Transurethral lithotripsy of bladder stones

Treatment of diseases: bladder stones Indication Transurethral bladder stone lithotripsy is suitable for: Transurethral bladder stone lithotripsy, preferably urethral obstruction, bladder without sacral chamber, stones below 4 ~ 5cm, can be used for liquid, ultrasound, laser lithotripsy, but also mechanical gravel. Contraindications 1. Hard and hard to smash or large stones, it is advisable to cut the stone with the suprapubic bladder; the stones formed by foreign bodies must be opened for surgery. 2. The bladder has acute inflammation, and the gravel can be cured after being cured. Preoperative preparation 1. Take abdomen X-ray film and intravenous urography to understand the condition of the whole urinary tract. 2. Perform a cystoscopy to find out if there are other lesions in the bladder. Surgical procedure Stone removal Small stones can be taken with a stone claw clamp under the direct view of the cystoscope, and the stone is grasped, and the operation mirror is pulled out together through the mirror sheath. 2. Mechanical gravel For stones that cannot be removed by the above method and have a diameter of >1.0 cm, the stone can be crushed by mechanical crusher under direct vision. Because of its thick diameter (24F), it can only be used for the larger diameter of the urethra. The vise claw of the stone clamp is fixed in the closed state and inserted into the bladder. After entering the bladder, the bladder is filled with 150ml of irrigation fluid, and the irrigation is too small. The stone clamp is easy to clamp the bladder mucosa; if too much, the stone is easy to move. After seeing the stone under the microscope, open the stone clamp vise clamp, align the stone, clip it into the vise clamp, then turn the stone breaker 180°, make the tiger mouth up, then force the clamp, tighten the vise clamp gravel. This is repeated several times until the stone is broken into small pieces until it is considered to be sucked out of the sheath. After the gravel is finished, the jaws of the lithotripter are returned to the closed state, and the lithotripter is taken out. Insert the resectoscope sheath and pull out the obturator, connect the Ellik ejector to flush out the stone fragments, and finally place a three-chamber balloon catheter in the bladder to drain the bladder urine. 3. Liquid electric gravel The small stones are crushed by a series of liquid electric shock waves. This is a pulse generating device for electrical energy that can discharge intermittently. The instrument device can control the voltage, and the generator and probe are connected by a high voltage wire. Use the foot brake to control the discharge frequency and wave period, and place the probe close to the stone through the cystoscope operator. You can also use the resection mirror instead of the ordinary cystoscope. The probe is 1 to 2 mm away from the stone, and emits a short series of 1 to 3 s shock waves at intervals of 5 to 10 s to enable the generator to establish energy. Due to the unequal size, structure and hardness of the stones, the appropriate current strength and type are determined as needed. In hard stones such as mixed or oxalic acid stones, considerable blasting is required, and the current intensity is large, intermittently bursting, until the stones are found to be fully broken. Small, hard stones, can be interrupted. At first, the shock wave is large, and it is directly blasted to the same point of the stone to crack it, and it is easily broken into pieces later. Rough stones are brittle than smooth stones. Avoid contact between the probe and the bladder mucosa. To avoid debris from smashing the mirror, you must see the probe bar red mark under peep, and the probe and mirror remain at the proper distance. After the end of the gravel, the stones were discharged using an Ellik ejector as in the mechanical gravel method described above. 4. Ultrasonic gravel Electromagnetic vibration is generated by an ultrasonic lithotripter high frequency generator and coupled to a transducer via a cable. The ultrasonic sensor drive head acts on the stone immediately. After a period of "hammering", the stone is crushed and the powdery pieces are sucked out. Because ultrasound is slow and time consuming for large stone lithotripsy, it is rarely used for bladder stones. 5. laser lithotripsy Usually 365m or 550m fiber, energy 1.0J, frequency 10Hz as the initial value, first make a small hole in the stone. When the fiber enters the interior of the stone, the energy setting can be increased. A 6F end opening conduit can be used to secure the fiber. The use of an endoscope with continuous flow flushing speeds up stone removal. After surgery, the stone residue will be excreted from the bladder with urine. 6. Pneumatic ballistic gravel Pass the probe through the endoscope cannula, insert the bladder into the stone, and crush the stone with energy of 85-100 MJ. All the stones of different hardness can be crushed. It does not produce heat, safety and speed, so it is an ideal means of crushing stones. complication 1, bladder electroporation can occur bladder perforation. The precaution is that the electrode probe can't resist the stone hardly to prevent the stone from rolling, and the electrode tip touches and hurts the bladder. Another important aspect of preventing bladder perforation is to tell the patient during the procedure that you should not suddenly increase your abdominal pressure. If the patient wants to suddenly breathe, cough, or sneeze, he should immediately inform the doctor and stop the operation. 2, larger stones or stone fragments, especially irregular, sharp face, do not use stone pliers forcibly pulled out together with the mirror sheath, so as not to cut through the urethra, leading to stenosis.

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