摘要:

ObjectiveTo observe morphological changes in the urothelium after exposure to laser beam and electrohydraulic spark.Materials and methodsThe pulse dye laser lithotripter (MDL‐2, Candela Corporation, Boston, USA) and the electrohydraulic lithotripter (AEH‐2, Circon ACMI Corporation Stamford, USA) were used directly on the bladder mucosa in six pigs. Immediately (after treatment, the bladder mucosa was prepared for light microscopic and scanning electron microscopic examination.ResultsBoth electrohydraulic spark and laser beam caused mucosal denudation, submucosal swelling and haemorrhage. There was a positive correlation between the degree of urothelial damage and the power and pulse numbers applied.ConclusionDirect contact of the urothelium in patients treated with laser beam or electrohydraulic spark should be avoi

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07106.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo compare the analgesic efficacy of a single 30 mg intramuscular dose of ketorolac with that of intramuscular pethidine 100 mg. in a double‐blind, parallel‐group investigation of patients presenting with pain suggestive of renal colic.Patients and methodsSeventy‐six patients (17 women, 15 men; mean age 45.2 years, range 20–80) were allocated by means of a pre‐determined randomization schedule to receive ketorolac and 78 patients (20 women, 58 men; mean age 42.1, years range 18–70) to receive pethidine. Data from eight patients in the ketorolac group and six in the pethidine group were excluded from the efficacy analyses because of protocol violations. The severity of each patient's pain was assessed on a four‐point verbal rating scale (VRS) and a 10 cm visual analogue scale at pre‐dose and at 15 min intervals for the first hour post dosing. The time to first administration of rescue analgesic, up to 24 h following dosing with the study medication, was recorded. Adverse events were elicited by general questioning.ResultsEighty‐eight per cent of patients in each treatment group had improved according to the VRS of pain severity 1 h after dosing; the summed pain intensity differences up to 1 h were statistically significantly different in favour of ketorolac (P<0.05). Fifty‐six per cent of patients who were receiving ketorolac required rescue analgesia during the study period compared with 74% receiving pethidine. The incidences of adverse events were lower in the ketorolac group (28%) than the pethidine group (51%).ConclusionKetorolac can be considered a viable alternative to pethidine for the treat

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07107.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo study the treatment of ureteric stones by laser lithotripsy (LL) and pneumatic lithotripsy (PL), and to evaluate the results of the two treatment modalities to assess effectiveness, complications and cost benefits.Patients and methodsBetween January 1993 and February 1994 200 ureteric stones in 194 patients were fragmented intracorporeally, 48 by LL and 152 by PL. The ages of the patients ranged from 31 to 40 years with a male to female ration 2:1. All procedures were performed under general/regional anaesthetic in a day‐care set‐up. Patients were followed at weekly intervals. Re‐treatment was carried out at 4 weeks where necessary.ResultsThe majority of the stones treated (84%) were in the lower third of the ureter, 69% measured 7–12 mm in diameter, and 61% were composed of calcium oxalate. Ninety‐three per cent of the stones were fragmented in one treatment session. The overall stone‐free status at 4 weeks was 95% for PL and 84% for LL. The non‐fragmentation rate was 10% for LL and 1% for PL. Post‐treatment complications were encountered in 8% of the patients treated by LL and 7% by PL.ConclusionsOur experience shows that PL and LL both provide a safe and effective means of performing intracorporeal lithotripsy for smaller ureteric stones. However, PL is more effective in fragmenting larger and harder stones. Moreover, PL is more user‐friendly and highly cost‐effecti

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07108.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo evaluate the use of the Swiss lithoclast in the management of urinary calculi.Patients and methodsBetween January and November 1993, 60 patients with a total of 61 urinary calculi were treated with the Swiss lithoclast. Forty patients had a ureteric calculus, two had a ureterocele with a calculus, one a steinstrasse, 16 a vesical stone and two a urethral calculus. Eighty per cent of patients were treated on a day‐care basis.ResultsFragmentation of the urinary calculi was successful in 59 of the 60 patients. Both patients with a urethral calculus and 15 of 16 with a vesical calculus were stone‐free after the procedure. All those with a ureteric calculus were stone‐free at 6 weeks. There were no intra‐operative or long‐term complications directly related to the use of the Swiss lithoclast.ConclusionThe results of this study show that the Swiss lithoclast is a simple, safe, reliable and economical method of endoscopic lithotripsy for the treatment of urinary tract calculi. Although the lithoclast's use is limited to rigid or semi‐rigid endoscopes there is now a suction facility for the immediate removal of small sto

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07109.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo describe the ultrasonographic appearance of ureteric lesions due toSchistosoma haematobiuminfection and to report prevalence rates of such lesions in endemic communities in Mali before and after praziquantel treatment.Subjects and methodsThe total population (n = 961) of threeS. haematobium‐endemic villages in Mali was examined ultrasonographically to detect urinary tract morbidity. Urine was tested forS. haematobiumova and for haematuria. An identical follow‐up study was performed 1 year after mass treatment with praziquantel.ResultsPrevalence rates ofS. haematobiuminfection in the three villages were 53%, 72% and 73%. Ultrasonography revealed dilatation of the ureters in 143 subjects (15%). In 20 of these, mainly children and adolescents, thickening and irregularities of the ureteric wall with distal ureter obstruction were directly visualized on ultrasonography. Within the bladder of two others, an intraluminal structure of ureterocele‐like appearance was seen. None of these alterations has been previously described as an ultrasonographic feature of schistosomal uropathy. ActiveS. haematobiuminfection and microhaematuria were found in 21 and 20 of these 22 subjects respectively. Significant renal obstruction was present in 10 of them. One year after treatment, an entirely normal urinary tract was found in 85% of 104 re‐examined individuals who had had ureter dilatation. Ureteric wall thickening or ureterocele‐like lesions had disappeared in 95% of subjects.ConclusionsThe role of ultrasound in the evaluation of schistosomal uropathy is confirmed. Ureteric wall abnormalities causing strictures and ureterocele‐like lesions of the ostium must be regarded as further ultrasonographic features of this condition. The study documents the excellent reversibility of ureteric abnormalities after antischistosomal treatment in children and adolescents, thus emphasizing the need for early and efficient medical treatment of th

