Magnifying endoscopy combined with narrow band imaging system for early gastric cancer : correlation of vascular pattern with histopathology

Purpose: To assess the safety and efficacy of ureteroscopy and holmium:YAG (yttrium-aluminum-garnet) laser lithotripsy in the treatment of upper urinary tract calculi in patients with known and uncorrected bleeding diatheses.
Materials and Methods: A retrospective chart review from 2 tertiary stone centers was performed to identify patients with known bleeding diatheses who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. Twenty-five patients with 29 upper urinary tract calculi were treated with ureteroscopic holmium laser lithotripsy. Bleeding diatheses identified were coumadin administration for various conditions (17), liver dysfunction (3), thrombocytopenia (4), and von Willebrand's disease (1). Mean international normalized ratio (INR), platelet count and bleeding time were 2.3, 50 x 10 9 /L, and > 16 minutes, for patients receiving coumadin or with liver dysfunction, thrombocytopenia, or von Willebrand's disease, respectively.
Results: Overall, the stone-free rate was 96% (27/28) and 29 of 30 procedures were completed successfully without significant complication. One patient who was treated concomitantly with electrohydraulic lithotripsy (EHL) had a significant retroperitoneal hemorrhage that required blood transfusion.
Conclusions: Treatment of upper tract urinary calculi in patients with uncorrected bleeding diatheses can be safely performed using contemporary small caliber ureteroscopes and holmium laser as the sole modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperative correction of hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoidance of the use of EHL is crucial in reducing bleeding complications in this cohort of patients.

Safety and efficacy of holmium:YAG laser lithotripsy in patients with bleeding diatheses

Are We All Doing It Wrong? Influence of Stripping and Cleaving Methods of Laser Fibers on Laser Lithotripsy Performance

To compare success and complication rates of shock wave lithotripsy (SWL), flexible ureterorenoscopy (F-URS) and percutaneous nephrolithotripsy (PNL) according to modified clavien grading system of renal pelvis stones between 1 and 2 cm. The results of 149 patients were evaluated retrospectively. Patients were divided into three groups as 52 for SWL, 47 for F-URS and 50 for PNL. Complications were evaluated by modified Clavien grading system. In the first group, stone-free rates after a mean of 2, 6 sessions was 86 % (45/52). In Group 2, this ratio was 91.4 % (43/47), and in Group 3, it was 98 % (49/50). The success rate in Group 3 was significantly higher than other groups. Complication rates for Group 1, 2 and 3 were 7.6 % (4/52), 6.3 % (3/47) and 12 % (6/50), respectively. Although PNL was the most successful technique compared with other techniques, complications were also higher in this group. Even though PNL is the most successful, it should be performed for selected patient groups and indications should be carefully evaluated.

Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones.

Transurethral Incision Versus Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Hypertrophy. A Preliminary Report

Introduction: Our goal was to investigate the efficacy of flexible ureteroscopy (FU) in the treatment of pyelocaliceal calculi. Materials and Methods: Between September 2002 and December 2004, a total of 41 patients with multiple (23 cases), pelvic (7 cases), and inferior caliceal (11 cases) SWL-resistant calculi underwent FU. We used a 7.5-F flexible ureteroscope with pressure irrigation and electro-hydraulic lithotripsy. The fragments were retrieved with triradiate graspers or tipless baskets. Results: A double J stent had been previously placed in 34% of the patients. Dilation of the ureteral orifice was necessary in 9.8%. The location of the calculi was renal pelvis, inferior calyx, and pelvis and calyxes in 7, 11, and 23 patients, respectively. The median operative time was 64 minutes for pyelocaliceal, 46 minutes for pelvic, and 39 minutes for inferior caliceal calculi. Complete stone clearance or good fragmentation (fragments less than 3 mm) was obtained in 71% of patients (57% for pyelocaliceal, 87% for pelvic, and 71% for inferior caliceal calculi). A successful outcome was achieved in 78%, 72%, and 49% for calculi sized 10 mm or smaller, 11 mm to 20 mm, and greater than 20 mm, respectively. Two or more procedures were required in 11 patients (27%). The complication rate was 7.3% (hematuria, persistent renal colic, and hyperthermia). Conclusion: Our experience shows that FU can be an effective approach in selected patients, especially those with kidney calculi that are resistant to SWL. However, percutaneous approach is a better alternative for calculi greater than 20 mm.

