pyeloscopy

The pyeloscopy is an auxiliary diagnostic method for checking whether the kidney is normal. Ureteroscopy is an important development in urinary endoscopy, which has changed the traditional concept that long-term ureteral sites are difficult to visually check and ureteral disorders require open surgery. Ureteroscopy can be divided into diagnostic and therapeutic according to the use. Basic Information Specialist classification: urinary examination classification: urine / kidney function test Applicable gender: whether men and women apply fasting: not fasting Tips: Maintain normal sleep and diet. Normal value No abnormalities in the kidneys were found during the examination. It is a dark red substantive organ that looks like broad beans. The kidney surface is smooth and can be divided into upper and lower ends, front and back sides, and inner and outer edges. Clinical significance Abnormal results: The incidence of ureteroscopic surgery complications varies greatly depending on the patient's condition, the ureteroscopy used, and the clinical experience of the surgeon. (1). Intraoperative complications: Subtalar lesions of the ureter are formed in the ureteral orifice and the ureteral bladder wall segment, the ureter is twisted into an angular position and the stone is invaded at the ureter. Submucosal injury is a mild ureteral injury. If it can be found in time, the guide wire or catheter is withdrawn and placed back into the correct ureteral lumen under the ureteroscope without any harm to the patient. However, if you do not pay attention, it will cause "guide wire cutting injury", that is, the surgeon fails to find the submucosal damage caused by the guide wire in the retrograde intubation, and continues to perform a series of expansion or retrograde insertion of the ureter along the guide wire. The mirror, the slight damage is constantly expanding and cutting, thus causing perforation and tearing. (2) ureteral perforation. (3) ureteral tear ureteral tear is the most serious complication of ureteroscopic stone removal, which may occur when the excessive stone is forcibly pulled out with a basket of stone, or after the perforation is not noticed, then blind Take the stone on the mirror and cause more serious damage. Sometimes in cases of ureteral stricture, forced ureteral dilatation or upper ureteroscopy caused severe ureteral laceration. In ureteroscopic lithotripsy, as long as the operator is cautious, surgical instruments are available. People who need to check: (1) Intravenous urography or retrograde angiography revealed renal pelvis and ureteral filling defects, and the nature of the lesion should be clearly defined. (2) Imaging examination is normal, but urine cytology has a positive finding, and it is necessary to identify the lesion. (3) Unexplained ureteral stricture or obstruction. (4) Unexplained ureteral spurting, it is necessary to identify the location and cause of bleeding. (5) Follow-up observation of local excision of upper urinary tract tumors. Precautions Preparation before inspection: 1. Familiar with the condition: The surgeon should inquire about the medical history in detail before the operation, check the body, re-read the imaging examination data, and clarify the purpose and function of the examination. In particular, the imaging examination data should be carefully analyzed to fully understand the direction of the ureter, the location of flexion and stenosis. 2. Patient preparation: comprehensively check the function of heart, liver, lung and kidney before operation. If there is any abnormality, it should be treated accordingly. Routine routine tests, if the white blood cells increase, should control urinary tract infections. 3. Device preparation: Check whether the components of the ureteroscope are complete and the functional status is good. In particular, check the visual field clarity of the ureteroscope. Find problems and correct them in time. Check that the accessories are complete. Various types of ureteral dilatation catheters, biopsy forceps and other accessories are available. Others such as irrigation devices should also be prepared before surgery. Requirements for examination: preoperative enema, given a sedative. Give patients and their families a comprehensive introduction to the purpose of the operation, the process, possible problems and treatment methods, and strive for close cooperation and improve the success rate. Inspection process 1. Position: The bladder lithotomy position is generally used. The patient takes the position of the stone removal. It can also adopt the position of the lower limb of the healthy side and the position of the lower limb of the affected side. This position tilts the pelvis to the affected side, making the angle of the ureteroscope into the ureteral orifice an obtuse angle, making the mirror body and the ureter a straight line, which can reduce the damage to the ureter during the examination. 2. Anesthesia: use spinal anesthesia or epidural anesthesia (individual patients can also be anesthetized). 3. Method of operation: When performing a rigid ureteroscopy, a cystoscopy is performed first. Under direct vision, a guide wire is inserted into the ureteral orifice of the affected side, and a ureteroscope is gradually inserted under the guidance of the guide wire. If the ureteral orifice is too small, the balloon catheter can be used to expand the ureteral orifice poster. When the ureteroscope is placed, the ureteral hydraulic dilatation pump is generally applied, and the ureter is continuously infused into the mirror to keep the visual field clear and the lumen open; when inserting the ureteroscope, it should be carefully stepped up along the guide wire (also called the safety guide wire); The ureteroscope can be rotated up and down, and the ureteroscope can be gradually ascended under the premise of confirming the lumen of the ureter. If the lumen is bent or the bleeding is unclear or the guide wire cannot be seen clearly, a small amount of physiological saline can be appropriately pressurized to overcome. If the visual field is still not ideal, it is forbidden to blindly use the mirror or use violence. If necessary, stop the mirror or use other methods of diagnosis to avoid perforation or tearing of the ureter. After the operation is completed, in order to prevent the drainage caused by mucosal edema, the ureteral catheter should be placed along the guide wire before the ureteroscope is pulled out, and the position of the drainage tube should be observed in the urinary tract plain film after the operation; the drainage tube is generally used after the operation. 3 to 5 days to remove. If the intraoperative mucosal damage is more serious, the Double-J tube can be left in place, and the mucosa is repaired after 2 to 3 months after surgery. If a severe ureteral perforation or tear occurs during the operation, open surgery should be performed without hesitation to repair the ureteral rupture. Not suitable for the crowd Inappropriate crowd: 1. The acute inflammatory period of the urethra should not be used for this test to avoid the spread of infection. 2. There is an organic obstruction in the urinary tract below the lesion. If you barely check it, it will lead to inspection failure and damage. 3. Systemic bleeding disorders. 4. Prostatic hyperplasia affects the entry of the ureteroscope. 5. Bladder contracture. Adverse reactions and risks No related complications or hazards.