The utility of instruments and disposables during endourologic practice among Egyptian urologists

Objective: We aimed to investigate the prevalence of utilization of different endourological instruments and disposables among Egyptian urologists and to see how availability could affect the deviation from the universal standards that might result in reduced patient safety. Patients and method: We surveyed members of the Egyptian Urological Association by a questionnaire evaluating the importance of different instruments and disposables used during ureteroscopy and percutaneous nephrolithotomy. All responses were collected by a commercially available Internet-based survey host ( www.surveymonkey.com ) over 8 weeks. Results: One hundred and fifty-two responses were received. For ureteroscopy, the most mandatory instruments and disposables included the C-arm device (83%), Dormia basket (61%), ureteral stone forceps (58%), pneumatic lithotripter (50%), and regular PTFE guide wire (49%). The instruments and disposables described as optional included 4.5 Fr ureteroscope (74%), flexible ureteroscope (70%), and hydrophilic guidewire (67%). For percutaneous nephrolithotomy, the most mandatory instruments and disposables were pneumatic lithotripter (78%), Alken metal dilator (75%), fascial dilator (45%), and regular PTFE guidewire (42%); while instruments and disposables described as optional included flexible cystoscope (70%), hydrophilic guidewire (67%), balloon dilator (57%), and laser machine (52%). Conclusion: The prevalence of the utilization of newly introduced instruments and disposables is low among Egyptian urologists.

The Use of Rigiflex Pneumatic Balloon Dilator during Laparoscopic Heller's Myotomy in Patients with Achalasia: A Novel Technical Method and Its Surgical Outcomes

Pneumatic balloon dilatation (BD) and laparoscopic Heller's myotomy (LHM) are usually preferred treatment options for relieving dysphagia symptoms in achalasia. The aim of the present study was to describe a new technical method for a safe and effective LHM. Endoscopic BD tube (Rigiflex 30-mm pneumatic balloon) is simultaneously insufflated and desufflated in the esophagus during LHM to assess myotomy in 50 consecutive patients. Dysphagia symptoms were determined using Eckardt's score. Three esophageal mucosal perforations occurred during surgery, which was primary repaired. The preoperative Eckardt score improved significantly from 4.54 ± 1.85 to 0.54 ± 0.73 ( P < 0.001) at the first postoperative annual follow-up. The use of endoscopic BD tube during LHM is an easy and valuable method that allows to assess whether the dissection of muscular fibers in the myotomy area is appropriate or not.

Analysis of Reported Balloon Malfunctions and Proposed Rescue Strategy for Malfunction during Airway Dilation

Objective The rate of balloon dilator failure is unknown, and a rescue strategy for device malfunction has not been established. The purposes of this investigation were to determine the approximate number of balloon failures in the gastrointestinal tract and airway, evaluate the parameters required to rupture balloon dilators, and develop a rescue strategy to efficiently reestablish airway patency. Study Design Retrospective cohort and basic medical research. Setting Academic tertiary care medical center. Subjects and Methods The Manufacturer and User Facility Device Experience database was queried for adverse events associated with tracheal and esophageal dilators between January 1, 2014, and January 1, 2017. A bench-top model of airway stenosis was developed, and optimal conditions for the safe removal of a malfunctioning dilator were assessed (2, 4, 6 atm). Results There were 420 reported balloon malfunctions, including 104 cases with deflation/removal issues. The bench-top model determined that device rupture allowing for immediate removal occurs with needle puncture at balloon pressures ≥8 atm. Balloons inflated to 6 atm required a median of 17.5 seconds (range, 0-55.3) for removal, in comparison with 30.2 seconds (range, 7.1-87.5) at 2 atm ( P > .05). Conclusion Balloon dilator malfunction is a significant problem that practitioners must be prepared for. Pressure ≥8 atm (~33% overinflation) is required to consistently cause complete balloon dilator rupture via needle puncture. While counterintuitive, increasing the inflation pressure of a malfunctioning balloon (8-10 atm) may expedite rupture and safe removal. A rescue strategy for balloon malfunction is proposed.

Current trends in percutaneous nephrolithotomy: an internet-based survey

Background: The aim of this study was to report current practices of percutaneous nephrolithotomy (PCNL) among endourologists. Methods: An internet survey was administered to Endourological Society members. Responders were distributed into three groups according to the number of PCNL cases per year (<50, 50–100, >100). PCNL technical details as well as opinions regarding specific clinical case scenarios were evaluated and compared between groups. Results: We received 300 responses from 47 different countries. Prone position was used in 77% of cases, while 16% used supine position and only 7% used modified lateral decubitus. Most endourologists performed their own access. There were no significant differences between the three groups regarding patient position ( p = 0.1), puncture acquisition by urologist or radiologist ( p = 0.2) and fluoroscopic puncture technique ( p = 0.2). Endourologists with high annual PCNL practice (>100) had least probability to utilize nephrostomy tube ( p = 0.0005) or use balloon dilator ( p = 0.0001). They also had the highest probability of performing mini-PERC ( p = 0.0001). Conclusions: The majority of endourologists performing PCNL obtain their own access. Prone positioning is predominant, while totally tubeless PCNL are uncommon. Mini-PERC is gaining more popularity among endourologists. Most endourologists follow the guidelines for their choice of treatment modality in different sizes and locations of upper tract calculi.