Knight R C, Owen L J
The Queen's Veterinary School Hospital, University of Cambridge Veterinary School, Madingley Road, Cambridge CB3 0ES, UK.
The Queen's Veterinary School Hospital, University of Cambridge Veterinary School, Madingley Road, Cambridge CB3 0ES, UK.
Vet J. 2025 Feb;309:106291. doi: 10.1016/j.tvjl.2024.106291. Epub 2024 Dec 16.
Percutaneous cystolithotomy (PCCL) is a minimally-invasive technique for removal of cystoliths. There is currently no information regarding optimum patient positioning during PCCL. The objective of this study was to assess whether patient positioning affected ease of cystolith retrieval via PCCL. PCCL was performed to retrieve artificial "cystoliths" in three canine cadavers weighing between 15 and 35 kg, using a threaded cannula and a rigid 30° 2.7 mm cystoscope. "Cystolith" retrieval was performed by retrograde flushing and use of a flexible stone basket, with the dog in 10° Trendelenburg, 10° reverse Trendelenburg, or neutral position. The location of the "cystoliths", number retrieved during flushing, and total time for retrieval were recorded and compared between different positions. The mean total time for "cystolith" retrieval was 392 ± 131 s, with 162 ± 20 s for flushing and 221 ± 123 s for basket-retrieval. The mean number of "cystoliths" retrieved during flushing was 3 ± 2. No significant differences were detected when comparing retrieval times between different positions. The predominant location of the "cystoliths" within the bladder varied depending on the position of the dog. In neutral, 93 % were located adjacent to the ureteric openings, whereas in 10° reverse Trendelenburg, 100 % were located by the urethral orifice. In 10° Trendelenburg, 60 % "cystoliths" were located at the tip of the cannula. Cystolith retrieval during PCCL can be performed in either neutral, Trendelenburg or reverse Trendelenburg position. Changing the dog's position may be useful in cases where cystolith retrieval is challenging, to move the cystoliths and enable different techniques to be employed using the stone basket.
经皮膀胱结石切除术（PCCL）是一种用于去除膀胱结石的微创技术。目前尚无关于PCCL期间最佳患者体位的信息。本研究的目的是评估患者体位是否会影响通过PCCL取出膀胱结石的难易程度。使用带螺纹的套管和刚性30°2.7毫米膀胱镜，对三只体重在15至35千克之间的犬类尸体进行PCCL以取出人造“膀胱结石”。在犬处于头低脚高位10°、头高脚低位10°或中立位时，通过逆行冲洗和使用柔性结石篮进行“膀胱结石”取出。记录并比较不同体位之间“膀胱结石”的位置、冲洗过程中取出的数量以及取出的总时间。“膀胱结石”取出的平均总时间为392±131秒，冲洗时间为162±20秒，篮取时间为221±123秒。冲洗过程中取出的“膀胱结石”平均数量为3±2个。比较不同体位之间的取出时间时未发现显著差异。膀胱内“膀胱结石”的主要位置因犬的体位而异。在中立位时，93%位于输尿管开口附近，而在头高脚低位10°时，100%位于尿道口处。在头低脚高位10°时，60%的“膀胱结石”位于套管尖端。PCCL期间的膀胱结石取出可在中立位、头低脚高位或头高脚低位进行。在膀胱结石取出具有挑战性的情况下，改变犬的体位可能有助于移动膀胱结石，并能够使用结石篮采用不同的技术。
