摘要:

Among 44 patients with distal-ureteral stones, 32 had no contraindications to extracorporeal shock wave lithotripsy (ESWL);i.e., they were not women of childbearing age and did not have ipsilateral renal stones. All these patients underwent simulation for ESWL. In 18 patients, it proved possible to localize the stone, and in 16 of these ESWL was successful. In the other two, localization was not possible at the start of ESWL, and ureteroscopy was used to remove the stones. In the 15 patients in whom simulation failed, the stone was moved up the ureter for ESWL in eight and was removed ureteroscopically in seven. In the eight women of childbearing age, the stone was moved out of the pelvis for ESWL in five and removed ureteroscopically in three. All three of the patients with ipsilateral renal stones underwent ESWL after manipulation of the stone. Thus stones were ultimately removed by ESWL in 32 of the 44 patients. ESWL can be used for distal-ureteral stones, although it is less straightforward than for stones else-where in the urinary tract.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.1

年代:1987

数据来源: MAL

摘要:

Seventy-three patients with ureteral calculi ranging in size from 5 x 5 to 10 x 30 mm and two patients withSteinstrasseunderwent lithotripsy with a pulsed tunable dye laser (504-nm wavelength; l-µsec bursts). The laser fiber was passed through a ureteral catheter or a new laser basket via a ureteroscope. In 70 cases, the patients were partially or entirely freed of stones. There were three equipment failures necessitating another form of lithotripsy, and two stones (one of brushite and one of cystine) that did not respond to laser energy and required ultrasonic lithotripsy. The laser is particularly useful in patients with impacted ureteral stones that cannot be bypassed and requires a smaller ureteroscope than does ultrasonic lithotripsy. It is now my preferred type of ureteroscopic lithotripsy unless the stone is thought to be of calcium oxalate monohydrate

ISSN:0892-7790    

DOI:10.1089/end.1987.1.9

年代:1987

数据来源: MAL

摘要:

Both actively and passively deflectable flexible ureteroscopes have a place in urologic practice. In general, we reserve the more expensive and more fragile actively deflectable instruments for those situations in which the passively deflectable instrument will probably fail, such as for examination of the entire intrarenal collecting system or the lateral or lower infundibula and for therapeutic procedures when the instrument cannot be directed to the area by passive deflection. Lesions within the ureter, the medial portion of the renal pelvis, and the upper infundibula usually can be reached easily with a passively deflectable instrument. I recommend having both types of instruments available.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.15

年代:1987

数据来源: MAL

摘要:

We studied the effects of rapid and slow balloon dilation of the distal ureter to 8 mm (24F) in six pigs. Rapid dilation (<10 seconds) resulted in short-term marked ureteral inflammation, extravasation, and periureteral hematoma, whereas slow dilation was well tolerated. Long-term changes were minimal with both methods. We consider that the distal pig ureter can be safely dilated to 8 mm.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.19

年代:1987

数据来源: MAL

摘要:

Retrograde percutaneous nephrostomy (RPCN) allows the urologist to gain easy percutaneous access to the kidney. Generally there is no benefit of the retrograde approach over antegrade percutaneous nephrostomy except in special situations. We have described the technique of performing RPCN and reviewed its use in calyceal stones, upper ureteral stones, a nondistensible collecting system, hypermobile kidney and horseshoe kidney. In one highly selected patient who had a very hypermobile kidney RPCN resulted in a percutaneous nephropexy which totally alleviated her symptoms.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.23

年代:1987

数据来源: MAL

摘要:

Symptomatic ureteral calculi averaging 6 x 7 mm in diameter were removed from the mid upper ureter in 5 patients with a 9F or 8.5F nondeflectable flexible ureteroscope and a basket or forceps. This instrument can be passed through a cystoscope easily and seldom requires dilation of the ureter. These facts, plus its lower cost, make flexible ureteroscopy available to all urologists.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.31

年代:1987

数据来源: MAL

摘要:

Voided stone fragments retrieved after extracorporeal shock wave lithotripsy (ESWL) in 200 patients were sorted by size and analyzed by optical microscopy for composition. The most common size by volume or weight was 0.85–1.4 mm, with the largest fragment in each sample usually being 1.4–2.0 mm in diameter. However, 30 specimens contained fragments of 2.8–5.6 mm. Hydroxyapatite/struvite and uric acid stones produced the largest fragments (>4 mm), probably because of the larger pretreatment stone burden. Calcium oxalate monohydrate stones produced larger fragments than did calcium oxalate combined with uric acid, hydroxyapatite, or calcium oxalate dihydrate. Stone size and location, the number of shock waves delivered, and patient habitus and ureteral size affect the size distribution of voided stone fragments. Chemical composition is not the sole determinant of particle size and extent of stone destruction by

ISSN:0892-7790    

DOI:10.1089/end.1987.1.37

年代:1987

数据来源: MAL

摘要:

Almost one-third (32%) of 221 kidneys manipulated percutaneously for calculi had had previous open procedures. Tract dilation was more difficult in these kidneys, and there was a statistically significant increase in the frequency of cases requiring multiple manipulations to rid them of calculi (14% vs. 7% in those without previous renal surgery). There also was a statistically significant difference in the number with retained stone fragments (13% vs. 8%). Although there were increases in the frequency of bleeding necessitating transfusion, procedure time, and complications, these differences were not statistically significant. We concluded that percutaneous stone removal is only minimally compromised by previous open renal surgery.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.45

年代:1987

数据来源: MAL

摘要:

Genitourinary fungal infections are often difficult to eradicate with antibiotics alone. We describe a case in which obstructive uropathy secondary toCandida albicansinfection with superimposedPseudomonas aeruginosawas controlled by percutaneous nephrostomy drainage and irrigation, percutaneous extraction of fungal masses, and systemic antibiotics and propose guidelines for the incorporation of endourological techniques into the treatment of renal candidiasis.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.49

年代:1987

数据来源: MAL

摘要:

We describe a technique for percutaneous ureteroneocystotomy in a patient with complete ureteral obstruction after reimplantation for correction of bladder exstrophy. Provided the obstruction is at the distal ureterovesical junction close to the bladder, this technique may be valuable in the treatment of some postoperative ureteral strictures.

ISSN:0892-7790    

DOI:10.1089/end.1987.1.55

年代:1987

数据来源: MAL