| Background:Development of flexible ureteroscopy had a significant impact on the diagnosis and treatment of upper urinary tract pathology. The aim of our study was to compare fiberoptic flexible ureteroscope (FFU) with those of a digital flexible ureteroscope (DFU).Despite the permanent improvements of FFU,there were still some specific limitations. One of the major causes was represented by the optical fibers component, which proved to be fragile and offered rather poor visibility by comparison with the rigid and semirigid ureteroscopes. Development of DFU improved image quality, marking important leap forward in the development of the retrograde endoscopic approach.Purpose:We aimed to compare the outcomes of patients who were treated using digital with the ones treated using fiberoptic flexible ureterorenoscopy for upper urinary.Material and Methods:We compared the maneuverability, ivisbility, and fragility of a Olympus URF-P5(FFU)and of an Olympus URF-V (DFU).In82diagnostic retrograde procedures (23with FFU and59with DFU), the maneuverability and visibility were evaluated with a score ranging from1to5. All procedures were performed by the same surgeon. The success of the frist inserting the ureteroscopy rate, total operation time, stones average operation time, stone clearance, make a diagnosis and give treatment average operation time were also compared. Use retrograde surgical method and let patient be placed in lithotomy position. Upper urinary tract stones (1):After the success of anesthesia, apply ureteroscopic to probe the ureter alignment and the presence of stenosis, place one COOK zebra guide wire, then exit ureteroscope, along the guide wire implanting one COOK14F flexible ureteroscope sheath expansion and outer sheath. Then exit the dilator core and retain expansion sheath. Olympus UFR p5flexible ureteroscope or OlymupusUFR-V digital flexible ureteroscope is placed along the guide wire into the ureter and then retrograde into the renal pelvis or calyces to determine the location and the number of stones. Along the working channel of flexible ureteroscope, the365um laser fiber (calyceal calculi select the200um fiber) is placed into the front of the working channel one centimetre. Fiber connections Versapulse PowSuite holmium laser lithotripsy machine (Lumenis medical laser company), its power is0.8-1.5J,10-25Hz,10-35W. Stones are gravelled to<2mm and during surgery, urethra is always to be kept flushing unobstructed in order to provide a good vision field and discharge the tiny stones. Stone forceps or stone basket is used to remove the larger stones, while the remaining smaller stones in postoperative patients will be excreted in urine. After gravelling, indwell the3F double J tube and catheter. If the ureter becomes tortuosity or thin, then we can use F8double J tube instead. After two weeks, we can perform the second stage surgery for the patient.Results:FFU and DFU received mean scores of3.64vs4.27for maneuverability and3.27vs4.68for visibility. The total operation time was FFU for1995min, DFU for4135min. In the urinary tract disease diagnosis and treatment of surgery average time,FFU and DFU was80min±22.80min vs63.33min±17.23min (P<0.05). But two groups in the success of the frist inserting the ureteroscopy rate(16/17vs39/47), stones surgery average time (94.69min±44.25minvs86.54min±30.50min), stones clearance (14/16vs37/39) and complications (4/17vsll/47) differences were no statistical significance (P>0.05).Conclusions:DFU proved to have superior maneuverability and visibility, although DFU did not shorten the calculi surgery average time and improved the stone-free rate. Regarding to the urinary tract disease diagnosis and treatment, the DFU significantly reduced the operative time compared with the conventional one. DFU is a reliable and durable device, but the larger tip of the DFU may decrease its accessibility, especially in narrow segments of the upper urinary tract. |
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