Urology > Technology: EndoU Instruments > Flashcards

Technology: EndoU Instruments Flashcards

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1
Q

What type of catheter is this?

A

Council tip - Allows catheter to be placed over a wire

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2
Q

What type of catheters are these? and what are they used for

A

A = Lapides Diagnostic catheter = Has 5 radiopaque rings each 1cm apart
-Used to calibrate female urethral length

B = Davis and Trattner diagnostic catheters
-One balloo for bladder neck, and the other to seal meatus.
-So can give contrast into urethra, and look for diverticulum
-Now mostly replaced by MRI

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3
Q

What types of catheters are these? And what are they used for

A

A type of drain catheter
Known as Malecot tube

The tip has 4 small arms
These can be compressed for drainage, but hold the catheter in place.

Often placed intraoperatively during indiana pouch creation

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4
Q

How about this one

A

Pezzar tube - Also a type of drainage catheter

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5
Q

What is cope catheter?

A

Is a pig tail

Has a string connected to distal tip
-Allows you to pull it and forms a secure coil that retains the catheter in place

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6
Q

What is this

A

Malecot catheter

Can be put after PCN = Has wings to keep the tube in place

When being removed - A stiffener is inserted via the malecot catheter
-This pushes on distal end and straightens the wings so it can be removed

Can also have re-entry catheter that allows you to pass a guidewire down the ureter

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7
Q

If stenting under II, where should the stent pusher marker go to?

A

Mid pubic symphysis

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8
Q

Most common material ureteral stent

A

Polyurethane

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9
Q

Initial scope arrangement

A

Max Nitze scope
-Series of optimal lenses at precise distaces, along the length of a hollow air filled scope

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10
Q

Second scope arrangement

A

Hopkins scope - Developed rod lens system

Used a series of glass rods, with only short gaps of air between
-Improved light transmission, and decreased scope size

These were the contemporary rigid scops used in urology

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11
Q

Third progression in scopes

A

John Tyndall

Fibre optics - Light can be transmitted via this
-And allowed for creation of flexible endoscopes

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12
Q

Fourth progression in scopes

A

Boyle and smith developed charge-coupled device (CCD)
-This is a sensor with ability to convert photons into a digital image.

Now the CCD is at distal tip of the scope.
-Digitial endoscopes

These provide improved resolution, and durability
-With no need for seperate light cable and camera

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13
Q

How is light delivered to scope

A

Usually high-intensity xenon or halogen external light source
-Transmitted through fibre optic cable to endoscope

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14
Q

Wavelength for NBI

A

Narrow band imaging = Only uses blue (415nm), and green (540nm) wavelengths

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15
Q

How does NBI work

A

The blue and green wavelengths are readily absorbed by haemoglobin.

So enhances visibility of urothelial capillaries, small papillary lesions, and CIS

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16
Q

Evidence for NBI?

A

Zheng et al 2012
-Meta analysis of 8 studies including 1022 patients
-NBI improves detection accuracy of noninvasive lesions, including CIS.

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17
Q

Components of traditional video-endoscopic system

A

Light source
Endoscope camera
Image processor/recorder
Monitor

New digital scopes = Light source and camera are combined

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18
Q

How is information passed from tip of camera to monitor in a traditional system?

A

Series of glass robs or fibre optic bundles transmit the endoscopic image to the eyepiece.

Then the external camera CCD chip receives this image, and produces an electrical charge (voltage waveform).

The units video processor then converts analog voltage into a digital signal that is passed to the monitor

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19
Q

How is information passed from tip of camera to monitor in a modern system?

A

Digital endoscope systems = The CCD chip is located at distal end of the scope

Image is immediately converted into electrical signal and is projected onto monitor.

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20
Q

What optical system do rigid scopes use?

A

Hopkins rod lens system

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21
Q

What optical system do flexible scopes use?

A

Fibre optic

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22
Q

What is this, and when is it used

A

Albarran’s bridge

Allows deflection of wire/catheters that are passed through working channel

Particular useful in large IPP = Where cannot reach down to UO

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23
Q

Why is semirigid URS with 2 working channels preferred

A

Remember each one will be smaller

But if basket stuck, can use second channel to fracture a stone stuck in a basket

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24
Q

Two ways that eyepiece can be arranged on semirigid URS and practical differences

A

Can be ‘in-line’ with scope

Or ‘offset’.

