Showing papers on "Ureteroscopy published in 1996"

Smith's Textbook of Endourology

Abstract: Two Volumes: BASIC PRINCIPLES: Optics of Flexible and Rigid Endoscopes: Physical Principles. Care and Sterilization of Instruments. How to Protect Yourself and Others from Radiation. Video Imaging and Documentation. Intracorporeal Lithotriptors. Lasers. Monopolar and Bipolar Electrosurgery and Associated Problems. Sedoanalgesia: an Adjunct to Modern Endourology. Informed Consent and Related Legal Issues in Laparoscopic Surgery. Patient Instructions and Nursing Care. Equipment, Instrumentation, And Operating Room Setup: Role of the Urology Nursing Team PERCUTANEOUS SURGERY: Surgical Anatomy of the Kidney. Assessment of Function in Kidney Obstruction. Percutaneous Access. Retrograde Access. Dilation and Maintenance of the Nephrostomy Tract. Nephroscopy. Stone Extraction. Treatment of Ureteral Stones. Chemolysis of Urinary Calculi. Complications of Stone Removal. Treatment of Ureteropelvic Junction Obstruction. Treatment of Caliceal Diverticula and Infundibular Stenosis. Treatment of Renal Cysts. Treatment of Upper Urinary Tract Transitional Cell Carcinoma URETEROSCOPY: Ureteroscopes and Working Instruments. Rigid Ureteroscopes. Flexible Ureteroscopes. Working Instruments. Ureteral Anatomy. Indications for Surgical Intervention. Ureteral Dilation: Indications and Techniques. Access to the Difficult Ureter. Techniques in Rigid Ureteroscopy. Flexible Fiberoptic Ureteropyeloscopy. Treatment of Ureteral Stones. Diagnostic Ureteroscopy. Treatment of Upper Urinary Tract Neoplasms. Ureteral Surgery. Retrograde Endopyelotomy for Ureteropelvic Junction Obstruction. Incisional Treatment of Ureteral Strictures. Postoperative Care. Complications EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY: Shock Wave Physics of Lithotriptors. Lithotripsy Systems. Treatment of Renal Calculi. Treatment of Ureteral Calculi. Nonurologic Applications. Focused Ultrasound. Complications BASIC and PROCEDURAL LAPAROSCOPY: Basic Laparoscopy: Patient Prepara Tion and Operating Room Setup. Instrumentation. Anesthetic Considerations. Physiologic Effects of

Clinical experience with holmium:YAG laser lithotripsy of ureteral calculi.

Abstract: Background and Objective We recently acquired a holmium:YAG laser with wavelength of 2.1 μm. We would like to report our success in using this machine for laser lithotripsy. Study Design/Patients and Methods: Forty-seven ureteroscopic laser lithotripsies were performed in 44 patients (three bilateral stones) over a 6 month period. Four stones were in the upper ureter, six in the middle ureter, and 37 in the lower ureter. The holmium laser beam was delivered via a 400 micron flexible quartz fiber through a 7 Fr rigid ureteroscope during the procedure. The stone size varied from 4 to 21 mm. Results The success rate was 91%. Most of the stones were fragmented to less than 2 mm in size. Larger fragments were removed with a Dormia basket (six cases) for stone clearance. Endoscopic laser ureterotomy was performed in two patients with stricture below the stone. One patient required conversion to open ureterolithotomy, and three required subsequent Extracorporeal Shock Wave Lithotripsy. A low complication rate was observed. Conclusion The pulsed holmium:YAG laser is safe and effective for use in ureteroscopic laser lithotripsy. © 1996 Wiley-Liss, Inc.

Occurrence and treatment of kidney graft lithiasis in a series of 1500 patients.

