Easy to use, minimally invasive, retrograde approach when antegrade approach not feasible.
Method of Use
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Select an appropriate sterile catheter (<21 Fr), lubricate, and confirm fit inside the TUSP cannula. Lubricate and screw the trocar tip into the distal end of the cannula until flush—it is secure with minimum finger tightening.
Place the patient in lithotomy position and prep with appropriate sterilizing solution. Perform cystoscopy to survey the anatomy of the urethra and bladder. If there is risk of urethral trauma, consider pre-placement of a guide wire (<0.038 in). Determine the optimal location for the trocar to exit the abdominal wall, and mark.
Place the TUSP retrograde through the urethra, into the bladder. For a male, place penis on stretch. While gently angulating the handle, palpate for the tip of the device near the exit mark,
Make an incision in the skin approximate 1 cm above the tip. While maintaining deflection on the abdominal wall with the TUSP, dissect the intervening tissue with electro-cautery until trocar emerges from the incision. Continue to push the trocar through incision about 5 cm. Remove the trocar tip and leave the cannula above the incision a few cm.
Guide the lubricated catheter into the cannula about 25 cm (10 in) until it appears at the handle opening. If catheter buckles while advancing, push on it closer to the entry of the cannula.
While holding the catheter at incision site, slowly withdrawal the TUSP from the urethra. Then using cystoscopic guidance retrograde through urethra, withdraw the catheter tip retrograde into the bladder by pulling externally above the incision site.
Once the catheter is within the bladder lumen, inflate the balloon to recommended volume. Then gently approximate the balloon against the anterior bladder wall. Secure the catheter externally with a suture.
Features
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Reusable
Cost-effective
TUSPTM features a patent-pending “soft dimple-thread,” which permits the smallest size cannula (23.8 Fr) to be used with the largest sized catheter (21.5 Fr).
The new urethrotome allows for easy and safe non-visual internal urethrotomy by passage over a guidewire, no moving parts and cutting of only fibrous scar. The flat blade protects normal urethra, which is pushed gently away during passage.
Method of Use
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Initially, after the instillation of an urethral anesthetic lubricant, a guide wire is passed into the urethra and through the stricture to the bladder. The urethrotome is loaded over the guidewire and slid gently to the stricture, which will be noted by increased resistance to the passage over the guide wire through the tactile feedback characteristic of the stem. Normal tissue is gently pushed out of the way. Markings on the stem will help localize the depth of the stricture from the meatus.
Advancing the urethrotome through the stricture will gently stretch fibrous bands, which will then be exposed to the sharp square edges of the urethrotome and divided as the urethrotome is advanced through the stricture.
The 12-26 F urethrotome may have a stricture reducing benefit prior to TURP as shown by Schultz et al in their article.
The urethrotome can also be used to enlarge a suprapubic tract over a guide wire as well as a nephrostomy tract. References below.
References:
Prevention of urethral stricture formation after transurethral resection of the prostate: A controlled randomized study of Otis urethrotomy versus urethral dilation and the use of the polytetrafluoroethylene coated versus the insulated metal sheath. Schultz A, Bay-Nielsen H, Bilde T, et al. Journal of Urology. 1989;141(1):73-75. http://www.ncbi.nlm.nih.gov/pubmed/2642313
Percutaneous nephrostomy tract incision using a modified Otis urethrotome. Ireton RC. Urology Clinics of North Am. 1990 Feb; 17(1):195-8 http://www.ncbi.nlm.nih.gov/pubmed/2305529
Features
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Surgical steel
Flexible stem with tactile feedbackcharacteristics
No sharp edges to come in contact withnormal tissue
Central hole for passage over a guidewire
“Cm” markings on the stem of the instrumentto help assess the depth of the stricture. “Double” markings at 5, 10 and 15 cm
Technical Aspects
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The design of the internal urethrotome has a conical shape in three different sizes: 8 – 14 F, 10 – 20 F and 12 – 26 F (Fig 1). There is a blade arising on one side from a recessed surface within the cone, which does not exceed the circumference of the cone (Fig 2). The blade has a flat surface, which does not cut normal tissue, but sharp square edges, which will cut fibrotic tissue when engaged by a tight stricture. The conical head of the urethrotome has a channel running through its center for passage over a guidewire, which allows blind passage to the stricture and thus minimizing trauma from blind passage (Fig 3).
