The F-Urs Screensaver – A Cost-Free Aid to Flexible Ureterorenoscopy

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TECHNICAL SECTION
Ann R Coll Surg Engl 2007; 89: 634–640
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TECHNIQUE
A one-finger assessment of the vagina is made in an attempt to
locate the urethral meatus along the anterior vaginal wall; it may
simply help estimate the length of anterior vaginal wall up to the
vault. A 16F catheter is mounted on a male catheter introducer
bent to achieve an angle of 30° along its distal end. It is then
gently slid along the anterior vaginal wall until it ‘drops’ into the
urethral opening (Fig. 2) without resistance. At this stage, the
introducer is disengaged and slowly withdrawn as the catheter is
eased across the urethra into the bladder.
DISCUSSION
In the hands of experienced urologists, this technique can be
safely employed to catheterise elderly women without the need
for a cystoscope or insertion of suprapubic catheter which
essentially may not be feasible in the absence of a full bladder.
References
1. Colley W. Know how – female catheterisation. Nurs Times 1997; 93: 34–5.
2. Devine AL. Female catheterisation: what nurses need to know. Accident Emerg
Nurs 2003; 11: 91–5.
3. Rushing J. Inserting an indwelling urinary catheter in a female patient. Nursing
2004; 34: 22.
BACKGROUND
Exposure of the ankle mortice during ankle arthrodesis can be
technically demanding. Charnley developed his pins and retractor
to improve acetabular exposure during hip replacement surgery.
We describe another use for them.
TECHNIQUE
The ankle joint is exposed through a lateral approach.1The distal
fibula is exposed and an osteotomy is performed to mobilise and then
excise the fragment, which gives the surgeon a clear view of the
lateral side of the tibio-talar joint. This is then distracted to display
the articular surfaces. Many surgeons use a laminar spreader;
however, the blades of the spreader can compromise the view of the
articular surfaces and the access required to denude the cartilage.
We prefer to place Charnley pins in the tibia and the talus as
shown in Figure 1. The joint can then easily be distracted using
the horizontal retractor.
Once the articular surfaces are prepared, the arthrodesis may
be secured by whatever means the surgeon prefers; our technique
is to employ two partially threaded cancellous screws crossing the
joint from distal to proximal, and then apply the distal fibula, pre-
pared following removal of its excess bone, as an onlay graft
securing it with screws. Cancellous bone from the fibula is har-
vested to graft the arthrodesis site.
DISCUSSION
The Charnley horizontal retractor and pins provide stable
distraction of the ankle joint. This allows the surgeon to remove
the articular cartilage safely and effectively, whilst maintaining
an excellent view of the joint space.
Reference
1. Mann RA, Van Manen JW, Wapner K, Martin J. Ankle fusion. Clin Orthop 1991;
268: 49.
BACKGROUND
Contrast radiology is an essential component of flexible
ureterorenoscopy (F-URS). As ureteroscope technology has
The F-URS Screensaver – a cost-free aid to
flexible ureterorenoscopy
J OATES1, R JENKINSON2, SR STUBINGTON1
1 Department of Urology, Mid-Cheshire Hospitals NHS Trust,
Leighton Hospital, Crewe, Cheshire, UK
2 Surgical Laser Hire, Ashurst, Skelmersdale, Lancashire, UK
CORRESPONDENCE TO
J Oates, Senior House Officer in Urology, Mid-Cheshire
Hospitals NHS Trust, Leighton Hospital, Crewe, Cheshire
CW1 4QJ, UK
T: +44 (0)1270 612010; E: joates@picr.man.ac.uk
A novel use of the Charnley pins in ankle
arthrodesis
A ROCHE, M MANNING
Department of Orthopaedics and Trauma, St Helens and
Knowsley NHS Trust, Merseyside, UK
CORRESPONDENCE TO
Andy Roche, Specialist Registrar in Orthopaedics and Trauma,
St Helens and Knowsley NHS Trust, Warrington Road,
Prescot, Merseyside L35 5DR, UK
T: +44 (0)151 426 1600; E: andyroche@hotmail.com
Figure 1Using the Charnley pins and retractor to expose the articular surfaces.

TECHNICAL SECTION
Ann R Coll Surg Engl 2007; 89: 634–640 637
improved, it has become possible to perform more complex
procedures within the kidney, some requiring visualisation of
each calyx. Although it is possible to re-find a calyx visually,
contrast radiology may be required when the anatomy is less
favourable, requiring numerous contrast injections. Here, we
describe a simple, cost-free alternative to repeated contrast
injections.
TECHNIQUE
Contrast is introduced into the pelvicalyceal system according to
the surgeon’s normal practice. Once an optimal image has been
achieved (Fig. 1A) a dry-wipe marker is used to trace the outline
(Fig. 1B). The tracing can be used to guide the ureteroscope with
screening even when all the contrast has been eluted by the
irrigating fluid (Fig. 2A,B).
DISCUSSION
Repeated introduction of radiological contrast disturbs the
rhythm of the surgical procedure as well as increasing operating
time. The ‘F-URS Screensaver’ obviates the need for repeated
contrast injections, allowing the surgeon to concentrate on the
operative task and so saves both time and money whilst
requiring nothing more than a simple dry-board marker.
Movement during respiration must be considered, but the
effects can be minimised by obtaining the first screening image
during a respiratory pause. If the image intensifier or patient is
moved, the screensaver must be redrawn.
It is recommended that dry-wipe markers should not be used
directly on liquid crystal displays. This may be overcome by fix-
ing a thin Perspex sheet over the screen to avoid damage.
Figure 1Image (A) with dry-wipe marker tracing of the outline (B).
Figure 2Tracing used to guide the ureteroscope with screening when all the contrast has been eluted by the irrigating fluid.
A
AB
B