摘要:

ABSTRACTExtracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologica11y 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever>38°C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P>0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P>0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3%v2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL

ISSN:0892-7790    

DOI:10.1089/end.1998.12.1

年代:1998

数据来源: MAL

摘要:

ABSTRACTTo evaluate the combined approach of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patients. The stone surface area ranged from 654 to 3042 mm2(1535 mm2on average). During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients. A double-J stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatient basis approximately 2 weeks after PCNL. The mean hospital stay was 4.4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, and a residual stone rate of 7%. With a follow-up of 52 months on average, the global stone growth rate was 17%, being 4.4% only among the stone-free group and 27% among the group with insignificant residual fragments. The global transfusion rate was 10%. Percutaneous stone debulking combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi. Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate while reducing the morbidity and hospital stay.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.5

年代:1998

数据来源: MAL

摘要:

ABSTRACTExtracorporeal shockwave lithotripsy (SWL) is currently accepted as an effective noninvasive treatment for a wide variety of urinary tract calculi. However, the bioeffects of high-energy shockwaves on renal parenchyma have yet to be fully elucidated. The objective of this study was to measure the acute changes in regional renal hemodynamics associated with SWL utilizing dynamic gadolinium-DTPA-enhanced magnetic resonance imaging (MRI). Seven patients who underwent SWL for renal calculi had an MRI study within 4 hours after the treatment. To assess renal hemodynamics, a bolus of Gd DTPA (0.03 mmol/kg) was administered, and dynamic contrast enhanced images was obtained. Regions of interest (ROI) were defined over the cortex and medulla to obtain signal intensity-v-time curves. The contralateral kidney in each patient was used as the control. The initial slope of the contrast-enhanced signal intensity-v-time curve was used as a measure of the perfusion index (PI). In six patients, perfusion imaging showed a consistent trend of decreased cortical flow (29 ± 8%) and a concomitant increase in medullary flow (34 ± 14%) in the region of the kidney that was targeted with SWL in six patients (86%). This study shows that renal hemodynamics are modified by SWL. We hypothesize that this change represents a shunting of flow from cortex to medulla in an attempt to prevent ischemia of the medull

ISSN:0892-7790    

DOI:10.1089/end.1998.12.9

年代:1998

数据来源: MAL

摘要:

ABSTRACTA 75-year-old woman formed a pyelocutaneous fistula after four extracorporeal lithotripsies over 10 months with continued stenting. Xanthogranulomatous pyelonephritis was confirmed at nephrectomy. Preprocedure renal function studies with culture and eradication of infection are advisable before SWL.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.13

年代:1998

数据来源: MAL

摘要:

ABSTRACTThe potential effects of extracorporeal application of shockwaves on an embryo or fetus were explored in an animal model. In experimental Series A, the fetuses of 30 gravid rabbits were exposed to piezoelectrically induced and sonographically guided shockwaves on Day 25 or 20 of gestation under technical conditions corresponding to extracorporeal lithotripsy in humans. Fetotoxicity was examined by abdominal section 24 hours or 9 days later, and immediate/intermediate damage was assessed (resorptions, viability, gross injuries, and microscopic lesions of the target and neighboring fetuses). In series B, the kidneys of an additional 28 gravid rabbits (including a control group) were exposed to the same shockwave treatment on Day 11 of gestation in order to investigate indirect embryotoxic effects, including teratogenic potency. One day before the expected birth, the maternal kidneys, uteri, and adjacent organs were examined for lesions, and the 156 offspring were assessed for embryolethal, embryonoxious, or teratogenic sequelae. Shockwave targeting of the cranium, thorax, abdomen, or placenta was usually lethal to the fetuses. When the uterine wall or the space between two fetuses was targeted, the fetuses suffered from superficial hematoma, as was found in the surrounding soft tissues within a radius of 1.5 cm. Fetuses outside this region were vital and free of lesions. Shockwave treatment of the maternal kidney resulted in renal petechial hemorrhage or subcapsular hematoma. However, statistically significant embryotoxic or teratogenetic effects could be demonstrated neither from maternal data (resorptions) nor from fetal findings (body measurements, vitality test, inner organs, skeletal deformities). When using a piezoelectric lithotripter with a small focus of high energy, lesions of a fetus are to be expected only when it is located in or close to the focus. It seems that embryotoxic or teratogenic sequelae do not occur when shockwaves are focused outside the uterus. Nonetheless, this preliminary research does not justify clinical use of extracorporeal shockwave lithotripsy in pregnant humans.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.15

年代:1998

数据来源: MAL

摘要:

