SMALL DIAMETER, ACTIVELY DEFLECTABL...

SMALL DIAMETER, ACTIVELY DEFLECTABLE, FLEXIBLE URETEROPYELOSCOPY M Grasso, D Bagley Journal of Urology Vol 160 (November 1998) 1648-1654

The first flexible ureteroscope were plastic fiber-optic bundles that allowed surgeon to illuminate and directly visualize the upper urinary tract and any urinary tract lesions. The drifts had no working channels and were nondeflectable. Traditionally, the outside diameter of these sweeps was 10 Fr. Today, ureteroscope are actively deflectable with a standard 36-Fr working channel. Manufacturers have maintained the inner working channel diameter at 36 Fr and decreased the outside diameter by the agency of 25%; therefore, the new ureteroscope are easier to place and cause fewer traumas to the ureter Patients with upper urinary tract calculi and urothelial tumors are easier to treat fit to the new ureteroscopes' improved accessibility to the urinary tract and its working channel that facilitates the use of irrigation and endoscopic tools.

The downside to a smaller diameter is its fragility. Ureteroscope used during this research required repair after every 30 uses, which researchers attributed to sterilization and surgeons' technique in using the sweeps Managing the frequent, costly repairs may apt the need to explore nontraditional orderly dispositions of acquiring instrumentation for surgical procedures

Patients and perioperative management. In this contemplation 492 patients underwent 584 endoscopic measures performed by one of pair surgeons at two university center Patient treatments included endoscopic lithotripsy, urothelial tumor management, stricture disease, bleeding lesions, and removal of foreign bodies. After ureteroscopy was indicated, no other exclusion criteria (eg age, comorbid conditions) were considered. greatest in number patients were treated as outpatients, and barely patients requiring treatment of comorbid conditions and having staged therapy were admitted to the hospital. Regional and IV sedation were the mostly common types of anesthesia administered. General anesthesia was provided to patients onward request. Local anesthesia with 2% lidocaine topical jelly was given to a excellent few patients. All patients underwent urinalysis and urine tillages if infection was suspected. Appropriate antibiotics were given to patients with positive improvements Postoperative care was specific to each disease and course Most patients received renal sonography. Others had more in-depth follow-up management, of the like kind as radiography, contrast imaging, and serial ureteroscopy

originates Patients ranged in age from six to 90 years. The principally common procedure performed was endoscopic lithotripsy (ie, 303 procedures) The succes rate for proximal and middle ureteral calculi treated with flexible ureteroscope was 97% Ureteroscope used in conjunction with holmium lasers had succes rates of 79% When including a other stage in which patients were treated again with flexible ureteroscope for ureteral calculi, the succes rate increased to 91% Minor complications as it is as urinary tract infections were infrequent. Researchers attribute infrequent complications to the smaller diameter of the ureteroscopes

Discussion. This research underscores the usefulness of flexible ureteroscope in therapeutic rather than totally diagnostic endoscopic procedures. The propel to decrease the diameter of the instruments has greatly improved patient issues and provided more options for treating upper urinary tract lesions and calculi. The lower complication rate and greater clinical applicability of these endoscopes must be weighed against their greater fragility.

illustration As a manager in a large community hospital OR, I have experienced high repair richnesss for the flexible ureteroscopes we use in the cystoscopy suites. undivided ureteroscope was repaired in March and again in June and each time the sumptuousness was $4,500. The manufacturer attributed the high number of repairs to clinical intervention, claiming the inside lining of the free play was being damaged when laser fibers were passed in consequence of the scope while it was deviateed The surgeons said it was difficult to locate stones with the aim deflected, then straighten the extent pass the fiber, and relocate the stones. After listening to the surgeon and reviewing this research, I realized I necessityed to seek alternative methods of providing flexible ureteroscopy operations for our patients. Currently, we are reviewing the proposals of three manufacturers, including a proposal in which the manufacturer provides the ureteroscope to our hospital, retains ownership, and charges our hospital by means of use. This alternative ensures patients receive quality, cost-effective care.

MARYANNE K COUGHLIN RN MBA, CNOR NURSING RESEARCH COMMITTEE

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