KR102362466B1 - System for reducing ureteral insertion pressure by artificially trigerring hydronephrosis based on measurement of pressure associated with the insertion of the ureteral access sheath for retrograde intrarenal surgery - Google Patents

Abstract

The present invention is based on the measurement of the pressure associated with the insertion of a ureteral access sheath (UAS) for retrograde intrarenal surgery (RIRS) to determine the location of the UAS in the ureter, the UAS When the ureter reaches an appropriate position in the ureter, artificially inducing hydronephrosis by injecting fluid into the ureter, thereby reducing the ureteral insertion pressure of the UAS and minimizing the occurrence of an intraureteral wound caused by the ureteral insertion of the UAS will be. According to various embodiments of the present disclosure, in a system, comprising: a Y-shaped medical connector, and a device coupled to the medical connector, the medical connector comprising: a first cylinder including a first opening and a second opening; and a second cylinder connected at an angle to the first cylinder and including a third opening so that the fluid is introduced into the third opening so that the fluid can be discharged through the first opening, wherein the first opening is a ureter entry house ( ureteral access sheath (UAS), wherein the first cylinder is configured to pass a guide wire through the first opening and the second opening, the guide wire passing through the UAS, the device comprising: a memory, a processor, and a UAS a force measurement gauge configured to measure a UAS insertion force (UASIF) upon insertion of the UAS into the bladder and ureter, wherein the processor determines the position of the UAS within the bladder and ureter based on the measured UASIF A system is provided, configured to determine.

Description

SYSTEM FOR REDUCING URETERAL INSERTION PRESSURE BY ARTIFICIALLY TRIGERRING HYDRONEPHROSIS BASED ON MEASUREMENT OF PRESSURE ASSOCIATED WITH THE INSERTION OF THE URETERAL ACCESS SHEATH FOR RETROGRADE INTRARENAL SURGERY}

The present invention is based on the measurement of the pressure associated with the insertion of a ureteral access sheath (UAS) for retrograde intrarenal surgery (RIRS) to determine the location of the UAS in the ureter, the UAS When the ureter reaches an appropriate position in the ureter, artificially inducing hydronephrosis by injecting fluid into the ureter, thereby reducing the ureteral insertion pressure of the UAS and minimizing the occurrence of an intraureteral wound caused by the ureteral insertion of the UAS will be.

Retrograde intrarenal surgery (RIRS) is an operation in which a ureteroscope is entered through the urethra to check stones, and a laser crusher is used to break up the stones. Existing rigid (硬性, rigid) ureteroscope was difficult to access depending on the location of urolithiasis in many cases, so the scope of application was limited. If it is difficult to apply rigid ureteroscopy for removal of urolithiasis, switch to invasive methods such as percutaneous nephrolithotomy (PNL) or laparoscopic surgery, or use extracorporeal shockwave lithotripsy (ESWL) several times. There was a problem that had to be repeated one after the other. In order to supplement this problem, a flexible (軟性, flexible) ureteroscope was first developed in 1994 and applied to the removal of urolithiasis, but initially it was not universalized due to technical limitations. However, in recent years, with the development of breakthrough technology, flexible ureteroscopes have been widely used worldwide, and RIRS has established itself as a standard treatment method for urolithiasis removal.

Advantages of RIRS using a flexible ureteroscope are: 1) no skin incision, very little postoperative pain and hematuria, 2) stones in the upper ureter and kidneys (renal pelvis, renal pelvis) that cannot be accessed through conventional rigid ureteroscopes can be removed, 3) a significant number of stones that can only be treated with laparoscopic surgery or PNL can be removed, so various complications can be avoided, and 4) multiple, large, or lower renal glia with a low success rate of removal after ESWL. There are some points that can effectively remove stones. Thanks to these advantages, recently, RIRS using a flexible ureteroscope has been recommended in the international guidelines for the treatment of urolithiasis, and a new paradigm of urolithiasis has been formed.

The driving force behind the expansion of RIRS is the demonstration and generalization of the usefulness of the ureteral access sheath (UAS). When using UAS, 1) the flexible ureteroscope can easily enter the renal pelvis, 2) the crushed stone can be easily removed through multiple re-entry of the flexible ureteroscope, and 3) the intra-renal pressure during surgery is minimized and 4) reduce the bulking pressure of the ureter.

