Chen Tony T, Metzler Ian, Sweet Robert M
Department of Urology, University of Washington, Seattle, Washington, USA.
J Endourol Case Rep. 2020 Sep 17;6(3):184-187. doi: 10.1089/cren.2020.0010. eCollection 2020.
During percutaneous nephrolithotomy, retrograde flexible ureteroscopy can be utilized to facilitate repositioning of stones, enable direct vision percutaneous access, minimize radiation exposure, reduce operating times, and improve stone-free rates. Although advancements in technique and flexible ureteroscope technology for the past decades have rendered complications rare, herein we report a case of a retained ureteroscope during percutaneous nephrolithotomy that was effectively managed endoscopically. A 59-year-old Caucasian gentleman with a history of recurrent bilateral nephrolithiasis presents for a left-sided percutaneous nephrolithotomy for a large stone burden >4 cm. A ureteral access sheath was used and retrograde ureteroscopy was performed to first reposition several stones into the renal pelvis. During manipulation, we were unexpectedly unable to retract the ureteroscope from the access sheath. We describe procedural details leading up to the event and subsequent intraoperative management using an antegrade approach. A retained flexible ureteroscope is a rare but serious intraoperative complication that may require invasive open surgical management. However, careful endoscopic management may be feasible in select cases, allowing for preservation of ureter and instrument.
在经皮肾镜取石术中，可利用逆行性可弯曲输尿管镜来促进结石重新定位、实现直视下经皮穿刺、减少辐射暴露、缩短手术时间并提高结石清除率。尽管在过去几十年中技术和可弯曲输尿管镜技术取得了进步，并发症已很少见，但在此我们报告一例经皮肾镜取石术中输尿管镜滞留的病例，该病例通过内镜有效地进行了处理。一名59岁有复发性双侧肾结石病史的白人男性因左侧一枚直径>4 cm的大结石负荷而行经皮肾镜取石术。使用了输尿管通路鞘并进行了逆行输尿管镜检查，首先将几块结石重新定位到肾盂中。在操作过程中，我们意外地无法将输尿管镜从通路鞘中撤出。我们描述了该事件发生前的操作细节以及随后使用顺行方法的术中处理情况。输尿管镜滞留是一种罕见但严重的术中并发症，可能需要进行侵入性开放手术处理。然而，在某些病例中仔细的内镜处理可能是可行的，从而能够保留输尿管和器械。
