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UROLOGY PRODUCT AND PROCEDURAL REVIEW

CLOVIS COMMUNITY MEDICAL CENTER

Central Valley Representative: Joey Lucchesi

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Lets take a look at the Urology basics..

• 5 Main Urological Procedure Types:

– Cystoscopy

– Ureteroscopy (fURS) or (srURS)

– Stone Lithotripsy

– Percutaneous Nephrolithotomy (PCNL)

– Ablation of the Prostate

• Transurethral resection of the Prostate (TURP)

• Photoselective Vaporization of the Prostate ( Greenlight laser PVP)

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Cystoscopy

• Cystoscopy is a procedure that allows your doctor to examine the lining of your bladder and the

tube that carries urine out of your body (urethra). A hollow tube (cystoscope) equipped with a

lens is inserted into your urethra and slowly advanced into your bladder.

• Boston Scientific products for Cystoscopy :

– Passport Urological Balloon Catheter

– Open Ended Catheter

– UroVac Bladder Evacuator

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Cystoscopy Product

• Passport Urological Balloon Catheter

– Low profile , 3Fr balloon catheter with HydroPlus coating

and mounted on a guidewire.

– Non-compliant

– Controlled pressure up to 8.5 ATM for dilating at a stricture

or ureteral narrowing

• UroVac Bladder Evacuator

– Designed for evacuation of irrigation solution containing

solution containing surgical specimens, calculi, or

blood clots from bladder

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Ureteroscopy (ureter access)

• Ureteroscopy is an examination of the upper urinary tract, usually performed with a ureteroscope

that is passed through the urethra and the bladder, and then directly into the ureter; usually the

lower 2/3 of the ureter is accessible by this procedure.

• Boston Scientific Ureteroscopy product:

– Navigator HD (ureteral dilator)

– Passport Balloon Dilator (ureteral dilator)

– Imager II Catheter

– Dual Lumen Ureteral Catheter

– Sensor Guidewire

– Zipwire Guidewire

– Amplatz Super Stiff Guidewire

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Ureteroscopy Product (Ureter Access)

• Navigator HD Access Sheath

– Sheaths for dilatation of the ureter creating access for scopes

and other devices to pass through while providing ureter wall protection.

– Also allows for injections of fluids into the urinary tract.

– Tapered proximal end on extruded inner stylet with radiopaque marker

– smooth tapered access allows for reduced ureter trauma .

Sizes: 11/13Fr, 12/14Fr, 13/15 Fr

Lengths: 28cm, 36cm, 48cm

• Imager II Catheter

– Single Lumen, torqueable catheter designed to

facilitate difficult access during ureteroscopic and PCNL

procedures.

– Can be placed retrograde or antegrade

– 5 open tip configurations and 3 working lengths

– Size: 5 Fr, Lengths: 40cm, 65cm, 100cm

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Ureteroscopy Product (Guidewire)

• Dual Lumen Catheter

– Dual lumen designed for over-the-wire placement

– Two separate working channels for second wire placement

or injection.

• Sensor Guidewire

– Has 5 cm Hydrophilic coated radiopaque floppy tip

– Nitinol core – kink resistant shaft for control

– Hybrid- access of Hydrophilic wire with control of PTFE wire

• Zipwire Guidewire

– Hydrophilic coated wire with Nitinol core

– Kink resistant, sturdy core for maneuverability in complex anatomy,

Tight obstructions

– Angled and straight tip variations available

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Ureteroscopy Product (Guidewire)

• Amplatz Super Stiff Guidewire

– PTFE Hydrophilic coating to reduce friction

– Flat wire which creates larger inner core, increased

stiffness, and added strength for easier access and

stability

– Variety of tip profiles: straight flex-tip, J-tip, Bentson

– Used often during PCNL procedure

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Ureteroscopy Stone Retrieval

• Ureteroscopy stone retrieval is the process of using a wire basket

to grasp, encapsulate, or lasso a stone or fragment by passing a basket

through a ureteroscope until the desired point of stone contact is reached.