However, the use of UAS is not the only advantage. When excessive pressure is applied to insert the UAS in a thin ureter, a shear injury may occur in the ureter, which is reported to occur in up to 50% of cases. In addition, when the ureter is pressed against the UAS and pressure is applied, there is a risk of secondary ureteral stenosis due to local ischemia in the future. In the implementation of RIRS, insertion of the UAS into the ureter is an essential procedure, but the insertion of the UAS into the ureter fails due to excessive resistance or the operation cannot proceed further due to damage to the ureter in 16% of cases.

Various methods and devices have been proposed for inserting a UAS into the ureter with low pressure and friction. 1) A UAS coated with a hydrophilic outer membrane has been released to reduce friction when the UAS is inserted into the ureter. However, in patients with an inherently thin ureter diameter, this method is less effective. 2) A method of passively expanding the ureter using ureteral stent indwelling has been proposed 1 to 2 weeks before RIRS surgery. In clinical studies, it has been reported that ureteral damage caused by UAS insertion is significantly less when an RIRS anterior ureteral stent is inserted. However, in order to insert the ureteral stent before RIRS, a complicated procedure is required, and there is a problem in that the patient suffers from discomfort such as hematuria, difficulty in urination, and pain in the side due to the ureteral stent. 3) ureteral balloon dilation has been proposed. This is a method to insert the UAS by actively expanding the narrow ureter using a balloon. However, this is not recommended as long-term secondary ureteral stenosis may occur.

Therefore, there is a need for a system for effectively and safely inserting the UAS into the ureter by reducing the ureter insertion pressure of the UAS and minimizing the occurrence of an intraureteral wound due to the ureteral insertion of the UAS.

Republic of Korea Patent Publication No. 10-2017-0118821 (2017.10.25.) (Access system, access system and related method)

Based on the foregoing discussion, the present invention provides a system for effectively and safely inserting a ureteral access sheath (UAS) into a ureter.

In addition, the present invention determines the position of the UAS in the ureter based on the measurement of the pressure associated with the insertion of the UAS for retrograde intrarenal surgery (RIRS), and the UAS reaches an appropriate position in the ureter Provided is a system for reducing the ureteral insertion pressure of UAS and minimizing the occurrence of ureteral wounds due to UAS insertion into the ureter by artificially inducing hydronephrosis by injecting fluid into the ureter.

According to various embodiments of the present disclosure, in a system, comprising: a Y-shaped medical connector, and a device coupled to the medical connector, the medical connector comprising: a first cylinder including a first opening and a second opening; and a second cylinder connected at an angle to the first cylinder and including a third opening so that the fluid is introduced into the third opening so that the fluid can be discharged through the first opening, wherein the first opening is a ureter entry house ( ureteral access sheath (UAS), wherein the first cylinder is configured to pass a guide wire through the first opening and the second opening, the guide wire passing through the UAS, the device comprising: a memory, a processor, and a UAS a force measurement gauge configured to measure a UAS insertion force (UASIF) upon insertion of the UAS into the bladder and ureter, wherein the processor determines the position of the UAS within the bladder and ureter based on the measured UASIF A system is provided, configured to determine.

The present invention provides a system for effectively and safely inserting a ureteral access sheath (UAS) into a ureter.

In addition, the present invention determines the position of the UAS in the ureter based on the measurement of the pressure associated with the insertion of the UAS for retrograde intrarenal surgery (RIRS), and the UAS reaches an appropriate position in the ureter To provide a system for reducing the ureteral insertion pressure of UAS and minimizing the occurrence of ureteral wounds due to UAS insertion into the ureter by artificially inducing hydronephrosis by injecting fluid into the ureter.

The effects obtainable in the present invention are not limited to the above-mentioned effects, and other effects not mentioned may be clearly understood by those of ordinary skill in the art to which the present invention belongs from the following description. will be.

1 shows an example of a ureteroscope entry through a ureteral access sheath (UAS) to the bladder, ureter and kidney.
2 shows an example of entry into the ureter of a UAS.
3 illustrates a configuration of a system according to various embodiments of the present disclosure.
Figure 4 shows a graph of the pressure by position in the ureter of the UAS.
5 illustrates a configuration of an apparatus among configurations of a system according to various embodiments of the present disclosure.

