摘要:

Prior to the use of lithotripsy techniques, there was no requirement for a vocabulary to describe the relative breakability of a urinary calculus. With the introduction of lithotripsy, we became aware that calculi of different radiologic appearances or chemical compositions varied in their susceptibility to fragmentation. Because all truly new distinctions require new expressions to characterize them, we had to create a term to express this new distinction, and the term we chose was "stone fragility." Currently, if we see a 1 -cm calcium oxalate dihydrate stone, we say it appears fragile ("easily broken," from the Latinfrangere, "to break", but if we see a dense brushite or a cystine stone, we can describe it only in terms of fragile; i.e., "not fragile" or, incorrectly, "hard": an antonym for "fragile" does not exist. In the interest of common understanding and more accurate quantitation of stone breakability, a neologism is suggested that has an appropriate Latin root, is easily spoken, sounds authentic, and is useful. It is proposed that, in the interest of accuracy and as a reflection of our greater sophistication regarding stone breakability, we use the Latin rootdur(hard, difficult) and a suffixHe(of, like, pertaining to) to create the terms "durile" (adj; pertaining to or capable of being difficult to break) and "durility" (noun; a quality of being difficult to break or fragment).

ISSN:0892-7790    

DOI:10.1089/end.1994.8.1

年代:1994

数据来源: MAL

摘要:

Calculus formation is a natural sequela of anatomic anomalies of the upper urinary tract, and endourologic and open surgery can be difficult in these cases. Since July 1988, 81 patients with urolithiasis and renoureteral anomalies were treated with SWL on the Siemens Lithostar. Retrograde ureteropyelography and double-J stenting was done in 75 and 73 patients, respectively. All patients had satisfactory fragmentation, although 48% needed more than one session. The 6-month stone-free rate was 90%. Follow-up of 3 to 44 months in 32 patients revealed urinary infection in 1 patient and asymptomatic residual calculi in 3. SWL may be considered safe and successful for noninvasive management of calculus disease in patients with upper tract anomalies.

ISSN:0892-7790    

DOI:10.1089/end.1994.8.5

年代:1994

数据来源: MAL

摘要:

Many authors recommend that stone manipulation or catheter placement be attempted before SWL of ureteral stones. We tried to insert ureteral catheters before SWL on the unmodified Dornier HM3 machine in all patients treated for solitary ureteral stones between April 1986 and December 1991, succeeding in 77.5% (n = 395) of those for whom adequate follow-up is available for analysis. The stone-free rates with SWL alone in the series of 510 patients were 93% in patients with catheters and 75% in patients without catheters. An additional 6% of the patients in both groups became stone free with the aid of ureteroscopy. Eventually, only 0.5% of the patients with a catheter and 1.7% of the patients without a catheter had residual fragments. Among patients with a ureteral catheter after any procedure, 58.7% had no need for pain relief medication and no fever; the figure in the patients treated without a catheter was 74.4%. Although the success rate of SWL for ureteral stones is higher with a ureteral catheter in place, the incidence of complications also is higher. We recommend trying in situ SWL initially for patients with a ureteral stone.

ISSN:0892-7790    

DOI:10.1089/end.1994.8.9

年代:1994

数据来源: MAL

摘要:

Early reports indicated that stones in the upper ureter that have been manipulated back into the kidney have a higher success rate with SWL than those treated in situ. Difficulties in detecting stones in the mid and lower ureter with lithotripters using ultrasonographic localization also limit in situ SWL of ureteral calculi. We treated 254 patients with ureteral calculi (85 upper, 72 mid, and 97 lower) using in situ SWL on the Dornier MFL 5000. The mean stone volume was 1.4 cm2. Approximately one third of the patients required more than one session. The mean number of shock waves was 2010 (range 1400-3000) with a mean voltage of 20 kV (range 14-30 kV). Fragmentation was achieved in 92.6% of the patients. Only 0.4% of the sessions involved general anesthesia. At 3-month follow-up, available in 75% of the patients, the stone-free rate was 82.6%. Ureteral calculi can be treated effectively in situ by means of SWL.

ISSN:0892-7790    

DOI:10.1089/end.1994.8.13

年代:1994

数据来源: MAL

摘要:

Studying renal function in patients with a solitary kidney undergoing SWL eliminates the compensatory effects of an untreated contralateral kidney and thus indicates any loss of function in the treated kidney. In 17 patients with a preoperative serum creatinine clearance of 1.5 mg/dl or less who underwent SWL to a solitary kidney, the glomerular filtration rate (GFR) was calculated by the formula of Cockcroft and Gault, which correlates significantly with measured creatinine clearance. A change of ≥20% in the GFR was considered a clinically significant deterioration of renal function. In 12 patients with24 months' follow-up (mean 36 months) had an average 22% reduction in the estimated GFR. This long-term effect is similar to the 29% long-term reduction in renal function recorded after percutaneous nephrolithotomy in solitary kidneys. Multiple stones, higher numbers of shock waves, and repeated SWL sessions correlated with decreases in GFR, but none of the differences was statistically significant. Like percutaneous nephrolithotomy, SWL results in a clinically significant long-term reduction in renal functio

