tract, and the elevated pressure in the renal pelvis is likely to cause sepsis.10 Third, the double-J stent, which is indwelled postoperatively to drain urine and prevent ureterostenosis for 2 to 4 weeks, may be also a potential risk factor because the procedure and subsequent stent removal may damage urinary mucosa.
Robotic correction of iatrogenic ureteral stricture: preliminary experience from a tertiary referral centre
Published in Scandinavian Journal of Urology, 2019
L. Masieri, S. Sforza, F. Di Maida, Antonio Andrea Grosso, A. Mari, Emma Maria Rosi, R. Tellini, M. Carini, A. Minervini
Patients were treated with three different robot-assisted techniques according to the level of the stenosis as previously described: Anderson-Hynes pyeloplasty for uteropelvic junction obstruction (UPJO), partial ureterectomy with end-to-end anastomosis and ureteral reimplantation for distal ureteral strictures [16–18]. The Da Vinci Si system was used in all the cases (Intuitive Surgical, Sunnyvale, CA, USA) with a transperitoneal approach. The pneumoperitoneum was induced using a standard mini-open access according to Hasson technique and, when feasible, robotic trocars were placed corresponding to previous scars. The ureter was spatulated in all of these surgeries to reduce the risk of restenosis. After these reconstructive procedures, a bladder catheter and drainage were left in place. The double J stent was removed ∼4 weeks after surgery in the outpatient department.