Acucise Endopyelotomy/Endoureterotomy

Abstract

The Acucise (Applied Urology) catheter provides the urologic surgeon with the ability to perform a fluoroscopically guided endopyelotomy or endoureterotomy. The 6F shaft of the catheter carries a cutting balloon section that provides a 10F profile. The cutting wire, mounted on the balloon, is 150 μm in width and 2.8 cm in length. The catheter has a 0.035-inch lumen. The device is passed over a preplaced nonconducting guidewire (e.g., Terumo); no other guidewires should be placed, as such there is only a working guidewire and no safety guidewire. The device is advanced until the balloon is above the area of narrowing, and then the balloon is pulled retrograde until it fluoroscopically is seen to straddle the area of obstruction. Under continuous fluoroscopic control, the cutting balloon is activated at 75 watts pure cutting current as it is simultaneously inflated with 2.2 mL of saline to its full 24F size. The inflated balloon is left in place for 10 min, following which it is deflated, and exchanged for 10/7F indwelling endopyelotomy stent. A Foley catheter is placed in the bladder. The Foley catheter is removed on the following morning and the patient is usually discharged shortly thereafter. The stent is left in place for 6 to 8 weeks; within 1 to 2 weeks of its removal, a lasix washout renal scan is performed to determine the outcome of the procedure.

This is an historical video of an important urological procedure that may be of interest to urologists today. The content of the video reflects the views of the authors, and the techniques and technologies used by the authors, at the time the video was produced. The complete author disclosures are no longer available.

Runtime of video: 7 min 06 sec