Abstract: In a series of 1500 patients transplanted between 1976 and 1992, 12 patients presented urinary calculi. The symptoms presented included obstructive anuria in 3 patients and abdominal pain in 1 patient. There were 8 asymptomatic patients. The risk factors were mainly hyperparathyroidism and non-absorbable sutures. The occurrence of renal graft calculi is now ten times less frequent than in the 1980s. In all, 5 of the patients were treated using incisional surgery, 5 with ESWL and 4 using ureteroscopy; a double J stent was inserted for the 3 cases of obstructive anuria. Nine patients are currently calculus-free and 2 have relapsed. One asymptomatic patient was not treated. The renal function of these 12 patient was not modified and no hypertension was noted after treatment. Calculi are generally asymptomatic when they are diagnosed by ultrasonography and in our experience they can be treated using ESWL or by ureteroscopy. In our opinion all patients can be treated successfully but with a high rate of relapse if the causal factors are not treated.

The holmium: YAG laser for ureteric stones.

Abstract: Objective To assess the efficacy of the pulsed holmium:YAG laser for the fragmentation of ureteric stones. Patients and methods One hundred patients (72 males and 28 females, age range 14 months–85 years) underwent 114 ureteroscopic procedures using either a 7.2 F semi-rigid or 9.5 F flexible ureteroscope. A holmium:YAG laser (Sunrise Technologies, Fremont, Ca, USA) was used for laser lithotripsy at a maximum energy of 1.0 J/pulse at 5 Hz. Most of the stones (46%) were located in the upper third of the ureter. The mean size of the stones was 9×8 mm and the mean duration of the procedure was 73 min (including anaesthesia) with a mean hospital stay of 2.7 days. Results All the stones were accessed successfully using miniaturized endoscopes either retrogradely or antegradely. The holmium laser effectively fragmented all types of stones. Total clearance of all stones fragments was achieved in 87% of cases, with the best results obtained for stones in the lower third of the ureter (96%). The complications attributed directly to the laser included three strictures and three perforations of the ureteric wall. Conclusion The holmium:YAG laser was effective in fragmenting ureteric stones irrespective of their hardness. However, it has the potential to damage the ureteric wall and must be used with caution.

Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy.

Abstract: Objective To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy. Patients and methods Four pregnant women (mean age 29.5 years, range 27–35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26–35 weeks of gestation. The stones (between 5 and 16 mm in diameter) were located in the proximal (one) or distal ureter (four). Results All five stones were removed successfully by ureteroscopy and laser lithotripsy. The operating time varied between 15 and 70 min. In two of the five cases, topical anaesthesia was adequate and in no case was fluoroscopy necessary. No complications occurred that could be related to the procedure. Conclusions Ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.

Long-term ureteroscopic management of low-grade transitional cell carcinoma of the upper urinary tract.

Abstract: Nephrouterectomy, or partial uterectomy, is the treatment of choice for transitional cell carcinoma (TCC) of the upper urinary tract. However, patients with solitary kidneys, bilateral tumors, renal insufficiency, or medical comorbidities require more conservative management. When the TCC is low grade, it would be desirable to manage such tumors endoscopically. Ten patients with low-grade TCC of the upper urinary tract have been managed for 2-6 years with ureteroscopy and electrofulguration or laser coagulation. All tumors have been managed successfully without evidence of progression. Recurrence is frequent in some patients and requires repeat treatment and vigilant surveillance.

Percutaneous ureterolitholapaxy : the best bet to clear large bulk impacted upper ureteral calculi

Abstract: OBJECTIVES The outcome of treating impacted upper ureteral calculi by extra corporeal shock wave lithotripsy was less satisfactory than antegrade litholapaxy in our earlier experience. During a four year period (October 1988 to September 1992) 86 reno-ureteral units with impacted upper ureteral calculi were treated by percutaneous litholapaxy. We review our methods and results of this accumulated experience. METHODS Moderate to severe proximal hydronephrosis on excretory urography or ultrasound was taken as evidence of impaction. Antegrade extraction was performed in a single stage, except in patients who presented with anuria, severe azotemia and urosepsis where the system was decompressed by initial nephrostomy drainage. RESULTS 86 impacted upper ureteral calculi in 80 patients were treated by the percutaneous antegrade approach. Eleven were in a solitary functioning unit; 33% presented with moderate to severe renal failure. The average stone size was 256 sq mm. Associated renal calculous disease was present in 22 ipsilateral and 28 contralateral units. Total clearance was achieved in 74 units (86%) by antegrade litholapaxy alone. Adjunct ESWL (5) and ureteroscopy (4) rendered 96% of the units free; 3 units with recurrent calculi were salvaged by ESWL (2) and ureterolithotomy (1). Complications encountered in 17 (20%) patients were fewer in 13 (16%), ureteric perforation in 7 (9%), hematuria in 6 (7%) and ureteric stricture 1 (1%). Hospital stay was 5 days in uncomplicated cases; prolongation of stay (average 8.8 days) was necessitated in staged procedures (sepsis, renal failure), treatment of the contralateral unit or due to postoperative morbidity. The majority of the stones (80%) were of the calcium oxalate monohydrate variety. CONCLUSION It is concluded that failing a retrograde manipulation, percutaneous ureterolitholapaxy offers the best bet to clear large bulk impacted upper ureteral calculi.

