PMC6100697_01
Poor cystoscopic image seen with damaged nephroscope during morcellation.
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Upon placement of the nephroscope into the bladder, it became apparent that the lens was damaged resulting in an extremely poor cystoscopic image (Fig. 1).
Arrangement of ultrasound machine with use of convex abdominal transducer probe under B-mode ultrasound to observe bladder in sagittal view. 1 = ultrasound monitor and console; 2 = ultrasound probe; 3 = resectoscope.
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To safely complete the procedure, it was decided to utilize a 3.5-MHz convex abdominal transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode ultrasound to view the bladder and guide morcellation (Fig. 2).
Ultrasonographic images of bladder, sagittal view. Black and white arrows with corresponding numbers used to label key structures. (a) The morcellator can be seen as it is introduced into the bladder. 1 = tip of nephroscope; 2 = tip of morcellator; 3 = dependent enucleated adenoma; 4 = bladder wall. (b) The morcellator is now imaged, positioned safely in the middle of the bladder, with the engaged adenoma being morcellated. 1 = tip of nephroscope; 2 = tip of morcellator; 3 = enucleated prostate adenoma engaged in morcellator.
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In the sagittal plane, the enucleated adenoma could be seen in the dependent portion of the distended bladder with both the nephroscope and Piranha morcellator just entering the bladder neck (Fig. 3a). The nephroscope and morcellator hand piece were then tilted anteriorly toward the center of the bladder and the morcellation pedal was activated, safely removing the adenoma away from the walls of the bladder (Fig. 3b).