運用軟式輸尿管鏡可彎式輸尿管導引鞘合併高水壓灌注能協助腎臟碎石的排出

周敬哲、林承家、劉冠麟、陳文祥、林政鋒、陳鴻毅、吳翊豪

基隆長庚紀念醫院 外科部 泌尿科

Extraction of renal residual stone fragments in retrograde intrarenal surgery using flexible and navigable suction ureteral access sheath with concurrent high pressure irrigation system

Ching-Che Chou, Cheng-Chia Lin, Kuan-Lin Liu, Wen-Hsiang Chen, Cheng-Feng Lin, Hung Yi Chen, Yi-Hao Wu

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose:  After renal stone management using retrograde intrarenal surgeries either with stone fragmentation or popcorning strategies, extraction of residual stone fragments remain a challenging issue.   We herein introduce a technical alternative for extraction of renal residual stones using flexible and navigable suction ureteral access sheath(FANS) with the aid of high pressure irrigation system in retrograde intrarenal surgeries.

Materials and methods:  Extraction of residual stone fragments after retrograde intrarenal surgeries may be aided with the use of FANS. Conventionally the combined use of suctioning devices improves stone clearance.  In cases where residual stone fragments remain, we attempt the use of high irrigation system to further enhance stone clearance.  

A near closed system is established by sealing the residual stone fragments with the FANS.  When the residual stone fragments are contained within the FANS, a high irrigation pressure of 500cmH₂O using infusion irrigation pump is delivered to the confined space through the flexible ureteroscope.  The flexible ureteroscope is then simultaneously withdrew from the FANS allowing flushing/exiting of residual stones.

Results and Conclusions:  The pressure gradient created with the use of high irrigation system flushes/floods the remaining stone fragments out through the FANS while withdrawing the flexible ureteroscope may further enhance stone clearance.