RESUMEN
ABSTRACT Objective: To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL. Materials and Methods: Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation. Results: This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases. Conclusions: Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Dilatación/métodos , Cálices Renales/cirugía , Nefrostomía Percutánea/métodos , Uréter/cirugía , Dilatación/instrumentación , Cálculos Renales/cirugía , Nefrostomía Percutánea/instrumentación , Punciones/instrumentación , Punciones/métodos , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , UreteroscopiosRESUMEN
Pheochromocytomas of urinary bladder are rare tumours. They present with non-specific clinical signs and symptoms. We present a case of bladder pheochromocytoma who presented with recurrent attacks of headache and hypertension during micturition in otherwise normotensive female. On evaluation she was found to have paroxysmal hypertension and raised urinary metanephrines with well-defined mass at the base of the bladder. The patient was treated surgically by partial cystectomy and lesion was confirmed postoperatively.