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