Division of Urology, St. Michael's Hospital , Toronto, Ontario, Canada.
J Endourol. 2011 Aug;25(8):1259-62. doi: 10.1089/end.2011.0008. Epub 2011 Jul 20.
Ureteral avulsion during ureteroscopic stone management is extremely rare. To date, many publications reporting avulsion have been associated with "blind basket extraction" under fluoroscopy and the use of the Dormia stone basket. Fortunately, despite the significant rise in the numbers of ureteroscopic cases being performed, the rate of ureteral avulsion remains low. This is likely in part because of improvements in ureteroscope technology and stone manipulation devices. We present three recent cases of ureteral avulsion referred to our center for further management. To our knowledge, these cases represent the first published description of avulsion where the ureteroscope became wedged in the intramural ureter, resulting in full-length avulsion of the ureter. The avulsion occurs both proximally and distally with a resultant length of ureter left attached to the ureteroscope. We dub this mechanism the "scabbard" avulsion. We describe the most likely mechanism of this injury, with suggestions on how to prevent it and how to release the ureteroscope should it become wedged in the intramural ureter.
输尿管镜碎石术中发生输尿管撕脱极为罕见。迄今为止，许多报告撕脱的出版物都与透视下“盲目篮式提取”和使用 Dormia 结石篮有关。幸运的是，尽管输尿管镜检查的数量显著增加，但输尿管撕脱的发生率仍然很低。这可能部分是由于输尿管镜技术和结石操作设备的改进。我们介绍了最近转诊到我们中心进一步治疗的三例输尿管撕脱病例。据我们所知，这些病例代表了首例报道的输尿管镜卡在壁内输尿管中导致输尿管全长撕脱的病例。输尿管撕脱发生在近端和远端，输尿管的剩余部分附着在输尿管镜上。我们将这种机制称为“护套”撕脱。我们描述了这种损伤最可能的机制，并就如何预防损伤以及如果输尿管镜卡在壁内输尿管中如何释放输尿管镜提出了建议。
