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Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a preferred treatment for large stones within the kidney or upper ureter. The procedure involves making a small incision (1 cm) in the back overlying the location of the kidney. A tunnel is then created from the skin into the kidney to allow passage of a nephroscope. The nephroscope is used to locate the existing stone and any small stones that may not have been visible by X-ray. The nephroscope has an inner channel that allows passage of instruments that are used to break up the stone.
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Prescriptive Information

Prescriptive Information

Indications

Indicated for use for catheterization of the urinary tract during interoperative procedures, including but not limited to ureteral occlusion for injection of contrast medium, delivery of irrigation fluids to the ureter, drainage of fluids from the urinary tract, and access, advancement or exchange of ancillary devices including guidewires.

Contraindications

Contraindicated for patients unsuitable for catheterization.

Warnings

For single use only. Do not reuse, reprocess or resterilize.

Potential Adverse Effects

The Potential Complications may include extravasation, hemorrhage, sepsis, edema, loss of renal function, perforation of kidney, renal pelvis, ureter and bladder, peritonitis, and unrinary tract infection.

Cautions

Indwelling not to exceed 24 hours.

Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.

Trademark

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Prescriptive Information

Indications

This basket is intended to be used endoscopically to grasp, manipulate and remove calculi from the urinary tract.

Contraindications

• Pregnancy • Renal malignancy • Sepsis • Anticoagulation or bleeding disorders • Presence of very large stones that in the past have failed lithotripsy with basket retrieval

Warnings

• The use of this device should be restricted to use by or under the supervision of physicians trained in urological endoscopic procedures. • Exercise care to prevent perforation or trauma of the linings of the urinary tract and associated tissues. • Some stones may be too large to be removed endoscopically with the stone retrieval basket. Use fluoroscopy or x-ray to determine the size of the stone prior to instrumentation. Do not use the basket if the stone is too large to be removed endoscopically. To do this may result in stone impaction and patient injury. • If resistance is encountered while attempting to withdraw the basket, DO NOT EXERT EXCESSIVE FORCE. • Do not fire the laser directly upon the basket. • If a basket wire is broken during lasing, discontinue lasing immediately. Good surgical procedures should be followed for basket removal. • This basket has no serviceable parts. Do not attempt to repair or alter the device. Do not resterilize the device. Any use of the device other than those indicated is not recommended. • Do not use this basket without the pre-packaged scope adapter. Doing so may result in inability to advance the laser fiber through the working channel of the scope. • This device must not come in contact with any electrified instrument.

Potential Adverse Effects

Potential complications generally recognized with the use of stone retrieval basket devices include, but are not limited to: • Pregnancy • Renal malignancy • Sepsis • Anticoagulation or bleeding disorders • Presence of very large stones that in the past have failed lithotripsy with basket retrieval • Edema • Stone impaction • Entrapment • Stone migration • Evulsion • Urinary frequency • Fever • Urinary tract infection • Hemorrhage • Pain • Ureteral trauma (including stripping, abrasion or perforation There may be other potential adverse events that are unforeseen at this time.

Cautions

PRECAUTION: Before using, inspect the blister pouch for any breach of the package to ensure a sterile product and inspect product for any damage. If seal has been broken or product is damaged. DO NOT USE. Immediately return package and product to your Boston Scientific representative. Kinks in the sheath will hinder the mechanical operation of the basket. It is recommended that the ureter be pre-dilated before endoscopy and stone retrieval to prevent impaction when retracting the stone.

Trademark

SlimLine and SLimLine EZ are trademarks of Lumenis Ltd. Sharplan is a trademark of Laser Industries, Ltd.


Prescriptive Information

Indications

The Urological Retrieval Devices are intended to be used during urological procedures to endoscopically grasp, manipulate and remove calculi and other foreign objects.

Contraindications

Some objects may be too large to be removed endoscopically with a retrieval device. To avoid stone impaction, fluoroscopy or x-ray should be used to determine the size of the object; do not use the retrieval device if the object is too large to be removed endoscopically or to be held within the device.

