Yarak Naim, Zouari Skander, Karray Omar, Sleiman Walid, Abdelwahab Alaa, Bart Stéphane, Abdessater Maher
Urology Department, Centre Hospitalier Régional René DUBOS, Pontoise, 95300, France.
Res Rep Urol. 2022 Oct 10;14:351-358. doi: 10.2147/RRU.S371856. eCollection 2022.
To describe our new endoscopic approach in treating iatrogenic ureteral stenosis using the "cut-to-The-light" technique.
Case of a 54 year-old female patient who underwent a right percutaneous nephrolithotomy to treat a staghorn calculus with two subsequent complimentary ureteroscopies complicated by a severe proximal ureteral obstruction. An antegrade flexible uretereroscope and a retrograde rigid ureteroscope were used to locate the stenosis. With the aid of a 365-µm Ho: YAG laser fiber (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope and a through-and-through guidewire was then placed, securing the ureter. Ureteral dilatation was then performed followed by a full thickness incision of the ureteral stenosis. A single 8Fr, 28 cm double J ureteral stent was finally placed after stone fragmentation.
The operating time was 200 mins. No blood loss. No fever or signs of UTI were seen shortly after the operation. The Foley catheter was successfully removed at day one post-op. The hospital stay was short of only 2 days.
The "cut-to-the-light" technique is a new application in the arsenal of ureteral stricture treatment that has been scarcely described in the literature before. The use of this method seems to offer excellent outcomes thus demonstrating the importance of this minimally invasive technique as an alternative to conventional invasive methods used. We believe that studies with larger samples and longer follow up are needed in order to fully determine the benefits of this method and to assess and reveal its suitable application and its drawbacks.
描述我们使用“切向光源”技术治疗医源性输尿管狭窄的新内镜方法。
一名54岁女性患者，因鹿角形结石接受了右侧经皮肾镜取石术，随后进行了两次辅助输尿管镜检查，并发严重的近端输尿管梗阻。使用顺行可弯曲输尿管镜和逆行硬性输尿管镜定位狭窄部位。借助一根365微米的钬激光光纤（设置为0.4焦耳，12赫兹），我们成功地在狭窄病变处制造了一个小切口，顺行可弯曲输尿管镜清晰地看到了硬性输尿管镜的光线，然后置入一根贯通导丝，固定输尿管。随后进行输尿管扩张，接着对输尿管狭窄进行全层切开。结石粉碎后，最终置入一根8Fr、28厘米的双J输尿管支架。
手术时间为200分钟。无失血。术后不久未出现发热或尿路感染迹象。术后第一天成功拔除导尿管。住院时间仅为2天。
“切向光源”技术是输尿管狭窄治疗手段中的一种新应用，此前在文献中鲜有描述。使用这种方法似乎能取得极佳的效果，从而证明了这种微创技术作为传统侵入性方法替代方案的重要性。我们认为，需要进行更大样本量和更长随访时间的研究，以充分确定该方法的益处，并评估和揭示其合适的应用范围及缺点。
