Application of blocking stone extraction catheter in ureteroscopic holmium laser lithotripsy Department of Urology, Siping Central Hospital, Siping Central Hospital, Jilin Province Chen Guofu Chen Guofu Department of Urology, Siping Central Hospital, Jilin Province [Abstract] Objective: to explore the treatment methods of ureteral stones. Methods: 52 cases of ureteral stones were treated with ureteroscopic holmium laser lithotripsy in the application of blocking stone extraction catheter. RESULTS: Stones were excluded in 51 cases with one treatment. CONCLUSION: The application of blocking lithotripsy catheter technique in ureteroscopic holmium laser lithotripsy has a high lithotripsy rate, short operation time, and no serious complications. 【Keywords】 blocking stone extraction catheter; ureteroscopy; holmium laser; ureteral stone Ureteral stone is one of the common diseases in urology, and there is still controversy on the choice of treatment method, although ESWL treatment of ureteral stone has the characteristics of rapid p fast looming p safe p basically non-invasive, but there are also shortcomings, for the stone stay for a long time, there is a mucous membrane wrapping, accompanied by polyp is not suitable for people. Open surgery is not only traumatic, but also has the possibility of ureteral stenosis, and it is extremely difficult to reopen if the stone recurs. With the development of luminal technology, ureteroscopic lithotripsy is widely used in clinical practice, but there is also a situation in which the stone returns to the renal pelvis, since October 2012, we have applied blocking stone extraction catheters in ureteroscopic holmium laser lithotripsy, and treated 52 cases of ureteral calculi, with satisfactory efficacy, and we are now The report is as follows:1. Data and Methods1.1 Clinical dataThe 52 cases in this group, 32 male, 20 female, age 31-76 years old average 48 years old, all of them were ureteral stones, 36 cases on the left side, 21 cases on the right side, 5 cases bilaterally; 28 cases in the upper section, 24 cases in the middle and lower section, all patients were clearly diagnosed by ultrasound and CTU examination.1. 2 Treatment MethodsApplication of the InnoWay Blocking stone extraction catheter, German wolfF8.9 ureteroscope and American Rimadyl holmium laser treatment machine, under continuous epidural anesthesia or general anesthesia, take the stonecutting position, under TV monitoring, insert the ureteroscope into the bladder through the urethra, find the mouth of the ureter on the affected side, insert the ureteral catheter, follow the catheter into the mirror to the lumen of the ureter, keep the field of vision clear under the hydraulic pump perfusion, reach the site of the stone, and place the InnovaWay The distal blade area of the stone-blocking catheter is immersed in saline for 10 seconds to lubricate the blade coating of the Inovair stone-blocking catheter, which is inserted from the positive working channel of the ureteroscope in the unfolded state of the blade until the front end of the Inovair stone-blocking catheter protrudes out of the ureteroscope, the Inovair stone-blocking catheter is pushed so that the tip of the catheter passes through the gap between the stone and the mucous membrane of the ureter, and the blade area is completely beyond the stone, and the handle is pulled gently backward until it reaches the locking area of the ureteroscope. Until the handle backs up to the locking part, to ensure that the blade folds into a ball, forming a complete blockage in the proximal end of the stone, preventing the stone from moving upward, inserting holmium laser fiber from the secondary channel of the ureteroscope, with the energy of 0.8-1.2J and the frequency of 6-10HZ, to pulverize the stone to less than 2mm, and the stone fragments are discharged with the flushing fluid, if the stone is large, the holmium laser fiber is used to remove the stone. If the stone is large and it is not easy to pass through the Inovi blocking stone extraction catheter, holmium laser lithotripsy can be carried out first, and when the stone is loosened, then the Inovi blocking stone extraction catheter can be inserted, and the stone can be broken after blocking; if the inner diameter of the ureter is loose, the D-J tube can be inserted into the ureter, and the urinary catheter can be left in place. 2. Results: Of 212 cases in the group, 208 cases were successfully broken at one time, and 4 cases were converted to open surgery because of the difficulty in accessing the scope, 16 cases were all in the upper segment of the ureter and all of them were in the upper segment of the ureter. cases were all upper ureteral stones, some stones returned to the renal pelvis during lithotripsy and were cured with ESWL after surgery, 36 cases were combined with polyps, Holmium laser ablation was performed at the same time, and D-J tube was removed via cystoscopy after reviewing ultrasonography and KUB 1 month after surgery.3. Discussion: The success rate of ESWL treatment for ureteral stones is very high but there exists ureteral damage, for stones that Those with long residence time, mucosal encapsulation, with polyps are not suitable. Open surgery is not only traumatic, but also has the possibility of ureteral stenosis, and it is extremely difficult to operate again if the stone recurs. Holmium laser (wavelength 2100nm) is a pulsed solid laser, which is emitted in pulses, and its emission time is very short (0.25ms), while the instantaneous power can be up to 10KW, so that stones of various compositions and densities can be crushed, and the fiber can be used to crush them as long as the operation procedure is followed. As long as the operating procedures are followed, the fiber optic tip maintains a safe distance of 1mm between the fiber optic tip and the ureter, which does not cause any damage to the ureter, and the depth of penetration into the tissue is less than 0.5mm, which is not likely to lead to the narrowing of the lumen of the ureter in the postoperative period. Our experience: ① Holmium laser lithotripsy under ureteroscopy requires the operator to master the operation technique of ureteroscopy, and it has been reported in the literature that the serious complications caused by this procedure, such as perforation of the ureter and avulsion of the ureter, are mostly due to improper operation, which is not related to the holmium laser; ② larger stones should be crushed from the edge slowly, and low-pressure insufflation is needed to keep the field of vision clear; ③ during lithotripsy, the insufflation fluid can be drawn out by syringe intermittently to prevent intrarenal pressure from becoming too high and reduce the pressure in the kidney, and to prevent the pressure in the kidney from rising. If there is a stenosis or polyp underneath the stone, holmium laser ablation of the polyp should be carried out before lithotripsy is performed. ⑤ If the stone is close to the renal pelvis, try to flush it at low pressure to prevent it from returning to the renal pelvis, and if it returns to the renal pelvis, it can be treated by ESWL. ⑥ When the stone is not yet at the site of the stone, and it is felt that there is a large resistance to the entry of the scope, it is not easy to force the scope to prevent the fracture of the ureter and the procedure should be transferred to the open surgery. Holmium laser lithotripsy under ureteroscopy is incomparable to other methods because of its high lithotripsy rate, short operation time and no serious complications.