I. Minimally invasive treatment of urinary stones
Kidney stones, ureteral stones, bladder stones and urethral stones are collectively known as urinary stones.
1, percutaneous nephrostomy pneumatic ballistic lithotripsy for kidney stones and upper ureteral stones: puncture in the lumbar region under the twelve ribs of the kidney intermediate level, posterior group of renal calyces, using 18 G puncture needle (needle sheath and needle core two parts), after entering the renal calyces or renal pelvis, there is urine flow from the needle sheath, from the needle sheath placed into the guide wire, along the needle sheath skin incision 0.5cm, exit the needle sheath along the guide wire step by step into the dilator expansion, from F6, F8, F10, etc. to F16 (diameter 0.5cm), into the F16 trocar to build a skin renal channel.
Because the channel is expanded step by step, it basically does not damage the renal units and blood vessels, which reduces the injury and bleeding. The channel is chosen in the lower middle kidney and the posterior renal group calyces, and the ureteroscope can enter most of the calyces and the upper ureter.
The ureteroscope and pneumatic ballistic lithotripsy needle were used to crush large stones into 0.5 cm stone particles, and the vortex effect of the water flow from the ureteroscope in the lumen of the trocar was used to flush the stone particles below 0.5 cm out of the body directly from the trocar. The fistula was removed 3-4 days after surgery. Lithotripsy is performed under direct vision to remove the stone, which is very effective. It is especially suitable for larger stones or cast stones.
2.Ureteroscopic pneumatic ballistic lithotripsy for lower and middle ureteral stones: Ureteroscope is inserted into the bladder through the ureter, and the ureter is inserted through the ureteral orifice to reach the stone site, and the stone is lithotripped under direct vision by entering the pneumatic ballistic lithotripsy needle from the ureteroscope. The ureter was placed with double pigtail tubes and bladder indwelling ureter to drain urine.
3.Treatment of bladder and urethral stones: through-tract lithotripsy cystoscope is inserted into the bladder through the urethra, and the pneumatic ballistic lithotripsy system is used for lithotripsy and stone extraction under direct vision.
4.Other applications of ureteroscopy.
(1) Transurethral ureteroscopic filamentary electrode electrodes for ureteral polyps, internal incision for pelvic ureteral junction (UPJ) stenosis, ureteral stricture, urethral stricture: our research has developed homemade ureteroscopic filamentary electrodes, we choose F3 ureteral catheter (with guidewire), the front end is cut off so that the guidewire is exposed for 0.3 cm, the rear end guidewire is connected to the output of high frequency electrodissection, and the middle section ureteral catheter that The middle section of the ureteral catheter is insulated. The anterior end of the exposed guidewire was folded downward by 30 degrees to make a filamentous electrode.
Under epidural anesthesia, the ureteroscope enters the bladder through the urethra and enters the ureter to reach the polyp site, and the filamentous electrode enters through the ureteroscope and contacts the polyp for electrodesection or electrocoagulation; for mild to moderate UPJ stenosis, the posterior lateral layer of the stenosis ring is incised in its entirety, and the F6 double pigtail tube is placed, and the double pigtail tube is removed by cystoscopy at 2 months; for urethral stenosis, the stenosis ring is incised at points 3, 6, 9, and 12, and the F20 ureter is placed and the urethral catheter was removed at 3 weeks.
(2) Suprapubic cystostomy ureteroscopic urethral rendezvous for urethral rupture: Urethral injury is a common urological emergency, and the treatment after injury requires emergency urethral rendezvous in addition to the treatment of shock, trauma and infection according to general principles, the main purpose of this procedure is to insert a urethral tube and restore the continuity of the urethra. In our study, we implemented suprapubic cystostomy ureteroscopic urethral commissurotomy to achieve this treatment purpose.
The specific operation is as follows: first the suprapubic cystocentesis is performed, the ureteroscope enters the bladder through the puncture cannula, probes the bladder for no rupture, finds the internal urethral opening, inserts the zebra guide wire from the internal opening to the urethra through the ureteroscope, withdraws the ureteroscope to retain the zebra guide wire, the ureteroscope then enters the urethral break through the external urethral opening to search for the zebra guide wire, finds it and pulls out the guide wire with a lithotripter, threads the zebra guide wire of the external urethral segment into a three-lumen balloon urethra ( The tip is perforated and the ureter is pushed into the bladder along the guidewire. A cystostomy tube (F14) was inserted suprapubically via a cystocentesis trocar (F16).
The catheter is routinely left in place for 3 to 4 weeks after surgery, and the suprapubic cystostomy tube is left in place for 2 weeks.
The gold standard in the treatment of enlarged prostate (BPH): transurethral electrodesiccation of the prostate
The prostate enlargement, also known as prostatic hyperplasia, is a common and prevalent disease in older men. According to statistics, the incidence of the disease is 60% at the age of 60-70, and the incidence increases with age.
The excised tissue is aspirated through the microscopic sheath. Recently, we have carried out transurethral resection of the prostate gland: the prostate tissue is cut at the tip of the prostate gland to the surgical envelope with an electrosurgical mirror, and the gland is removed with a mirror sheath between the gland and the envelope as in open surgery, then electrosurgically crushed and aspirated out of the bladder.
Transurethral resection of bladder tumors and ureteral cysts: the electrodesiccoscope enters the bladder through the urethra and removes the tumor to the depth of the muscular layer or even the whole bladder, with a range of 2 cm around the tumor, and leaves the ureter in place after the operation; the electrodesiccoscope enters the bladder through the urethra and removes the ureteral orifice cyst.
Third, the application of laparoscopy in urology
The development of TV laparoscopic urological surgery came about with the development of urological endoscopy. Laparoscopic surgery is performed through three to four perforations (0.5-1.0cm in diameter) in the abdomen or lumbar area to establish a working channel through which surgical instruments are inserted and the operation is completed under direct television vision, which has the advantages of less damage, faster postoperative recovery, smaller scars, shorter hospitalization time and lower hospitalization cost.
Since 2004, we have successfully performed laparoscopic high spermatic vein ligation, laparoscopic nephrectomy, laparoscopic radical nephrectomy, laparoscopic adrenal tumor resection, laparoscopic renal cyst decompression, laparoscopic pyeloplasty, laparoscopic cryptorchidopexy, etc.