Grasso M, Bagley D
Department of Urology, Loma Linda University Medical Center, California.
Urology. 1994 Apr;43(4):435-41. doi: 10.1016/0090-4295(94)90226-7.
To develop and employ in a prospective fashion a small-diameter, actively deflectable, flexible ureteroscope that could be easily placed into the upper urinary tract and would increase the overall therapeutic potential for this class of endoscope.
A small-diameter, actively deflectable flexible ureteroscope was recently employed in clinical trials at two university centers. Improvements in fiberoptic engineering allowed endoscope miniaturization (7.5 F tip and 8.2 F shaft) while maintaining a relatively large (3.6 F) centrally located working channel. A variety of design modifications were employed through various prototype stages. Mechanical parameters included maximizing two-way active deflection, adequate secondary deflection allowing access to the lower pole caliceal system, and maintaining a sturdy (nonbuckling) durometer.
The 7.5 F flexible ureteroscope was employed in sixty-seven procedures (64 patients). Therapeutic rather than purely diagnostic maneuvers made up the majority of procedures. Thirty-one upper ureteral, renal pelvic, or caliceal calculi were treated with a variety of endoscopic lithotriptors placed through the ureteroscope. Six patients underwent both biopsy and endoscopic treatment of superficial papillary transitional cell malignancies. Retrograde endopyelotomy, incision or dilation of ureteral strictures, extraction of renal pelvic foreign bodies, and endoscopic access and treatment of obstructed caliceal diverticula were other applications. Endoscopic access to the upper urinary tract rarely required active intramural ureteral dilation (14%). Excluding patients with prior ureteral stents or those who underwent rigid distal third ureteral endoscopy prior to flexible proximal ureteroscopy, 31 patients (48%) required no intramural ureteral dilation prior to placing the endoscope.
The increased therapeutic potential observed with the 7.5 F actively deflectable, flexible ureteroscope opens a variety of upper urinary tract pathologic states to minimally invasive (endoscopic) treatments.
前瞻性地研发并应用一种小口径、可主动弯曲的柔性输尿管镜，该输尿管镜能够轻松置入上尿路，并提高此类内镜的整体治疗潜力。
一种小口径、可主动弯曲的柔性输尿管镜近期在两个大学中心进行了临床试验。光纤工程技术的改进使得内镜得以小型化（尖端为7.5F，镜杆为8.2F），同时保持了相对较大（3.6F）的位于中央的工作通道。在各个原型阶段采用了多种设计改进。机械参数包括使双向主动弯曲最大化、具备足够的二次弯曲以便进入下极肾盏系统，以及保持坚固（不易弯曲）的硬度。
7.5F柔性输尿管镜用于67例手术（64例患者）。大多数手术为治疗性而非单纯诊断性操作。通过输尿管镜置入各种内镜碎石器治疗了31例上段输尿管、肾盂或肾盏结石。6例患者接受了浅表乳头状移行细胞恶性肿瘤的活检及内镜治疗。逆行肾盂切开术、输尿管狭窄切开或扩张、肾盂异物取出以及阻塞性肾盏憩室的内镜进入及治疗是其他应用。内镜进入上尿路很少需要主动进行输尿管壁内扩张（14%）。排除有输尿管支架置入史的患者或在进行柔性近端输尿管镜检查之前接受过硬性远端三分之一输尿管内镜检查的患者，31例患者（48%）在置入内镜之前无需进行输尿管壁内扩张。
7.5F可主动弯曲的柔性输尿管镜所观察到的治疗潜力增加，为多种上尿路病理状态开启了微创（内镜）治疗的大门。