Electrohydraulic lithotripsy of upper ureteral calculi with semirigid ureteroscope.

Abstract: Forty-three patients with single ureteral calculi located above the pelvic brim were treated by electrohydraulic lithotripsy (EHL) using a semirigid mini-ureteroscope. Of the 43 calculi, 36 (84%) were fragmented in one procedure. Six calculi (14%) were pushed back to the renal pelvis and treated successfully by complementary extracorporeal shockwave lithotripsy (SWL). The total success rate of ureteroscopic manipulation thus was 98%. The operation time (mean 26.4 minutes) and postoperative hospital stay (mean 2.53 days) were relatively short. Complications were limited to four (9%) minor perforations of the ureter managed by internal stenting. Among these patients with complications, there were no significant ureteral strictures noted on excretory urography or ureteroscopic examination 1 to 3 months after ureterolithotripsy. The costs of ureteroscopy with EHL are lower than that of SWL or ureteroscopic lasertripsy. The total fees for ureteroscopy with EHL are about two thirds those for SWL in Taiwan. Despite the longer learning curve required for ureteroscopy, ureteroscopy associated with EHL is a cost-effective alternative for the treatment of upper ureteral calculi, especially when SWL is not readily available.

One-session bilateral ureteroscopy: Is it safe in selected patients?

Abstract: The aim of this study was to investigate the possibility to perform bilateral ureteroscopy in one session and to determine the procedure's indications and complication rate.

Retrograde Ureteral Intussusception: A Rare Complication

Abstract: A 45-year-old man with a history of cyclophosphamide exposure underwent repeated ureteroscopy for positive urine cytology findings after resection of a Grade 2 papillary transitional-cell carcinoma of the bladder. Despite careful technique, an intussusception developed in the left ureter, which was repaired by resection and construction of a Boari flap. To our knowledge, this is the first report of retrograde ureteral intussusception caused by ureteroscopy.

Ureteroscopy in Pregnancy

Abstract: Purpose: We report our experience with ureteroscopy in pregnancy.Materials and Methods: From 1984 to 1994, 24 pregnant women with lasting symptoms of ureteral obstruction underwent diagnostic and therapeutic ureteroscopy. Most of the women were in the second or third trimester of gestation.Results: A rigid ureteroscope was introduced easily to the upper third of the ureter or into the renal pelvis in all patients. Ureteral calculi were extracted in 13 cases. There were no serious complications.Conclusions: Ureteroscopy is a safe procedure that may be used to diagnose and extract obstructing ureteral calculi during pregnancy when conservative measures fails.

Limitations of ureteroscopy in diagnosis of invasive upper tract urothelial cancer.

Abstract: The efficacy of ureteroscopic evaluation of upper tract abnormalities was evaluated in 40 patients. Twenty-eight patients presented with a radiologic filling defect, 9 with a filling defect and hematuria and 3 individuals exhibited hematuria alone. Cold cup biopsies revealed transitional cell carcinoma in 7 of 9 patients with papillary tumors and in 2 of 3 with nonpapillary tumors. Four patients without ureteroscopic diagnosis of urothelial cancer were found to have invasive tumors on subsequent nephroureterectomy. Of 15 patients with upper tract urothelial cancer, 12 were treated with total nephroureterectomy. Three individuals with grade 1 neoplasms received conservative ureteroscopic ablative therapy. Ureteroscopy is effective when combined with biopsy in the diagnosis and treatment of papillary lesions, but exhibits a low sensitivity in patients with invasive lesions.

