Ureter is the pipe where the urine passess from the kidney into the bladder. If a stone lodged in a patient’s higher urinary tract, a fine type of endoscope is inserted through the bladder up to the ureter. The Uteroscope is a thin elongated fiber-optic device with small basket on its tip, used by the urologist to remove stones from the urinary tract. A flexible fiber laser uteroscope is used to break larger stones to smaller pieces to be carried out of the body through the excretion of urine from the bladder.
Flexible uteroscope is more preferred in use than rigid uteroscope type of instrument in accessing the ureter and intrarenal. The first uterosope came out in 1964. To visualize the impacted uretral calculus, a 9F fiberscope was inserted into the ureter. These uteroscopes were only designed for diagnosis. It is capable of being directed and do not have a working channel for urologist to perform intraoperative surgeries.
The following are the specifications of a rigid ureteroscope : •Tip diameter ranges from 4.5 -9.6F but most common is the 6.9F in diameter. •Made of bundles of Fiber Optics •Usually consist of 1, 2, or 3 working channels •Tube length averages to 40 cm
The following are the specifications of a flexible ureteroscope : •Tip diameter ranges from 6.9 - 9.8F but most common is the 7.5F in diameter. •Made of bundles of Fiber Optics •Consist of Single working channel of 3.6F •Has Two Guidewires for easy access (0.035 in nitinol or 0.038 in stainless steel). First is a safety guidewire, the second guidewire is attached to help facilitate endoscope exploration. •Tube length averages to 100 cm
Recently, a uteroscopy can now be obtained through the use of wireless ureteroscope technique to visualize the ureter without the assistance of guidewire. If wireless uretroscope is not possible, a small size rigid uretroscope instead is used to inspect and map portion of collecting system. Guidewire guides the flexible instrument move around to view the organ. The flexible uretroscope moves from calyx to calyx. Oftentimes, a diluted contrast material is injected to help ensure that the entire collecting system is checked.
Ureteroscopy can be classified into diagnostic endoscopy and therapeutic treatments. Through diagnostic endoscopy, the upper urinary tract experiences less possible trauma and accession of uretroscope is through wireless uretroscopy technique. The ureteral oral cavity can be visualized and intubated with the support of a guidewire. A no- touch technique navigates and map renal and collecting system. This way trauma is minimized, mucosal irritation and mucosal lesions caused by guidewires is avoided.
Rigid uretroscope facilitates the passage of fluid irrigation. Through the use of video camera surgical can better assist the urologist in comfortable positions.
Regional and general anesthesia is used in performing ureteroscopy and ureteroscopic surgery. Procedures are all performed using video magnification. Mostly diagnosis would last for 30 minutes to an hour. While therapeutic procedures may last from one up to two hours.