Terms used in the present invention are only used to describe specific embodiments, and may not be intended to limit the scope of other embodiments. The singular expression may include the plural expression unless the context clearly dictates otherwise. Terms used herein, including technical or scientific terms, may have the same meanings as commonly understood by one of ordinary skill in the art described in the present invention. Among the terms used in the present invention, terms defined in a general dictionary may be interpreted with the same or similar meaning as the meanings in the context of the related art, and unless explicitly defined in the present invention, ideal or excessively formal meanings is not interpreted as In some cases, even terms defined in the present invention cannot be construed to exclude embodiments of the present invention.

1 shows an example of ureteroscope entry through a ureteral access sheath (UAS) to the bladder, ureter and kidney.

Referring to FIG. 1 , the kidney 101 is connected to the bladder 102 through a ureter. When urine generated in the kidney 101 passes through the renal pelvis, it is a long and thin tube that delivers urine to the bladder. The renal and proximal portion of the ureter is the proximal ureter (103). At the end of the proximal ureter 103 is the renal pelvis. The portion of the ureter close to the bladder is the distal ureter. At the end of the distal ureter is the bladder 102 .

The ureter is connected to the kidney 101 based on the boundary between the proximal ureter 103 and the renal pelvis upward, and connected to the bladder 102 downwardly forming a long tunnel in the bladder wall to prevent bladder ureteral reflux.

A ureterovesical junction (UVJ) 104 is located at a portion where the ureter meets the bladder 102 . The UVJ has a ureteral bladder valve that prevents backflow of urine. If UVJ is disrupted, vesicoureteral reflux can occur.

Since the boundary between the proximal ureter 103 and the renal pelvis and the UVJ 104 is narrow, it is a site where ureteric stones are likely to occur.

The urethra 105 is a membranous tube that carries urine from the bladder 102 out of the body. The urethra 105 begins at the lower opening of the bladder 102 and connects outside the body. The urethra 105 may be narrowed due to scar tissue in the urethra 105 , which may cause urethral stricture. Urethral stricture can lead to complications such as the formation of stones in the bladder.

After the guide wire first enters the bladder, ureter, and kidney, the UAS 107 through using the guide wire enters the bladder, ureter and kidney. After UAS 107 enters bladder, ureter, and kidney, ureteroscope 106 may enter bladder, ureter, and kidney through UAS 107 .

2 shows an example of entry into the ureter of a UAS.

Referring to FIG. 2 , after the guide wire 203 enters the kidney 201 through the bladder and ureter, the UAS 206 enters the bladder, ureter, and kidney 201 along the guide wire 203 .

The UAS 206 consists of an inner sheath 204 and an outer sheath 205 . The inner house 204 is disposed more inside than the outer house 205 . When the UAS 206 enters the bladder, ureter, and kidney 201 along the guide wire 203 , the inner house 204 and the outer house 205 enter in a combined form. After the UAS 206 has reached the proper location, the inner house 204 may be detached. After the inner house 204 is separated, the ureteroscope may enter the space where the inner house 204 was inside the outer house 205 . The ureteroscope may enter through the outer sheath 205 without causing frictional damage to the bladder, ureters and kidneys 201 .

The UAS 206 can cause frictional damage when the passageway narrows while entering the bladder, ureter, and kidney 201 . Typically, the narrowing of the passage is the urethra (urethra), ureterovesical junction (ureterovesical junction, UVJ), the proximal ureter (202).

2 illustrates a condition in which the UAS 206 may cause friction in the proximal ureter 202 . The passage of the UAS 206 in the proximal ureter 202 bends towards the renal pelvis. At this time, if the passage of the UAS 206 in the proximal ureter 202 is narrow, the front portion of the UAS 206 may cause frictional damage to the proximal ureter 202 .

3 illustrates a configuration of a system according to various embodiments of the present disclosure.

A system according to various embodiments of the present disclosure includes a Y-shaped medical connector 301 and a device 307 coupled to the medical connector 301 .

The medical connector 301 injects the fluid into the first cylinder 304 and the third opening 305 including the first opening 302 and the second opening 303 , and the fluid flows out through the first opening 302 . and a second cylinder (306) connected at an angle to the first cylinder (304) and including a third opening (305).

The first opening 302 is configured to connect to a ureteral access sheath (UAS) 309 . UAS 309 is configured to enter the bladder, ureters and kidneys.

The first cylinder 304 is configured such that the guide wire 311 passes through the first opening 302 and the second opening 303 . The guide wire 311 passes through the UAS 309 .

