TECHNIQUE TO MANIPULATE A GLIDEWIRE® UP THE URETER IN DIFFICULT SITUATIONS
Cu N Phan, M.D., Dominic Tran-Nguyen, B.S., Jeffrey W. Wong, B.A., Jin S. Lee, B.A., Jonathan M. Nguyen, B.S.
Purpose: There are situations that cause passing a Glidewire®up the ureter difficult: a very tortuous ureter, a stricture in the ureter, an impacted stone or tumor in the ureter. We present a technique to help manipulate the Glidewire®up the ureter in an efficient manner which will decrease trauma to the ureter.
Materials and Methods: We pass a 5 Fr. open-ended catheter up the ureter to near the point where we cannot advance further. Then we insert a 0.035 hydrophilic angled tip stiff shaft Glidewire® into the 5 Fr. open-ended catheter. With a mosquito clamp or Kelly clamp, we clamp the wire approximately 3 inches from the external end of the open-ended catheter. Under intermittent fluoroscopy, we advance the Glidewire® by moving the mosquito clamp back and forth, while rotating the Glidewire® with an increment of about 10 degrees. We do this until the tip of the Glidewire® finds the opening in the lumen of the ureter and we can see the Glidewire® advancing up the ureter as seen on fluoroscopy. If the rotated angle is not successful we can reverse the direction of rotation to look for the right angle.
Results: For the past 5 years, we have used this technique successfully manipulating the glide wire in very challenging situations including obstructive, tortuous strictures of ureter with no complications. The reason for this is that the tip of the Glidewire® is very flexible and soft, preventing serious trauma. In contrast to the vice clamp which makes judging the degree and change of angle difficult, this technique allows easier and more precise control to the angle of rotation. Compared to the vice clamp, this technique is much easier to use.
Conclusion: Our technique is easy to perform and time efficient in helping pass a Glidewire® up the ureter in challenging situations. We hope that this technique will be added to the urologists’ armamentarium.