摘要:

From February 1, 1989, to February 1, 1990, 21 patients with gallbladder disease were treated with percutaneous methods according to two algorithms we devised. Twelve patients had a nonfunctioning gallbladder prior to treatment. Only one of these had an afunctional gallbladder at the conclusion of the treatment, and a chemical cholecystectomy was performed in this case. Five older patients underwent dissolution of cholesterol stones with methyltert-butyl ether after previous percutaneous drainage of an empyema or hydrops. In the 16 other patients, percutaneous cholecystolithotomy was performed. Altogether, 18 of the 21 patients were successfully treated. Three patients had to undergo cholecystectomy because of technical infeasibility (two cases) or delayed bile leak (one case). There were no deaths and no wound infections. Percutaneous treatment of gallbladder disease seems attractive because of the absence of a significant scar, the possible physiologic importance of leaving the gallbladder in place, and the increasing ease of dealing with possible recurrences thanks to improved diagnostic imaging and an array of minimally invasive treatment techniques.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.1

年代:1991

数据来源: MAL

摘要:

Perinephric abscess in the past was associated with high morbidity and mortality rates. Standard therapy has included antibiotics and open surgical drainage. The advent of sonography and computed tomography has facilitated the diagnosis and treatment via percutaneous drainage. A retrospective search yielded 16 cases of perinephric abscesses at our institution between January 1980 and January 1990. Each case was evaluated with regard to age, sex, predisposing factors, diagnostic tests, treatment modality, morbidity and mortality. Seven patients underwent percutaneous drainage by either a Seldinger or trocar catheter techique. Six of these had successful drainage. The one unsuccessful case was a patient with an infected hematoma, which was treated successfully with open surgical drainage. Nine patients initially underwent open surgical drainage. Five also had nephrectomies for renal scan-documented nonfunctioning kidneys that contained renal caluli. Of the remaining four patients, one had a staghorn calculus and poor renal function and refused nephrectomy. She is doing well. The remaining three patients had good renal function. Two of these required further open surgical drainage. One had reaccumulation of the abscess, while the other had a septated abscess. We conclude that the notion of surgical drainage as the gold standard of therapy is no longer applicable given the success rate with percutaneous drainage. However, neither is percutaneous drainage to be considered the treatment of choice for all cases.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.7

年代:1991

数据来源: MAL

摘要:

Occasionally, during the course of endourologic procedures, there is need for percutaneous nephroscopy, cystoscopy, and retrograde ureterscopy in the same patient. This may involve repositioning the patient from the lithotomy to the prone position during the procedure. Simultaneous access for cystoscopic and percutaneous nephroscopic and retrograde ureteroscopic procedures can be obtained by placing the patient in the prone position with the legs abducted using split-leg adapters for a standard urologie endoscopie table. Access is thus afforded to the urethra for cystoscopic and retrograde ureteroscopic procedures, as well as to a percutaneous nephrostomy tract. Endourologic procedures can be performed under either general anesthesia or with intravenous sedation. We have used this position in 10 patients in whom simultaneous nephroscopic and ureteroscopic access was necessary, and it has proved to be valuable. Operator comfort is maintained while providing excellent percutaneous nephroscopic, cystoscopic, and retrograde ureteroscopic access for therapeutic and diagnostic procedures.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.13

年代:1991

数据来源: MAL

摘要:

Pathologic-anatomic examinations of the kidneys from four patients—three adults and one child—were done after treatment with extracorporeal piezoelectric lithotripsy (EPL). Examination revealed alterations dependent on the number of shock waves administered. The pattern of renal lesions corresponded to the results known from animal studies. The renal alterations; i.e., hemorrhages and hematomas, were preferentially located at the corticomedullary junction. In comparison with the findings in laboratory animal studies, the lesions in human kidneys were decidedly minor after administration of the same number of shock wa

ISSN:0892-7790    

DOI:10.1089/end.1991.5.17

年代:1991

数据来源: MAL

摘要:

Inguinal pelviscopy is a new approach for examining structures in the extraperitoneal and intraperitoneal pelvic cavity. The total number of patients studied was 84. The technique was used to examine and take biopsies from masses in the presacral area (6 patients), right (8) and left (3) iliac fossa, and ovaries (8 patients). Ovarian biopsies were taken from 26 patients (14 with primary amenorrhea and 12 with elevated serum FSH levels), and ovarian cyst aspiration and biopsy were performed in 12 patients. Tubal sterilization was done in 18 cases and lysis of pelvic adhesions in 3 infertile patients. The procedure consists of entry of the extraperitoneal pelvic cavity or the iliac fossa and loin through the inguinal canal. Intraperitoneal pelvic cavity examination can also be done by piercing the peritoneum at the deep inguinal ring or close to the falloppian tube. No complications were encountered except urinary retention in one patient with presacrai tumor and abdominal wall hematoma in another patient. Right iliac fossa hematoma occurred in two patients. None of the complications warranted laparotomy. The approach is safe, direct, and easy. It is performed on an outpatient basis.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.21

年代:1991

数据来源: MAL

摘要:

