JP2001070439A - Gage for indwelling urethral stent - Google Patents

Abstract

PROBLEM TO BE SOLVED: To make it possible to exactly determine the size of an urethral stent and to exactly position the indwelling position of the urethral stent under fluoroscopy. SOLUTION: This gage for indwelling the urethral stent 1 indwells the urethral stent 1 in the prostatic urethra and holds the prostatic urethra in a diametrally expanded state. In such a case, the gage has a first gage for measuring the size from the reference position L of the urethral stent 1 to be used and determining the indwelling position thereof by determining the line L connecting the bottom ends of right and left closure holes 13a and 14a in accordance with the X-ray photograph photographed by injecting a contrast medium to the prostatic urethra as the reference position of the urethral stent and a second gage 5 which is placed on the abdomen under fluoroscopy and is used to check the size of the urethral stent 1 and to display the indwelling position to the prostatic urethra when indwelling the urethral stent 1 in the prostatic urethra.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

The present invention relates to a urethral stent placement gauge.

[0002]

2. Description of the Related Art As a treatment for improving urinary retention and dysuria due to benign prostatic hyperplasia (BPH) in a short time, a urethral stent is placed in the prostatic urethra as a urethral tube to enlarge the prostatic urethra. There are treatments designed to maintain the condition.
In this treatment method, when the urethral stent is placed in the prostatic urethra, the ultrasound is applied to the prostatic urethra and the vicinity thereof which should be originally placed by an ultrasonic device, and the reflected wave is detected to detect the urethral stent. In recent years, a contrast agent has been injected into the prostatic urethra to position the urethral stent in the operating room or X-ray room under fluoroscopy.

[0003]

However, the conventional treatment described above has a problem that the size of the urethral stent cannot be determined accurately. Further, when positioning the indwelling position of the urethral stent under fluoroscopy,
When the urethral stent is inserted into the prostatic urethra, the contrast medium is discharged, so that the indwelling position of the urethral stent cannot be determined, and there has been a problem that accurate positioning cannot be performed.
For this reason, there has been a problem that the result after placement of the urethral stent is often unsatisfactory. This can be caused by
This is because the determination of the size of the urethral stent and the placement position has not been established.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and has an advantage in that it is possible to accurately determine the size of a urethral stent and to accurately position the indwelling position of the urethral stent under fluoroscopy. It is intended to provide an indwelling gauge.

[0005]

According to the first aspect of the present invention, there is provided a urethral stent for placing a urethral stent in the prostatic urethra and maintaining the prostatic urethra in an expanded state. A gauge for injecting a contrast agent into the prostatic urethra and taking a line connecting the lower ends of the right and left obturator holes based on an X-ray photograph taken as a reference position of the urethral stent, A first gauge for measuring the size from the reference position and determining an indwelling position; and the urethral stent, which is placed on the abdomen under X-ray fluoroscopy and is used for placing the urethral stent in the prostatic urethra And a second gauge for confirming the size of the urethra and displaying the indwelling position in the prostatic urethra.

[0006] Based on an X-ray photograph taken by injecting a contrast agent into the prostatic urethra, a line connecting the lower ends of the right and left obturator holes is set as a reference position of the urethral stent, and the urethral stent to be used by a first gauge is used. Is measured from the reference position, and the placement position is determined. Next, a second gauge is placed on the abdomen under X-ray fluoroscopy, and when placing the urethral stent in the prostatic urethra, the size of the urethral stent and the placement position in the prostatic urethra are confirmed. This makes it possible to accurately, reliably, and easily perform the process of placing the urethral stent in the prostatic urethra.

According to the second aspect of the present invention, the first gauge includes a transparent plate, a scale for determining the size of the urethral stent from the reference position, a plurality of urethral stents having different sizes, and a placement position. A positioning hole to be determined is provided. A transparent first gauge is placed on an X-ray photograph taken by injecting a contrast agent into the prostatic urethra, the distance from the reference position to the prostatic urethra is read on a scale, and the size of the urethral stent from the reference position is determined. At the same time, the indwelling position in the prostatic urethra is determined and marked by the positioning hole. Then, an optimal urethral stent is selected from a plurality of urethral stents having different displayed sizes.

