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What is the role of retrograde ureteroscopy in the management of large renal calculi?
British Journal of Medical and Surgical Urology (2009) 2, 85—86
LETTER TO THE EDITOR What is the role of retrograde ureteroscopy in the management of large renal calculi? Dear Editor We were delighted to read the paper ‘‘What is the role of retrograde ureteroscopy in the management of large renal calculi?’’ by Forster JA, Moazzam M, Lloyd SN in the inaugural Br J Surg Urol 2008;1:14—20 [1]. We too use retrograde ureteroscopy with a 7.5 F Wolf ureteroscope and the Swiss Lithoclast for upper 1/3 ureteric and renal pelvis calculi. Working as we do in the Third World imposes severe financial restrictions. Flexible ureteroscopes and other expensive refinements are unavailable. Our early experience was that the propulsive force that fragments the calculus also drove the calculus upwards with the risk of the calculus, or a large fragment, falling into the lower polar calyx where the calculus/fragment is inaccessible to the semi-rigid ureteroscope. To prevent this course of events we enlist the help of gravity; lower the head end and rotate the table so that the affected side is higher [head down, side up]. This makes the upper polar calyx most dependent. Calculi/fragments that are driven into the upper polar calyx can be fragmented with the semi-rigid ureteroscope and Swiss Lithoclast probe. The accompanying IVU film with superimposed straight edge indicates that ureter to upper polar calyx is nearly a straight line.
We cannot overstate the level of confidence we now enjoy. Previously [pre head down, side up] upper 1/3 ureteric and renal pelvis lithotripsy was an ‘‘if and perhaps’’. We stent ureters if the process
1875-9742/$ — see front matter © 2008 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjmsu.2008.12.002
86
Letter to the Editor
is difficult or prolonged or use a ureteric catheter and affix it to a Foley catheter for 24 h. We congratulate the authors of this fine paper.
Reference [1] Forster JA, Moazzam M, Lloyd SN. What is the role of retrograde ureteroscopy in the management of large renal calculi? Br J Surg Urol 2008;1:14—20.
D.P. Sharma ∗ S.R. Gobin A.B. Harvey Woodlands Hospital, 110 Carmichael St., Georgetown, Guyana ∗ Corresponding author. E-mail address: [email protected] (D.P. Sharma)
Available online at www.sciencedirect.com
21 November 2008
LETTER TO THE EDITOR What is the role of retrograde ureteroscopy in the management of large renal calculi? Dear Editor We were delighted to read the paper ‘‘What is the role of retrograde ureteroscopy in the management of large renal calculi?’’ by Forster JA, Moazzam M, Lloyd SN in the inaugural Br J Surg Urol 2008;1:14—20 [1]. We too use retrograde ureteroscopy with a 7.5 F Wolf ureteroscope and the Swiss Lithoclast for upper 1/3 ureteric and renal pelvis calculi. Working as we do in the Third World imposes severe financial restrictions. Flexible ureteroscopes and other expensive refinements are unavailable. Our early experience was that the propulsive force that fragments the calculus also drove the calculus upwards with the risk of the calculus, or a large fragment, falling into the lower polar calyx where the calculus/fragment is inaccessible to the semi-rigid ureteroscope. To prevent this course of events we enlist the help of gravity; lower the head end and rotate the table so that the affected side is higher [head down, side up]. This makes the upper polar calyx most dependent. Calculi/fragments that are driven into the upper polar calyx can be fragmented with the semi-rigid ureteroscope and Swiss Lithoclast probe. The accompanying IVU film with superimposed straight edge indicates that ureter to upper polar calyx is nearly a straight line.
We cannot overstate the level of confidence we now enjoy. Previously [pre head down, side up] upper 1/3 ureteric and renal pelvis lithotripsy was an ‘‘if and perhaps’’. We stent ureters if the process
1875-9742/$ — see front matter © 2008 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjmsu.2008.12.002
86
Letter to the Editor
is difficult or prolonged or use a ureteric catheter and affix it to a Foley catheter for 24 h. We congratulate the authors of this fine paper.
Reference [1] Forster JA, Moazzam M, Lloyd SN. What is the role of retrograde ureteroscopy in the management of large renal calculi? Br J Surg Urol 2008;1:14—20.
D.P. Sharma ∗ S.R. Gobin A.B. Harvey Woodlands Hospital, 110 Carmichael St., Georgetown, Guyana ∗ Corresponding author. E-mail address: [email protected] (D.P. Sharma)
Available online at www.sciencedirect.com
21 November 2008