Warnings

For single use only. Do not reuse, reprocess or resterilize. This device must not come in contact with any electrified instrument. This device should not be directly fired upon by a laser or lithotripter; to do so may damage the device and could result in patient injury.

Potential Adverse Effects

The Potential Complications, which may result from a urological retrieval procedure, include perforation, entrapment, evulsion, hemorrhage, and edema.

Cautions

Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physcian.


Prescriptive Information

Indications

The Stone Cone Device is intended to be used endoscopically to entrap and remove calculi and other foreign objects from the urinary tract.

Contraindications

No contraindications are known.

Warnings

For single use only. Do not reuse, reprocess, or resterilize.

Potential Adverse Effects

The Potential Complications that may result from use of the Stone Cone are perforation, entrapment, evulsion, hemorrhage, edema, stone migration, and stone impaction.

Cautions

Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.

Trademark

Stone Cone is a registered trademark of Med Source Technologies.


Prescriptive Information

Refer to the operator's manual for complete instructions for use.

Indications
Urology indications:

The following applications are indicated for urology while using the Ho:YAG wavelength:
  • Endoscopic transurethral incision of the prostate (TUIP), bladder neck incision of the prostate (BNI), holmium laser ablation of the prostate (HoLAP), holmium laser enucleation of the prostate (HoLEP), holmium laser resection of the prostate(HoLRP),hemostasis, vaporization and excision for treatment of benign prostatic hypertrophy (BPH). The clinical procedure for HoLRP, along with clinical study results, is described in Appendix A of the operator manual.
  • Open and endoscopic urological surgery (ablation, vaporization, incision, excision, and coagulation of soft tissue) including treatment of:
    • Superficial and invasive bladder, urethral and ureteral tumors
    • Condylomata
    • Lesions of external genitalia
    • Urethral and penile hemangiomas
    • Urethral strictures
    • Bladder neck obstructions
Contraindications
Urology contraindications

The Ho:YAG wavelength should not be used for HoLRP for treatment of BPH in patients with:
  • Carcinoma of the prostate
  • Desire for future fertility
The Ho:YAG wavelength should not be used in patients with the following conditions:
  • Inability to receive endoscopic treatment
  • Intolerance to anesthesia
Warnings
Refer to operators manual provided with product for a complete list of warnings.
General warning:
Lasers generate a highly concentrated beam of light which may cause injury if improperly used. To protect the patient and operating personnel, the entire laser and the appropriate delivery system operator manuals, including all Safety and Regulatory sections, should be carefully read and comprehended before operation.

Urology warnings:
Good clinical judgement should be used prior to performing the HoLRP procedure on patients who are taking anticoagulants.

Potential Adverse Effects
General laser complications

  • Refer to complications specific to each surgical specialty and wavelength in the "Directions for Use"
  • The potential complications encountered in endoscopic laser surgery are the same as those normally encountered in conventional endoscopic surgery.
  • Acute pain may occur immediately following laser therapy and may persist for as long as 48 hours.
  • Immediately following laser therapy, the patient may experience fever and leukocytosis, which are commonly associated with tissue destruction. These generally resolve without treatment.
  • Laser ablated tissue may become necrotic or infected after treatment
  • If a question of infection exists, appropriate treatment should be carried out.