Urinary calculi during pregnancy. When are they cause for concern

Abstract: Urolithiasis during pregnancy, though rare, can be challenging both diagnostically and therapeutically. It is helpful if the physician is quick to suspect the presence of stones in the presence of appropriate signs and symptoms, particularly flank pain and tenderness, hematuria, or unresolved bacteriuria. Ultrasonography is the diagnostic imaging method of choice, but modified intravenous urography should be performed whenever this study is necessary for a prompt diagnosis. In the absence of sepsis, renal failure, or intractable pain, conservative management with hydration, analgesics, and (if infection is present) antibiotics is the favored initial approach. If conservative management fails, stent insertion or placement of a percutaneous nephrostomy tube may be appropriate. Ureteroscopy with stone manipulation for distal ureteral stones during pregnancy has also been reported in some cases. If these methods fail, open surgery should be used for stone removal.

Distal ureteral calculi: Ureteroscopy vs. ESWL. A prospective analysis

Abstract: Two groups of 50 consecutive patients each, with distal ureteric calculi, were treated by ureteroscopy or in situ ESWL (Dornier HM-4 lithotriptor) in order to establish the effectiveness of ESWL at the distal portion of the ureter. In comparison to ureteroscopy, ESWL for distal ureteral calculi was performed on an outpatient basis, required less time, patients had more rapid convalescence and the procedure was simpler and safer. The overall success rate was 100% for ureteroscopy and 92% for ESWL. Our observations showed that in situ ESWL with the Dornier HM-4 lithotriptor is the method of choice for the treatment of distal ureteral calculi.

Fibroepithelial ureteral polyp--a case report; endoscopic removal of large ureteral polyp.

Abstract: We report a case of primary fibroepithelial polyp of the right midureter. The patient was a 41-year-old-woman, complaining of right flank pain. An excretory urogram revealed right hydronephrosis and a filling defect of the the right midureter. The filling defect was produced by a large fibroepithelial polyp that was diagnosed and removed by ureteroscopy without open surgery. Large fibroepithelial ureteral polyps are relatively rare and ureteroscopy is the gold standard of diagnosis for ureteral filling defect.

ABC of urology. Urinary stone disease.

Abstract: Most patients with urinary stones have microscopic haematuria detected by routine urine analysis. An absence of red cells in the urine suggests an alternative diagnosis. #### Presenting features of urinary stone disease An x ray film of the kidneys, ureters, and bladder shows the position and size of the kidneys as well as the presence of any calculi, which usually obstruct at the pelviureteric junction, the point where the ureter crosses the iliac arteries at the pelvic brim, or the vesicoureteric junction. All patients suspected of having a urinary stone should then have intravenous urography, although renal ultrasonography is acceptable in patients who are either allergic to contrast medium or pregnant. Obstruction may be detected by the delayed appearance or persistence of the nephrogram phase on the intravenous urogram or by the finding of caliceal dilatation in an ultrasound scan. #### Differential diagnosis of renal colic Renography after injection of technetium-99m mercapto acetyltriglycine is not routinely used and …

[Treatment of ureteral lithiasis with lithoclast: analysis of our experience].

Abstract: OBJECTIVES To analyze the role and the results achieved with the Lithoclast in the treatment of distal ureteral calculi in the era of ESWL. METHODS From March, 1994 to April, 1995, 41 patients with ureteral calculi were treated by ureteroscopy and direct stone fragmentation with the Lithoclast. RESULTS 90% of the patients were stone-free one month after treatment; 3 patients in whom stone fragmentation could not be achieved required ESWL; one patient required open surgery for ureteral detachment. CONCLUSIONS Ureteroscopy and stone fragmentation with the Lithoclast is a good, inexpensive mode of treatment of ureteral stones and is particularly indicated as the first mode of treatment in those centers, like ours, where ESWL is unavailable.