Device 307 includes a force measurement gauge configured to measure UAS insertion force (UASIF) upon insertion of UAS 309 into the bladder and ureter.

According to various embodiments of the present disclosure, the third opening 305 may be connected to a device for injecting a fluid, such as a syringe 310 .

According to various embodiments of the present disclosure, the device 307 includes a memory and a processor, and the processor may be configured to determine a location in the bladder and ureter of the UAS 309 based on the measured UASIF.

According to various embodiments of the present disclosure, the processor determines the location of the bladder and the ureter of the UAS 309 according to the measured peak value of the UASIF to the urethra, the ureterovesical junction (UVJ), and the proximal ureter ( It can be further configured to determine the proximal ureter.

According to various embodiments of the present disclosure, the processor determines the positions of the bladder and the ureter of the UAS in the order of the peak values of the measured UASIF to the urethra, ureterovesical junction (UVJ), and proximal ureter, respectively. (proximal ureter) may be further configured, and the order of measured peak values of UASIF may mean an order in which peak values exceeding a previous peak value of measured UASIF by more than a predetermined error range occur.

According to various embodiments of the present disclosure, the memory stores the cutoff value of the peak value of the UASIF for each position in the bladder and ureter of the UAS 309, and the processor is based on the comparison of the measured peak value of the UASIF with the cutoff value The UAS 309 may be further configured to determine the location of the bladder and the ureter into the urethra, the ureterovesical junction (UVJ), and the proximal ureter, respectively.

According to various embodiments of the present disclosure, the device 307 may further include at least one of a wired or wireless transceiver, or an output unit configured to output an audio or visual indication, and the transceiver may be wired or wirelessly connected. It may be configured to transmit information of the measured UASIF to another device 308, or the output unit may be configured to output the measured UASIF as an audio or visual indication.

According to various embodiments of the present disclosure, the device 307 may further include at least one of a wired or wireless transceiver, or an output unit configured to output an audio or visual indication, and the transceiver may be wired or wirelessly connected. It may be configured to transmit information to another device 308 informing that the UAS 309 has reached UVJ, or the output unit may output information indicating that the UAS 309 has reached UVJ as an audio or visual indication. can be configured.

According to various embodiments of the present disclosure, the device 307 may further include a flow rate measuring sensor configured to measure a flow rate of the fluid flowing out through the first opening 302 , and the transceiver may be connected to another device wired or wirelessly. It may be further configured to send to 308 flow rate information of the fluid flowing out through the first opening 302 after the UAS 309 has reached UVJ, or the output unit may be configured to send the UAS 309 to UVJ when the UAS 309 has reached UVJ. After that, it may be further configured to output flow rate information of the fluid flowing out through the first opening 302 as an audio or visual display.

According to various embodiments of the present disclosure, the memory may store the cut-off value of the flow rate of the fluid flowing out through the first opening 302 after the UAS 309 reaches the UVJ, and the transceiver is wired or wirelessly connected. further configured to send information to the other device 308 indicating that the flow rate of fluid exiting through the first opening 302 has reached a cutoff value of the flow rate after the UAS 309 has reached the UVJ; or The output unit may be further configured to output, as an audio or visual indication, information indicating that the flow rate of the fluid flowing out through the first opening 302 has reached a cutoff value of the flow rate after the UAS 309 has reached the UVJ. .

According to various embodiments of the present disclosure, the cut-off value of the flow rate causes hydronephrosis in the proximal ureter after the fluid flowing out through the first opening 302 flows toward the proximal ureter through the UAS 309 that has reached the UVJ. It may be a value of a possible flow rate.

Figure 4 shows a graph of the pressure by position in the ureter of the UAS.

The following first study was performed to obtain the graph of FIG. 4 .

patient

A total of 156 patients from a single institution who underwent RIRS for stones in the ureteropelvic junction or renal pelvis were prospectively enrolled in this study from December 2015 to January 2017. Patients were identified based on clinic visits. UASIF was measured and recorded for patients. This study was approved by the Institutional Ethics Committee (3-2016-0117).

UAS development

A UASIF measurement gauge was designed and manufactured to measure real-time UASIF during ureteral insertion of UAS. The UASIF measuring gauge is a V-block jig that holds the UAS hub, a linear jig that counteracts the potential torque applied to the V-block jig during UAS insertion, at a frequency of 1.0 to 5,000 milliseconds. It consisted of 4 components including a ZTA-50N digital force gauge (IMADA Instruments, Toyohashi City, Japan) capable of measuring UASIF in 1G increments over a range of G, and an aluminum linear lift to install on all jigs. .