    The following complications could be serious and could result in death:
    • Patients may experience bleeding at the site of laser therapy. Posttreatment hematocrits are recommended to identify this potential complication.
    • Sepsis can result from performing any surgical procedure. If a question of sepsis exists, appropriate evaluations should be made.
    • Perforation may occur as a result of laser treatment. To diagnose perforations, patients must be carefully followed post-operatively with appropriate tests.
    Cautions
    Federal (USA) law and governing law outside the USA restrict these devices to sale by or on the order of a physician.
    Urology precautions
    The following precautions are suggested when using the Ho:YAG wavelength in urology:
    • Care should be exercised so as not to over distend the bladder when using the laser endoscopically. Excessive bladder distention could result in coagulative necrosis of the superficial and inner muscular region of the bladder wall. The following precautions are recommended for HoLRP for treatment of BPH:
    • Confirm that the tip of the fiber optic delivery device extends at least 1.25 centimeters beyond the end of the urethroscope or endoscope during laser treatment.
    • Activating the laser when the tip of the delivery device is within the urethroscope or endoscope can result in penetration of holmium laser energy through the scope and destruction of the scope.
    • Use caution during laser treatment near the verumontanum.
    • The learning curve to obtain proficiency in HoLRP has been described by experienced urologists to be similar to that of learning TURP
    Read “Directions for Use” for a list of additional precautions. Trademark
    Legal Manufacturer: Lumenis. Ltd. Distributed in the U.S. by: Boston Scientific Corporation. VersaPulse, VersaPulse Select, PowerSuite and Duotome are trademarks of Lumenis Ltd. Copyright: 2007 Boston Scientific Corporation or its affiliates. All rights reserved


    Prescriptive information

    Refer to the operator's manual for complete instructions for use.

    Indications
    Urology indications:

    The following applications are indicated for urology while using the Ho:YAG wavelength:
    • Endoscopic transurethral incision of the prostate (TUIP), bladder neck incision of the prostate (BNI), holmium laser ablation of the prostate (HoLAP), holmium laser enucleation of the prostate (HoLEP), holmium laser resection of the prostate(HoLRP),hemostasis, vaporization and excision for treatment of benign prostatic hypertrophy (BPH). The clinical procedure for HoLRP, along with clinical study results, is described in Appendix A of the operator manual.
    • Open and endoscopic urological surgery (ablation, vaporization, incision, excision, and coagulation of soft tissue) including treatment of:
      • Superficial and invasive bladder, urethral and ureteral tumors
      • Condylomata
      • Lesions of external genitalia
      • Urethral and penile hemangiomas
      • Urethral strictures
      • Bladder neck obstructions
    Contraindications
    Urology contraindications

    The Ho:YAG wavelength should not be used for HoLRP for treatment of BPH in patients with:
    • Carcinoma of the prostate
    • Desire for future fertility
    The Ho:YAG wavelength should not be used in patients with the following conditions:
    • Inability to receive endoscopic treatment
    • Intolerance to anesthesia
    Warnings
    Refer to operators manual provided with product for a complete list of warnings.
    General warning:
    Lasers generate a highly concentrated beam of light which may cause injury if improperly used. To protect the patient and operating personnel, the entire laser and the appropriate delivery system operator manuals, including all Safety and Regulatory sections, should be carefully read and comprehended before operation.

    Urology warnings:
    Good clinical judgement should be used prior to performing the HoLRP procedure on patients who are taking anticoagulants.

    Potential Adverse Effects
    General laser complications

    • Refer to complications specific to each surgical specialty and wavelength in the "Directions for Use"
    • The potential complications encountered in endoscopic laser surgery are the same as those normally encountered in conventional endoscopic surgery.
    • Acute pain may occur immediately following laser therapy and may persist for as long as 48 hours.
    • Immediately following laser therapy, the patient may experience fever and leukocytosis, which are commonly associated with tissue destruction. These generally resolve without treatment.
    • Laser ablated tissue may become necrotic or infected after treatment
    • If a question of infection exists, appropriate treatment should be carried out.