According to the third aspect of the present invention, the second gauge includes a transparent plate, an alignment line for adjusting to the reference position, a size of the urethral stent, and placement in the prostatic urethra. The display line for displaying the position is written with a radiopaque substance. In the second gauge, an alignment line and a display line for indicating an indwelling position are written on a transparent plate with an X-ray opaque substance. When the urethral stent is placed in the prostatic urethra, the size of the urethral stent and the placement position in the prostatic urethra are checked. This makes it possible to accurately, reliably, and easily perform the placement position even when the contrast medium is discharged during the placement process of the urethral stent in the prostatic urethra.

[0009]

Embodiments of the present invention will be described below in detail with reference to the drawings. FIG. 1 shows a urethral stent applied to the present invention. The urethral stent 1 is formed so that its outer shape is a ring-shaped head 1a as a base end, a linear neck 1b as a continuous portion extending from one end of the head 1a, and a neck connected to the neck 1b. And a tip 1d having a slightly tapered diameter at the tip of the body 1c. The urethral stent 1 is formed by spirally winding a wire made of a thin stainless steel wire and plated with gold in multiple layers. The head 1a is densely wound several times, and the body 1c is a predetermined length. The tip 1d at the tip is wound slightly coarser than the body 1c. This urethral stent 1
Is set to a predetermined shape. For example, head 1a
And the outer diameter of the body 1c is 7φ, and the length of the neck 1b is
The length from the base end of the body 1c to the tip of the tip 1d (hereinafter referred to as "stent size") is set to various sizes (lengths). I have. Incidentally, the stent size is, for example, 35 mm, as shown in FIG.
45mm, 55mm, 65mm, 75mm, 85mm,
There are seven sizes at intervals of 10 mm up to 95 mm. The urethral stent of each of these sizes is
The lengths of b and chip 1d are set to the same length.

FIG. 2 shows a template as a first gauge. This template 2 is for measuring the size of the urethral stent 1 and determining the placement position. Scales 3, 3 are provided on both sides of the template 2, and these scales 3, 3 are set to α times the actual scale (1.1 times as a standard). this is,
This is because when the prostatic urethra is radiographed, the size of the prostatic urethra is slightly larger than the actual size, and the length of the prostatic urethra on the photograph is α times (1.1 times) longer than the actual length. Note that scales 3 and 5 are 5
The minimum memory (1 mm) is omitted as the mm interval.

On the template 2, the urethral stents 1 of various sizes described above are picture-displayed. The positioning holes 2a, 2b, and 2 are located at the position of the head 1a of each urethral stent 1, the base end position of the body 1c, and the continuous portion (upper position of the body 1c) between the body 1c and the tip 1d.
c is drilled. The template 2 is formed of a transparent thin plate such as plastic.

FIG. 3 shows a positioning gauge as a second gauge. This positioning gauge 5 has X
When the urethral stent 1 is placed in the prostatic urethra under fluoroscopy, this is for confirming the size of the urethral stent 1 and displaying the placement position. Lines and numbers indicating the size of the urethral stent 1 and lines and characters indicating the indwelling position are written on the positioning gauge 5. That is, a positioning line A indicating the position of the head 1a of the urethral stent 1, a display line B indicating the base end position of the body 1c of the urethral stent 1 (hereinafter referred to as "body distal end"), and Tip position of tip 1d (3
5, 45, 55, 65, 75, 85, and 95 mm). The alignment line A is used as a reference position for placing the urethral stent 1 in the prostatic urethra.

The positioning gauge 5 is composed of two transparent plastic thin plates bonded to each other, and a line and a number indicating the size of the urethral stent 1 and a line and a character indicating the indwelling position between the two by a radiopaque substance. Is written and configured. As a result, peeling of lines, numerals, characters, and the like written by the X-ray opaque substance is prevented. Hereinafter, a method of using the template and the positioning gauge will be described.

