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ureterorenoscopy and lithotripsy to treat ureteric stone in Thailand (limited to Rajavithi hospital only)... History of URS in Thailand • URS was invented and has been in use for[r]

(1)

Ureterorenoscope (URS) and lithotripsy

In Thailand

Rajavithi Hospital Experiences Viroj Chittchang, M.D

The purpose of this presentation • To share our experiences of doing

(2)

History of URS in Thailand • URS was invented and has been in use for

more than 30years

• In 1989 the Japanese government granted funding and modern equipments to set up urolithiasis center in Rajavithi hospital

First generation URS

• Bulky 13.5 Fr

• Rod lens

• Not straight instrument channel

• Basket was used extensively to extract stone

• Ultrasonic lithotripsy or electrohydraulic

(3)

Second generation URS

• Semi-rigid

• Fibreoptic bundle instead of rod lens

• Straight working channel

• Pneumatic lithotripsy was available

• Laser lithotripsy came later

• Couple with TV camera made it less tiring to

• Effective setting made it into routine procedure

Patient selection • Lower or mid UC

–(upper UC only in female patient)

• Less than cm in size

• No previous open surgery

(4)

Steps of operation in URS

After anaesthesia and set in lithotomy position

• Cystoscope

– (optional) RP with fluoroscope in difficult case – Guide wires insertion: one working wire – dilatation of intramural ureter

• Ureteroscope insertion

– Intervention • Lithotripsy

• Basket • Ureteral stent

Choices of lithotripter

• Pneumatic lithotripter: used the most because it is – low in cost

– safe – Effective

• Laser lithotripter: used less frequently – used only in selected case

• Movable stone that easily migrate

• Failed pneumatic lithotripter

(5)

Stents

• Ureteric catheter: is preferred because it is

–Low cost

–Easy to insert

–Easy to remove

• Double J stent (DJ): is used in case that need prolong stenting

Statistics:

Interventions for ureteric stones in Rajavithi Hospital

Last year there were 218 interventions for UC

• 152 ESWL

–112 were upper UC

–40 were lower UC

• 15 ureterolithotomy

• 51 URS

(6)

Flexible URS • Use for diagnostic only

• Always use with access sheath

Conclusions

• In Rajavithi Hospital, the intervention of choice for upper ureteric calculi is ESWL

• Semi-rigid URS with pneumatic lithotripsy is preferred in lower or mid UC

Ngày đăng: 02/04/2021, 23:51

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