View WOC from NURSING at Airlangga University. Makalah Neurogenic ; Airlangga University; NURSING – Summer. Looking for Documents about Makalah Urolithiasis? Makalah Dan Asuhan Keperawatan UROLITHIASISmakalah pbl 20 urolithiasis-kasus Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial.
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A straight safety wire is present, but the working urolithiais, over which the access sheath is being passed, is substantially coiled in the bladder. If you are still unable to pass the flexible scope, stent the ureter with a view to performing a repeat procedure in approximately 2—6 weeks.
When initially placing the ureteroscope, we would advocate having it free of all attachments irrigation channel, light and camera leadsenabling smoother passage.
Makalah Urolithiasis Documents –
It is important to be aware of the individual properties of the different intra-renal baskets available, and especially to understand the pros and cons of the preferred basket. With minor bleeding, increasing the urolkthiasis for a few minutes may help improve the view. The stone has been identified in the lower pole, and is grasped in a basket to prepare for relocation.
Laser fragmentation and basket technique Before performing laser fragmentation in the kidney, consider repositioning the stone into a more favourable position upper calyx or even upper ureter if feasible. The scope is advanced into the patient to the upper pole — the presence of the safety wire in the upper calyx can aid this both under endoscopic and fluoroscopic control.
The interpole, not well seen on urolithiasus images 3a-c is filled with urooithiasis via the scope to confirm it has been visualised.
Correct adjustment of these factors aids vision and results in successfully completed procedures. They are best used judiciously as they transiently increase intra-renal pressure.
If considering leaving a stent, good preoperative counselling of the patient urolithiasiss vital.
Furthermore, it can aid the rapid reintroduction of the scope towards the calyx of interest stone or TCC bearing later in the procedure see Figure 2.
The sheath passage should be monitored with pulsed fluoroscopy during ureteric passage, preventing makalxh buckling in krolithiasis bladder or to identify early resistance and failure to progress. When the laser fibre is inserted, ensure that the ureterorenoscope is straight in a non-deflected, neutral position — one of the advantages of having an additional wire in the kidney is maintaining a straight ureterorenoscope.
Urolithiass ureteric injury can then be noted and stented accordingly. Maintaining the scope straight as the laser fibre is passed reduces the risk of working channel damage, avoiding costly repairs. If a safety wire is not already in place, a wire can be pre-emptively inserted through the flexible ureterorenoscope to allow stent insertion if required. Improved optical characteristics translate to improved clinical outcomes with significant improvements in mean operative time, flexible ureterorenoscopy time and efficiency of stone fragmentation [ 89 ].
Although these might be an option in very particular circumstances, in most cases involving an unfavourable ureter, it is usually preferable to place a stent and return for the definitive operation at a later date The decision to leave a safety wire outside an access sheath is one of personal preference.
Irrigant flow and intrarenal pressure during flexible ureteroscopy: Is a safety wire necessary during routine flexible ureteroscopy? In vitro assessment has shown improved image resolution and colour reproducibility without compromising depth of field, image distortion, grayscale imaging and ureteroscope deflection.
Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy
The stone is then released from the basket, which is withdrawn from the scope, and replaced with an appropriate laser fibre for stone fragmentation. Patients will need to be aware that they might urolithiaxis some pain or discomfort postoperatively.
Vision is key to achieving good fragmentation and stone-free rates, particularly in the kidney.
The stone has been successfully broken into small pieces. Do not forget to check that your assistant is maintaining adequate stiffness of urooithiasis wire whilst the stent is being inserted.
Once the lower third has been successfully traversed, the image intensifier can be moved to the proximal ureter to allow precise positioning of the tip of the sheath in the upper ureter. When the procedure is completed, withdraw the ureteroscope and access sheath together with the tip of the ureteroscope placed just at the end of the sheath, watching the ureteric mucosa move past.
The ureterorenoscope is manoeuvred out of the lower calyx towards the renal pelvis. The second technique utilises single use biopsy devices. Ureteroscopy with and mamalah safety guide wire: Aspiration of the collecting system may result in further bleeding; therefore, be patient and wait for the vision to improve. Somani2 Jake Patterson3 Ben R.
Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Blood will affect vision and may result in a premature end to the procedure.
Change tack, pass the flexible scope over the stone wire and urolithiaiss your flexible ureteroscopy without a sheath see below or simply stent the patient and come back another day.
Placing a ureteric access sheath The use of ureteric access sheaths prior to flexible ureterorenoscopy can be both a surgical malalah and case-specific.
Excess wire in the renal end can equally hamper progress. The aim is to keep the ureteroscope as straight as possible while fragmenting, reducing the risk of damage to the flexible ureterorenoscope see Figure 3.