Operation

All patients were placed in the standard lithotomy position under general anesthesia, and UASIF was recorded by a single surgeon (KCK). The operation was started with the placement of a guide wire (Amplatz super stiff Urowire XF (Boston Sceintific Microinvasive, Miami, FL, USA)). Retrograde ureteropyelography was performed to exclude existing pathological lesions. After arranging the guide wire, a UAS with a UASIF measuring gauge was inserted. A UAS of 12/14Fr diameter (46 cm male, 35 cm female) was used.

A UAS with a UASIF measurement gauge was inserted into the patient, and at the same time, the position of the distal tip of the UAS was determined by real-time X-ray imaging. The peak UASIF was recorded and was considered the maximum UASIF. Maximum UASIF was measured as the UAS passes through the urethra, UVJ, and proximal ureter.

Referring to Figure 4, with respect to the peak value of UASIF, the distal tip of the UAS according to the order in which the new peak value exceeding the previous peak value by a predetermined error range, for example, 50 g or more occurred urethra), ureterovesical junction (UVJ), and proximal ureter. Therefore, it is possible to determine the location of the UAS in the bladder and ureter based on the measurement and peak value analysis of UASIF.

In addition, as another method, the location of the UAS in the bladder and ureter may be determined by applying a cut-off value to the peak value of the UASIF. For example, if the peak value of UASIF exceeds 300 g for the first time, the UAS is located in the urethra, if the peak value of UASIF for the first time exceeds 500 g, the UAS is located at the ureterovesical junction (UVJ), and UASIF is located in the ureterovesical junction (UVJ). It can be seen that the UAS is located in the proximal ureter when the peak value of α exceeds 600 g for the first time. These cut-off values are exemplary and may be changed according to a user's setting.

In the present invention, based on the data of FIG. 4, after determining the location of the UAS in the bladder and ureter, artificial hydronephrosis is induced in the proximal ureter, which is a location where frictional damage is likely to occur when the UAS is inserted, thereby proximal while the UAS passes. A system for artificially widening the passage of the ureter is provided.

When the tip of the UAS is positioned in the UVJ, a predetermined amount of fluid, for example, water, is sprayed toward the proximal ureter to induce hydronephrosis to the extent that the UAS can easily pass through the proximal ureter.

In order to verify the effect of the present invention, the following second study was conducted.

Development of artificial hydronephrosis inducer

A pulse-type quantitative motor capable of injecting a fluid causing artificial hydronephrosis at a constant flow rate was manufactured, and an algorithm capable of controlling the flow rate and cycle was developed. The range of the pressure of the injected fluid was selected through prior research, and the collection range (mmHg) of the liquid pressure sensor was selected accordingly. A flow path was designed to measure the pressure in the injected fluid, and a pressure sensor was installed at a location that would not interfere with the procedure. An amplifier circuit for amplifying the measured pressure signal and a single board microcontroller circuit for information collection were constructed. For communication with a personal portable terminal, a Bluetooth circuit module was installed in the circuit, and an algorithm was developed that can receive pressure information from the wireless communication module using the App Inventor platform, diagram it on the terminal screen, and store it inside the terminal.

Verification of artificial hydronephrosis inducer

The 3D modeling was designed by simulating the stenosis shape of the ureter, and the ureter requiring artificial hydronephrosis was simulated and manufactured using liquid-curable silicone. Using the developed integrated pressure device, the axial force experienced by the UAS in the simulated ureter and the pressure of the sprayed liquid were simultaneously collected and wirelessly communicated with the terminal. When the UAS passed through the stenotic ureter, it was quantitatively confirmed whether artificial hydronephrosis relieved the UAS insertion pressure by observing the collected axial force and the injected liquid pressure.

RIRS Surgical Procedure Animal Testing

All RIRS were performed under general anesthesia in the lithotomy position. Before insertion of the UAS, retrograde ureteropyelography was performed to evaluate the position of the organic ureter, the presence of ureteric stenosis, and the location of stones. If ureteral stenosis was observed, it was withdrawn from the pool of subjects in this study. For the artificial hydronephrosis inducing group, artificial hydronephrosis induced motion was performed through the artificial hydronephrosis inducer. After confirming that there is no ureteral stenosis, a guide wire (Amplatz super stiff Urowire XF (Boston Sceintific Microinvasive, Miami, FL, USA)) was placed into the renal pelvis, and the UAS was inserted along the guide wire while performing real-time X-ray imaging. For accurate measurement of the UAS insertion pressure, 1) no safety guidewire was used, 2) a 12/14Fr diameter UAS (46 cm male, 35 cm female) was used in all cases, and 3) between observers In order to minimize measurement deviation, all manipulations and measurements were performed by a single researcher.