      The following complications could be serious and could result in death:
      • Patients may experience bleeding at the site of laser therapy. Posttreatment hematocrits are recommended to identify this potential complication.
      • Sepsis can result from performing any surgical procedure. If a question of sepsis exists, appropriate evaluations should be made.
      • Perforation may occur as a result of laser treatment. To diagnose perforations, patients must be carefully followed post-operatively with appropriate tests.
      Cautions
      Federal (USA) law and governing law outside the USA restrict these devices to sale by or on the order of a physician.
      Urology precautions
      The following precautions are suggested when using the Ho:YAG wavelength in urology:
      • Care should be exercised so as not to over distend the bladder when using the laser endoscopically. Excessive bladder distention could result in coagulative necrosis of the superficial and inner muscular region of the bladder wall. The following precautions are recommended for HoLRP for treatment of BPH:
      • Confirm that the tip of the fiber optic delivery device extends at least 1.25 centimeters beyond the end of the urethroscope or endoscope during laser treatment.
      • Activating the laser when the tip of the delivery device is within the urethroscope or endoscope can result in penetration of holmium laser energy through the scope and destruction of the scope.
      • Use caution during laser treatment near the verumontanum.
      • The learning curve to obtain proficiency in HoLRP has been described by experienced urologists to be similar to that of learning TURP
      Read “Directions for Use” for a list of additional precautions. Trademark Legal Manufacturer: Lumenis. Ltd. Distributed in the U.S. by: Boston Scientific Corporation. VersaPulse, VersaPulse Select, PowerSuite and Duotome are trademarks of Lumenis Ltd. Copyright: 2006 Boston Scientific Corporation or its affiliates. All rights reserved


      Prescriptive Information

      Indications

      The Urological Retrieval Devices are intended to be used during urological procedures to endoscopically grasp, manipulate and remove calculi and other foreign objects.

      Contraindications

      Some objects may be too large to be removed endoscopically with a retrieval device. To avoid stone impaction, fluoroscopy or x-ray should be used to determine the size of the object; do not use the retrieval device if the object is too large to be removed endoscopically or to be held within the device.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize. This device must not come in contact with any electrified instrument. This device should not be directly fired upon by a laser or lithotripter; to do so may damage the device and could result in patient injury.

      Potential Adverse Effects

      The potential complications, which may result from a urological retrieval procedure, include perforation, entrapment, evulsion, hemorrhage, and inability to disengage from irretrievable object, edema, and basket inversion.

      Cautions

      Before using, inspect the sterile barrier for any breach of the package to ensure a sterile product and inspect product for any damage. If seal has been broken or product is damaged DO NOT USE. Immediately return package and product to Boston Scientific. If resistance is encountered during advancement or withdrawal of device, DO NOT EXERT EXCESSIVE FORCE.

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.




      Prescriptive Information

      Indications

      The Imager II Urology Torque Catheter is indicated for use in facilitating access to the urinary tract, either through a retrograde or antegrade route, and may be used in conjunction with a guidewire or for the infusion of radiopaque contrast material.

      Contraindications

      This device is, in general, contraindicated for use in patients who are unsuitable for ureteral catheterization or the infusion of contrast material.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize.

      Potential Adverse Effects

      The potential adverse effects, which may result from ureteral catheter placement may include, but are not limited to: extravasation; hemorrhage; sepsis; edema; loss of renal function; perforation of kidney, renal pelvis, ureter and bladder; peritonitis; and urinary tract infection.

      Cautions

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.

      Trademark

      Pebax is a trademark of Atochem Corporation.


      Prescriptive Information

      Refer to the operator's manual for complete instructions for use.
      Indications

      The Urological Retrieval Devices are intended to be used during urological procedures to endoscopically grasp, manipulate and remove calculi and other foreign objects.

      Contraindications

      Some objects may be too large to be removed endoscopically with a retrieval device. To avoid stone impaction, fluoroscopy or x-ray should be used to determine the size of the object; do not use the retrieval device if the object is too large to be removed endoscopically or to be held within the device.

      Warnings

      For single patient use only. Do not reuse, reprocess or resterilize. This device must not come in contact with any electrified instrument. This device should not be directly fired upon by a laser or lithotripter; to do so may damage the device and could result in patient injury.

      Potential Adverse Effects

      The potential complications, which may result from a urological retrieval procedure, include perforation, entrapment, evulsion, hemorrhage, inability to disengage from irretrievable object, edema, and basket inversion.