ABSTRACTOver the course of 18 months, 160 patients underwent endoscopic holmium:YAG laser surgery at our institution for the treatment of urolithiasis. After appropriate consent had been obtained, 127 patients were treated for ureteral calculi, 18 for renal calculi, and 15 for large bladder stones. All procedures were performed using the VersaPulse combination holmium:YAG/Nd:YAG laser by Coherent Inc., and all were done endoscopically using video guidance. Of the 16 patients treated percutaneously for renal calculi, 5 were rendered stone free (mean stone size 3.5 cm). Two patients with renal calculi were treated in a retrograde fashion. One had a 1-cm stone in an upper-pole calix with a narrow infundibulum, while the other had a stone just proximal to the ureteropelvic junction. Both patients were rendered stone free. Of the 127 patients with ureteral calculi, 46 had stents placed after fragmentation of their stones. To date, 123 patients in this group (97%) are free of stones. All 15 patients with bladder calculi had complete fragmentation of their stones. The Ho:YAG laser is effective and versatile in the treatment of urolithiasis.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.23

年代:1998

数据来源: MAL

摘要:

ABSTRACTWe report our experience performing simultaneous bilateral percutaneous nephrolithotomy (SBPN) in four patients with large stone burdens in both kidneys. We modified the previously described approach by combining SBPN with subarachnoid Duramorph (preservative-free morphine sulfate) in an effort to decrease postoperative discomfort and shorten the duration of hospitalization. These patients (study group) were then compared with a contemporary group of four patients with similar bilateral stone burdens who underwent staged bilateral percutaneous nephrolithotomies (PCNs) (control group). The comparison showed a marked advantage in hospital stay (4.8 days for the study groupv11 days for the control group) and postoperative narcotic requirement (27.5 mg of meperidine for the study groupv533 mg for the control group). All four patients were rendered stone free. This method of treatment for large bilateral renal calculi with the addition of subarachnoid Duramorph resulted in less postoperative discomfort, less morbidity, and a more rapid recovery than staged PCN or sandwich PCN/SWL/PCN.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.27

年代:1998

数据来源: MAL

摘要:

ABSTRACTA retrospective review of 48 consecutive morbidly obese patients with urolithiasis who were treated successfully by endoscopic modalities over 3.5 years was performed. Of the 73 endoscopic procedures, 48 were ureteroscopic laser lithotripsy (UL), 4 were ureteroscopic basket extraction, and 21 were percutaneous nephrolithotripsy (PCNL). The patients' weight ranged from 205 to 385 lbs. (average 286 lbs.). Their abdominal girth ranged from 53 to 65 inches (average 59 inches). Twenty-six patients had one procedure, eight patients had bilateral procedures, eleven patients had two procedures, and three patients had three procedures with utilization of either multiple ureteroscopic treatments or the combination of percutaneous and ureteroscopic techniques. The stone-free rate after one procedure was 77.8% for UL and 60% for PCNL. The stone-free rate after planned repeat procedures was 97% for UL/UL and 89% for PCNL/UL. There were two minor complications. Forty-eight procedures were performed on an outpatient basis, and the remaining 25 procedures necessitated hospital admission (average 3.6 days). Morbidly obese patients with urolithiasis who are unable to have SWL because of their body weight and abdominal girth can be treated successfully with UL, ureteroscopic basket extraction, and PCNL with efficacy comparable to that in patients of normal weight and with minimal morbidity. Many renal calculi were treated with UL alone with a high success rate.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.33

年代:1998

数据来源: MAL

摘要:

ABSTRACTThe disadvantages of highly flexible endoureteral (double J) stents in the face of tumor-induced extrinsic ureteral compression are a consequence of insufficient cross-sectional stability, leading to stent compression and thus to hydronephrosis or pyonephrosis. The newly developed tumor stent, which is used in cases of tumor-induced ureteral compression, is available in sizes from 6F to 8F in diameter and 24 to 32 cm in length. The shaft consists of a combination of high-stability plastics that presents sufficient elasticity in length. Both ends are made of extremely elastic J parts, guaranteeing stable fixation. Compared with common double-J stents with the same outside diameter, the tumor stent possesses a comparable interior diameter and compared with available stents promises sufficient interior flow in the face of extrinsic diseases. The application can be undertaken using well-known endoscopic techniques, needs no special instrumentation, and entails no learning curve. To date, 49 stents were placed at our urologic departments without any problems, the latest stent remaining for 15 months. Tumor-induced compression or a higher rate of encrustation were not seen. All patients tolerated these stents well. In our opinion, the new stabilized endoureteral stent can be seen as a better solution than percutaneous nephrostomy or frequent stent changing to tumor-induced extrinsic ureteral compression.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.37

年代:1998

数据来源: MAL

摘要:

ABSTRACTVesicoureteral reflux (VUR) in the animal model for experimental purposes can be created either by open transvesical or endoscopic techniques. The concept of reflux creation is the same for both techniques: incision of the roof of the intramural portion of the ureter at the 12 o'clock position. The open method has the disadvantages of requiring a cystotomy and a lengthy healing period prior to initiating a study, thereby incurring additional expense and the problem of introducing several confounding factors. The open method is unreliable because of the resolution of reflux over time. Herein, we present a simple transurethral endoscopic technique for creating VUR in pigs. This technique was successful in producing persistent Grade II or III reflux in 94% of the incised ureters.

ISSN:0892-7790    

DOI:10.1089/end.1998.12.41

年代:1998

数据来源: MAL