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Flexible Ureteroscopy with a Modular “Disposable” Endoscope
Accepted 273
274
URODYNAMICS OF THE !LEAL POUCH BLADDER. *Charlotta Persson and Hansjoerg Melchior, Kassel, FRG (Presentation to be made by Dr. Persson) 17 patients after urinary diversion via a continent ilea! reservoir were subjected to a clinical study to elucidate the functional characteristics of the ilea! bladder. Urodynamic evaluations by means of combined video-cystoflowmetry 2 - 3 weeks after surgery revealed bladder capacities ranging between 120 and 300 ml with reduced compliance (x 9,7 ml/cm H 0). The low pressure system showed no intraluminal pressu~e spikes due to peristaltic contractions. Conditioned voiding every 2 - 3 hours using abdominal pressure guaranteed daytime continence and effective drainage. Follow-ups 2 - 3 and 4 months later demonstrated increased capacity (310 - 500 ml) and improved compliance (x 27,3 ml/cm H 0). In 76 %day- and nighttime continence was achieved, vgiding intervals increased with capacity. Radiographic observations show neither relevant reflux nor residual urine. Electrolyte imbalance due to reabsorption could not be found. The unclarified death of one patient 3 weeks after discharge could have been in connection to unobserved metabolic disorders. Our results show the low pressure reservoir function of the ilea! bladder with daytime continence and effective voluntary voiding.
FLEXIBLE URETEROSCOPY WITH A MODULAR "DISPOSABLE" ENDOSCOPE. Demetrius H. Bagley, M.D., Phila., PA (Presentation to be made by Dr. Bagley) A new modular flexible ureteroscope has been constructed with interchangeable, 11 disposable 11 fiberoptic tips. These
flexible segments are 70 ems. in length and available in 6.0, 8.5, or 11.0 French caliber. Each tip contains a small irrigating channel (1.4 - 1.5 F) and a larger (3.0, 3.2 or 5.0 F) working channel. The flexible tips can be reused but if the fiberoptic bundles are damaged, the tips can be replaced in the permanent occular module.
The
flexible endoscope can be placed into the ureter over a guidewire or through an introducer sheath. Irrigation can be maintained through the smaller channel even as a guidewire or working instrument fills the working lumen,
This endoscope has been used to diagnose radiologic abnormalities in the upper tract, to inspect the ureter
after ureteral lithotripsy and to remove residual fragments of calculus. Inspection is limited to the ureter, a
portion of the renal pelvis and the upper infundibulum in most patients. Techniques for the introduction and advancement of the instrument with irrigation can provide optimal visualization. Retrieval and lithotripsy techniques allow
the approach to ureteral calculi.
275
276
URETEROSCOPIC* RESECTION OF URETERAf;. NEOPLASMS, Culley ~· Carson, Robert A, Bertram, Rudy T, Andriani, Michael W, Brown, Durham, NC Ureteral neoplasms present a frequent dilemma for urologists, Diagnosis of these lesions is frequently inexact and treatment unsatisfactory, In patients with solitary kidneys and recurrent neoplasms, treatment and followup is especially difficult, Treatment and followup of these lesions ureteroscopically promises direct visual examination and biopsy as well as local resection and fulguration of neoplastic lesions, The technique and results of these procedures is presented
ENDOSCOPIC MANAGEMENT OF LARGE DISTAL URETERAL POLYP AS AN OUT-PATIENT J. B. Ho llandero', A. C. Diokno, G. Devendra*
with a case of ureteroscopic resection of a recurrent
upper ureteral neoplasm in a patient with a solitary kidney.
A 34-year-old woman presented to her urologist with hematuria. Cystoscopy revealed a non-papillary polyp protruding from the left ureteral orifice. A cup biopsy revealed the polyp to be a benign fibroepithelial polyp, and she was referred for further evaluation and therapy.
The IVP revealed polyp to be based in the distal ureter and at least 4 cm long. Using a combination of ureteroscopy, cystoscopy, and a polyp snare, the polyp was excised at its base and the patient sent home the same day with a J stent indwelling. The pathology revealed a 4 cm fibroepithelial polyp. The J stent was removed via a pull suture one week post-op, and the patient has done we 11 since. This endoscopic video tape describes the unusual procedure in detail. Benign ureteral polyps are briefly reviewed.
