Traxer Olivier, Pasqui Federico, Dubosq Francis, Tchala Kessile, Gattegno Bernard, Thibault Philippe
Service d'Urologie, Hôpital Tenon, 4, rue de la Chine, 75020 Paris.
Prog Urol. 2003 Sep;13(4):592-7.
Secondary deflection of a flexible ureterorenoscope (FUR) is a passive mechanism, which can only be performed under certain anatomical conditions. The objective of this study was to present a new double active deflection FUR and to assess its value based on our initial experience.
From October 2002 to February 2003, we performed flexible retrograde ureterorenoscopy in 30 consecutive patients (34 renal units) using a double active deflection FUR (ACMI DUR 8 Elite). Bilateral ureterorenoscopy was performed during the same operating time in four patients. Ureterorenoscopy was diagnostic for 9 patients (macroscopic haematuria, urinary tract tumour), and therapeutic for 21 patients (stones, urinary tract tumour, ureteropelvic junction stenosis with stone). The value of double deflection as well as the efficacy and morbidity of the technique were evaluated.
The main indication for flexible ureterorenoscopy was the treatment of urinary stones (73.6%), followed by the diagnosis of macroscopic haematuria and urinary tract tumours (26.4%). Ureteric dilatation was necessary in 38.3% of cases. The use of active secondary deflection was essential in 20% of cases (7/34) for complete investigation of the pyelocaliceal cavities. Access to the lower calices was not possible in one patient with a left pelvic kidney. 19 patients with urinary stones had no fragments (79.2%) at the end of the operation, while 4 had residual fragments in the lower calices. The global success rate for all operations was 85% (29/34). Two patients developed acute pyelonephritis during the 48 hours after the procedure and another two patients experienced acute renal colic.
Our study confirms the data of the literature on flexible ureterorenoscopy in terms of indications and efficacy. The URS DUR 8 Elite allowed complete exploration of the pyelocaliceal cavities in more than 97% of cases. The use of active secondary deflection was unnecessary for the majority of patients (80%), but it represents a major technical progress which should be taken into account in the design of future flexible ureterorenoscopes.
软性输尿管肾镜（FUR）的二级偏转是一种被动机制，仅在特定解剖条件下才能实现。本研究的目的是介绍一种新型双主动偏转FUR，并根据我们的初步经验评估其价值。
2002年10月至2003年2月，我们使用双主动偏转FUR（ACMI DUR 8 Elite）对30例连续患者（34个肾单位）进行了软性输尿管肾镜逆行检查。4例患者在同一手术时间内进行了双侧输尿管肾镜检查。输尿管肾镜检查用于9例患者（肉眼血尿、泌尿系统肿瘤）的诊断，以及21例患者（结石、泌尿系统肿瘤、伴有结石的输尿管肾盂连接处狭窄）的治疗。评估了双偏转的价值以及该技术的有效性和并发症。
软性输尿管肾镜检查的主要适应证是治疗尿路结石（73.6%），其次是诊断肉眼血尿和泌尿系统肿瘤（26.4%）。38.3% 的病例需要进行输尿管扩张。20% 的病例（7/34）需要使用主动二级偏转来全面检查肾盂肾盏腔。1例左盆腔肾患者无法进入下肾盏。19例尿路结石患者术后无结石残留（79.2%），4例患者下肾盏有残留结石碎片。所有手术的总体成功率为85%（29/34）。2例患者在术后48小时内发生急性肾盂肾炎，另外2例患者出现急性肾绞痛。
我们的研究在适应证和有效性方面证实了文献中关于软性输尿管肾镜检查的数据。URS DUR 8 Elite在超过97% 的病例中能够全面探查肾盂肾盏腔。大多数患者（80%）不需要使用主动二级偏转，但这代表了一项重大技术进步，在未来软性输尿管肾镜的设计中应予以考虑。