Figure 1
Figure 2
Figure 3
CPT® code1
Total Non Facility RVUs2
Medicare National Allowed Amount2, 3
Physician Coding
52275 – Cystourethroscopy with internal urethrotomy; male
15.1
$544
Uramix does not endorse any particular code for billing purposes. These codes are only provided for information purposes.
The Stent Removing Snare allows for the non-visual removal of indwelling ureteral stents, without the use of cystoscopy. The instrument is designed to be passed over a guide wire if clinically needed.
Method of Use
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Men – When the ureteral stent is inserted, the attached string should be left connected to the stent and a loop should be created in the string at the point where the string exits the urethra (see figure 1).
This loop will self-retract into the urethra, with a slight tug on the genitalia, where it comes to rest in the bulbous urethra or anterior urethra and it is not symptomatic. At time of removal, after the instillation of an urethral anesthetic lubricant, the snare is passed into a man’s urethra until the bulbous portion (see figure 2). Rotating the snare, the loop at the end of the string is hooked by the snare and then gently pulled out (see figure 3). Occasionally more than one pass is required. If multiple passes do not allow the snare to hook the string loop, it is possible that that the loop could have retracted into the bladder and cystoscopic removal is required. In men the snare should not be passed beyond the bulbous urethra. Women – In women, the loop does not self-retract, but has to be pushed into the bladder with the scope or a well-lubricated hemostat. The hook of the snare enters the bladder and may grab the string or the stent itself (see figure 4). If the snare misses, repeat passes, or US supervision can be used to locate the stent. Cystoscopic removal is the fallback option.
Figure 1
Figure 2
Figure 3
Figure 4
Features
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The snare is made of surgical steel, and has a flexible stem for tactile feedback in case of resistance during the course of its passage. There are no sharp edges on the snare to minimize discomfort during passage. It also has a central hole for passage over a guide wire.
Technical Aspects
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The design of the snare has a conical appearance with increasing size between 16-18 F. The snare element at the base of the cone is a groove 3 mm wide, which can hook the stent or the string attached to it. The design of the head allows for non-traumatic travel through the urethra. This conical configuration also allows this instrument to be used as a dilator, when passed over a guide wire, as a way to avoid a false passage with blind dilatation.
Removing a Stent with a Stent Removing Snare
How To Create A “Loop” In The String Attached To The Stent To Facilitate Stent Removal
Patient Having Stent Removed With A Stent Removing Snare
CPT® code1
Total Non Medicare National Facility RVUs2
Medicare National Facility RVUs2 Allowed Amount2, 3
Physician Coding
50386 – Removal (via snare/ capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation.
21.8
$785
50385 – Removal (via snare/ capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation.
33.8
$1,217
Uramix does not endorse any particular code for billing purposes. These codes are only provided for information purposes.
All uses of the cavernotomes resulted in successful implantation of inflatable cylinders or semimalleable rods without urethral injury or corporal perforation.
Fifteen of the patients received downsized prosthesis (13 Alpha NB, 2 AMS 700 CXM).
Of the remaining four patients, three patients were implanted with Mentor Alpha 1 standard size cylinders, and 1 patient was implanted with an AMS semimalleable prosthesis.
Graft material was not required and only two patients required additional distal penile incisions for optimum cylinder tip placement.
Average operative time was 51 minutes (39-86 minutes range).
As seen in: Wilson”s Perils and Pitfalls of Penile Prosthesis Surgery, Tobias S. Kohler, MD, Nikhil Gupta, MD, Steven K. Wilson, MD, 2nd edition, January 2018
Easier and faster creation of an intracorporeal space in scarred genitalia from previous surgery or disease (i.e. – Peyronie’s, Sickle Cell). The cavernotome is great at removing bacterial film from previously infected corpora.