172A
274
URODYNAMICS OF THE !LEAL POUCH BLADDER. *Charlotta Persson and Hansjoerg Melchior, Kassel, FRG (Presentation to be made by Dr. Persson) 17 patients after urinary diversion via a continent ilea! reservoir were subjected to a clinical study to elucidate the functional characteristics of the ilea! bladder. Urodynamic evaluations by means of combined video-cystoflowmetry 2 - 3 weeks after surgery revealed bladder capacities ranging between 120 and 300 ml with reduced compliance (x 9,7 ml/cm H 0). The low pressure system showed no intraluminal pressu~e spikes due to peristaltic contractions. Conditioned voiding every 2 - 3 hours using abdominal pressure guaranteed daytime continence and effective drainage. Follow-ups 2 - 3 and 4 months later demonstrated increased capacity (310 - 500 ml) and improved compliance (x 27,3 ml/cm H 0). In 76 %day- and nighttime continence was achieved, vgiding intervals increased with capacity. Radiographic observations show neither relevant reflux nor residual urine. Electrolyte imbalance due to reabsorption could not be found. The unclarified death of one patient 3 weeks after discharge could have been in connection to unobserved metabolic disorders. Our results show the low pressure reservoir function of the ilea! bladder with daytime continence and effective voluntary voiding.
FLEXIBLE URETEROSCOPY WITH A MODULAR "DISPOSABLE" ENDOSCOPE. Demetrius H. Bagley, M.D., Phila., PA (Presentation to be made by Dr. Bagley) A new modular flexible ureteroscope has been constructed with interchangeable, 11 disposable 11 fiberoptic tips. These
flexible segments are 70 ems. in length and available in 6.0, 8.5, or 11.0 French caliber. Each tip contains a small irrigating channel (1.4 - 1.5 F) and a larger (3.0, 3.2 or 5.0 F) working channel. The flexible tips can be reused but if the fiberoptic bundles are damaged, the tips can be replaced in the permanent occular module.
The
flexible endoscope can be placed into the ureter over a guidewire or through an introducer sheath. Irrigation can be maintained through the smaller channel even as a guidewire or working instrument fills the working lumen,
This endoscope has been used to diagnose radiologic abnormalities in the upper tract, to inspect the ureter
after ureteral lithotripsy and to remove residual fragments of calculus. Inspection is limited to the ureter, a
portion of the renal pelvis and the upper infundibulum in most patients. Techniques for the introduction and advancement of the instrument with irrigation can provide optimal visualization. Retrieval and lithotripsy techniques allow
the approach to ureteral calculi.
275
276
URETEROSCOPIC* RESECTION OF URETERAf;. NEOPLASMS, Culley ~· Carson, Robert A, Bertram, Rudy T, Andriani, Michael W, Brown, Durham, NC Ureteral neoplasms present a frequent dilemma for urologists, Diagnosis of these lesions is frequently inexact and treatment unsatisfactory, In patients with solitary kidneys and recurrent neoplasms, treatment and followup is especially difficult, Treatment and followup of these lesions ureteroscopically promises direct visual examination and biopsy as well as local resection and fulguration of neoplastic lesions, The technique and results of these procedures is presented
ENDOSCOPIC MANAGEMENT OF LARGE DISTAL URETERAL POLYP AS AN OUT-PATIENT J. B. Ho llandero', A. C. Diokno, G. Devendra*
with a case of ureteroscopic resection of a recurrent
upper ureteral neoplasm in a patient with a solitary kidney.
A 34-year-old woman presented to her urologist with hematuria. Cystoscopy revealed a non-papillary polyp protruding from the left ureteral orifice. A cup biopsy revealed the polyp to be a benign fibroepithelial polyp, and she was referred for further evaluation and therapy.
The IVP revealed polyp to be based in the distal ureter and at least 4 cm long. Using a combination of ureteroscopy, cystoscopy, and a polyp snare, the polyp was excised at its base and the patient sent home the same day with a J stent indwelling. The pathology revealed a 4 cm fibroepithelial polyp. The J stent was removed via a pull suture one week post-op, and the patient has done we 11 since. This endoscopic video tape describes the unusual procedure in detail. Benign ureteral polyps are briefly reviewed.
172A