Department of Urology, IRCCS-INRCA, Ancona, Italy.
Int Braz J Urol. 2019 Jul-Aug;45(4):853. doi: 10.1590/S1677-5538.IBJU.2018.0229.
Urological surgery is estimated to be the third most common cause of iatrogenic-retained foreign bodies (1).
A 76-year old man was undergoing a transurethral resection of bladder tumor with a 26-Ch continuous flow resectoscope (Karl Storz, Germany). Before starting resection, a detachment of resectoscope sheath tip was noted. The ceramic tip was free-floating in the bladder lumen, and it would not fit within the sheath, making direct extraction using the loop impossible. An attempt was made to break it with a stone punch, but it was unsuccessful due to impossibility of closing it in the branches. Therefore, we decided to fragment the tip with holmium laser (RevoLix®, LISA Laser products, Germany), using an 800-micron, front-firing fiber. Laser device was settled at with 2.5 J energy and 5 Hz frequency. Ceramic appeared very hard, but it was difficult to carry on breaking with this setting because of tip retropulsion. Then, laser setting was switched to lower energy and higher frequency (1 J and 13 Hz). This setting guaranteed the same power of 13 W, but with minimal retropulsion.
Tip was fragmented against the posterior bladder wall in seven pieces, which were retrieved trough the outer sheath. A total 5.62 kJ were used to fragment it. At the end, superficial lesions of the posterior bladder wall were highlighted. Surgical time was 55 minutes. Patient was discharged home next day without problems.
Holmium laser fragmentation is a safe and effective approach to remove foreign bodies from the bladder.
泌尿科手术估计是医源性遗留异物的第三大常见原因(1)。
一名 76 岁男性正在接受经尿道膀胱肿瘤切除术，使用 26-Ch 连续流电切镜（Karl Storz，德国）。在开始切除前，注意到电切镜鞘尖端的一个部分脱落。陶瓷尖端在膀胱腔内自由漂浮，无法放入鞘内，因此无法使用圈套直接提取。尝试用碎石冲头将其打碎，但由于无法将其卡在分支处而失败。因此，我们决定使用钬激光（RevoLix®，LISA Laser 产品，德国）将尖端打碎，使用 800 微米的前发射光纤。激光设备的能量设定为 2.5 J，频率为 5 Hz。陶瓷看起来非常坚硬，但由于尖端的后向推力，很难继续用这种设置进行破碎。然后，将激光设置切换到较低的能量和较高的频率（1 J 和 13 Hz）。这种设置保证了相同的 13 W 功率，但后向推力最小。
尖端被打碎成七块，碎片通过外鞘取出。总共使用了 5.62 kJ 的能量来打碎它。最后，发现膀胱后壁有浅表性损伤。手术时间为 55 分钟。患者第二天出院，没有问题。
钬激光碎块是一种安全有效的方法，可以从膀胱中取出异物。