      Cautions

      Before using, inspect the sterile barrier for any breach of the package to ensure a sterile product and inspect product for any damage. If seal has been broken or product is damaged DO NOT USE. Immediately return package and product to Boston Scientific. If resistance is encountered during advancement or withdrawal of device, DO NOT EXERT EXCESSIVE FORCE.

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.




      Prescriptive Information

      Refer to the operator's manual for complete instructions for use.
      Indications

      The Guidewires are intended to facilitate the placement of endourological instruments during diagnostic or interventional procedures.

      Contraindications

      No contraindications are known.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize. Do not manipulate, advance and/or withdraw the guidewire through a metal cannula or needle; to do so may result in destruction and/or separation of the device, which may result in injury. Do not use a retrieval device while the guidewire is in place; to do so may cause damage to the guidewire.

      Potential Adverse Effects

      The Potential Complications, which may result from the use of a guidewire in urological guidewire procedures, include perforation of the urinary tract, hemorrhage, edema, acute bleeding, and tissue trauma.

      Cautions

      Before using, inspect the sterile barrier for any breach of the package to ensure a sterile product and inspect product for any damage. If seal has been broken or product is damaged DO NOT USE. Immediately return package and product to Boston Scientific. If resistance is encountered during advancement or withdrawal of device, DO NOT EXERT EXCESSIVE FORCE. Do not use the guidewire if it becomes damaged to do so will prevent accurate torque or tactile response and may cause injury.

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.

      Trademark

      Glidewire is a registered trademark of Terumo Corporation.


      Prescriptive Information

      Indications

      The Urological Retrieval Devices are intended to be used during urological procedures to endoscopically grasp, manipulate and remove calculi and other foreign objects.

      Contraindications

      Some objects may be too large to be removed endoscopically with a retrieval device. To avoid stone impaction, fluoroscopy or x-ray should be used to determine the size of the object; do not use the retrieval device if the object is too large to be removed endoscopically or to be held within the device.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize. This device must not come in contact with any electrified instrument. This device should not be directly fired upon by a laser or lithotripter; to do so may damage the device and could result in patient injury.

      Potential Adverse Effects

      The Potential Complications, which may result from a urological retrieval procedure, include perforation, entrapment, evulsion, hemorrhage, and inability to disengage from irretrievable object, edema, and basket inversion.

      Cautions

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.

      Trademark

      ZeroTip is a trademark of Boston Scientific Corporation or its affiliates.


      Prescriptive Information

      Indications

      The Urological Guidewires are intended to facilitate the placement of endourological instruments during diagnostic or interventional procedures.

      Contraindications

      No contraindications are known.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize. Do not manipulate, advance and/or withdraw the guidewire through a metal cannula or needle; to do so may result in destruction and/or separation of the device, which may result in injury. A retrieving device, such as a gripper or basket forceps, should only be used after the guidewire has been removed from the patient's channel or duct. Using a retrieving device while the guidewire is in place may cause the guidewire to break.

      Potential Adverse Effects

      The Potential Complications, which may result from use of a guidewire in urological guidewire procedures, may include perforation of the urinary tract, hemorrhage, edema, acute bleeding, and tissue trauma.

      Cautions

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.


      Prescriptive Information

      Refer to the operator's manual for complete instructions for use. Indications

      The Urological Guidewires are intended to facilitate the placement of endourological instruments during diagnostic or interventional procedures.

      Contraindications

      No contraindications are known.

      Warnings

      For single use only. Do not reuse, reprocess, or resterilize. Do not manipulate, advance and/or withdraw the guidewire through a metal cannula or needle; doing so may result in destruction and/or separation of the device, which may result in injury. Do not use a retrieval device while the guidewire is in place; doing so may cause damage to the guidewire.

      Potential Adverse Effects

      The Potential Complications, which may result from use of a guidewire in urological guidewire procedures, may include, but are not limited to: perforation of the urinary tract, hemorrhage, edema, acute bleeding, and tissue trauma.

      Cautions

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.