The mounting of the urethral stent on the prostatic urethra
It is performed under X-ray fluoroscopy in an X-ray room. FIG.
The head 1a of the urethral stent 1 of the template 2 is placed near the urethral bulb 10a of the urethra 10 on an X-ray photograph (UCG) photographed obliquely by injecting a contrast agent into the urethra 10 and the prostatic urethra 11 as shown in FIG. Match. At this time, the template 2 is positioned such that the head 1a is positioned a few millimeters closer to the urethral bulb 10a with a line L indicated by a dotted line connecting the lower ends of the closing holes 13a and 14a of the left and right pubic bones 13 and 14 as a reference position (standard). And a reference position (point of slot A) is marked by the small hole 2a.

Next, after the position of the head 1a of the urethral stent 1 is determined, the distal end (slot B point) of the urethral stent 1 is marked by the small hole 2b. The distance between the slot A point and the slot B point is the same for any size urethral stent, and therefore, the positioning holes 2a and 2b of any urethral stent may be used. Then, the length from the bladder neck 12a to the slot B point is measured using the scales 3 and 3 on both sides of the template 2. At this time, if there is an elevation 12b of the bladder bottom,
A point C is set a predetermined distance (about 5 mm) below c, and the length from the point C to the slot B is measured. And
The length measured and set is defined as the prostate length, and the length of the tip 1d (tip length 10 mm) of the urethral stent is added to determine the optimal size of the urethral stent.

Next, 35 mm to 95 mm
mm, select a urethral stent close to the optimal size from the urethral stents prepared at 10 mm intervals, align the selected urethral stent with the oblique X-ray photograph,
Simulate the detention position. In this case, the position of the head 1a is set as a reference position using a line L connecting the lower ends of the left and right closing holes 13a and 14a, and where the distal end of the body is located at the pubic symphysis, It is preferable to check whether the projections are formed. At this time, it is preferable to use an X-ray photograph in the supine position together. This is because the depth can be grasped to some extent by using the oblique X-ray photograph, the line L connecting the lower ends of the left and right closing holes 13a and 14a as reference positions, the size of the urethral stent, and the like. Can be selected, but by using the X-ray photograph in the supine position together, it is possible to determine more accurately.

As described above, the left and right closing holes 13a and 14
The use of the line L connecting the lower end of a as the reference position (standard) for determining the indwelling position of the urethral stent has been clarified and set for the first time in the present invention. That is,
By using the line L connecting the lower ends of the left and right closing holes 13a and 14a as the reference position, it is possible to almost certainly and easily place the urethral stent 1 in the prostatic urethra regardless of the skill of the operator. This makes it possible to perform positioning.

Next, as shown in FIG. 5, a contrast medium is injected into the urethra 10 and the prostatic urethra 11, and under X-ray fluoroscopy, the positioning gauge 5 is placed on the abdomen and the urethral stent is placed. Position (line L connecting lower ends of left and right closing holes 13a and 14a), bladder neck 12a, elevation of bladder bottom 12
Confirm the presence or absence of b. Next, as shown in FIG. 6, X-ray fluoroscopy is performed at the supine position, and the positioning line A of the positioning gauge 5 is aligned with the position where the urethral stent is placed.
Positioning gauge 5 along prostatic urethra 11
Affix.

Next, the surgeon inserts the urethral stent 1 into the prostatic urethra 11 according to a predetermined procedure. When inserting the urethral stent 1, the urethra 1 shown in FIGS.
0, the contrast agent injected into the prostatic urethra 11 and the bladder 12 is discharged. As a result, as shown in FIG. 6, the left and right pubic bones 13 and 14, the obturator holes 13a and 14a, and the lines and numbers (35 to 95) indicating the size of the urethral stent written in the radiopaque material of the positioning gauge 5 ,
Only the line and the letter (A, B) indicating the indwelling position and the inserted urethral stent 1 become visible. Thus, the operator inserts the urethral stent 1 into the prostatic urethra 11 until the head 1a reaches the alignment line A as shown in FIG.

When the head 1a has reached the position of the positioning line A, the display line B positions the distal end of the body 1c so as not to hang on the external sphincter 15, and the tip 1d is inserted into the bladder 12 by a predetermined distance. (5-10m
m) Position so that it protrudes. Thus, FIG.
The urethral stent 1 is placed in the prostatic urethra 11 as shown in FIG. This makes it possible to securely, accurately and easily place the urethral stent 1 in the prostatic urethra 11 as shown in FIG.

