共查询到20条相似文献，搜索用时 31 毫秒
1.
G. Garg A. Aggarwal M. Singh S.N. Sankhwar D. Sharma S. Pandey 《The African Journal of Urology》2018,24(4):315-318
Objective
To retrospectively compare the efficacy and safety of extra-corporeal shock wave lithotripsy (ESWL) for renal/upper ureteric calculi in pediatric/adolescents (group 1) vs adults(group 2).Subjects and methods
Medical records of 948 patients who underwent ESWL for renal/upper ureteric calculi at a tertiary care center in North India from January 2012 to December 2017 (five years). The Dornier compact alpha-K1025163 (Dornier Med Tech) equipment was used for ESWL. We evaluated the stonefree rates, the number of ESWL sessions, use of ancillary procedures and complications between the two groups.Results
A total of 110 patients were in group 1 and 838 patients were in group 2. The mean stone size in group 1 patients was 1.20 ± 1.18 cm2 while in group 2 it was 1.49 ± 0.37 cm2. The stone clearance rate was 85/110 (77%) for the group 1 and 545/838(65%) for group 2 patients. In group 1, a second session was required in 28/110 (25.4%) patients and the third session was required in 5/110 (4.5%) patients while in the adult group two sessions were required in 175 (20.8%) and three sessions were required in 24 (19.2%) patients. The overall complication rate in group 1 was 15/110 (13.63%) and in the group, II was 105/838 (12.5%). No statistical difference was found between post-ESWL complications and use of ancillary procedures (DJ stenting/PCNL) (p = 0.067).Conclusion
In renal/upper ureteric calculi ESWL has got better efficacy, comparable safety and requires equivalent ancillary procedures in children and adolescents compared to adults. 相似文献2.
G.A. Alsagheer O. Mohamed M.S. Abdel-Kader A.M. Hasan M. Abdel Razek A. Fathi O. Mahmoud A. Abolyosr 《The African Journal of Urology》2018,24(2):120-125
Objective
To compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2?cm in children.Patients and methods
A randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2?cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications.Results
Finally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient's demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively (p value?=?0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group (p value?=?0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively (p value?=?0.5).Conclusion
Stone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy. 相似文献3.
Hossam Elawady Diaa Eldin Mostafa Mahmoud Ahmed Mahmoud Mohamed Abuelnaga Ahmed Farouk Ahmed Tawfick Tarek Elzayat Abdallah Ahmed 《The African Journal of Urology》2018,24(4)
Objectives
To evaluate and analyze the efficacy and the safety of multiple tracts PCNL in management of complex renal calculi.Patients and Methods
The study was conducted during the period between March 2016 till January 2017 on 265 patients with complex renal stones, all patients underwent multiple tracts PCNL, either with double or triple punctures, preoperative and postoperative laboratory and radiological results were compared together in correlation to the stone size, shape and site.Results
The results of our study have shown that increased size and complexity of stones is associated with increased number of punctures needed to achieve stone clearance, and the aggressive approach to complex renal calculi using multiple tracts PCNL is a safe and effective modality in management of complex renal calculi with acceptable complications.Conclusion
Number of percutaneous tracts needed for stone clearance was increased with the increase in stone size and complexity. Surgeon experience, accurate choosing puncture site and carefully performed multiple tracts will decrease the intra-operative and postoperative complications or transfusion requirements. 相似文献4.
Objective
To compare the safety and efficacy of tamsulosin, tadalafil, deflazacort and combination of tamsulosin with tadalafil in lower ureteric orifice negotiation by large size ureteroscope (8/9.8 Fr) prior to intracorporeal lithotripsy.Patients and methods
In this prospective study, 180 patients presented with ureteric stone of size 8–15 mm were randomly assigned to 5 groups: tamsulosin (group A), tadalafil (group B), deflazacort (group C), combination of tamsulosin with tadalafil (group D) and placebo (group E). After 10 days of drug therapy 168 patients were underwent ureteroscopy and findings like endoscopic configuration of ureteric orifice, need for ureteric dilatation, ureteroscope negotiation, operating time, drug related side effect and procedural complication were noted in each group.Results
All four groups (A, B, C, D) were significantly better than group E in terms of ureteric orifice appearance (wide) during endoscopy. Negotiation of ureteric orifice was easy in group A (70.59%), B (58.82%) and D (78.13%) as compare to group E (31.43%) which was statistically significant. Group A (32.35%) and D (34.38%) were statistically better with group E (62.86%) in terms of ureteral dilatation. Operative time was less in all four groups as compared to group E. All patients well tolerated the drugs with no serious side effects.Conclusion
Both tamsulosin and tamsulosin with tadalafil helps in forward propagation of large size ureteroscope as compared to other groups with less operative time without any significant complications. So, we can conclude that tamsulosin alone can be helpful for lower ureteric orifice negotiation during intracorporeal lithotripsy with minimal side effects. 相似文献5.