      Prescriptive Information

      Indications

      The Swiss LithoClast Ultra is intended for the fragmentation of urinary tract calculi in the kidney, ureter and bladder.

      Contraindications

      Contraindicated in patients with active bleeding disorders, solitary functioning kidney, creatinine greater than or equal to 3 mgm percent, during pregnancy, under the age of 18, stricture and obstruction problems, and with electrical stimulator implanted e.g. pacemaker.

      Warnings

      For single use only. Do not reuse, reprocess, or resterilize.

      Potential Adverse Effects

      The Potential Complications from use of the Swiss LithoClast Ultra may include, but are not limited to, perforation, hemorrhage, lesion, stone migration, pain/colic, macroscopic hematuria, infection, and ureteral obstruction.

      Cautions

      Federal (USA) law and governing law outside the USA restricts this device to sale by or on the order of a physician.

      Trademark

      Swiss LithoClast is a registered trademark of Ferton Holding SA

      Federal (USA) law and governing law outside the USA restricts these devices to sales by or on the order of a physician.

      Swiss LithoClast Ultra is manufactured by EMS Electro Medical Systems S.A. and distributed in the U.S. exclusively by Boston Scientific Corporation.


      Prescriptive Information

      Refer to the operator's manual for complete instructions for use.
      Indications

      The Boston Scientific Urological Guidewires are intended to facilitate the placement of endourological instruments during diagnostic or interventional procedures.

      Contraindications

      No contraindications are known.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize. Do not manipulate, advance and/or withdraw the guidewire through a metal cannula or needle; to do so may result in destruction and/or separation of the device, which may result in injury. Do not use a retrieval device while the guidewire is in place; to do so may cause damage to the guidewire.

      Potential Adverse Effects

      The Potential Complications, which may result from use of a guidewire in urological guidewire procedures, include perforation of the urinary tract, hemorrhage, edema, acute bleeding and tissue trauma.

      Cautions

      Federal (USA) law and governing law outside the USA restricts these devices to sale by or on the order of a physician.


      Prescriptive Information

      Indications

      Indicated for dilatation of the nephrostomy tract.

      Contraindications

      Contraindicated in the presence of conditions which create unacceptable risk during catheterization.

      Warnings

      For single patient use only. Do not reuse, reprocess or resterilize.

      Potential Adverse Effects

      The Potential Complications which may result from a balloon dilatation procedure may include, but are not limited to tissue trauma, tissue perforation, mucosal trauma, urethral perforations, tissue disruption, bleeding, infection, creation of false passages, inability to void, scar tissue formation, and procedural problems due to muscle spasms.

      Cautions

      Before using, inspect the sterile barrier for any breach of the package to ensure a sterile product and inspect product for any damage. If seal has been broken or product is damaged, DO NOT USE. Immediately return package and product to Boston Scientific Urology. If resistance is encountered during advancement or withdrawal of device, DO NOT EXERT EXCESSIVE FORCE. Refer to package label for balloon's rated burst pressure. Federal (USA) law restricts these devices to sale by or on the order of a physician.


      Prescriptive Information

      Indications

      The Urological Retrieval Device is intended to be used during urological procedures to endoscopically grasp, manipulate and remove calculi and other foreign objects.

      Contraindications

      Some objects may be too large to be removed endoscopically with a retrieval device. To avoid stone impaction, fluoroscopy or x-ray should be used to determine the size of the object; do not use the retrieval device if the object is too large to be removed endoscopically or to be held within the device.

      Warnings

      For single use only. Do not reuse, reprocess or resterilize. This device must not come in contact with any electrified instrument. This device should not be directly fired upon by laser or lithotripter; to do so may damage the device and could result in patient injury.

      Potential Adverse Effects

      The Potential Complications, which may result from a urological retrieval procedure, include perforation, entrapment, evulsion, hemorrhage, and edema.

      Cautions

      Federal (USA) law and governing law outside the USA restricts the sale by or on the order of a physician.


