Introduction and objectives: When using the flexible ureteroscope, there is a large outflow or backflow with the standard rubber cap. Especially, when using a basket, guidewire or laser fiber. In this case, the ureteroscope-seal is efficient to prevent irrigant backflow and secure devices inserted through the working channel. However, if the fibroscope-seal is not available, is there an option?
The injection port of a serum bag can be used.
Material and methods: In the beginning of the endourologic procedure, the sterile empty 500 ml serum bag is kept on the operating table. The injection port is harvested from the serum-bag. The whole length can be used or it can be shortened. Then, the injection port is adapted to the working channel of the flexible uretero-renoscope, nephroscope, or cystoscope. To insert a device (basket, guidewire..), the puncture needle is inserted from inside-out in the injection port, then the basket is inserted into the needle and it is attracted through the port.
Results: the injection port fit perfectly to the working channel of flexible scope, thus, there is no longer any backflow. Moreover, there is no backflow with any instrument inserted in the working channel guidewire, basket, or laser fiber, even with large movements of the instrument.
Limitations: However, the spontaneous insertion of a device, guidewire, basket or laser fiber, is almost impossible. It necessitates the use of the puncture needle or an introducer. Moreover, since the rubber of the injection port is so tight, the progression of the basket or guidewire is difficult. However, this limitation can be used to reduce the movements and to secure the inserted device: baskets, guidewire, or laser fiber.
Conclusion: the injection port of a serum bag can be adapted perfectly to the working channel of the flexible scope and it is watertight without any irrigant outflow. It is a good cost-free alternative to the ureteroscope-seal.