Method of Use
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Entry to fibrotic corpora needs to be accessed by scalpel & extended both proximally & distally to allow entry to dilator
Working element should initially be directed laterally
Cutting of fibrotic tissue can be obtained longitudinally & also in a rotating
shaving action
Dilators are used in succession to the desired size
Dilators can be used in nonfibrotic corpora for speedier dilation
Features
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Two blades in the place of one
Additional handle for increased torque in difficult dilations
Top grade surgical steel – does not need sharpening
Both the instrument and the handle are autoclavable
Velcro case included
Technical Aspects
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Set consists of six dilators 6, 7, 8, 9, 10 and 11 mm
Length: 23.5 cm
Working element: 2 parallel blades of 5 cm
Height of blade does not exceed circumference of the dilator
Easily mountable/removable handle for use and cleaning
Rounded protective tip
Two blades advanced to within 0.5 cm of the tip
Blades do not exceed the circumference of the dilator
1 cm markings- can be used as a measuring tool
Flat surface on the same plane as the blade for ease of orientation
Cuts and Shaves Fibrotic Tissue
Peronie’s disease, sickle cell, priapism, prolonged intracavernosal therapy, redos, subcapsular space creation in eroded prosthesis Improves and Shortens the Dilation Process Avoids multiple corporatomies
Avoids false passages Controls the Depth of the Internal Cut by its Design Represents a significant improvement over existing instruments
Method of Use
Click to Expand
Entry to the fibrotic corpora needs to be accessed by scalpel and extended both proximally and distally to allow entry to the cavernotome
The working element should be directed laterally initially
If tissue does not respond to the cutting process the cavernotome can be rotated or moved in an oscillating fashion to create a shaving action that removes fibrotic tissue and at the same time propels the cavernotome forward
The cavernotomes are used in succession until the desired size is attained
Can be used in normal corpora for a speedier dilation
Can be used as a measuring tool
Features
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The cavernotomes are designed of top grade surgical steel
Cavernotomes can be resterilized
Velcro case included
Technical Aspects
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The set consists of 5 cavernotomes with diameters between 6 and 10 mm sequentially.
Length: 23 cm.
The working element is 5.5 cm long and the blade is advanced to within 0.5 cm of the tip.
The height of the blade starts at 1 mm for the 6, 7, and 8 mm cavernotomes and increases to 1.5 mm for the 9 and the 10 mm dilators. The blades do not rise above the circumference of the cavernotomes.
The cavernotomes are graded in cm and can be used as measuring tools.
The Advanced System Cavernotomes are designed at the request of physicians who work with more challenging cases of fibrotic corpora.
Cuts and Shaves Fibrotic Tissue
Peronie’s disease, sickle cell, priapism, prolonged intracavernosal therapy, redos, subcapsular space creation in eroded prosthesis Improves and Shortens the Dilation Process
Avoids multiple corporatomies
Avoids false passages Controls the Depth of the Internal Cut by its Design
Represents a significant improvement over existing instruments
Method of Use
Click to Expand
Entry to the fibrotic corpora needs to be accessed by scalpel and extended both proximally and distally to allow entry to the cavernotome
The working element should be directed laterally initially
If tissue does not respond to the cutting process the cavernotome can be rotated or moved in an oscillating fashion to create a shaving action that removes fibrotic tissue and at the same time propels the cavernotome forward
The cavernotomes are used in succession until the desired size is attained
Can be used in normal corpora for a speedier dilation
Can be used as a measuring tool
Features
Click to Expand
The cavernotomes are designed of top grade surgical steel
Cavernotomes can be resterilized
Velcro case included
Technical Aspects
Click to Expand
The original set consists of 5 cavernotomes with diameters between 6, 7, 9, 11, and 13 mm.
Length: 23 cm.
1 cm long, rounded and tapered head to protect the ends of the corpora.
The working element is 6 cm long, and starts 1 cm from the tip.
The height of the blade is 1 mm and does not exceed the circumference of the cavernotome to avoid cutting beyond this perimeter.
The cavernotomes are graded in centimeters and can be used as a measuring tool.
A 4 cm flat beveled surface is placed about 7 cm from the cutting element on the same plane as the beveled surface of the blade to let the operator know how the cavernotome is oriented, if the blade is buried and not visible.
The original cavernotomes were designed for use in both moderately fibrotic corporas as well as virgin implants.
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