      Prescriptive Information: Holmium 60W Laser

      Urology indications
      The following applications are indicated for urology while using the Ho:YAG wavelength:
      Open and endoscopic urological surgery (ablation, vaporization, incision, excision, and coagulation of soft tissue) including treatment of:
      • Superficial and invasive bladder, urethral, and ureteral tumors
      • Condylomata
      • Lesions of external genitalia
      • Urethral and penile hemangiomas
      • Urethral strictures
      • Bladder neck obstructions
          Urology contraindications
          The Ho:YAG wavelength should not be used in patients with the following conditions:
          • Inability to receive endoscopic treatment
          • Intolerance to anesthesia
          Urology warnings
          Read “General laser warnings” the operators manual for a list of warnings.
          Urology precautions
          CAUTION – Care should be exercised so as not to over distend the bladder when using the laser endoscopically. Excessive bladder distention could result in coagulative necrosis of the superficial and inner muscular region of the bladder wall.
          Read “General laser precautions” in the operators manual for a list of additional precautions.
          Urology complications
          Read “General laser complications” in the operators manual for a list of complications.
          Urinary lithotripsy indications
          The following applications are indicated for urinary lithotripsy while using the Ho:YAG wavelength:
          • Endoscopic fragmentation of urinary (urethral, ureteral, bladder and renal) calculi, including cystine, calcium oxalate, monohydrate and calcium oxalate dihydrate stones
          • Treatment of distal impacted fragments of steinstrasse when guide wires cannot be passed
          Urinary lithotripsy contraindications
          The Ho:YAG wavelength must not be used in patients with the following conditions:
          • Inability to receive endoscopic treatment
          • Intolerance to anesthesia
          Urinary lithotripsy warnings
          WARNING – Unexpected tissue damage may occur due to excessive power application. Refer to “Urinary lithotripsy clinical parameters” in the operators manual for recommended initial power settings. Use of excessive power may result in inadvertent perforation of the ureter or damage to other urologic structures. Read “General laser warnings” in operators manual for a list of additional warnings. Indications for Use Specific to the Ho:YAG Wavelength
          Urinary lithotripsy precautions
          CAUTION – The laser should be used with an optical fiber delivery system in direct view and in direct contact with the target ureteral stone. To minimize the potential for migration up the ureter, laser energy should be directed to the side of the stone, if possible, rather than the leading edge. Maintaining low energy levels and repetition rates will reduce the potential for possible stone migration.
          CAUTION – Be aware of edematous folds of epithelium that may lie between the optical fiber and the stone; however, research suggests such folds are very rare.
          CAUTION – Basketing may be used with larger stone fragments that are relatively hard or tend to escape in a retrograde fashion up the ureter. Use of endoscopes in laser procedures allows excellent viewing and minimal trauma to the ureter during fragmentation. Baskets, guide wires, and other ureteroscopic accessories may be damaged by direct contact with the laser treatment beam.
          CAUTION – The use of irrigation is recommended throughout the lithotripsy procedure to absorb any heat produced, to carry stone fragments out of the urinary system, and to enhance direct visualization. The rate of irrigation should be carefully adjusted to avoid flux of calculi into the kidney. Read “General laser precautions” in operators manual for a list of additional precautions. Indications for Use
          Urinary lithotripsy complications
          • As with other endoscopic urologic procedures, there may be urine leakage following the laser procedure.
          • The use of flexible endoscopes carries an equivalent incidence of stricture formation; these rates may improve with further advances in ureteroscope design.
          • Although rare, loss of a kidney may occur as a result of the procedure or because of the stone, itself.
          Read “General laser complications” in the operators manual for a list of additional complications.


          Prescriptive Information: SlimLine EZ Single-use Holmium Laser Fiber

          Caution: Federal Law (USA) restricts these devices to sale by or on the order of a physician.
          Refer to package insert provided with product for complete instructions for use including Indications for Use, Contraindications, Potential Complications, Warning and Cautions.

