??????? ESWL (Extracorporeal Shock Wave Lithotripsy)

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??????????

• By ???

2
????????

• ??
• ??????? ESWL (Extracorporeal Shock Wave
  Lithotripsy)
• ????????? URSL (UreteroRenoScopic Lithotripsy)
• ????????? PCNL (PerCutaneous NephroLithotripsy)
• ???????? ESCL (EndoScopic CystoLithotripsy)

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????????

• ??? Hydronephrosis
• ??????? IVP (Intravenous Pyelography)
• ??????? RP (Retragrade Pyelography)
• ??????? AP (Antegrade Pyelography)
• ??????PCN (PerCutaneous Nephrostomy)
• 16-18Fr. Nephrostomy tube
• 6x8 silicon tube
• Pigtail tube ???????, ??????????????
• ?J? (DJ, double J) ??
• ???????? (RUC, retrograde ureteral catheter)??

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IVP ???????? ?????0 ??? 5 ????10 10???30
30??? ?????????????2-4??,?? delay
visualization IVP ????? 1)?????????? 2)??
3)??????? 4)?????
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• RP
• ? RUC (Retrograde Ureteral Catheter) ???????????,
  ??????X??, ????????? RUC ???????????
• ??
• ???????, ??? IVP
• IVP??????
• ??????? urine cytology

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AP or Nephrostomography ???????????????????.
?????????????????????
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????? PCN

• ??????????

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????? PCN

• ????????????????????????, ???????????????

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????? PCN

• ????(guidewire), ??????(dilator)?10Fr-22Fr
• ?????????????4Fr.

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????? PCN

• ?????????????? (nephrostomy tube)

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????? PCN

• ????? silk ? nylon ?????????????

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PCN vs. PCNL

• PCN ???????
• ?? ???, ??
• ?? AP, nephrostomography, urine cytology
• PCNL ?? PCN ?????????
• Staghorn stone ????
• Diverticulum stone ????, ???????????????
• ????, ????????????? (???? ????????????????
  0.5-2.5 cm)

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PCN PCNL
?? ???? ????
???? ?? ??, ??????
?? 16-18 Fr. Nephrostomy tube 6x8 silicon tube
???? ????, ????? ??3-7?
???? ? ???
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PCN ???????

1. ????????????, ??????????????????
2. ??????, ????????, ????????????????
3. ????? 6-10 ???, ?????????????, ???????????
   (kinking)
4. ????????????, ????????????

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PCN ???????

1. ?????????, ?????????????, ???????, ?????????????,
   ???????????
2. ???????????, ???????????, ???2-3cc???????,
   ???????????
3. ??????????, ???????, ????????????????,
   ?????????????????????????

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PCN ???????

• ??PCN ?????PCN tract ???intercostal approach,
  ???,???????
• ??????????????,???????renal parenchma??gravity
  drainage, ??clamp , ??????????????, ??????????
• ????????????, ??????, ?????. ??gravity drainage,
  ??clamp , ??????????????, ??????????
• ??????, ????????????,???????????????????

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PCNL ???????

1. ??????????????????, ???????????, ??????? RUC,
   ???????
2. ??????????, ?????? (clamp) ???30cm,
   ??????????????
3. ????3-5???? KUB ??????????, ?????????.
   ????????????? ?, ??, ??. ????????????????,
   ???????????, ???????????

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?J?? (Double J)

• ??????J?, ???????, ???????, ?????????
• ?? ????????, ???????????????????
• ??????????,?????,??????????
• ??????? 3000cc
• ??????,?????????
• ?X????,???????????
• ??????,???????????
• ??????????????

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(No Transcript)
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????? Cystostomy

• ??????????????
• ??
• ????
• ????
• ????
• ??????????????
• ?????????????????

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????? Cystostomy

• ????????????
• ??????
• ???
• ?????????
• ????
• ???????

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(No Transcript)
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???????ESWL

• ESWL??????????????,???????????,???????????(F1),???
  ?????,????????????????????(F2),???????????????????
  ????,?????,??????(F2)????????,??????,?????????????
  ?????????????,?????????

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(No Transcript)
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???????ESWL

• ?????????ESWL???????,???ESWL??????????????????????
  ??????,????????,ESWL???????????????,??????????????
  ?????????,???????????????????,?????????????,??????
  ??ESWL?????????ESWL?????

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???????ESWL

• ESWL???????,???????????????,??????????????????,???
  ??????????,?????????????,???????
• ?????????????ESWL?????????????????????,?????,????,
  ????????,??????,????????????????????????????????"