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07110.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo study the histological and radiological potential of the biomaterial fibrin in the treatment of vesico‐ureteric reflux by a subureteric injection.Materials and methodsFor histological studies the bladders of 22 non‐refluxing adult female dogs were exposed and in 20 of these two‐component fibrin glue was injected into the right subureteric intramuscular portion of the bladder and teflon was injected into the lamina propria of the left ureter; two of them acted as controls. Two dogs were killed on alternate days over the course of 21 post‐operative days and the bladders and distal portions of the ureters were examined histologically. For radiological studies micturating cystograms were obtained from 15 female puppies. In only eight puppies was vesico‐ureteric reflux naturally present. In six of these two‐component fibrin was injected into the right and teflon into the left subureteric areas, and in two puppies fibrin was injected into the subureteric areas, while the left sides acted as controls. Micturating cystograms and intravenous urograms were obtained from all puppies 3 weeks post‐operatively.ResultsHistopathological studies showed persistence of increased amounts of endogenous collagen at the fibrin‐injected sites; at the Teflon‐injected sites a mass surrounded by dense granulation tissue was seen. Radiological studies revealed complete disappearance of reflux in the study group of six fibrin and Teflon‐injected puppies: in two control puppies fibrin was injected into the right subureteric area only; the left sides were left untouched to show that maturation did not play a role in abolishing the spontaneously occuring reflux. Follow‐up intravenous urography showed no evidence of vesico‐ureteric obstruction in the treated ureters.ConclusionFibrin has the properties of a substance inducing a controlled increase in the number of end

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07111.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo report on the use of extravesical detrusorraphy for megaureter repair.Patients and methodsTwenty‐three children underwent an extravesical megaureter repair over a 25 month period. There were 17 boys and 6 girls with an average age of 4.4 years. Three children had bilateral megaureters for a total of 26 repairs. Ureters were defined as megaureters if the ureteric diameter exceeded 1.0 cm on pre‐operative imaging. There were 14 obstructing and 12 refluxing ureters. Three of the refluxing ureters were tapered while five of the obstructing megaureters were tapered.ResultsTwenty‐one of the 23 patients were successfully repaired using this method. Complications were minimal.ConclusionThe extravesical approach can be used to correct reflux or obstruction in dilated ureters with efficacy equivalent to transvesical re

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07112.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo evaluate and discuss the recurrent symptoms presented by eight patients with refluxing ureteric stumps.Patients and methodsEight patients (three boys, five girls: mean age: 8 years, range 11 months‐14 years) with refluxing ureteric stumps presented with recurrent urinary tract infections. Six developed symptoms mimicking pyelonephritis, even though the kidney had been partially [5] or totally [3]removed. The stump was removed in all patients.ResultsThe stumps that were excised measured between 5 and 10 cm in length and were always dilated and inflamed. The results of histological examination and follow‐up are reported.ConclusionsA dual approach is recommended when complete excision of the kidney and ureter is required. Symptoms of pyelonephritis are not pathognomonic of parenchymal infection but reflect infection above the vesico‐ureteric junction. The distinction between supra‐junctional and infra‐junctional urinary tract infections seems more appropriate and is

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07113.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo evaluate the extent of diagnostic evaluation that is necessary in young men with asymptomatic microscopic haematuria.Patients and methodsA group of 157 men (mean age 24.8 years [range 18–53]) who presented with asymptomatic haematuria were investigated with repeated urine analysis, Addis count, urinary cultures, blood tests, ultrasonography, pyelography, cystourethroscopy and finally renal biopsy.ResultsThe results showed pathological findings in 31.2% of patients. Of the 157 individuals, 33.1% did not complete the study. In 14.6% urological disease was found, including two patients with urothelial cancer. Renal biopsy detected glomerulopathy in 16.5% of all patients. IgA nephritis being the most common diagnosis (42% of all biopsies).ConclusionEven in young patients, microscopic haematuria should be investigated and followed thoroughly. Renal biopsy seems to be optional: once a diagnosis is established repeated and unnecessary examinations can be avoide

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07114.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo assess the incidence of urological pathology in a group of patients referred for the investigation of haematuria and whose symptoms had resolved at the time of investigation.Patients and methodsThe results from examination of 395 patients attending for investigation of haematuria were analysed. The group comprised 198 men and 197 women with a mean age of 51 years (range 19–73).ResultsIn 220 patients (56%) no evidence of haematuria was detected despite its diagnosis in all patients at the time of referral. One‐hundred and thirteen patients (51%) without detectable haematuria had urological pathology and 16 of these (14%) had an underlying malignancy in the urinary tract.ConclusionRepeat urine analysis to determine whether haematuria persists has been considered as a way to define a high risk group which requires urgent investigation. Our results clearly indicate that the finding of haematuria, even in one urine specimen, warrants full urological assessm

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07115.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY