AN EFFICIENT TECHNIQUE TO ENGAGE AND CATHETERIZE A URETERAL ORIFICE 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: In some situations, catheterization of the ureteral orifice can be very challenging. These situations include patients with: a very large median lobe of the prostate, a transplanted kidney, a cross-trigonal ureteral re-implantation, tumors/stones obstructing the lumen of the ureteral orifice, and a distal ureteral stricture. We will present a technique that makes ureteral catheterization efficient and easier to perform.
MATERIALS AND METHODS: Use a 5 Fr. open-ended ureteral catheter and an angled tip Glidewire® (hydrophilic guidewire with an angled tip). Insert the open-ended catheter into the scope and insert the Glidewire® into the lumen of the catheter with 1.5 cm of the Glidewire® sticking out of the inserted end. We can adjust the length, and thus curvature, of the Glidewire® sticking out of the inserted end. Use the Kelly clamp or mosquito clamp at the distal end of the catheter to fix the catheter to the Glidewire® inside. In order to steer the angled tip inside the bladder we just need to gently rotate the clamp from the outside. The angled tip Glidewire® inside the bladder is soft and flexible. It can get into a challenging ureteral orifice easier than a regular open-ended catheter. We then advance both the catheter and the Glidewire® up the ureter. The catheter is fixed to the Glidewire® by the clamp.
RESULTS: We have used this technique to catheterize multiple patients with a transplanted kidney, cross-trigonal ureteral implantation, and with very large prostates. Once the catheter gets inside the ureteral orifice and into the ureter, we can easily release the clamp to advance the Glidewire® quickly.
CONCLUSION: This technique is simple and more effective than traditional techniques. For example, Endourologyadvocates the use of the Alberran deflecting bridge or an angled tip angiographic catheter. The Alberran deflecting bridge, however, cannot achieve the curvature that may be necessary to insert the catheter. The Alberran deflecting bridge may also catch organs such as the prostate and cause bleeding. On the other hand, the angled tip angiographic catheter, though also curved, is static—meaning the surgeon has no flexibility in adjusting the curvature of the catheter, potentially making the insertion of the catheter more challenging. The advantage of using a Glidewire® as opposed to simply using an open-ended catheter is that the curvature can easily be manipulated and that the wire is flexible enough to fit into tortuous paths such as a J-hook ureter.