Flexible ureteroscope is one of the commonly used minimally invasive diagnosis and treatment instruments in urology, which can be used in combination with holmium laser and stone basket, and is widely used in the diagnosis and treatment of upper urinary tract diseases such as urinary stones and renal pelvic tumors. While this technology is becoming more and more popular, there are also many controversial issues, which we will discuss from the aspects of surgical method decision-making, surgical instrument selection, preoperative preparation, and intraoperative operation.
2 4 cm large volume kidney stones, choose flexible endoscope or PCNL?
Historically, percutaneous nephrolithotomy (PCNL) has been the preferred modality for large nephrolithiasis. However, with the development of flexible ureteroscopy, flexible endoscopy is increasingly used in the treatment of large kidney stones (2 cm in diameter**, and the latest EAU guidelines also clearly state that for experienced surgeons, the indication for surgery can be expanded to 3 cm in diameter. So how to choose the surgical method for 2 4cm large-volume kidney stones?We believe that we should consider the stone removal rate, surgical safety and economic effects. First of all, in terms of stone removal rate, there are many studies that show that the primary stone removal rate of flexible ureteroscopy** large-volume kidney stones is not as good as that of PCNL, and multiple surgeries are required**. Zhang et al.'s study showed that the first-phase clear stone rate of PCNL was 857% (36 42), while the soft mirror is only 588%（20/34，p=0.008）。After staged surgery, the PCNL stone removal rate was 9286% (39 42), the stone clearing rate of the soft mirror is 8529% (29 34), the difference was not statistically significant. Secondly, in terms of surgical safety, soft endoscopic surgery has obvious advantages for special patients (patients with isolated kidney stones, patients with kidney stones taking anticoagulants). Our study shows that flexible ureteroscopy** has a high success rate and a low complication rate for isolated kidney stones. For patients with large stones, it is not necessary to pursue a one-time operation, and a stone basket should be used to remove the stone fragments as much as possible during the operation, so as to avoid acute events caused by postoperative stone fragments blocking the ureter. Westerman et al. showed that flexible ureteroscopy is safe for ongoing anticoagulation and antiplatelet medications and does not increase the risk of complications. Finally, in terms of economic effects, there are large regional differences around the world. According to a study in the United States, the cost of a single procedure** with a flexible scope is significantly lower than that of PCNL ($6675 vs.).$19845，p＜0.001）。However, the lithotripsy efficiency of soft mirrors is low, requiring multiple surgeries**, and a study in China showed that the overall economic effect of flexible mirror lithotripsy is not significantly superior to that of PCNL ($1857.).71vs.$1999.21，p=0.205）。In our study, the economic effect of surgery was judged by the stone removal rate of large-volume solitary kidney stones and the efficacy quotient EQ value calculated by the number of ** times, and the results showed that for large-volume kidney stones, especially stones of 3 4 cm, the stone removal rate of PCNL was better than that of the flexible scope, with fewer surgeries and a higher EQ value.
Equipment model: STORZ 11278VS Electronic ureteroscope.
Test Result:1The image is dark, and the CMOS is aged;
2.The beam is partially broken;
3.Insertion tube is mildly aged;
4. The pliers tube is worn and seriously leaking;
5.Steel wires and spiral pipes are worn.
Maintenance plan: maintenance and replacement: CMOS, beam, insertion tube, pliers tube, steel wire, spiral tube, eraser.
Maintenance cycle: 5 working days.
Warranty duration: 6 months.