Nephroscope is the ideal tool for percutaneous nephrostomy (PCN). It can be used in both pediatric and adult patients. It can be inserted into the renal pelvis over a guide wire by means of an access needle. It is also possible to perform balloon dilation and sheath placement over this wire.
What is a Nephroscope?
A nephroscope is a thin, tube-shaped instrument that is used to examine the kidney and treat certain conditions in the upper urinary tract. The procedure is performed under anesthesia, and it involves making a small cut in the skin and inserting the nephroscope into the body. The nephroscope has a telescope, channels for insertion of different instruments, and an irrigation system. It also has a device that can break apart large stones and make them easier to remove.
During this procedure, your doctor will inject dye into your kidney to locate the stone or blockage and check your blood flow. After this, he or she will make a small cut in your back and insert a protective sleeve, called a sheath, into your kidney. The nephroscope and other surgical tools are then passed through the sheath to access your kidney. Your doctor will use the nephroscope to see the stone and, if necessary, break it up or remove it. Depending on your condition, your doctor may place a nephrostomy tube or ureteral stent to help your kidney heal and drain urine while you recover.
The nephroscope is used in percutaneous nephrolithotomy (PCNL) to remove large kidney stones. This is a minimally-invasive surgery that reduces the need for traditional open surgery, which has a longer recovery time. This procedure is typically reserved for patients with kidney stones that are too big to be removed through other methods.
During the PCNL procedure, your urologist will make a small cut in your skin and then insert a nephroscope into your kidney through the opening. The nephroscope has specialized instruments that can break up and remove the kidney stone. Your doctor can also use the nephroscope to remove a blocked or enlarged ureter, remove cysts (fluid-filled pouches on or in the kidney), and remove foreign bodies that have entered your body through the urinary tract.
Uses and Applications of a Nephroscope
Nephroscopy is used for a variety of procedures to diagnose or treat kidney diseases. It is a minimally invasive technique that involves inserting a thin tube with a light source, a camera and irrigation channels into the kidney through a small cut in the skin. This tube has channels inside that carry instruments to perform various therapeutic actions, such as removing a kidney stone or breaking up large stones into smaller pieces. A laser can also be used to break up a large stone into tiny particles. The stones are then either suctioned out or swept away by the irrigation channel.
A nephroscope is a key instrument for percutaneous nephrolithotomy (PCNL). This procedure involves using a nephroscope to remove kidney stones from the renal pelvis through an opening in the skin. Smaller stones can be removed directly by a stone grabber, while larger ones need to be broken up using a device like a laser. After the stones are removed, your surgeon will use a contrast material to confirm that there are no remaining fragments in the kidney.
The nephroscope can also be used to examine the ureters, which are the tubes that connect the kidneys and the bladder. It can be used to detect certain types of blockages, including those caused by a hernia or cancer. It can also be used to determine whether you have a condition called pyelonephritis, which is characterized by inflammation of the lining of the kidney.
A nephroscope can be used to remove kidney stones from the lower pole, or morbidly obese patients who can’t undergo other treatments. It can also be used to remove staghorn or multiple calculi from the upper urinary tract.
Types of Nephroscope
As states above, a nephroscope is a small telescope-like device that allows doctors to see inside the kidney. It can also be used to break up or remove kidney stones. This procedure is called percutaneous nephrolithotomy (PCNL). It is usually performed with the help of another instrument called a lithotripsy machine. PCNL is usually reserved for patients with large stones that cannot be removed by other methods. In PCNL, a urologist inserts a nephroscope into the kidney through a small opening in the flank and uses special instruments to remove the stones.
A standard rigid nephroscope with a diameter of up to 28 F is the most commonly used instrument for renal percutaneous surgery. The Wickham and Amplatz-type rigid nephroscopes are the most popular models. Both have an external sheath and a working channel that can accommodate different tools, including the lithothripter and stone forceps. A nephroscope with a smaller diameter is also available and is used for mini-PCNL. This type of nephroscope is sometimes referred to as a “mini-perc.”
To perform a PCNL, the patient’s access needle is inserted into the kidney through a skin incision (usually on the flank). Then, the tract is dilated with a series of 10 to 22-Fr fascia dilators. Finally, a 13-Fr Rigi-flex nephroscope is advanced into the renal pelvis through the working access sheath.
The advantage of this combined technique is that the various advantages of both flexible and rigid ureteroscopes can be utilized simultaneously. This is particularly important for complex calculi and staghorn calculi, which can cause significant morbidity. In addition, the use of a nephroscope can reduce the need for multiple auxiliary procedures, which increases procedural stone free rate and shortens the time required for complete stone clearance.
Working Principles of a Nephroscope
Nephroscopy is a minimally invasive procedure in which a thin, tube-like instrument called a nephroscope is inserted into the kidney. This instrument has several channels within it, including a source of light, a telescope and an irrigation system (water system to flush the operation site). It is used for diagnosing and treating certain conditions in the kidney or upper urinary tract, such as obstructive uropathy. Nephroscopy is also an effective treatment for certain types of kidney stones. The nephroscope is used to break up large kidney stones into smaller fragments that can then be removed with special stone holding forceps.
Before a nephroscope is positioned into the renal pelvis and calyces, it is necessary to introduce a guidewire into the kidney. This step helps to prevent inadvertent urethral injury during the removal of large stone fragments. Once the nephroscope is placed into position, it can be used to visualize the stones. The stones can then be broken apart with an ultrasound probe or laser, and the fragments are suctioned or endoscopically removed.
Rigid nephroscopes have a wide working channel of between 24 and 28 Charr (Fig. 2.5). However, they are often difficult to insert into narrow and curved renal tubules. To overcome this problem, flexible nephroscopes with smaller diameters are being used. These instruments are referred to as mini-nephroscopes or mini-perc.
Rigid nephroscopes with a flexible distal end can be used to access renal calyces that are not easily accessible with standard channels. These instruments are also more able to bend at their tip, which allows them to reach a wider range of locations within the renal pelvis and calyces. They can be combined with a flexible ureteroscope to allow the advantages of both instruments to be brought into play simultaneously during ultrasonic lithotripsy and calculus clearance.
Repair and Maintenance of a Nephroscope
The nephroscope is an instrument used by physicians to remove large and small kidney stones in a minimally invasive procedure called Percutaneous Nephrolithotomy (PCNL). During this procedure, your doctor makes a small incision in your back or side and inserts a thin tube area with a telescope inside it.
After this, your doctor will use a video scope to locate and remove the stone. The procedure typically takes 30-45 minutes. A catheter is often left in your kidney to collect urine until you are fully healed. After the procedure, you will likely spend one to two days in the hospital.
A second-look nephroscopy procedure is usually performed to clear remaining stone fragments after PCNL. It is performed under general anesthesia. After the patient is fully anesthetized, a 5 Fr 40 cm Bern torque catheter (Boston Scientific) is inserted into the ureteral opening in the collecting system and advanced into the renal pelvis. A 0.035″ dual durometer guide wire is then coiled and inserted. The nephroscope is then passed over the guide wire to enter the collecting system. A digital flexible nephroscope is used and normal saline is used for irrigation.
After the flexible nephroscope has entered the collecting system, careful inspection is performed under direct vision and fluoroscopic guidance. If the stone is too large to be removed by lithotripsy, then a holmium laser or a stent can be used to break up the stone. The resulting fragments can then be removed with a nitinol stone basket. The stone is then flushed away with a jet of normal saline pressure.