Offset means working channel is straight
-Better if using more rigid instruments in the working channel

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25
Key components of digital and non digital flexible ureteroscopes
Digital = Optical system, working channel, deflection mechanism Non digital = Also flexible fibre-optic cables and light bundles
26
Two types of deflection mechanism for flexible ureteroscope
Intuitive = Down is down, up is up Non-intuitive = Down is up, up is down
27
How does the deflecting mechanism work
The deflecting lever controls wires that run along the flexible ureteroscope through moveable metal rings to the very distal tip
28
Most common 2x designs/material for guidewires
Most common = Solid stainless core with a wire wrapped around (usually PTFE) Next common = Nitinol (nickel-titanium for inner core
29
Benefits of nitinol core
More kink resistant, slightly stiffer
30
What is sensor wire made of?
Nitinol core with PTFE wire coating And a hydrophilic tip
31
Size of most common guidewire?
0.038inches
32
Range of guidewire sizes
0.018in to 0.038in
33
Most common length of wires for endourology
145cm
34
Two types of ureteral dilation
Passive = placing a stent Active = Using a dilator
35
Two forms of ureteral dilation
Dilating catheters = Hydrophilic coated polyurethrane catheters Balloons = Passed over wire and pump up to dilate
36
Max size to dilate ureter
Dilation of ureter beyond 15Fr is rarely required for routine ureteroscopy
37
Three types of intraluminal devices used for lithotripsy
Electrohydraulic lithotripsy (EHL) Pneumatic lithotripsy Ultrasonic Lithotripsy Laser lithotripsy
38
How does electrohydraulic lithotripsy work
Two electrodes at tip of probe - Create a spark when triggered. When immersed in liquid - Spark creates immediate transition from fluid to gas, creating rapidly expanding plasma shockwave. This shockwave collapses cause a cavitation bubble, that creates secondary shockwave and high pressure microjets Works well - But not as good for dense stones such as cystine/calcium oxalate monohydrate.
39
Pros and cons electrohydraulic lithotripsy
Pros = Uses small and flexible EHL probes -So can use in both rigid and flexible scopes Cons = Not so good for harder stones (eg Cystine and calcium oxalate monohydrate) -Also energy is poorly focused, can cause ureteral damage. -Easy to damage ureteroscope also So overall = Rarely used now
40
How does pneumatic lithotripsy work?
Uses either compressed gas to drive a projectile forcefully against the prob tip -A bit like a piston
41
Pros/cons of pneumatic lithotripsy
Pros = Very good fragmentation -Lower risk ureteral injury Cons = Can cause significant stone retropulsion -Limited to rigid scopes (there are some flexible probes, but significantly limit deflection in flexible ureteroscopes)
42
Why does pneumatic lithotripsy have low risk of injury to ureter?
When applied to soft/compliant tissues (ie ureter) Energy is absorbed and dispersed Whereas to rigid objects are not compliant and results in fracture
43
Pneumatic lithotripsy and wire?
Pneumatic devices are the only modality not to cut through wire
44
Example of pneumatic lithotripsy device?
Boston Scientific LithoClast system -Uses mechanical air Also StonBreaker (Cook) -Uses CO2 cartridge
45
What is ultrasonic lithotripsy
Uses electric current through piezoceramic crystals to produce waves that propogate down the probe to impact the stone. -Waves between 23,000 and 27,000 THe meta prob vibrates, and this reverberation causes stone fracturing.
46
Example ultrasonic lithotripsy
Olympus Shockpulse
47
Difference ultrasonic lithotripsy and pneumatic lithotripsy
Ultrasonic = Has an additional central channel for suction, so stones easily aspirated out
48
Can you cause injury to shockpulse?
Quite difficult. Studies in rabbits = No injuries to bladder Ureteral/bladder perf essentially not possible with perpendicular application of the ultrasonic and pnuematic probes. Can cause oedema and submucosal haemorrhages due to the suction
49
Wavelength of Hol:Yag laser?
2100nanometers
50
How far is laser penetration for Hol:yag?
The laser is absorbed in 3mm of water - Making it very safe in urology
51
Components of stone-retrieval devices?
Control handel Control wire The Sheath The device itself (The basket)
52
Safest basket and why? Is it used?
3 prong basket - Very safe as it will just release stones that are too big, when pulling Therefore preventing damage to ureter Hardly used because of better designs now
53
Second development after 3 pring baskets?
Tipless/zero tip baskets These tipless baskets open at the distal end, like three prong -So help to disengage calculi that are too large to pull from the ureter
54
