PROGRESS IN ENDOSCOPIC TREATMENT OF UROLITHIASIS TREATMENT OF UROLITHIASIS Olivier Traxer Tenon Tenon Hospital Hospital, Paris, France , Paris, France Université Pierre & Marie CURIE (PARIS VI) Université Pierre & Marie CURIE (PARIS VI) [email protected]
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PROGRESS IN ENDOSCOPIC TREATMENT OF UROLITHIASISTREATMENT OF UROLITHIASIS
Olivier TraxerTenon Tenon HospitalHospital, Paris, France, Paris, France
Université Pierre & Marie CURIE (PARIS VI)Université Pierre & Marie CURIE (PARIS VI) [email protected]
FLEXIBLE URS
• Since 2001 recent development of newSince 2001, recent development of new flexible URS and the miniaturisation of i t t ll t d th di tinstruments allow today the direct diagnosis and treatment of upper urinary tract diseases
– Smallest caliber actively deflectable (7.5F)– Working channel is 3.6FWorking channel is 3.6F– 2-way active deflect°. : 270-270 degrees – Improved fiberoptics and digital technologyImproved fiberoptics and digital technology
Basillote JB et al. Urol Clin North Am. 31, 2004
F-URS : NEW GENERATION
FLEXIBLE URS
Flex-X2 DUR-D
URF P5 URF VURF-P5 URF-V• Access to the entire
collecting system :collecting system : 95-100%
Busby & Low, 2004Beiko & Denstedt, 2007
Improvements in Ureteroscope Designp p g
FiberOptic Digital System
ELECTROMAGNETIC SPECTRUM NANOMETER
RAYON X MICRONDE-390
-514
32 7-63
0
5594 064
40 600
80 100
ONDE RADIO
190
-
488 53
577 7569 10 29 1069 21
UV VISIBLEINFRA-RED
400 700
HOLMIUM YAG LASER
• I t d ti f H l i YAG
CALCULASE 10W: Karl Storz
• Introduction of Holmium:YAGlaser wich can fragment any type of stone ablate and cut tissueof stone, ablate and cut tissue has expanded the role of FURS
Grasso et al, J Clin Laser Med Surg 1998
SPECIAL CIRCUMSTANCES
DJ INCRUSTATION
SPECIAL CIRCUMSTANCES
DJ INCRUSTATION
MATERIALS• WIRES
MATERIALS
• DLC & URETERAL ACCESS SHEATH • NITINOL BASKET• PORT SEAL / MANUAL HAND DEVICE• LASER FIBERS
We successfully treated caliceal diverticulunm stone in lower pole while others calim difficulties of obtaining success ratepole while others calim difficulties of obtaining success rate
Glenn M Preminger J endourol 2002; 16:557-563Glenn M. Preminger. J endourol. 2002; 16:557-563Batter S, Dretler S: J Urol 1997; 158
Stone-Bearing caliceal diverticulum
SPECIAL CIRCUMSTANCES
HORSESHOE AND PELVIC KIDNEYHORSESHOE AND PELVIC KIDNEY
• Preminger G. J Endourol 2005Preminger G. J Endourol 20058 patients : SFR 85% (1 session)
SPECIAL CIRCUMSTANCES
COMBINED BODY DEFORMITIESCOMBINED TREATMENT
BODY DEFORMITIES
Wi ll U l Cli N A 2008Wignall, Urol Clin N Am. 2008