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Retrograde flexible ureteroscopic approach for pyelocaliceal calculi.

OBJECTIVE To perform a prospective, randomized, long-term comparison between bipolar plasma vaporization of the prostate (BPVP), bipolar transurethral resection in saline (TURis), and monopolar transurethral resection of the prostate (TURP) concerning the perioperative and follow-up parameters. METHODS A total of 510 patients with benign prostatic hyperplasia (BPH), Qmax 10 mL/s, International Prostate Symptom Score (IPSS) 19, and prostate volume between 30 and 80 mL were enrolled in the trial. All cases were evaluated preoperatively and at 1, 3, 6, 12, and 18 months after surgery by IPSS, quality of life, Qmax, and ultrasonography. RESULT Each study arm including 170 cases emphasized similar preoperative parameters. The capsular perforation and intraoperative bleeding rates as well as the mean hemoglobin drop were significantly decreased for BPVP by comparison with TURis and TURP. The postoperative hematuria, blood transfusion, and clot retention rates were significantly higher in the TURP group. The operation time was significantly shorter only for BPVP patients, whereas the catheterization period and hospital stay were significantly reduced for BPVP, followed by TURis. The rates of irritative symptoms and urethral strictures were similar in the 3 series. The recatheterization, bladder neck sclerosis, and retreatment rates were significantly lower in the BPVP group. During the 1, 3, 6, 12, and 18 months’ follow-up, the BPVP series emphasized significantly superior parameters in terms of IPSS and Qmax. CONCLUSION BPVP represents a valuable endoscopic treatment alternative for BPH patients, with superior efficacy and satisfactory complication rate. The long-term follow-up emphasized durable improvements of the postoperative parameters for BPVP. UROLOGY 78: 930‐936, 2011. © 2011 Elsevier Inc.

Prostatic Diseases and Male Voiding Dysfunction Bipolar Plasma Vaporization vs Monopolar and Bipolar TURP-A Prospective, Randomized, Long-term Comparison

The instruments used for the ureteroscopic approach of upper urinary tract conditions are in a continuous evolution. The first ureteroscopes were too large in diameter, their use being restricted to a small number of patients. Moreover, the methods for stone fragmentation or extraction, as well as for tissue resection/fulguration, were limited. Subsequently, the instruments evolved and the technique improved, the ureteroscopes allowing the use of an increasing number of accessory instruments, in the conditions of a decreasing diameter. The development of rigid and flexible ureteroscopes with increasingly smaller dimensions determined the diversification of transurethral upper urinary tract endoscopy.

Chapter 3 – Instruments

Fluorescence is defined as the property of a structure to emit light without a noticeable delay when irradiated. According to Stoke’s law, the light emitted has a higher wavelength than the absorbed light, while the photons are characterized by a low level of energy.

The fluorescent emission from untreated materials is known as primary, natural fluorescence, or autofluorescence. When fluorescence is generated artificially by the use of additional fluorescent substances, secondary fluorescence occurs. Haitinger (1959) called these materials “fluorochromes” to distinguish them from other dyes used in visible light microscopy.

Chapter 2 – Fluorescence Cystoscopy

The first descriptions of urethro-vesical catheters date back to antiquity, when straws or palm leaves were used for this purpose. In China, Sun Shimiao (581–682 AD) used tubular leaves from green onions through which air was blown to remove the obstacle. In 1036, Avicenna sensed the need for gentle insertion of catheters and created flexible models from animal skin, treated with ox blood for firmness and lubricated with cheese. The aim of modern medicine was the development of a prosthesis, which, inserted into the urethra, would achieve recalibration only for the stenosed segment.

Petrişor Geavlete

Papers

Retrograde flexible ureteroscopic approach for pyelocaliceal calculi.

Prostatic Diseases and Male Voiding Dysfunction Bipolar Plasma Vaporization vs Monopolar and Bipolar TURP-A Prospective, Randomized, Long-term Comparison

Chapter 3 – Instruments

Chapter 2 – Fluorescence Cystoscopy

Chapter 3 – Urethral Stents