“Valve”-Type Retainment of Flexible Ureteroscope in the Distal Ureter

Abstract

Introduction: Flexible ureteroscopy (fURS) is an endoscopic procedure for the minimally invasive treatment of ureteral and renal calculi. Due to improvements in technique and ureteroscopic instrumentation over the past two decades, complications associated with URS are infrequent. However, in the event of an unexpected device malfunction or failure, the operating surgeon must employ prompt, resolute decision-making to resolve any intraoperative complications and avoid significant injury to the kidney or ureter.Case Presentation: The patient was a 53-year-old male with a 7 mm left upper pole renal stone managed by fURS and laser lithotripsy. A ureteral access sheath (UAS) was not deployed during the procedure. During fragmentation of the stone, we were unexpectedly unable to retract the ureteroscope from the ureter. Herein, we describe the procedural details leading up to the complication and the careful maneuvering required to remove the ureteroscope without damaging the ureter or the instrument.Conclusions: We recommend use of a UAS during fURS for the treatment of ureteral and renal calculi, if not using ureter access sheath, not advancing the ureteroscope above the stone, leaving it behind the tip of the instrument, while in the ureter. Utilization of a ureter access sheath could have possibly avoided this kind of complication.

Safety enhanced surgical robot for flexible ureteroscopy based on force feedback

“…The flexible ureteroscope may be stuck in the urinary system during FURS. Urologists need to be aware of it and take action in time, [14][15][16] or severe complications will be caused. Moreover, the flexible shaft is inside the patient's urinary system, and the urologist can only see the endoscopic view in front of the scope.…”

“…As stated in the introduction section, three interactive forces exist between the flexible ureteroscope and the environment during manipulation, including axial force, axial torque, and bending knob's torque. If the flexible ureteroscope is trapped in the urinary tract for unexpected reasons, 14–16 the axial force and torque will help urologists to notice this dangerous event and avoid worse complications. The torque exerted on the flexible ureteroscope's bending knob is also important, which helps protect the flexible ureteroscope because excessive torque will damage it 18 .…”

“…It will challenge the urologist's operation, surgical safety, and the instrument's efficacy as well. For example, the flexible ureteroscope may be stuck in the urinary system for various reasons 14–16 . If the feeling of force doesn't exist, it will be hard for urologists to perceive this dangerous event.…”

“…For example, the flexible ureteroscope may be stuck in the urinary system for various reasons. [14][15][16] If the feeling of force doesn't exist, it will be hard for urologists to perceive this dangerous event. Moreover, withdrawing the bending flexible ureteroscope from the renal calyx without awareness may also lead to severe intraoperative complications.…”

Trapped Flexible Ureteroscope in Ureteral Access Sheath During Retrograde Intrarenal Surgery: An Unexpected Problem

“…For removing the fURS, they used orthopedic bolt cutters in one case and in another the procedure was even converted to open surgery. Gadzhiev et al 2 reported a ''Valve Type'' retainment of fURS in distal ureter caused by impaction of stone fragments between distal ureter and fURS. Use of muscle relaxants and gentle rotational, back and forth maneuvers with moderate traction helped them in retrieving the fURS.…”