UASIF Measurement Animal Experiments for Measurement of UAS Entry Pressure

The UAS was inserted while relying on the UASIF measuring gauge, that is, the UAS insertion pressure measuring gauge, in a direction parallel to the guide wire (super stiff guidewire). Using an X-ray fluoroscopy device, the UASIF until reaching the front of the ureteral opening at the distal tip of the UAS, that is, the urethral resistance pressure to the UAS was measured. After that, the maximum pressure was measured when entering the ureter, UVJ, and proximal ureter of the UAS, respectively, and then the limit value for the urethral resistance pressure was recorded.

Evaluating ureteral injury after surgery in animals

After the animal experimental operation, the UAS was removed, and the presence or absence of ureteral damage and damage grade were evaluated and recorded. The ureter injury grade was established using the following standard table [Table 1]. As a result of the evaluation of ureteral damage, it was confirmed that the average of the ureteral injury grades due to UAS insertion in the group in which the artificial hydronephrosis induction was performed was significantly lower than the average of the ureteral damage grades by the UAS insertion in the group in which the artificial hydronephrosis induction was not performed.

[Table 1] Grades of Ureter Injury by UAS Insertion

Expected effect and contribution

Recently, flexible ureteroscopy has become popular worldwide, and RIRS has become the standard treatment for urolithiasis. However, UAS used during the surgical procedure can cause ureter damage due to excessive insertion pressure, so despite its many advantages, it is not recognized as a standard.

Improving the success rate of RIRS surgery and preventing complications

The ultimate expected effect of the present invention and study is to increase the success rate of UAS insertion with minimal risk and at the same time shorten the surgical time required for UAS insertion, thereby having a positive effect on the patient.

5 illustrates a configuration of an apparatus among configurations of a system according to various embodiments of the present disclosure.

Specifically, the device 500 of FIG. 5 shows an example of a detailed configuration of the device 307 in the system configuration of FIG. 3 .

Referring to FIG. 5 , the device 500 includes a force measurement gauge 501 configured to measure a UAS insertion force (UASIF) upon insertion of the UAS into the bladder and ureter. The force measuring gauge 501 may be composed of a force measuring gauge such as the ZTA-50N digital force gauge (IMADA Instruments, Toyohashi City, Japan) used in the experiment of the present invention.

According to various embodiments of the present disclosure, the device 500 includes a processor 502 and a memory 503 , and the processor 502 determines a location in the bladder and ureter of the UAS 309 based on the measured UASIF. can be configured to determine.

The processor 502 controls the overall operations of the device 500 . For example, the processor 502 controls the transceiver 506 to transmit or receive information and the like. The processor 502 controls the output unit 505 to output information and the like. In addition, the processor 502 writes data to and reads data from the memory 503 . The processor 502 may include at least one processor.

The memory 503 is connected to the processor 502 and stores data such as a basic program, an application program, and setting information for the operation of the processor 502 . The memory 503 includes information on the cut-off value of the peak value of the UASIF for each position in the bladder and ureter of the UAS, which is measured in advance, information on the cut-off value of the flow rate of the fluid for inducing artificial hydronephrosis, which is measured in advance when the UAS is inserted. UASIF information and the like can be stored. The memory 503 may be configured as a volatile memory, a non-volatile memory, or a combination of a volatile memory and a non-volatile memory. In addition, the memory 503 provides stored data according to the request of the processor 502 .

According to various embodiments of the present disclosure, the processor 502 determines the location of the bladder and the ureter of the UAS 309 according to the measured peak value of the UASIF to the urethra, the ureterovesical junction (UVJ), and may be further configured to determine with a proximal ureter.

According to various embodiments of the present disclosure, the processor 502 determines the positions of the bladder and the ureters of the UAS according to the order of the measured peak values of the UASIF to the urethra and the ureterovesical junction (UVJ), respectively. , the proximal ureter may be further configured to determine the order of the peak values of the measured UASIF, which means the order in which the peak values exceeding the previous peak value of the measured UASIF by more than a predetermined error range occurred. have.

