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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Furthermore, it can aid the rapid reintroduction of the scope towards the calyx of interest stone or TCC bearing later in makallah procedure see Figure 2. If you are still unable to pass the flexible scope, stent the ureter with a view to performing a urollthiasis procedure in approximately 2—6 weeks. It is important to be aware of the individual properties of urrolithiasis different intra-renal baskets available, and especially to understand the pros and cons of the preferred basket.

A pre-instrumented ureteric sample is preferable. Placing a ureteric access sheath The use of ureteric access sheaths prior to flexible ureterorenoscopy can be both a surgical preference and case-specific. Flexible ureteroscope insertion via wire Some surgeons prefer to place the flexible ureteroscope over a wire, without using an access sheath. Which ureteral access sheath is compatible with your flexible ureteroscope?

Any ureteric injury can then be noted and stented accordingly.

National Center for Biotechnology InformationU. If this should occur, gradual step-wise withdrawal of the wire, under close fluoroscopic control, is needed to straighten the wire, and then retry the insertion with particular attention to the sheath crossing the ureteric orifice and lowermost ureter see Figure 1.

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. Makqlah are best used judiciously as they transiently increase intra-renal pressure. The ureterorenoscope is directed to the upper medial calyx as the starting point for an anti-clockwise tour of the collecting system.

Excess wire in the renal end can equally hamper progress. Is a safety wire necessary during routine flexible ureteroscopy? When initially placing the ureteroscope, we would advocate having it free of all attachments irrigation channel, light and camera leadsenabling smoother passage.



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 makxlah wire in the kidney is maintaining a straight ureterorenoscope.

It is best to visualise and ensure its position in the bladder before sending the patient to 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!

After a diagnostic cystoscopy, a previously saline-filled ureteric catheter can be placed in the ureter to collect selective urllithiasis from one or both ureters relatively quickly. Consider the use of a ureteric catheter or tethered stent if feasible, for short-term drainage.

Makalah Urolithiasis Documents –

These can migrate into the ureter and be tricky to reposition. Selective urine cytology is an important aspect of this procedure.

The stone has been identified in the lower pole, and is grasped in a basket to prepare for relocation. Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Change tack, pass the flexible scope over the stone wire and perform your flexible ureteroscopy without a sheath see below or simply stent the patient and come back another day.

They facilitate multiple passages of the ureterorenoscope, reduce intra-renal pressure and help improve irrigation flow [ 1 ]. Improving vision in the kidney Vision is key to achieving good makqlah and stone-free rates, particularly in the kidney. The scope is seen in the posterior upper pole calyx. The ureterorenoscope is deflected into the lower medial calyx.

Urolithiawis placing the stent, if one is irolithiasis difficulty with buckling at the UO, bring the cystoscope closer to the UO and push slowly under vision. This will also reduce torque and pressure on the flexible scope. Blood will affect vision and may result in a premature end to the procedure. The indications for endoluminal surgery continue to widen, mainly through technological advances, such that this branch of urological practice continues to increase year on year.

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

When placing a stent it is useful to try and deploy the proximal coil especially multi-length stent in the upper calyx, thus enabling a smaller component of the stent in the bladder. As with most forms of surgery, meticulous preoperative planning will lead to a more successful outcome.


Before performing laser fragmentation in the kidney, consider repositioning the stone into a more favourable position upper calyx or even upper ureter if feasible. Although these might be an option in very particular circumstances, in most cases involving an unfavourable ureter, it is usually preferable to place a stent and return for uorlithiasis definitive operation at a later date The decision to leave a safety wire outside an access sheath is one of personal preference.

The scope is advanced into the patient to the upper pole — the presence of the safety wire in the upper makalzh can aid this both under endoscopic and fluoroscopic control. 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 urolithiasls 4 ]. Be aware that these wires can cause intra-renal bleeding if forced too hard or pushed through the urothelium.

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

The different laser settings and their effect on stone fragmentation have been highlighted in a recent publication [ 5 ]. Simple hand held pump devices can be used and will help increase irrigant urolihtiasis. Whilst field of view may be reduced in some comparisons, this is counteracted by an increase in image size [ 7 ].

Finally, regardless of the circumstances leading to stent placement, it is important to ensure that an appropriate postoperative plan is in place to track and remove the stent. This will not only increase efficacy of lasertripsy but also reduce the risk of compromising the view from bleeding through urolithiais accuracy of laser onto the stone as opposed to the urotheliumand both factors will help reduce the overall operating time as well.

This technique can be technically challenging and is not universally practised.