Landman Jaime, Monga Manoj, El-Gabry Ehab A, Rehman Jamil, Lee David I, Bhayani Sam, Sundaram Chandru P, Clayman Ralph V
Division of Urology, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
J Urol. 2002 Jun;167(6):2377-9.
Lower pole renal access during flexible ureterorenoscopy is often limited by the active deflection capabilities of the ureteroscope. Deterioration in the deflection and flow capabilities of ureteroscopes occurs with the passage of instrumentation through the working channel. We performed in vitro evaluation of a novel technique using unsheathed nitinol baskets to minimize the deterioration in deflection and maximize the irrigant flow associated with instrument passage through the working channel during flexible ureterorenoscopy.
Alterations in the irrigant flow and active deflection of 4 ureteroscopes from different manufacturers were evaluated. Each ureteroscope was evaluated with an empty working channel, and then with sheathed and unsheathed 2.2, 3 and 3.2Fr (Cook Urological, Inc., Indianapolis, Indiana), 2.4 and 3Fr (Microvasive Urology, Natick, Massachusetts) nitinol baskets in the working channel.
With all baskets tested and in all ureteroscopes the deterioration in active deflection and irrigant flow was improved with the unsheathed baskets. The disassembled basket within the working channel allowed an additional 15 to 20 degrees of active deflection. In addition, the disassembled basket allowed for a 2 to 30-fold increase in irrigant flow compared with an intact basket.
The combination of improved deflection and irrigant flow with this technique may improve ureteroscopic access to lower pole renal calculi.
在软性输尿管肾镜检查过程中，下极肾通路常常受到输尿管镜主动弯曲能力的限制。随着器械通过工作通道，输尿管镜的弯曲和冲洗能力会下降。我们对一种新技术进行了体外评估，该技术使用无鞘镍钛合金网篮，以尽量减少在软性输尿管肾镜检查过程中与器械通过工作通道相关的弯曲能力下降，并使冲洗液流量最大化。
评估了来自不同制造商的4台输尿管镜的冲洗液流量和主动弯曲的变化。每台输尿管镜先在工作通道为空的情况下进行评估，然后在工作通道中分别置入有鞘和无鞘的2.2、3和3.2Fr（库克泌尿外科公司，印第安纳波利斯，印第安纳州）、2.4和3Fr（微创泌尿外科公司，纳蒂克，马萨诸塞州）镍钛合金网篮后进行评估。
在所有测试的网篮和所有输尿管镜中，无鞘网篮可改善主动弯曲和冲洗液流量的下降情况。工作通道内拆解后的网篮可使主动弯曲增加额外的15至20度。此外，与完整网篮相比，拆解后的网篮可使冲洗液流量增加2至30倍。
该技术结合了改善的弯曲能力和冲洗液流量，可能会改善输尿管镜对下极肾结石的通路。