Often this is done after lithotripsy of a large stone where fragments then are

left.

Boston Scientific Stone Retrieval Product:

– Zero Tip Nitinol Basket

– Escape Nitinol Basket

– Dakota Nitinol Basket

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A New Approach to Retrieval – LithoVue Empower (Dec. 2018)

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Ureteroscopy Stone Retrieval

• Zero Tip Nitinol Basket

– Tipless basket allows close stone approximation

– Low profile, low friction, internal knotted tip

– Sizes: 1.9Fr, 2.4Fr, 3Fr

– Lengths: 90cm, 120cm

• Escape Nitinol Basket

– Laser cut cage designed for stability

– 4 wire cage with 2 long ends that convert from 11mm to 15mm total

diameter

– 3.0Fr sheath with 1.9Fr working channel

– Size: 1.9Fr

– Length: 90cm, 120cm

• Dakota Nitinol Basket

– Nitinol basket that expands a lasso like end to grab stones and release.

– Allows for forward approach to grasping stones

– Size: 1.9Fr, 3.0Fr - with 8mm to 11mm expansion, 13mm to 15mm expansion

– Length: 90cm, 120cm

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Stone Lithotripsy

• Lithotripsy is a medical procedure involving the physical destruction of hardened masses like kidney stones, bezoars or gallstones. The term is derived from the Greek words meaning "breaking stones”

• Boston Scientific Stone Laser Lithotripsy Product:

– Flexiva TracTip Laser Fiber

– AccuTrac Laser Fiber

– Lumenis SlimLine SIS

Sizes in Micron: 200, 365, 550, 1000

• Lithotriptor Systems for PCNL

– Swiss LithoClast

– Trilogy - *Coming Soon* Feb 2019

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Laser Anatomy

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Stent Product Lines

• 8 Characteristics of Ureteral Stents

– High tensile strength

– High retention coil strength

– Biocompatability

– High Biodurability

– Improved ID/OD ration

– Varying Durometers

– Excellent Radiopacity

– Coefficient/Lack of Friction

• Boston Scientific Stent Product Lines:

– Polaris Ultra

– Percuflex

– Percuflex Plus

– Contour

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Stent Product Lines

• Polaris Ultra

– Co-extrusion from firm to soft durometer ( Blue to white)

– Soft coil design to reduce bladder irritation

– Relaxed renal coil design for ease of removal

– Markings along stent to confirm placement

– Lubricious HydroPlus Coating facilitates advancement in the ureter

– 365 day indwell time

• Percuflex

– High retention coil strength to maintain pigtail shape and

prevent migration

– Tapered tip and markings for placement

• Percuflex Plus

– High coil strength and material strength help navigate tight strictures

– Lubricious HydroPlus Coating facilitates advancement in the ureter

– 365 day indwell time

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Stent Product Lines

• Contour

– Soft Percuflex material that softens with body temperature

– Promotes patient tolerance during indwelling time

– Relaxed renal coil

– 365 day indwelling time

• Stent Sizes and Lengths:

– Sizes (in Fr): 4.8, 5, 6, 7,8

– Lengths (in cm): 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30

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Percutaneous Nephrolithotomy (PCNL)

• Percutaneous nephrolithotomy is a minimally-invasive procedure to remove stones from the

kidney by a small puncture wound through the skin. It is most suitable to remove stones of more

than 2 cm in size and which are present near the pelvic region.

• What kind of stones create the need for a PCNL procedure?

– Stones that have become large enough to block function of the kidney and have grown into each calyx

are typically Staghorn Stones/Calculi.

– Staghorn calculi refer to branched stones that fill all or part of the renal pelvis and branch into several

or all of the calyces. They are most often composed of struvite (magnesium ammonium phosphate)

and/or calcium carbonate apatite.

• Boston Scientific Lithotriptor Unit:

– Swiss LithoClast

– Trilogy *Coming Soon* Feb 2019

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Swiss LithoClast Set Up

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SWISS LITHOCLAST TRILOGY *COMING FEB. 2019*

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QUESTIONS?

THANK YOU!