According to various embodiments of the present disclosure, the memory 503 stores the cut-off value of the peak value of UASIF for each location in the bladder and ureter of the UAS 309, and the processor 502 stores the measured peak value and cut-off of the UASIF. It may be further configured to determine the location of the bladder and the ureter of the UAS 309 as a urethra, a ureterovesical junction (UVJ), and a proximal ureter, respectively, based on the comparison of the off values.

According to various embodiments of the present disclosure, the device 500 may further include at least one of a wired or wireless transceiver 506 , or an output unit 505 configured to output a voice or visual indication. The unit 506 may be configured to transmit information of the measured UASIF to another device 308 connected by wire or wirelessly, or the output unit 505 is configured to output the measured UASIF as an audio or visual indication can be

The output unit 505 is connected to the processor 502, the measured UASIF, information indicating that the UAS 309 has reached UVJ, and the first opening 302 after the UAS 309 has reached UVJ. Flow rate information of the outflowing fluid, information indicating that the flow rate of the fluid flowing out through the first opening 302 has reached the cutoff value of the flow rate after the UAS 309 reaches UVJ in the form of a voice or visual indication can be output as The output unit 505 may include at least one of a speaker and a display.

The transceiver 506 may be connected to the processor 502 and transmit and/or receive information to another device 308 connected by wire and/or wirelessly. All or part of the transceiver 506 may be referred to as a transmitter, a receiver, or a transceiver. The transceiver 506 is a wired access system and/or wireless access systems, such as an Institute of Electrical and Electronics Engineers (IEEE) 802.xx system, an IEEE Wi-Fi system, a 3rd generation partnership project (3GPP) system, and a 3GPP long term (LTE) system. Evolution) system, 3GPP 5G NR (new radio) system, 3GPP2 system, and at least one of various wireless communication standards such as Bluetooth (bluetooth) may be supported.

Another device 308 is a device capable of sending and/or receiving and outputting information with the device 500 wired and/or wirelessly, such as a smartphone, tablet computer, personal computer, or the like.

According to various embodiments of the present disclosure, the device 500 may further include at least one of a wired or wireless transceiver 506 , or an output unit 505 configured to output a voice or visual indication. The unit 506 may be configured to transmit information notifying that the UAS 309 has reached UVJ to another device 308 connected by wire or wirelessly, or the output unit 505 may be configured to indicate that the UAS 309 has reached UVJ. It may be configured to output information indicating that it has arrived as an audio or visual indication.

According to various embodiments of the present disclosure, the device 500 may further include a flow rate measurement sensor 504 configured to measure a flow rate of the fluid flowing out through the first opening 302 , and the transceiver 506 includes: It may be further configured to transmit flow rate information of the fluid flowing out through the first opening 302 after the UAS 309 reaches the UVJ to another device 308 connected by wire or wirelessly, or the output unit 505 ) may be further configured to output flow rate information of the fluid flowing out through the first opening 302 as an audio or visual indication after the UAS 309 reaches the UVJ. According to various embodiments of the present disclosure, the flow measurement sensor 504 may measure the flow rate of the fluid flowing out through the first opening 302 in combination with the first cylinder 304 .

According to various embodiments of the present disclosure, the memory 503 may store a cut-off value of the flow rate of the fluid flowing out through the first opening 302 after the UAS 309 reaches UVJ, and the transceiver 506 ) transmits information indicating that the flow rate of the fluid flowing out through the first opening 302 reaches the cutoff value of the flow rate after the UAS 309 reaches the UVJ to another device 308 connected by wire or wirelessly or, the output unit 505 outputs information indicating that the flow rate of the fluid flowing out through the first opening 302 has reached the cutoff value of the flow rate after the UAS 309 has reached the UVJ Or it may be further configured to output as a visual indication.

According to various embodiments of the present disclosure, the cut-off value of the flow rate causes hydronephrosis in the proximal ureter after the fluid flowing out through the first opening 302 flows toward the proximal ureter through the UAS 309 that has reached the UVJ. It may be a value of a possible flow rate.

In the specific embodiments of the present invention described above, elements included in the present invention are expressed in the singular or plural according to the specific embodiments presented. However, the singular or plural expression is appropriately selected for the context presented for convenience of description, and the present invention is not limited to the singular or plural element, and even if the element is expressed in plural, it is composed of the singular or singular. Even an expressed component may be composed of a plurality of components.

