ROCAMED MH01 - Urinary Lithotripsy Warnings; Urinary Lithotripsy Precautions; Urinary Lithotripsy Complications

50
NOTE-MH01-EN rev05
6.4.2 Urinary Lithotripsy Warnings
Warning
Unexpected tissue damage may occur due to excessive power application. Refer to
Urinary Lithotripsy Clinical Parameters (see Section 6.4.5) for recommended
initial power settings. Use of excessive power may result in inadvertent
perforation of the ureter or damage to other urologic structures.
Read General Laser Warnings (see Section 6.2.1) for a list of additional warnings.
6.4.3 Urinary Lithotripsy Precautions
Caution
- The laser should be used with an optical fiber delivery system in direct view and in
direct contact with the target ureteral stone. To minimize the potential for migration up
the ureter, laser energy should be directed to the side of the stone, if possible, rather than
the leading edge. Maintaining low energy levels and repetition rates will reduce the
potential for possible stone migration.
- Be aware of oedematous folds of epithelium that may lie between the optical fiber
and the stone;
- Basketing may be used with larger stone fragments that are relatively hard or tend to
escape in a retrograde fashion up the ureter. Use of endoscopes in laser procedures allows
excellent viewing and minimal trauma to the ureter during fragmentation.
- Baskets, guide wires, and other ureteroscopic accessories may be damaged by direct
contact with the laser treatment beam.
- The use of irrigation is recommended throughout the Lithotripsy procedure to absorb
any heat produced, to carry stone fragments out of the urinary system, and to enhance
direct visualization. The rate of irrigation should be carefully adjusted to avoid flux of calculi
into the kidney.
Read General Laser Precautions (see Section 6.2.2) for a list of additional precautions.
6.4.4 Urinary Lithotripsy Complications
As with other endoscopic urologic procedures, there may be urine leakage following the
laser procedure.
- The use of flexible endoscopes carries an equivalent incidence of stricture formation;
these rates may improve with further advances in ureteroscopic design.
- Although rare, loss of a kidney may occur as a result of the procedure or because of
the stone itself.
Complications for Uretero renoscopy (URS):
Minor complications are fever, macro haematuria and pain. In literature, the rate of
significant complications (sepsis, ureter perforation or torn ureter is 3-11%).
Urinary strictures as a long-term complication have become rare and are estimated to be
1 to 3%. Previous ureter perforations represent the key risk factor.
Complications for Percutaneous Nephrolithotomy (PCNL):
Typical are the following complications:
- Fever, sepsis
- Bleedings requiring transfusion
- Absorption of irrigation fluid
- Perforation of the intestine
- Lesion of the pleura