ureterorenoskopi (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Basisoplysninger<a title="Mark L. Cutress, Grant D. Stewart, Paimaun Zakikhani, Simon Phipps, Ben G. Thomasand, David A. Tolley, Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. Bju International 2012;110: 614-628" href="%20" data-url="reference-link" data-value="Mark L. Cutress, Grant D. Stewart, Paimaun Zakikhani, Simon Phipps, Ben G. Thomasand, David A. Tolley, Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. Bju International 2012;110: 614-628" data-type="journal-reference" data-value-piped="Mark L. Cutress, Grant D. Stewart, Paimaun Zakikhani, Simon Phipps, Ben G. Thomasand, David A. Tolley|Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review|Bju International|2012|110|614-628"><sup>1</sup></a><sup>,</sup><a title="Anna E Wright, Nicholas J Rukin, Bhaskar K Somani, Ureteroscopy and stones: Current status and future expectations. World J Nephrol 2014;3: 243-248" href="%20" data-url="reference-link" data-value="Anna E Wright, Nicholas J Rukin, Bhaskar K Somani, Ureteroscopy and stones: Current status and future expectations. World J Nephrol 2014;3: 243-248" data-type="journal-reference" data-value-piped="Anna E Wright, Nicholas J Rukin, Bhaskar K Somani|Ureteroscopy and stones: Current status and future expectations|World J Nephrol|2014|3|243-248"><sup>2</sup></a></h2>
<h3>Baggrund</h3>
<ul>
    <li>Fleksible ureteroskoper tillader i dag retrograd kirurgi i ureter, nyrepelvis og calyces<a title="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." href="%20" data-value="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." data-type="other-reference"><sup>3</sup></a></li>
</ul>
<h2>Indikation</h2>
<ul>
    <li>Metoden benyttes i stenbehandling og til tumordiagnostik i ureter og nyrepelvis</li>
    <li>Metoden muligg&oslash;r, at sten i de &oslash;vre urinveje behandles i dagkirurgisk regi</li>
    <li>Fleksible instrumenter benyttes ogs&aring; i nyreb&aelig;kkenet i situationer, hvor <a href="~/link.aspx?_id=3FF0C8F48F5845CFB4E51D188528610E&amp;_z=z">chokb&oslash;lgebehandling</a> og <a href="~/link.aspx?_id=C200329B7E1547BFA0F8BF55972C9DA0&amp;_z=z">perkutan nefrolitotomi</a> er mindre egnet </li>
    <li>Komplicerede tilf&aelig;lde kr&aelig;ver kombination af flere metoder</li>
</ul>
<h2>Kontraindikationer</h2>
<ul>
    <li>Kontraindikationerne er alle relative, og behandlingen er h&oslash;jt individualiseret<a title="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." href="%20" data-value="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." data-type="other-reference"><sup>3</sup></a></li>
</ul>
<h2>Metode</h2>
<ul>
    <li>Indgrebet kan foretages i intraven&oslash;s sedoanalgesi (sedation + lokal an&aelig;stesi), men typisk benyttes generel an&aelig;stesi, <a href="~/link.aspx?_id=C368C7B1C3DC48C8B65B4CE949E484C1&amp;_z=z">spinalan&aelig;stesi eller epiduralan&aelig;stesi</a></li>
    <li>Ureteroskopet f&oslash;res under synets vejledning via urethra og vesica op i ureter</li>
    <li>R&oslash;ntgengennemlysning giver peroperativt overblik over ureter og nyreb&aelig;kken samt ureteroskopets placering i urinvejene&nbsp;</li>
    <li>Konkrementer hentes ud ved hj&aelig;lp af specielle kurve, efter evt. f&oslash;rst at v&aelig;re fragmenteret med endoskopiske knusesonder (ultralyd, laser, elektrohydraulisk, mekanisk) </li>