Meanwhile, although specific embodiments have been described in the detailed description of the present invention, various modifications are possible without departing from the scope of the present invention. Therefore, the scope of the present invention should not be limited to the described embodiments and should be defined by the claims described below as well as the claims and equivalents.

101: kidney 102: bladder
103: proximal ureter 104: ureter-bladder junction
105: urethra 106: ureteroscope
107: ureter entry house 201: kidney
202: proximal ureter 203: guide wire
204: inner house 205: outer house
206: ureteral entry house 301: medical connector
302: first opening 303: second opening
304: first cylinder 305: third opening
306: second cylinder 307: device
308: other device 309: ureteral entry house
310: syringe 311: guide wire
500: device 501: force measuring gauge
502: processor 503: memory
504: flow measuring sensor 505: output
506: transceiver

Claims (9)

In the system,
Y-shaped medical connector; and
a device coupled to the medical connector;
The medical connector,
a first cylinder including a first opening and a second opening; and
and a second cylinder connected at an angle to the first cylinder and including the third opening so that the fluid is introduced into the third opening so that the fluid can flow out through the first opening,
the first opening is configured to connect to a ureteral access sheath (UAS);
The first cylinder is configured such that a guide wire passes through the first opening and the second opening, and the guide wire passes through the UAS,
The device is
Memory;
processor;
a force measurement gauge configured to measure a UAS insertion force (UASIF) upon insertion of the UAS into the bladder and ureter;
at least one of a wired or wireless transceiver, or an output unit configured to output an audio or visual indication; and
a flow measurement sensor configured to measure the flow rate of the fluid flowing out through the first opening;
The processor is configured to determine the position in the bladder and the ureter of the UAS based on the measured UASIF, and determine the position in the bladder and the ureter of the UAS according to the measured peak value of the UASIF, respectively, to the urethra. , a ureterovesical junction (UVJ), a proximal ureter,
The transceiver is configured to transmit information notifying that the UAS has reached the UVJ to another device connected by wire or wirelessly, or the output unit transmits information indicating that the UAS has reached the UVJ as a voice or visual indication configured to output,
The transceiver is further configured to transmit flow rate information of the fluid flowing out through the first opening after the UAS reaches the UVJ to the other device connected by wire or wirelessly, or the output unit is configured to transmit the flow rate information of the UAS to the UVJ further configured to output flow rate information of the fluid flowing out through the first opening as an audio or visual indication after reaching
system.
delete According to claim 1,
The processor is
Further configured to determine the position of the bladder and the ureter of the UAS into a urethra, a ureterovesical junction (UVJ), and a proximal ureter, respectively, according to the order of the measured peak values of the UASIF, ,
The order of the peak values of the measured UASIF means an order in which a peak value exceeding a previous peak value of the measured UASIF by more than a predetermined error range occurs,
system.
According to claim 1,
The memory stores a cut-off value of the peak value of the UASIF for each location in the bladder and the ureter of the UAS,
The processor is
Based on the comparison of the measured peak value and the cut-off value of the UASIF, the location of the UAS in the bladder and the ureter was determined in the urethra, ureterovesical junction (UVJ), and proximal ureter, respectively. further configured to determine as
system.
According to claim 1,
The device further comprises at least one of a wired or wireless transceiver, or an output unit configured to output an audio or visual indication,
The transceiver is configured to transmit the measured UASIF information to another device connected by wire or wirelessly, or
The output unit is configured to output the measured UASIF as an audio or visual indication,
system.
delete delete According to claim 1,
The memory stores a cut-off value of the flow rate of the fluid flowing out through the first opening after the UAS reaches the UVJ,
The transceiver is further configured to transmit information indicating that the flow rate of the fluid flowing out through the first opening reaches the cutoff value of the flow rate after the UAS reaches the UVJ to the other device connected by wire or wirelessly become, or
The output unit is further configured to output information indicating that the flow rate of the fluid flowing out through the first opening has reached the cut-off value of the flow rate after the UAS reaches the UVJ, in a voice or visual indication,
system.
9. The method of claim 8,
The cut-off value of the flow rate is a value of the flow rate that can cause hydronephrosis in the proximal ureter after the fluid flowing out through the first opening flows toward the proximal ureter through the UAS that has reached the UVJ,
system.

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