Laser endoureterotomy with cut-to-the-light technique for complete ureteral obstruction - A case report

Shiozaki, Keito; Ishikawa, Hirofumi; Fukuta, Kyotaro; Fukawa, Tomoya; Takahashi, Masayuki; Kanayama, Hiro‐omi

doi:10.1016/j.eucr.2022.102036

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Blackout of scopes is particularly undesirable, as the surgeon would like to maintain a decent level of vision even at the lowest brightness setting of the scope. The only rare situation where blackout is desired is in a setting of an endoscope meeting procedure, typically referred to as a “cut to the light” procedure [ 30 ]. In this special situation, one would need a scope that is capable of switching off its light source to artificially create a blackout situation.…”

Section: Discussionmentioning

confidence: 99%

Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS

Kwok,

De Coninck,

Panthier

et al. 2024

World J Urol

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Purpose To date, no study has evaluated effects of varying brightness settings on image quality from flexible ureteroscopes submerged in saline. The aim was to evaluate blackout and whiteout occurrences in an in-vitro kidney calyx model. Material and methods We evaluated a series of contemporary flexible ureteroscopes including the Storz Flex-Xc and Flex-X2s, Olympus V3 and P7, Pusen 7.5F and 9.2F, as well as OTU WiScope using a 3D-printed enclosed pink in-vitro kidney calyx model submerged in saline. Endoscopic images were captured with ureteroscope tip placed at 5 mm,10 mm and 20 mm distances. The complete range of brightness settings and video capture modes were evaluated for each scope. Distribution of brightness on a grayscale histogram of images was analyzed (scale range 0 to 255). Blackout and whiteout were defined as median histogram ranges from 0 to 35 and 220 to 255, respectively (monitor image too dark or too bright for the human eye, respectively). Results Blackout occurred with the P7, Pusen 7.5F, 9.2F and WiScope at all distances, and V3 at 20 mm - with lowest brightness settings. Whiteout occurred with Flex-X2s, V3 and P7 at 5 mm and 10 mm, as well as with V3 and P7 at 20 mm - mostly with highest brightness settings. The Flex-Xc had neither blackout nor whiteout at all settings and distances. Conclusion Blackout or whiteout of images is an undesirable property that was found for several scopes, possibly impacting diagnostic and therapeutic purposes during ureteroscopy. These observations form a guide to impact a urologist’s choice of instruments and settings.

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Section: Discussionmentioning

confidence: 99%

Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS

Kwok,

De Coninck,

Panthier

et al. 2024

World J Urol

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“…[13][14][15] Hence, contrast pyelography is useful for evaluating whether endoureterotomy can be performed. 16 Under direct vision and using fluoroscopic guidance, the chief step is to pass a guidewire from one of the lumens, through and through to the other lumen. As we already stated in our surgical technique, the cutting is made at one end and guided towards the light source from the ureteroscope on the opposite end of the stricture.…”

Section: Dovepressmentioning

confidence: 99%

“…The cause of the latter is mainly an ischemic event of the ureter around the stent. 16 However, there are still some controversies about the stent size and number. Comparing the efficacy and safety of double versus single ureteral stent placement after laser endoureterotomy, Hamdy et al found that, in the case of benign ureteral strictures of more than 1.5 cm, a higher success rate was achieved with double stent placement of the ureter after laser endoureterotomy in comparison to single stent placement.…”

Section: Dovepressmentioning

confidence: 99%

The “Cut-to-the-Light” Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique

Yarak¹,

Zouari²,

Karray³

et al. 2022

RRU

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To describe our new endoscopic approach in treating iatrogenic ureteral stenosis using the "cut-to-The-light" technique. Methods: Case of a 54 year-old female patient who underwent a right percutaneous nephrolithotomy to treat a staghorn calculus with two subsequent complimentary ureteroscopies complicated by a severe proximal ureteral obstruction. An antegrade flexible uretereroscope and a retrograde rigid ureteroscope were used to locate the stenosis. With the aid of a 365-µm Ho: YAG laser fiber (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope and a through-and-through guidewire was then placed, securing the ureter. Ureteral dilatation was then performed followed by a full thickness incision of the ureteral stenosis. A single 8Fr, 28 cm double J ureteral stent was finally placed after stone fragmentation. Results: The operating time was 200 mins. No blood loss. No fever or signs of UTI were seen shortly after the operation. The Foley catheter was successfully removed at day one post-op. The hospital stay was short of only 2 days. Conclusion:The "cut-to-the-light" technique is a new application in the arsenal of ureteral stricture treatment that has been scarcely described in the literature before. The use of this method seems to offer excellent outcomes thus demonstrating the importance of this minimally invasive technique as an alternative to conventional invasive methods used. We believe that studies with larger samples and longer follow up are needed in order to fully determine the benefits of this method and to assess and reveal its suitable application and its drawbacks.

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Retrospective study of ureteral stenosis after holmium laser lithotripsy

2024

J Int Med Res

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Objective To identify the factors influencing postoperative ureteral stenosis following holmium laser lithotripsy. Methods A retrospective study was conducted of 106 patients who underwent ureteroscopic holmium laser lithotripsy. The effects of variables including stone location, stone size, the duration of surgery, water intake, disease duration, and stone-associated polyps were investigated. Results Logistic regression analysis revealed significant associations of ureteral stenosis with stone location, stone size, duration of surgery, water intake, disease duration, and stone-associated polyps. Patients with proximal stones, with large stones, who underwent long surgical procedures, who drank a large amount of water, who had long-term disease, and who had stone-related polyps were more likely to develop postoperative ureteral stenosis. Conclusion Significant perioperative complications of holmium laser lithotripsy are associated with prolonged disease, large ureteral stones, long incarceration periods, and the presence of polyps. Surgeons should consider these risk factors during the preoperative evaluation of patients and surgical planning to minimize the risk of postoperative ureteral stenosis.

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Laser endoureterotomy with cut-to-the-light technique for complete ureteral obstruction - A case report

Cited by 3 publications

References 4 publications

Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS

Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS

The “Cut-to-the-Light” Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique

Retrospective study of ureteral stenosis after holmium laser lithotripsy

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