ISSN:0892-7790    

DOI:10.1089/end.1994.8.15

年代:1994

数据来源: MAL

摘要:

Stones of the salivary glands may cause recurrent swelling, ascending inflammation, and colic-like pain. Previously, in order to get rid of these stones, the gland usually had to be removed surgically in spite of the associated risks to adjacent structures, especially the facial nerve. We treated 104 salivary gland stones in patients 14 to 78 years old using the Storz Modulith SL 10 lithotripter. Each session (average 3.6 per patient) consisted of 1000 impulses at 2 Hz and 16 to 18 kV. No anesthesia was required. Earplugs were applied to patients being treated for parotid gland stones. With the aid of SWL and drug-induced salivation, 17 (59%) of the patients with parotid gland stones and 42 (56%) of those with submandibular gland stones obtained either total stone clearance or sufficient fragmentation to permit spontaneous passage. Four patients required surgery. The remaining patients are still being treated. The noninvasive SWL for salivary gland stones is noninvasive and painless and has a considerable success rate. It can be performed on an outpatient basis.

ISSN:0892-7790    

DOI:10.1089/end.1994.8.21

年代:1994

数据来源: MAL

摘要:

The application of the coumarin-based pulsed-dye laser has allowed the endoscopist to employ more delicate instruments with smaller working channels in treating urinary and biliary calculi. We have previously reported our first 100 patients treated with this laser. In 159 consecutive patients, 176 renal, ureteral, bladder, urethral, and biliary calculi with an average size of 1.6 cm were treated with the pulsed-dye laser in antegrade or retrograde fashion using rigid (6.9F-11.5F) or flexible (8.5-10.5F) endoscopes. The laser fibers ranged from 200 to 550 μm and the energy from 60 to 200 mJ. In some cases, the laser was used as an adjunct to percutaneous nephrolithotomy for staghorn calculi, to fragment bladder calculi without anesthesia, to free encrusted ureteral catheters, or as a lithotrite in the biliary tree. Only 4 stones (2.5%) could not be fragmented. There were no complications directly attributable to the use of laser energy. The pulsed-dye laser is safe and efficacious as an endoscopic lithotrite

ISSN:0892-7790    

DOI:10.1089/end.1994.8.25

年代:1994

数据来源: MAL

摘要:

We report an unusual ureteral foreign body resulting from a complication of pulsed-dye laser lithotripsy: a retained laser fiber fragment. It was removed with two endoscopic procedures without long-term problems.

ISSN:0892-7790    

DOI:10.1089/end.1994.8.29

年代:1994

数据来源: MAL

摘要:

Traditionally, general or regional anesthesia has been employed during endourologic procedures. The success of sedative-analgesic sedation during SWL prompted an investigation into its use in minor endourologic procedures. We compared intravenous alfentanil-midazolam anesthesia (n = 30) with spinal anesthesia (n = 35) during procedures such as ureteroscopy and stent placement using physiologic measures and patient and anesthetist ratings. The former series was prospective; the latter was retrospective. Physiologic measures remained stable and oxygen saturation was above 90% in all patients in both groups during the procedures. The average anesthesia and recovery room times were significantly shorter for patients given alfentanilmidazolam: 23.3 ν 36.1 minutes and 85.5 ν 179.6 minutes, respectively (P<0.001;t-test), and this difference reduced the anesthesia cost an average of 46%. The anesthetists rated the intravenous regimen satisfactory in 92% of the patients, and 94% of the patients rated the procedure as comfortable. All 18 of the patients who had previously had spinal anesthesia considered alfentanil-midazolam superior. Intravenous alfentanil-midazolam sedation anesthesia can provide adequate analgesia for many minor endourologic procedures while shortening the anesthesia recovery tim

ISSN:0892-7790    

DOI:10.1089/end.1994.8.33

年代:1994

数据来源: MAL

摘要:

Diagnosis of upper tract filling defects sometimes presents a difficult dilemma. In many patients, a direct endoscopic approach may permit both diagnosis and treatment. Patients (n = 28) suspected of having malignancies or with known upper tract filling defects underwent ureteropyeloscopy. Malignancy was confirmed in 18 patients, who underwent treatment of the urothelial tumors and the tumor bases with Nd:YAG laser irradiation (25-30 W; 3 seconds). The follow-up included endoscopic surveillance every 3 months. Ten patients remain tumor free after 6 to 30 months (mean 15 months). Eight patients who had recurrences underwent a new laser irradiation followed by intracavitary therapy with mitomycin C. Only one nephrectomy has been necessary, and no cases of disseminated disease have been found. A ureteropyeloscopic approach coupled with Nd:YAG laser irradiation is a useful treatment for selected patients with upper tract urothelial tumors. In the future, the indications may expand.

ISSN:0892-7790    

DOI:10.1089/end.1994.8.37

年代:1994

数据来源: MAL