使用Lithoclast在膀胱鏡取石手術治療膀胱結石時的小技巧
仇光宇、黃一勝、蔡德甫
新光醫療財團法人新光吳火獅紀念醫院 外科部 泌尿科
A Small Trick on CystoscopicLithotripsy when UseLithoclast forTreating Bladder Stone
Kuang-Yu Chou, Thomas I-sheng Hwang, Te-Fu Tsai
Division of Urology, Department of Surgery
Shin Kong WHS Memorial Hospital, Taiwan Taipei
Bladder stones are the most common manifestation oflower urinary tract lithiasis, currently accounting for 5% of all urinary stone disease. The cystoscopic lithotripsy is one of the least invasive procedures. Modern series reportthe use of the holmium laser, electrohydraulic lithotripter, andlithoclast technology, all with success in both adults and children. Now a day, the Holmiun laser is commonly used, but the laser probe is relatively expensive. The electrohydraulic lithotripter is not so powerful and the mucosal damage is quite common. The lithoclast, boast of no or minimal consumable, has acceptable effectiveness on stone fragmentation. The lithoclast is still widely used on treating bladder stone.
Materials and Methods:
We used the “pusher” of the Double- J ureteral stent in the working channel of 21 or 22 Fr. cystoscope to form a route for passing the probe of lithoclast. The working channel was big enough to have the probe jump or vibrate too much in it. Thus, the stone will jump inside the bladder, and cause the aiming of the stone difficult. And the working channel of cystoscopy has a nipple at the rear end for preventing water leakage.The opening of the nipple might be too big for excessive water leaking and cause difficulty of inflation of the bladder.
Results:
We use this trick to enable effective stone fragmentation, decrease the water leaking, and protect the sheath of the cystoscope. There was no extra consumable needed since the pusher of the double-J ureteral stent is disposable. We are glad to share the experience with the other urologist.