          SlimLine and SlimLine EZ are trademarks of Lumenis Ltd. SlimLine EZ is manufactured by Lumenis and distributed by Boston Scientific.


          VersaPulse PowerSuite 20W Holmium Surgical Laser

          Urology indications
          The following applications are indicated for urology while using the Ho:YAG wavelength:
          Open and endoscopic urological surgery (ablation, vaporization, incision, excision, and coagulation of soft tissue) including treatment of:
          • Superficial and invasive bladder, urethral, and ureteral tumors
          • Condylomata
          • Lesions of external genitalia
          • Urethral and penile hemangiomas
          • Urethral strictures
          • Bladder neck obstructions
              Urology contraindications
              The Ho:YAG wavelength should not be used in patients with the following conditions:
              • Inability to receive endoscopic treatment
              • Intolerance to anesthesia
              Urology warnings
              Read “General laser warnings” the operators manual for a list of warnings.
              Urology precautions
              CAUTION – Care should be exercised so as not to over distend the bladder when using the laser endoscopically. Excessive bladder distention could result in coagulative necrosis of the superficial and inner muscular region of the bladder wall.
              Read “General laser precautions” in the operators manual for a list of additional precautions.
              Urology complications
              Read “General laser complications” in the operators manual for a list of complications.
              Urinary lithotripsy indications
              The following applications are indicated for urinary lithotripsy while using the Ho:YAG wavelength:
              • Endoscopic fragmentation of urinary (urethral, ureteral, bladder and renal) calculi, including cystine, calcium oxalate, monohydrate and calcium oxalate dihydrate stones
              • Treatment of distal impacted fragments of steinstrasse when guide wires cannot be passed
              Urinary lithotripsy contraindications
              The Ho:YAG wavelength must not be used in patients with the following conditions:
              • Inability to receive endoscopic treatment
              • Intolerance to anesthesia
              Urinary lithotripsy warnings
              WARNING – Unexpected tissue damage may occur due to excessive power application. Refer to “Urinary lithotripsy clinical parameters” in the operators manual for recommended initial power settings. Use of excessive power may result in inadvertent perforation of the ureter or damage to other urologic structures. Read “General laser warnings” in operators manual for a list of additional warnings. Indications for Use Specific to the Ho:YAG Wavelength
              Urinary lithotripsy precautions
              CAUTION – The laser should be used with an optical fiber delivery system in direct view and in direct contact with the target ureteral stone. To minimize the potential for migration up the ureter, laser energy should be directed to the side of the stone, if possible, rather than the leading edge. Maintaining low energy levels and repetition rates will reduce the potential for possible stone migration.
              CAUTION – Be aware of edematous folds of epithelium that may lie between the optical fiber and the stone; however, research suggests such folds are very rare.
              CAUTION – Basketing may be used with larger stone fragments that are relatively hard or tend to escape in a retrograde fashion up the ureter. Use of endoscopes in laser procedures allows excellent viewing and minimal trauma to the ureter during fragmentation. Baskets, guide wires, and other ureteroscopic accessories may be damaged by direct contact with the laser treatment beam.
              CAUTION – The use of irrigation is recommended throughout the lithotripsy procedure to absorb any heat produced, to carry stone fragments out of the urinary system, and to enhance direct visualization. The rate of irrigation should be carefully adjusted to avoid flux of calculi into the kidney. Read “General laser precautions” in operators manual for a list of additional precautions. Indications for Use
              Urinary lithotripsy complications
              • As with other endoscopic urologic procedures, there may be urine leakage following the laser procedure.
              • The use of flexible endoscopes carries an equivalent incidence of stricture formation; these rates may improve with further advances in ureteroscope design.
              • Although rare, loss of a kidney may occur as a result of the procedure or because of the stone, itself.
              Read “General laser complications” in the operators manual for a list of additional complications.


Image Gallery
1. Advance Guidewire and Occlusion Balloon 10. Remove Stone Fragments 11. Place Nephrostomy Drainage Catheter 2. Opacify the Collecting System