tailieunhanh - Manual Endourology - part 10

phạm vi linh hoạt với tầm cỡ của 6,5-9 Cha có thể được đưa vào đường tiết niệu trên mà không có sự giãn niệu quản trước. ▬ Trong khi các phạm vi linh hoạt được sử dụng gần tàu chậu qua bởi bác sĩ niệu khoa tại Hoa Kỳ, chúng tôi khuyên bạn nên sử dụng phạm vi nửa cứng bên trong niệu quản | 109 12 Chapter 12 Ureterorenoscopy Flexible URS Flexible scopes with calibers of Fr can be introduced into the upper urinary tract without prior ureter dilation. While flexible scopes are used proximal from the iliac vessel crossing by many urologist in the United States we recommend the use of semirigid scopes inside the ureter whenever possible. However for the passage of difficult anatomy such as strictures kinking or ureter wall edema a flexible scope may be necessary. Most flexible scopes have an active bilateral deflection mechanism at the tip and a passive deflection mechanism proximally of the tip. Recently a scope with two separate active deflection mechanisms has been introduced. O Fig. . Tip of semirigid ureteroscope with separate working irrigation channel While most standard flexible scopes have maximal deflection angles of 120 -180 O Fig. a new generation of flexible ureterorenoscopes have bilateral deflections 270 12 O Fig. . A second advantage of such new-generation endoscopes is a stiffer shaft that improves durability and controllability O Fig. . Modern generation flexible ureterorenoscope with bilateral 270 maximal tip deflection O Fig. . Maximal tip deflection of standard flexible ureterorenoscope with 170 left and a modern semiflexible scope with 325 down movement right 110 Chapter 12 Ureterorenoscopy Stone Disintegration and Stone Extraction Tools Intracorporal Lithotripsy Intracorporeal lithotripsy will be necessary for most fragments with sizes exceeding 3-4 mm. Several different systems are available. Electrohydraulic Principle electric current generates a flash at the tip of the probe the resulting heat produces a cavitation bubble leading to a spheric shockwave. EHL is able to disintegrate stones of all chemical compositions. The undirected transmission of heat comes with a frequent risk of tissue injury which is why EHL is no longer use as a standard procedure. Flexible electrohydraulic probes EHL are .