Numerous clinical and experimental reports indicate that shock wave lithotripsy (SWL) causes acute renal effects in a majority, if not all, treated kidneys. The induced acute renal damage may be severe, and clinical findings point to several risk factors that appear to predispose SWL patients to an increased incidence of renal trauma. In addition, compelling clinical data suggest that exposure to shock waves in therapeutic doses is associated with at least three chronic adverse effects: (1) an accelerated rise in arterial blood pressure; (2) a decrease in renal function; and (3) an increased rate of stone recurrence. These long-term complications raise concern about the potential for increased and significant patient morbidity as SWL continues to gain in popularity. Such concern is heightened by the prospect that little is known about the factors of SWL treatment that contribute to stone comminution or cause tissue injury.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.25

年代:1991

数据来源: MAL

摘要:

Domestic pigs were used as an animai model in experiments involving detailed pathologic examination immediately after extracorporeal shock wave lithotripsy (SWL) in-order to study the effects of shock wave number, focal pressure, and size on the extent of renal damage. All 41 animals were treated under general anesthesia and sacrificed after treatment. Twelve kidneys (Group 1) were treated with 2000 shock waves at 38 MPa; 12 kidneys (Group 2) were treated with 600 shock waves at 38 MPa, 11 kidneys (Group 3) were treated with 2000 shock waves at 62 MPa, 11 kidneys (Group 4) were treated with 600 shock waves at 62 MPa; and 7 kidneys (Group 5) were treated with 2000 shock waves at 40 MPa. On histopathologic examination, parenchymal lesions of various extents were seen in 10/12 (83%) kidneys of Group 1, 9/12 (75%) of Group 2, 11/11 (100%) of Group 3,9/11 (82%) of Group 4, and 5/7 (71%) of Group 5. From the results of our study and those of other investigators, we conclude that renal damage in SWL correlates with the number and energy of the shock waves and also with the focal size.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.37

年代:1991

数据来源: MAL

摘要:

Since the advent of extracorporeal shock wave lithotripsy (SWL) for renal stones, urologists have become more aggressive in using this modality in the treatment of complicated stone disease. Many centers have treated patients with bilateral stones consecutively under a single anesthetic. Concern has arisen regarding this practice because of potential damage to renal function. We used four adult and eight infant Rhesus monkeys that were treated in the Dornier XL-1 experimental Iithotripter and divided into three groups as follows: adults—18 kV, 2000 shocks; low-dose infants—15 kV, 1500 shocks; and high-dose infants—18 kV, 2000 shocks, with the same ketamine anesthetic. The animals were monitored with an indwelling catheter for hematuria. Blood was collected to determine extent of blood loss. Animals were followed with131I-Hippuran renal scans to monitor effective renal plasma flow (ERPF) and predicted return (PR). Single and two-tailed t tests were used for statistics. The infants had an overall loss of ERPF by 13.6 ± 6 ml/min per m2over baseline (P= 0.0008). The low-dose animals lost 15.5 ± 4.5 ml/min per m2, and the high-dose animals lost 11 ± 7 ml/min per m2(P>0.1). The adults lost 13.7 ± 30 ml/min per m2, which was not different from baseline. In terms of percentage loss, the infants' ERPF declined by 20 ± 8 (NS). We have confirmed that consecutive bilateral SWL treatments may be damaging to renal function. Moreover, this modality may specifically be inappropriate in the pediatrie

ISSN:0892-7790    

DOI:10.1089/end.1991.5.41

年代:1991

数据来源: MAL

摘要:

The results of 117 consecutive staghorn stones treated with extracorporeal shock wave lithotripsy (SWL) monotherapy between March 1985 and October 1988 were reviewed. At 8 months after the initial treatment, 46% of patients were stone free by plain abdominal radiolographs and renal ultrasound; 24% had minimal debris radiologically or by ultrasound, and 30% had a significant though fragmented residual stone burden. When patients were stratified by stone burden only, a maximum stone-free rate of 55% could be attained for staghorn stones filling a nondilated renal collecting system. When further stratified by caliceal anatomy, patients with stones filling a nondilated renal collecting system with no caliceal abnormalities could achieve a maximum stone-free rate of 78%. On the basis of these results, we conclude that staghorn stones filling a nondilated collecting system (Group 1) are eligible for SWL as monotherapy; however, more complex staghorn stones filling a mildly (Group 2) or grossly (Group 3) dilated renal collecting system or staghorn stones associated with altered caliceal anatomy should be primarily approached by percutaneous routes or, in selected cases, open surgery.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.45

年代:1991

数据来源: MAL

摘要:

Eleven retrograde endopyelotomies of the ureteropelvic junction (UPJ) have been performed; the treated stenosis had occurred in three cases after surgical lithotomy and in eight after plastic operation on the ampulla. With the use of a rigid ureteroscope, a deep incision of the stenotic portion was performed utilizing a cold knife until the peripheral fat was reached. Then, the area was dilated with a balloon. An indwelling double-J stent was left in place for 10 weeks and a percutaneous nephrostomy tube for 4 weeks. After 1 year, intravenous urography showed excellent patency of the stenotic tract in nine cases. Improved renal function was demonstrated with sequential scintigraphy in three patients, and a furosemide washout test showed a satisfactory flow in seven cases. In our series, the procedure proved to be rapid, simply executed, and trustworthy.

ISSN:0892-7790    

DOI:10.1089/end.1991.5.49

年代:1991

数据来源: MAL