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김범수,이준녕,최재영,박윤규,김태환 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.11
In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.
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Controversies associated with ureteral access sheath placement during ureteroscopy
Victor K.F. Wong,Khatereh Aminoltejari,Khaled Almutairi,Dirk Lange,Ben H. Chew 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.5
The use of ureteral access sheaths (UAS) is common practice during routine flexible ureteroscopy procedures. However, debates and concerns continue amongst endourologists on routine UAS placement. UAS placement allows for multiple passages of the ureteroscope, decreases intrarenal pressure, and may improve stone-free rates. However, concerns for the UAS's effectiveness in these claimed benefits and complications related to UAS placement has been documented and investigated by many. In this review, we will discuss the controversies surrounding the placement of UAS during ureteroscopy.
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박동춘,김영수,모성종,서준규 영남대학교 의과대학 1990 Yeungnam University Journal of Medicine Vol.7 No.2
Ureteroscopic removal of the stone is now popular for the management of the lower ureteral stone. A clinical study was performed on our 75 patients with lower ureteral stone treated with ureteroscopy. Of the 75 stone manipulations 62(83%) were immediately successful and the final success rate including spontaneous delivery of stone or fragment after the procedure was 87 percents(65 cases). Of 57 smaller calculi than 1Cm(radiographic largest diameter) 50(88%) were removed successfully. Mean duration of postoperative hospitalization was 5.6 days. There were no interrelations between the success rate and anesthetic methods. Significant complications durinf or after procedure were not identified. We conclude that ureteroscopic removal of stones under direct vision can be done safely and be the first choice of procedure for the lower ureteral stones.
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Ureteral Obstruction Caused by Aspergilloma in a Non-Immunosuppressive Patient
장준보,송필현,최재영 대한요로생식기감염학회 2016 Urogenital Tract Infection Vol.11 No.3
Although rarely, aspergillosis can cause obstructive uropathy. This generally occurs in patients with immunosuppressive conditions. Herein, we report a case of aspergilloma that caused ureteral obstruction in a 79-year-old man with no immunosuppressive conditions. A computed tomography revealed that his left pelvocalyceal system and ureter showed mild dilation, without a definite obstructive lesion. The fungal bezoar was removed using an ureteroscopy. The patient was successfully treated with antifungal medication.
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Efficacy and Safety of Emergency Ureteroscopic Management of Ureteral Calculi
윤준호,김성수,유지형,성락희,노충희,정재용 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.9
Purpose: To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. Materials and Methods: We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher’s exact tests were used to analyze qualitative data. Results: Mean stone sizes in groups A and B were 2.41±1.62 mm and 4.11±2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. Conclusions: Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain. Purpose: To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. Materials and Methods: We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher’s exact tests were used to analyze qualitative data. Results: Mean stone sizes in groups A and B were 2.41±1.62 mm and 4.11±2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. Conclusions: Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain.
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요로조영상에서 요관폐색 및 음영결손을 보인 환자에서의 요관경검사
염규영,하용원,노안식,손성용,김진겸,설종구 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.2
Purpose: To evaluate the clinical value of ureteroscopy for the ureteral filling defect or obstruction on the excretory or retrograde pyelogram(RGP). Materials and Methods: The 72 patients with filling defect or intrinsic obstruction ureteral lesion on the excretory urogram or RGP underwent ureteroscopy to examine and treat the lesions. We used the 9.5Fr. or 11.5Fr. rigid ureteroscope with 5Fr. working channel. Results: The results were as follows; I. Among the 72 patients, 39 were male and 33were female. The mean age of patient was 45.7 years. 2. Ureteroscopy was successfully performed in 70 cases(97%) out of 72. In 2 cases, the advance of ureteroscope was failed. 3. Among 70 successful cases, ureteroscopy revealed 45 radiolucent stones, 9 ureteral stricture, 2 ureteral TCC. I metastatic tumor, 3 blood clot, each case of ureteral polyp, epithelial hyperplasia and Von-Brunn's nest. In 7 cases, no causative lesions were identified. 4. 41 out of 45 radiolucent stones were successfully removed by ureteroscopic procedure and 9 ureteral strictures were dilated. 6 cases of ureteral mass were successfully biopsied for pathological diagnosis. 5. 23 cases of post-operative or fever were treated conservatively and 10 cases of mucosal tearing and 1 case of ureteral perforation were treated with double-J stent indwelling. Conclusions: The ureteroscopy is effective modality to evaluate and treat in the ureteral filling defect or obstruction on the excretory urogram.
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박주현,곽찬훈,김동원,신정현,임범진,김준환,천병식,한정민,권동수,박형근 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.6
Purpose: To investigate the usefulness and ergonomics of a newly developed robotic system for flexible ureteroscopy (easyUretero). Materials and Methods: During in vitro testing, six participants performed renal stone removal four times in an artificial kidney-ureter-bladder model. Each participant manipulated a single-use digital flexible ureteroscope (LithoVue) with their hands and the robotic system, sequentially. We compared the task completion times of each participant. The ergonomics of and operational satisfaction with each procedure were assessed by questionnaires. In vivo tests evaluated the operability and safety of the robotic system in two live female pigs. We checked that all the steps of flexible lithotomy for renal stones could be completed individually. Results: The task completion time with the robotic system during in vitro testing was significantly longer than with manual ureteroscopy regardless of the operator’s competence level (expert professors: 282.6±92.4 seconds vs. 73.6±43.3 seconds, p<0.001; fellows: 247.5±57.7 seconds vs. 95.8±43.7 seconds, p<0.001; residents: 281.3±111.0 seconds vs. 188.6±138.6 seconds, p<0.001). The residents took more time to remove the upper and mid caliceal stones with the robotic system. The ergonomic evaluation was better for the robotic system, but operational satisfaction was lower, and there was no statistical difference among the groups. In vivo tests showed that all the steps of robotic flexible ureteroscopy could be completed without difficulty. No safety issues were encountered during the procedure. Conclusions: The robotic system (easyUretero) was ergonomic and safe for flexible ureteroscopy and laser lithotripsy for renal stones.
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정연수,이동환,이민승,김학주,이상철,홍성규,변석수,이상은,오종진 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.2
Purpose: To evaluate the impact of diagnostic ureteroscopy performed before radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: From May 2003 to December 2018, patients who underwent RNU for UTUC were enrolled and divided into two groups according to whether they underwent preoperative ureteroscopy (Pre-U vs. Non-U). We excluded patients who had a history of bladder cancer and did not receive bladder cuff resection during surgery. Perioperative parameters were compared between the two groups by use of t-tests or chi-square tests. Kaplan–Meier and Cox proportional hazards analyses were used to assess the association between Pre-U and IVR. Results: Of the 453 total patients, 226 patients (49.9%, Pre-U group) had received diagnostic ureteroscopy before RNU, and 227 patients (50.1%, Non-U group) had not. IVR occurred in 99 patients (43.8%) in the Pre-U group and 61 patients (26.9%) in the Non-U group (p=0.001). The median time to recurrence was 107 months. The 5-year IVR-free survival rates were 56.2% and 73.1% in the Pre-U and Non-U groups, respectively (log rank test, p<0.001). Multivariate Cox proportional hazards analysis showed that Pre-U was a significant factor (hazard ratio, 1.413; 95% confidence interval, 1.015–1.965; p=0.040) after adjustment for other factors including tumor stage, location, etc. Conclusions: Preoperative diagnostic ureteroscopy before RNU was a significant factor for IVR. Therefore, we should carefully consider Pre-U before RNU for nonobvious ureteral lesions. These results should be validated in a prospective study.
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