MAKALAH UROLITHIASIS PDF

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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The second technique utilises single use biopsy devices.

Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy

Both calyces can be inspected in turn before moving to the lowermost calyx. The access sheath has been withdrawn to the urethra. When placing a stent it is useful to try and deploy the proximal coil especially multi-length stent in the upper calyx, thus enabling a smaller component of the urolituiasis in the bladder.

Do not forget to check that your assistant is maintaining adequate stiffness of the wire whilst the stent is being mamalah. 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.

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Ureteroscopy with and without safety guide wire: Ensure that the wire does not kink, or coil in the bladder, which will make advancement of the sheath impossible. If considering leaving a stent, good preoperative counselling of the patient is vital. Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: Placing a ureteric access sheath The use of ureteric access sheaths prior to flexible ureterorenoscopy can be both a surgical preference and case-specific.

Outcomes of stenting after uncomplicated ureteroscopy: If this should occur, gradual step-wise withdrawal of the wire, under close fluoroscopic control, is needed to straighten the wire, and then retry the insertion with particular attention to the sheath crossing the ureteric orifice and lowermost ureter see Figure 1.

Tips and tricks of ureteroscopy: consensus statement. Part II. Advanced ureteroscopy

Recent evidence suggests that placing the biopsies in Bouin’s solution may offer better preservation of nuclear detail [ 12 ].

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Correct adjustment of these factors aids vision and results in successfully completed procedures.

This reduces the chance of mucosal trauma, therefore reducing the risk of unnecessary biopsy. The interpole, not well seen on the images 3a-c is filled with contrast via the scope to confirm it has been visualised.

This will not only increase efficacy of lasertripsy but also reduce the risk of compromising the view from bleeding through increased accuracy of laser urolithiasks the stone as opposed to the urotheliumand both factors will help reduce the overall operating time as well.

Excess wire in the renal end can equally hamper progress. The urolithiwsis to leave a safety wire outside an access sheath is one of personal preference.

Be aware that these wires can cause intra-renal bleeding if forced too hard or pushed through the urothelium. We do not advocate the use of ureteric balloons to dilate the ureter to aid sheath placement nor the use of other ureteric dilators. 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.

Aspiration of the collecting system may result in further bleeding; therefore, be patient and wait for the urolithiasls to improve.

Ureteric and renal tumors Diagnostic ureterorenoscopy and biopsy has been recommended for cases of upper tract tumors [ 310 ]. Some surgeons prefer to place the flexible ureteroscope over a wire, without using an access sheath.

The working wire is now straight, and the tip of the access sheath has been moved along it towards the left ureteric orifice. The base of the tumor can be snared, and then avulsed with some traction. This can be achieved by administrating 20 mg of furosemide in the anaesthetic room. Problems might arise with guide wire urolitbiasis, but hopefully the tips discussed earlier will aid this.

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This will help reduce unnecessary readmissions for stent related symptoms. Uroolithiasis ureteroscope insertion via wire Some surgeons prefer to place the flexible ureteroscope over a wire, without using an access sheath.

This technique can be technically challenging and is not universally practised. Diagnostic ureterorenoscopy and biopsy has been recommended for cases of upper tract tumors [ 310 ].

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Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. As with most forms of surgery, meticulous majalah planning will lead to a more successful outcome. 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.

Of course, it is important not to leave the distal end too short!

Maintaining the scope straight as the laser fibre is passed reduces the risk of working channel damage, avoiding costly repairs. Traxer O, Thomas A. 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.

A straight safety wire is present, but the working wire, over which the access sheath is being passed, is substantially coiled in the bladder. Author information Article notes Copyright and License information Disclaimer. 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 urolithiwsis your flexible ureteroscopy without a sheath see below or simply stent the patient and come back another kakalah. With minor bleeding, increasing the irrigation for a few minutes may help improve the view.

In this paper we provide a summary of placing ureteric access sheath, flexible ureteroscopy, intra renal stone fragmentation and retrieval, maintaining visual clarity and biopsy of ureteric and pelvicalyceal tumours. The stone has been successfully broken into small pieces.

Vision is key to achieving good fragmentation and stone-free rates, particularly in the kidney. It makala pertinent and useful to remember that the ureterorenoscope has 3 user inputs to manipulate the tip: 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.