    <li>Tumorer kan biopteres&nbsp;og sm&aring; benigne tumores behandles med laser<a title="Mark L. Cutress, Grant D. Stewart, Paimaun Zakikhani, Simon Phipps, Ben G. Thomasand, David A. Tolley, Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. . Bju International 2012;110: 614-628" href="%20" data-url="reference-link" data-value="Mark L. Cutress, Grant D. Stewart, Paimaun Zakikhani, Simon Phipps, Ben G. Thomasand, David A. Tolley, Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. . Bju International 2012;110: 614-628" data-type="journal-reference" data-value-piped="Mark L. Cutress, Grant D. Stewart, Paimaun Zakikhani, Simon Phipps, Ben G. Thomasand, David A. Tolley|Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. |Bju International|2012|110|614-628"><sup>4</sup></a></li>
    <li>De mere komplicerede behandlinger afsluttes med anl&aelig;gning af&nbsp;en ureterstent, som fjernes ambulant</li>
</ul>
<h2>Resultater</h2>
<ul>
    <li>Stenfrihed i ureter opn&aring;s hos &gt;90 % - afh&aelig;ngig af beliggenhed<a title="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." href="%20" data-value="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." data-type="other-reference"><sup>3</sup></a><sup>,</sup><a title="C. Türk (chair), T. Knoll (vice-chair), A. Petrik, K. Sarica, C. Seitz, A. Skolarikos, M. Straub. Guidelines on Urolithiasis (Update March 2013)" href="%20" data-value="C. Türk (chair), T. Knoll (vice-chair), A. Petrik, K. Sarica, C. Seitz, A. Skolarikos, M. Straub. Guidelines on Urolithiasis (Update March 2013)" data-type="other-reference"><sup>5</sup></a></li>
    <li>Sm&aring; benigne&nbsp;tumorer kan ligeledes succesfuld behandles endoskopisk</li>
</ul>
<h2>Komplikationer</h2>
<ul>
    <li>Alvorlige akutte komplikationer er i dag sj&aelig;ldne</li>
    <li>Den gennemsnitlige&nbsp;komplikationsrate er ligger p&aring; omkring 1,5 %<a title="Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW, Ureteroscopy: current practice and long-term complications. J Urol 1997;157: 28 - 32" href="%20" data-url="reference-link" data-value="Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW, Ureteroscopy: current practice and long-term complications. J Urol 1997;157: 28 - 32" data-type="journal-reference" data-value-piped="Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW|Ureteroscopy: current practice and long-term complications|J Urol|1997|157|28 - 32"><sup>6</sup></a> </li>
    <li>Den hyppigste akutte komplikation er ureterperforation, som behandles med&nbsp;en ureterstent i 2-3 uger </li>
    <li>Udvikling af ureterstrikturer&nbsp;ses hos ca. 0,1 %<a title="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." href="%20" data-value="Tiselius H-G, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Türk C. Guidelines on urolithiasis. Arnhem: European Association of Urology, 2009." data-type="other-reference"><sup>3</sup></a></li>
</ul>
<h2>Forl&oslash;b</h2>
<ul>
    <li>Indgrebet f&oslash;lges typisk af yderst beskedent&nbsp;ubehag i form af kortvarige vandladningsgener eller trykken i flanken i den opererede side</li>
    <li>Ureterstenten&nbsp;kan give anledning til irritation i urinbl&aelig;ren</li>
    <li>Rekonvalescens og sygemeldingsperiode udover f&aring; dage er us&aelig;dvanligt</li>
    <li>De prim&aelig;re opf&oslash;lgning er individualiserede og udf&oslash;res hos urolog </li>
</ul>
<h2>Patientinformation</h2>
<ul>
    <li>
    <a href="~/link.aspx?_id=056BE36CDF9C414396E18BB502B5913F&amp;_z=z">Nyresten</a> </li>
    <li>
    <a href="~/link.aspx?_id=9F01C856F7C04DCE8E9E5806DCBBA0C4&amp;_z=z">Chokb&oslash;lgebehandling ved nyresten</a> </li>
    <li>
    <a href="~/link.aspx?_id=DF62C3545F114739BE914D5829F88EF2&amp;_z=z">Ureterorenoskopi ved nyresten</a> </li>
    <li>
    <a href="~/link.aspx?_id=16A5EEBD4CF249C8930F90C93C6AC989&amp;_z=z">Perkutan nefrolitotomi</a></li>
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