distal ureter Endo-ureterotomy live surgery in the Military Hospital Moulay Ismail Meknes скачать в хорошем качестве

distal ureter Endo-ureterotomy live surgery in the Military Hospital Moulay Ismail Meknes

This endo-ureterotomy was performed during a ureteroscopy live surgery workshop of the military hospital Moulay Ismail, Meknes, held in June 2007. It is the case of 50 years old patient, who presented with a large uretero-hydronephrosis due to a distal ureter stenosis. This was treated by dilation and iterative double J stent, for 3 years. Cystoscope is introduced, the double J stent is removed and a guide wire is inserted. The ureteroscope is introduced and progression until the stenosis, which is persistent even after multiple dilations and double J stents. Another guide wire is inserted through the stricture, and the ureteroscope is advanced through the stenosis with a small resistance. Above, ureteroscopy find a ureteral bifidity. The endoureterotomy will be performed in the medial aspect of the ureter since there is only the bladder there. A 5 French electrode is introduced through the ureteroscope. The endoureterotomy begins above the stricture and progress until being largely bellow. A 30 watt cutting current is used, and the whole ureteral wall is incised until reaching the fat. A double diameter 14/7 French, double J stent is used. 3 months after cystoscopy is performed, the stent is removed, and a guide wire is inserted. Introduction of the ureteroscope, the ureter is large; there is no longer any stenosis. Slow motion, showing the ancient location of the stricture with the scar of the endo-ureterotomy. Above, there is the ureteral bifidity. Intra venous urography, showing a non-dilated kidney and a normal diameter ureter. Endoureterotomy scar How to control a ureteral stricture after treatment? 1- Double J stent removal and control with intra venous urography at 1 month? There is a risk of progression of the stricture with impossibility to insert a stent, Also the risk of aggravation of the renal function deterioration. 2- To perform a control ureteroscopy or a retrograde uretero-pyelography: If the ureter is wide open, the double J stent is removed and a control intra venous urography is performed at 1 month. If the ureter is still narrow or equivocal, another double j stent is placed, with or without dilation.