Thakur Abhishek, Devana Sudheer K, Sharma Aditya P, Mavuduru Ravimohan S, Bora Girdhar S, Parmar Kalpesh
Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Endourol Case Rep. 2020 Sep 17;6(3):235-237. doi: 10.1089/cren.2020.0027. eCollection 2020.
Instrument-related complications occur occasionally with the use of flexible ureteroscopes. In this study, we present a unique problem related to instrument malfunction of flexible ureteroscope during retrograde intrarenal surgery. A 60-year-old male patient with a 1.2 cm left upper ureteral stone initially underwent semirigid ureteroscopic laser lithotripsy and during the procedure the stone got retropulsed into middle calix of the kidney. Subsequently, a 9.5F (internal diameter) ureteral access sheath was placed and using URF P6R flexible ureteroscope (Olympus) the stone was completely dusted with holmium laser. At the end of the procedure, the operating surgeon was unable to remove the ureteroscope out of the ureteral access sheath as it was getting stuck inside. On careful inspection under fluoroscopy, it was noticed that there was a partial break in the outer surface of the flexible ureteroscope at the level of the junction of the distal flexible part of the ureteroscope with the shaft. Since multiple attempts to retrieve the ureteroscope into the access sheath failed, a decision was made to pull the ureteroscope and ureteral access sheath as a whole over a 0.035″ terumo guidewire. Gentle traction was applied on the entire assembly and the instrument was withdrawn out of ureter over the guidewire under fluoroscopic guidance. A lateral angulation of the distal flexible portion with the shaft of the flexible ureteroscope caused by breakage of the fiber-optic cables led to this problem intraoperatively. Breakage of fiber-optic cables caused by excessive manipulation of flexible ureteroscope during retrograde intrarenal surgery can lead to entrapment of the ureteroscope within the ureteral access sheath. This problem might be solved by gently withdrawing the whole assembly out of the ureter over a guidewire.
使用软性输尿管镜时偶尔会出现与器械相关的并发症。在本研究中，我们呈现了一个在逆行性肾内手术期间与软性输尿管镜器械故障相关的独特问题。一名60岁男性患者，患有1.2厘米的左输尿管上段结石，最初接受了半硬性输尿管镜激光碎石术，术中结石被反推至肾中盏。随后，置入了一个9.5F（内径）的输尿管通路鞘，并使用URF P6R软性输尿管镜（奥林巴斯），用钬激光将结石完全粉碎成粉末。手术结束时，主刀医生无法将输尿管镜从输尿管通路鞘中取出，因为它卡在里面了。在荧光透视下仔细检查发现，软性输尿管镜远端可弯曲部分与镜身交界处的外表面有部分断裂。由于多次尝试将输尿管镜收回通路鞘均失败，决定将输尿管镜和输尿管通路鞘作为一个整体，顺着一根0.035英寸的泰尔茂导丝拔出。在荧光透视引导下，对整个组件施加轻柔牵引力，将器械顺着导丝从输尿管中撤出。术中，由于光纤电缆断裂，导致软性输尿管镜远端可弯曲部分与镜身呈侧向成角，从而引发了这个问题。逆行性肾内手术期间对软性输尿管镜过度操作导致光纤电缆断裂，可致使输尿管镜被困在输尿管通路鞘内。通过顺着导丝将整个组件轻柔地从输尿管中撤出，这个问题或许可以得到解决。
