V6-13: Microureteroscopy: Miniaturization for the treatment of ureteral stones
VideoIntroductions and Objectives
Ureteroscopy is the gold standard for the management of distal ureteral stones unsuitable for expulsive therapy. Ureteral injuries during the procedure resulting from handling of the ureter and the passage of the scope have been related to the need of ureteral stenting. Miniaturization of endoscopic devices for percutaneous nephrolithotomy is opening new possibilities in diagnosis and treatment of ureteral and kidney stones. In order to minimize the impact of instrumentation on ureteral injury we employed a micro-perc device to perform distal ureteroscopy in a novel technique named Micro-Ureteroscopy (Micro-URS).
Four patients, 3 women and 1 man with distal ureteral stones and indication for surgery were operated by Micro-URS technique. _x000D_ This video demonstrates Micro-URS in a 82-year-old woman with 5,8 x 6.2 mm stone located in the right distal ureter. The compounds of micro-Perc´s set were employed (4.8Fr-sheath, 0.9 mm semirigid optic, a 230 micron laser fiber).
We achieved the stone-free status. Operative time was 35 minutes. A lession grade 0C in PULS scale was observed after the Micro-ureteroscopy. The patient was discharged 18 hours after the procedure. In the following week she only needed a single butilescopolamine pill. In this series of patients we only identified Clavien-Dindo grade I complications.
The Micro-URS is a novel, feasible, simple and effective technique for the treatment of distal ureteral stones optimizing minimal invasion, with results comparable to conventional ureteroscopy in terms of quality of vision and resolution capacity, and may reduce ureteral damage and stenting need. Furthermore, Micro-URS simplifies distal ureteral access, avoids ureteral dilation, minimizes stone retropulsion, decreases hyperpressure, reduces risk of bacteriemia and analgesia requirements.