New coaxial ureteral stricture knife.
Open surgical repair of upper urinary collecting system strictures or obstructions is difficult and is less likely to be accepted by the patient than an endoscopic or ureteroscopic approach. In the hands of an experienced urologic endoscopist the use of our cold blade has the advantage of less trauma to the ureter, already compromised by poor blood supply, than blind dilation; there is visual control of the procedure and acceptance by the patient that the urologic surgeon is doing the procedure; and it is adaptable to rigid or flexible endoscopes and ureterorenoscopes. Furthermore, there is information that the results are better, at least in the short term, than the more traumatic endoscopic procedures associated with dilation. However, only long-term future series will give us an evolving view of this resistant problem. Finally, the ureteral knife we have developed has the potential to be converted to an electrosurgical device for incision or coagulation, when appropriate. An application is pending with the US Food and Drug Administration concerning electrosurgical applications of the ureteral knife (in conjunction with J.R. La Course, PhD, and G.C. Gerhard, PhD, Department of Electrical Engineering and Computer Sciences, University of New Hampshire, Durham). The high dielectric constant of the sheath, combined with hemostatic or incisional properties in this latter mode, would likely prove advantageous.