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???????ESWL

• ???????????ESWL??????,???????????ESWL???????,???
  ???????????????????????????ESWL,??????????????ESWL
  ????????,????????????ESWL?????????,?????????,?????
  ????,???????(???ESWL,?????????,??ESWL,?????)

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???????ESWL

• ?????,?????????????
• ?X???,??X????????????????
• ????,?????????????????
• ?????
• ????
• ????
• ?????????????
• ?????

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???????URSL

• ?????????,?????????,?????????????
• ??????????????????EHL(????),?????

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???????URSL

• ??????????4F,??????1.3mm????????10.513F??????????
  ?,????????,?ESWL????,????????????????????????6?8F,
  ??????????,???????????3?5?????????????????????????
  ???????????????,???????,?????????????????,??????
  ??????????,???????????????,???????????

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???????URSL

• ?????????????,???????J????????????,???????????????
  ??????????????,??????????????????????????,????????
  ???,?????????????,???????????,????????????????????
  ????????????????

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???????URSL

• ?????URSL??????????,????????95,???ESWL?60?70????
  ?????????????85,?ESWL???URSL?????????????,???????
  ???,??ESWL??????????????????????????????
• URSL?????????????????,????????????????????????,???
  ??????????????????????,???????????

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???????Benign Prostatic Hyperplasia

• ??"??"?????????,????????????"??"???????????????,"?
  ??????"????????????,??????????
• BPH?????,????????????BPH??????????????????,???????
  ????????,????50??????????????BPH???,??????????????
  ???????????60???,??????????BPH???80?,10????????8??
  ????

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???????Benign Prostatic Hyperplasia

• ?????????
• ?????,?????????(???????)??????????????????????????
  ??,???????????????????????????,??????????????????(
  ????????????)??????????????????????,??????????,???
  ??????????????????????,????????????,??????????,???
  ????????????????

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???????Benign Prostatic Hyperplasia

• ????????
• ???????BPH????????,????????,??????????????????????
  ???BPH??
• ??,???????????????????????????????????????????????
  ?????????????,??????????,?????????????????????????
  ????,??????????????

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???????Benign Prostatic Hyperplasia

• ?????????? (IPSS)
• 1.??????????????????????????????
• 2.???????????????????
• 3.???????????????????
• 4.???????????
• 5.?????????????????
• 6.???????????????????????
• 7.??????????????????????
• ???0?5?,??15?????????

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???????Benign Prostatic Hyperplasia

• ????
• alpha-blocker ? hytrin, dozaben, Xatral,
  ??????????????,????????
• 5-alpha reductase ?????????,?????????
• ????
• TURP ???????
• ?????(Dilation)????(Stent)????(Microwave
  Thermotherapy)??????????(TUNA) ??????

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?????????TURP

• TURP(Transurethral Resection of
  Prostate),?????????,????????,??????,???????????
• ?????????,????????????????-????,?????????????,????
  ???,????????????,???????????????,?????????????????
  ???????????????,?????????(????),??????????????????
  .??????,??????????,???????

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?????????TURP

• ???,?????????????,???????????,????????????????????
  ???????????????????????????,??????????????,???????
  ,?????,??????????????????????????
• ?????????????????(????),????????????????????????,?
  ????????,?????,?????????,???????????????

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?????????TURP

• ?????????????????,??????????,????,???????????????,
  ???????????????,???????????
• ??????,????????????,???????????????????????????,??
  ???,????????
• TUR ???
• ??????? ????,????
• ????? ????,????,??,??????

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??????????TUR-BT

• Transurethral resection of bladder tumor
• ???????,????????,??????????,????????(obturator
  nerve),?????????????????????
• ???
• ????
• TUR ???
• ??
• ????

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?????Inguinal Hernia

• ?????????
• ??? (indirect) ?????????????,???????????????
• ??? (direct) ????????????,????????????,??????????
  ?,?????,??,?????
• ????????????,??????????????

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??Hematuria

• ?????,??,??,???????
• ??????????,???????????
• ??????????? IVP, ???????????? (?????,??)
• ??????????? R-P
• ???????????,????????,??????????????????
• ???????

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??? Foley ???

• ????????????????,???????????
• ??????,??????????????
• ????,??????????
• ???????,?????????,????????????????
• ??????????????,???????????????????,????????,??????
  ?,??????????,????????

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Thanks for Attention!