Otis Urethrotomy Procedure

1. McDougall EM, Liatsikos EN, Dinlenc CZ, Smith AD (2002) Percutaneous approaches to the upper urinary tract. In: Walsh P, Retik A, Vaughn C, Wein A (eds.) Campbell's urology, 8th edn.. Philadelphia, Saunders, pp3320

2. Liatsikos EN, Bernardo NO, Dinlenc CZ, Kapoor R, Smith AD (2000) Caliceal diverticular calculi: is there a role for metabolic evaluation? J Urol 164:18-20

3. Irby PB, Schwartz BF, Stoller ML (1999) Percutaneous access techniques in renal surgery. Tech Urol 5:29-39

4. Young AT, Hunter DW, Castenda-Zuniga WR et al (1985) Percutaneous stone extraction: use of intercostal approach. Radiology 1154:633-638

Image Gallery

Access Sheath Ureterorenoscopy

□ Fig. 11.1. Retrograde placement of the ureteral catheter to occlude the renal pelvi-calyceal system. Left, status preoperatively; right, artificial hydronephrosis to facilitate puncture and to prevent dislocation of stone fragments into the ureter during the procedure

Transurethral Otis Urethrotomy

□ Fig. 11.4. Establishment of the working tract achieved by progressive dilatation with the aid of concentric metal serial dilators

Otis Urethrotomy
□ Fig. 11.6. Introduction of the nephroscope and ultrasonic lithotripsy

□ Fig. 11.7. Removal of stone fragments with a stone grasper: The fixed stone is removed together with the nephroscope through the sheath. X-rays: A and B: stone too big (danger: loss of working tract and/or dislocation of the stone into the working tract), C: stone removable through the sheath

Otis Urethrotomy

□ Fig. 11.8. Inspection of the collecting system for stone fragments: This must particularly include inspection of the UPJ and the junction of the working tract and lower calyx

Upper Calyx Middle Calyx Lower Calyx

□ Fig. 11.10. Stone lithotripsy through the lower, the middle or upper calyx during the same procedure (Staghorn calculi)

Otis Urethrotomy Procedure

□ Fig. 11.11. Stone fragments of smaller diameter in areas inaccessible to the rigid nephroscope: A flexible cystoscope (or ureterorenoscope) is inserted through the nephroscope sheath. Stone fragmentation or removal can be achieved by laser or Dormia basket


Thomas Knoll, Maurice-Stephan Michel

Introduction - 106 Preoperative Preparation - 106 Anaesthesia - 107

Indications for Ureterorenoscopy - 107 Limitations and Risks - 108 Contraindications - 108 Ureterorenoscopes - 108

Stone Disintegration and Stone Extraction Tools - 110

Stone Extraction - 110

Operative Technique (Step by Step) - 111

Operative Tricks - 113

Postoperative Care - 113

Common Complications - 114

Postoperative Complications - 114

References - 114

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