Name 3 examples of retropulsion prevention devices?
Left side: NTrap (Cook Medical) Middle: Accordion Right: Stone Con (boston scientific)
55
What basket is this
NGage based from cook medical
56
Why should you empty bladder before doing URS/Advanced T6, putting stent?
Because it can cause buckling of instrument when resistance is met at the UO
57
Available laser sizes and when used
200-micron = RIRS 365-micron = URS only 500-micro = PCNL um (micrometer or micron)
58
59
Components of laser
Energy source (eg flashlamp Active medium (eg Ho/Yag crystal) Resonant cavity (mirrors_ Optical fiber delivery system - Such as quartz fibres to guide laser energy
60
How is laser produced?
1) Light generated with active medium (can be solid/liquid/gas) -Atoms in active medium need to be brought to higher energy state by an energy source (known as pumping) 2) This light is photons is in the same wavelength and in same direction -Resonant cavity is created with mirrors to refelect light, allowing it to have many passes through medium 3) Small portion of amplified light escapes out of resonant cavity and forms beam of laser light
61
What is coherence
Light in same wavelength, same direction and highly ordered. known as coherence
62
Properties of laser light
Monochromatic Singlewavelength Cohere Has directionality with minimal divergence
63
Wavelength of Ho:Yag, and depth of penetration
2100nm Only travels 0,.5cm in fluid medium
64
What is a chromophore
Part of a molecule responsible for absorption of specific wavelengths Eg are melanin, haemoglobin or water
65
What is the Beer-Lambert law
Absorbance of light by a substance is directly proportional to its concentration and the path length of the light through the sample
66
Neodymium:Yttrium-Aluminium-Garnet laser other name
Nd:YAG Laser
67
Nd:YAG wavelength and tissue depth penetration
1064nm Tissue depth penetration = 1cm Was used for Laser ablation of prostate before
68
What is the green light laser?
Potassium Titanyl Phosphate
69
Potassium Titanyl Phosphate wavelength and depth. Also what absorbed by?
532nm (green in colour) Strongly absorbed by haemoglobin Depth = In well vascularised tissue is only 1-2mm
70
How is green light laser produced?
Takes a Nd:YAG Laser and passes through a KTP crystal This doubles the frequency And halves the wavelength to 532nm
71
Describe how pulse modification works and why its good
Allows for adjustments of pulse duration Longer laser pulse duration = Breaks stones well, with reduced laser tip degradation and less stone retropulsion Moses effect = Laser pulse modulated to first separate water, then deliver remaining energy to stone
72
Wavelength of Thulium:Yag and difference
2000nm - It is a continuous wave laser Slight shorter then Ho:Yag = Means slightly less depth of penetration
73
Differences laser generation Thulium:Yag vs Hol:Yag
Thulium ions excited by higher power laser diodes instead of flashlamp excitation like in Ho:Yag = Means less geat generation, and increased power efficiency by factor of 5
74
Differences in waveform in Thulium:Yag vs Hol:Yag
Thulium is continuous wave output = Means more direct cutting action rather then splattering with Ho:YAG Has very little retropulsion
75
What are 'high power lasers'
These are Hol:Yag lasers but with higher overall wattage Eg. 100-W or 120-W
76
Describe what laser properties allow 'popcorning' to work
Photoacoustic = Light absorbed produces sound wave Photothermal = Light absorbed produces heat = These properties are functions of pulse duration and energy.
77
Common duration of Ho:Yag pulse?
250-350um (micron)
78
Pros/cons of shorter and longer pulse duration?
Shorter pulses = Higher peak power in resulting shockwaves Longer pulses = Reduces stone retropulsion -Reduces fiber tip degredation
79
Laser settings for popcorning?
Low energy High frequency Eg 1J and 20+Hz
80
Name a dual-modality lithotripser, and what modalities it uses
Lithoclast Ultra Shockpulse-SE Cyberwand -Both olympus They use ultrasonic and pneumatic lithotripsy in one handpiece Pneumatic good for hard big stones Ultrasonic makes small fragments, and can suction out at same time
81
Benefits of dual modality lithotripsy?
More efficient when compared to either modality alone Soucey et al 2008 = -3.8x faster then pneumatic -1.7x faster then ultrasonic -Compared to dual modality Lithoclast Ultra
82
Differences between the 3 different types of dual modality lithotripsers?
Lithoclast ultra = two independantly driven lithotrites in once handpiece Cyberwand = Double layered probe, with central ultrasonic probe, and ballistic outer probe Shockpulse-SE = Single probe that has both ultrasonic and intermittent ballistic shockwave energy.
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