By David S. Chou MD, Elspeth M. McDougall MD, FRCSC (auth.), Stephen Y. Nakada MD, Margaret S. Pearle MD, PhD (eds.)
Although such a lot scientific urologists use numerous simple endourological options of their practices, the advanced top tract pathology and anatomy usually calls for extra complex endoscopic talents and instrumentation. In complicated Endourology: the full scientific advisor, prime nationwide and overseas urologists within the box of endourology describe average and complicated endoscopic methods for treating top tract pathology. The authors supply step by step directions for the most recent endoscopic strategies, starting from top urinary tract calculi and strictures to urothelial melanoma.
Authoritative and hugely instructive, complex Endourology: the full scientific consultant deals lively urologists and urology citizens not just a finished, illustrated advisor to endourological procedures-particularly the extra complicated techniques-but additionally a pragmatic capacity to extend the variety and scope of the strategies they perform.
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Extra info for Advanced Endourology: The Complete Clinical Guide
The 8-Fr dilator has been removed and the stent is being advanced over the guidewire into the 10-Fr sheath. The 10-Fr sheath acts as a conduit to prevent buckling of the stent in the urethra, bladder, or ureter. Tension must be placed on the guidewire while the stent is advanced. guidewire should be replaced through a ureteral catheter. Although balloon dilators are more expensive, they are less traumatic to the ureter than coaxial dilators. Ureteral Access Sheath Ureteral access sheaths were first developed in the 1970s to aid in difficult access to ureters for ureteroscopy (83).
The percentage of successful retrograde stent placements is lower than nephrostomy tube insertion which is nearly always successful in a dilated system (3,63). With very distal ureteral obstruction owing to advanced pelvic malignancies, retrograde stenting may be difficult because of the lack of “purchase” required to advance a guidewire or stent up the ureter (3,63). Recently, a third method of diversion involving a silicone polytetrafluorethylene coated tube that connects the renal pelvis to the bladder via a tunneled subcutaneous route has been described (64–66).
23) Chen et al. (26) Hollenbeck et al. (27) Byrne et al. (28) Year Authors (ref) Number of patients stented/not stented No Yes 83/107 (15- or 18-Fr balloon) No Yes (15-Fr balloon) No No Yes 82/93 (15-Fr balloon) Balloon dilation of ureter? No No No No No No No Difference in stone-free rates? ) HO:YAG Laser Method of intracorporeal lithotripsy No No No No No No N/A Significant difference in major complications? (fever, rehospitalization, obstruction) Table 2 Summary of Stent vs No-Stent Trials Following Ureteroscopy No More pain in stented patients Suprapubic discomfort on POD no.
Advanced Endourology: The Complete Clinical Guide by David S. Chou MD, Elspeth M. McDougall MD, FRCSC (auth.), Stephen Y. Nakada MD, Margaret S. Pearle MD, PhD (eds.)