Urological endoscopes and percutaneous devices are expensive and their maintenance and cleaning need special attention. Sometimes urologists can help repairing their devices.
During taking out a Double J, Double J was trapped in the working channel of ureteroscope unintentionally. It was not possible to take it out by pushing methods. Finally, Double J was pulled out by a changed nephrostomy needle to a small curve hook.
Using the hand-made hook to pull out a trapped Double J from ureteroscope does not destroy the device.
In press - Corrected proof
Article Type: CASE REPORT
- • Accepted on 15/06/2017
- • Available online on 07/08/2017
This article is available as full text PDF.
Medical equipment has become an inseparable part of practice. Urology because of numerous endoscopic interventions is a prominent example.
Urologists sometimes need to repair their endoscopes by themselves instead of waiting for somebody to help them during a procedure. Another possible reason is high price of repairing or replacing the equipment (1), especially in developing countries. One unreported possible problem during ureteroscopy is trapped double J in ureteroscope.
Herein, we present a simple method to take out a trapped double J in a semi-rigid ureteroscope.
A 34-year-old man with long standing ureteral stone and severe hydroureteronephrosis was treated by transureteral lithotripsy and double J insertion in the first session. Unfortunately, double J had migrated upward in the ureter.
During the second session while trying to extract double J and remove remained stone particles, a semi-rigid 8 French ureteroscope was used. While the urologist was taking out the double J, the vision got obscured. It was assumed that the double J was not grabbed by the grasper, mistakenly. During extraction of grasper through ureteroscope, the double J was released inadvertently. In second-look ureteroscopy in order to take out the double J, it was not visible. As no instrument could pass through the ureteroscope, it was revealed that double J was stuck in the middle of ureteroscope, with about 10 cm distance from each end.
Using guide wire, double J pusher, lithoclast probe, high pressure water, high pressure air and high pressure jelly, we were not able to push the double J out.
We used a nephrostomy needle afterward. The tip of the needle was bent to form a small 2 mm hook. It was inserted through the tip of ureteroscope towards the double J. After reaching it, we advanced it a little forward by pressure and twisted the needle 180º, hoping to pierce the double J. Then, we managed to extract the double J, which was covered by the injected lubricant jelly.
The ureteroscope was used to extract the remained stone particles successfully with no disturbance in its function and vision.
Expensive medical equipment plays an important role in medical daily practice nowadays (1). Practitioners, in addition to providing optimum medical services to their patients, care about depreciation of their instruments (2). Sometimes, they are obliged to make a balance between the best surgical approach and maintenance of their equipment. Ureteroscopes with their high price need special attention in this regard. When something is grabbed by grasper, it should not been taken out through the ureteroscopes, instead it should been taken out with ureteroscope. We did not find a similar report in literature except for reports on trapped graspers in ureteroscope (3). In this case, the urologist left the double J in ureteroscope, unintentionally. Stucked double J cannot be pulled out by being pushed according to the author’s experienced due to its long length, soft texture and high friction. We could not pull out the double J by high pressure water, air or lubricant jelly. The author had the experience of pushing out retained DJ-pushers in ureteroscope with another pusher or lithoclast probe, but it did not work in this case because of aforementioned factors.
The author had used his technique years ago as a general practitioner to extract beans or peas stuck through the pediatric patients’ nose or ear, by a handmade hook that was developed from a tip-bent needle and used to pull out the foreign body.
In the recent experience, the bent-tip of the nephrostomy needle was forced under the double J and with twisting; its sharp tip had pierced the double J and like a hook kept the double J during extraction. Injected jelly played an important role in decreasing friction, otherwise releasing or tearing of double J was possible.
When ureteroscope and grasper are used to pull out double J from urinary system, it should not be done through ureteroscope. If double J is stuck in ureteroscope, after injection of lubricant jelly to the ureteroscope, a bent-tip nephrostomy needle can be used to pull it out without any damage to the ureteroscope.