When the urethral stent 1 indwelled in the prostatic urethra 11 is displaced as shown in FIG. 7, or when the urethral stent 1 is removed, the tip called a pusie has a substantially L-shape. A grasping forceps is inserted into the urethra 10 using a pipe-shaped instrument that is curved in a shape, and the head 1a of the urethral stent 1 is grasped to adjust the displacement or to be removed.

[0022]

As described above, according to the first aspect of the present invention, it is possible to accurately, reliably and easily perform the procedure for placing the urethral stent in the prostatic urethra under X-ray fluoroscopy. It is extremely effective in treating used prostatic hyperplasia. According to the second aspect of the present invention, an X-ray photograph taken by injecting a contrast agent into the urethra of the prostate is transparent and has a first transparent property.
By placing a gauge and reading the distance from the reference position to the prostatic urethra with a scale, determining the size of the urethral stent from the reference position, determining the indwelling position in the prostatic urethra by the positioning holes and marking. In addition, the optimal urethral stent can be quickly selected, and the position of the prostatic urethra to be placed can be accurately determined.

According to the third aspect of the present invention, the second gauge is such that the alignment line and the display line for indicating the indwelling position are written on a transparent plate with an X-ray opaque substance. When placing the urethral stent in the prostatic urethra under fluoroscopy by placing it on the abdomen, confirm the size of the urethral stent and the placement position in the prostatic urethra, and accurately and reliably even if the contrast agent is discharged In addition, the indwelling treatment can be easily performed, and the indwelling treatment can be performed extremely well.

[Brief description of the drawings]

FIG. 1 is a side view of a urethral stent placed in the prostatic urethra.

FIG. 2 is a plan view of a template (first gauge) in the urethral stent placement gauge according to the present invention.

FIG. 3 is a plan view of a positioning gauge (second gauge) in the urethral stent placement gauge according to the present invention.

FIG. 4 is an illustration for positioning the size and placement of a urethral stent using the template of FIG. 2 by radiographs of the oblique urethra and prostatic urethra.

5 is an explanatory diagram for confirming the indwelling position of the urethral stent using the positioning gauge of FIG. 3 based on the X-ray photograph of FIG. 4;

FIG. 6 is an explanatory view of positioning a urethral stent in a supine position using a positioning gauge in a supine position under fluoroscopy.

FIG. 7 is a view showing a state in which a urethral stent is placed in the prostatic urethra.

[Explanation of symbols]

 Reference Signs List 1 urethral stent 1a head 1b neck 1c body 1d tip 2 template (first gauge) 2a, 2b, 2c positioning small hole 3 scale 5 positioning gauge (second gauge) A positioning line B display line L reference position 10 Urethra 11 prostatic urethra 13, 14 pubis 13a, 14a obturator foramen

Claims (3)

[Claims] 1. A urethral stent placement gauge for placing a urethral stent in the prostatic urethra and maintaining the prostatic urethra in an enlarged state, wherein a contrast agent is injected into the prostatic urethra and photographed. A line connecting the lower ends of the right and left obturator foramen as a reference position of the urethral stent based on the obtained X-ray photograph, a size for measuring the size of the urethral stent to be used from the reference position, and determining an indwelling position. 1 gauge, for placing the urethral stent on the abdomen under fluoroscopy and placing the urethral stent in the prostatic urethra, and for displaying the placement position in the prostatic urethra And a second gauge for urethral stent placement. 2. The first gauge according to claim 1, wherein: a scale for determining a size of the urethral stent from the reference position, a plurality of urethral stents having different sizes, and a positioning hole for determining an indwelling position. Claim 1 provided with
The urethral stent placement gauge according to the above. 3. The X-ray gauge according to claim 2, wherein the second gauge has an X-ray alignment line on a transparent plate for adjusting to the reference position and a display line for confirming the size of the urethral stent and indicating the indwelling position. The urethral stent placement gauge according to claim 1, which is written with an impermeable material.