Canby-Hagino E D, Caballero R D, Harmon W J
Department of Urology, Wilford Hall Medical Center, San Antonio, Texas 78236-5300, USA.
J Urol. 1999 Dec;162(6):2058-60. doi: 10.1016/S0022-5347(05)68100-1.
Urologists frequently treat patients requiring long-term urinary drainage with a percutaneous nephrostomy tube or ureteral stent. When such tubes are neglected and become encrusted, removal challenges even experienced urologists. We describe a new, minimally invasive technique for safely and rapidly removing encrusted, occluded tubes using the Swiss Lithoclast pneumatic lithotriptor.
Patients presenting with an encrusted urinary catheter were evaluated by excretory urography for renal function and obstruction. Gentle manual extraction of the tube was attempted, followed by traditional extracorporeal shock wave lithotripsy and/or ureteroscopy. When the tube was not extracted, patients were then treated with intraluminal insertion of a pneumatic lithotripsy probe.
One patient presented with an encrusted, occluded nephrostomy tube and 2 had an encrusted, occluded, indwelling ureteral stent. None was removed by manual traction. Intraluminal encrustations prevented the pigtail portions of these tubes from uncoiling and removal. In each case a pneumatic lithotripsy probe was inserted into the lumen of the catheter and advanced in a jackhammer-like fashion. This technique resulted in disruption of the intraluminal encrustations and straightening of the tubes so that they were removed in an atraumatic manner.
Intraluminal pneumatic lithotripsy is a safe, easy and rapid technique for removing encrusted urinary catheters. It is unique in that the pneumatic lithotripsy probe functions in an aqueous and nonaqueous environment, and dislodges intraluminal calcifications. We recommend its use as first line treatment for removing encrusted urinary catheters.
泌尿外科医生经常使用经皮肾造瘘管或输尿管支架来治疗需要长期尿液引流的患者。当这些导管被忽视并形成结石时，即使是经验丰富的泌尿外科医生在移除时也会面临挑战。我们描述了一种新的微创技术，使用瑞士碎石气弹式超声碎石机安全、快速地移除结壳堵塞的导管。
对出现结壳导尿管的患者进行排泄性尿路造影，以评估肾功能和梗阻情况。尝试轻柔手动拔除导管，随后进行传统的体外冲击波碎石术和/或输尿管镜检查。当导管无法拔除时，患者接受腔内插入气动碎石探针治疗。
1例患者出现结壳堵塞的肾造瘘管，2例患者出现结壳堵塞的留置输尿管支架。均无法通过手动牵引拔除。腔内结石形成阻止了这些导管的猪尾部分展开和拔除。在每种情况下，将气动碎石探针插入导管腔内，并以类似风镐的方式推进。该技术导致腔内结石破碎，导管变直，从而以无创方式拔除。
腔内气动碎石术是一种安全、简便、快速的移除结壳导尿管的技术。其独特之处在于，气动碎石探针可在水性和非水性环境中发挥作用，并清除腔内钙化。我们建议将其作为移除结壳导尿管的一线治疗方法。
