La boîte à outils de l’urétéroscopie ou « ce qu’il faut emporter sur une île déserte »
Progrès en Urologie - FMC, ISSN: 1761-676X, Vol: 34, Issue: 3, Page: F76-F81
2024
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
Citation Benchmarking is provided by Scopus and SciVal and is different from the metrics context provided by PlumX Metrics.
Article Description
Les avancées technologiques en endo-urologie font désormais de l’urétéroscopie souple (URSS) une technique de choix pour traiter les calculs urinaires mais aussi un casse-tête lorsqu’il s’agit de choisir son équipement. La mise en place d’un guide de sécurité au sein des cavités rénales (nitinol, 0,035″, « stiff ») par cystoscopie rigide est non obligatoire mais constitue un critère de sécurité. Il en est de même concernant les gaines d’accès urétéral, celles avec aspiration étant en cours d’évaluation. Si leur utilisation réduit la pression et la température au sein des cavités rénales facilitant la vision, leur insertion peut occasionner des lésions urétérales. Les systèmes d’irrigation utilisant la gravité avec pompe manuelle sont à privilégier pour minimiser le risque de barotraumatisme. Le choix de l’urétéroscope est complexe : diamètre, capacité de déflexion, position du canal opérateur et qualité de vision sont à considérer. Aussi, il est difficilement envisageable de n’utiliser qu’un modèle endoscope pour l’intégralité des URSS. Les lasers Holmium:Yttrium-Aluminium-Grenat (Ho:YAG) et Thulium Fibré (TFL) sont aujourd’hui recommandés pour le traitement des calculs urinaires en URSS, avec un avantage potentiel du TFL pour la pulvérisation fine. Les paniers sont nombreux et divers, leur taille et forme devant également être considérées avant acquisition. En fin d’intervention, un drainage urétéral n’est pas systématique, mais les sondes JJ en silicone ont montré des risques d’incrustation et de gêne fonctionnelle plus faibles que les sondes faites de polyuréthane. Flexible ureteroscopy is now widely used as the preferred option to surgically treat a urinary stone, due to several technological advancements. Thus, choosing the adequate equipment is challenging, but respects safety concepts. Indeed, placing the safety wire (nitinol, 0,035″, “stiff”) under rigid cystoscopy is not mandatory but improve safety. Regarding ureteral access sheath (UAS), considerations are similar: UAS facilitates vision, pressure and temperature control but can also be responsible of ureteral injuries at insertion. Suction devices are now under evaluation and could not be discussed. To limit the barotrauma risk, irrigation devices with manual pumps should be used (40 cmH 2 0). Choosing a flexible ureteroscope (fURS) is challenging; a special attention has to be given to size, deflexion, working channel position and vision. Thus, using a single fURS is hardly imaginable. Both Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) and Thulium Fiber (TFL) lasers are recommended to treat urinary stones during fURS, with a potential advantage of TFL on thin pulverization. A wide variety of baskets exists and size and shape have to be considered before acquisition. Finally, if ureteral stenting is not mandatory in uncomplicated cases, silicone stents present a lower risk of encrustation and stent-related symptoms compared to polyurethane ones.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S1761676X24000427; http://dx.doi.org/10.1016/j.fpurol.2024.03.002; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85191470629&origin=inward; https://linkinghub.elsevier.com/retrieve/pii/S1761676X24000427; https://dx.doi.org/10.1016/j.fpurol.2024.03.002
Elsevier BV
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