D.A. Hameed A.S. Safwat M.M. Osman M.M. Gadelmoula A. Kurkar M.A. Elgammal 《The African Journal of Urology》2017,23(1):33-37
Introduction
“Difficult ureter” is a known problem that increases the complications during ureteroscopy.Objective
To categorize ureters according to their distensibility, and to determine whether ureteric distensibility is associated with the success of ureteroscopy and its complications.Subjects and methods
Between January 2010 and September 2012, we tested ureteral distensibility in 306 patients who had a unilateral single radiopaque ureteral stone, 6–20 mm in diameter. Ureteral distensibility was classified into two categories according to the maximum size of a ureteral dilator that could be introduced before ureteroscopy: non-distensible ureters, which admitted a dilator up to 10 Fr and distensible ureters, which admitted a dilator >10 Fr. Correlations between distensibility and the success rate and complications of ureteroscopy were determined.Results
Overall, 102 patients (33.3%) had non-distensible ureters and 204 (66.7%) had distensible ureters. Distensibility was correlated with the success of ureteroscopy because initial ureteroscopy failed in 38.2% of non-distensible ureters. Ureteroscopy was successful in all distensible ureters. The incidence of ureteric injury was higher in non-distensible ureters than in distensible ureters.Conclusions
Our results suggest that ureteric distensibility should be tested before ureteroscopy. Primary ureteroscopy is recommended in distensible ureters because of its low complication rates and favorable outcome. Pre-stenting may be necessary before ureteroscopy in non-distensible ureters; secondary ureteroscopy may be safer and more feasible in these settings. 相似文献6.
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8.
Ahmed Adam Ruan de Jongh Charles Mathye Amit Satish Bhattu Haroun Patel 《The African Journal of Urology》2017,23(3):224-227
Introduction
The ‘encrusted and forgotten double J ureteric stent (JJ) phenomenon has always proven to be a challenging dilemma facing the attending urologist.Observation
Herein, we describe the first reported case of 3 encrusted stents within the same ureter, with an overall KUB score of 14 (K = 5, U = 4, B = 5). Complete (stent and stone) clearance was achieved using multiple combined, endo-urological procedures (sequentially) including; bladder stone laser lithotripsy, distal JJ stent coil resections, PCNL and prograde (flexible) ureteroscopy, followed by rigid and flexible retrograde ureteroscopy. The resulting reno-gram confirmed a 45% functioning ipsilateral system.Conclusion
The first report of 3 encrusted stents within the same ureter is presented. The prevention of JJ stent encrustation is crucial via adequate and appropriate patient counselling. In most patients with forgotten encrusted stents who qualify for endoscopic management, a multi-modality approach is required. 相似文献9.
Introduction
Incidence of lower ureteric injuries has increased due to proliferation of complex pelvic laparoscopic and ureteroscopic procedures.Objective
To describe our experience of laparoscopic ureteric reimplantation for lower ureteric strictures and ureterovaginal fistulas due to different aetiologies.Patients and methods
A total of 42 patients underwent laparoscopic ureteric reimplantation from January 2007 to December 2013 after preoperative evaluation by intravenous urography or CT urogram to delineate the site and length of stricture or ureterovaginal fistula. All the patients were followed up with ultrasonography and micturating cystourethrogram at 3 months. Out of the total 42 patients, 22 patients (group 1) underwent laparoscopic ureteric reimplant for lower ureteric stricture and 20 patients (group 2) underwent laparoscopic ureteric reimplant for ureterovaginal fistula.Results
There were 5 male and 37 female patients. The mean patient age was 43.5 ± 12 (range 24–62 yrs), mean operating time was 129 ± 11 (range 110–160) minutes, mean hospital stay was 2.8 (range 2–6) days and mean follow up period of 16 months (range 6–70). Two procedures had to be converted to open (one each in both groups). There were no major (Clavien grade III and above) intra-operative or post-operative complications. One of the failures in lower ureteric stricture group was managed by open reconstruction with boari flap.Conclusion
Laparoscopic ureteric reimplantation is an excellent modality for both lower ureteric strictures and ureterovaginal fistulas with long term good outcomes in addition to the advantage of lesser hospital stay and lesser comorbidities. 相似文献10.
A. Narváez C. Torrecilla S. Colom J.M. Cuadrado J. Fernández-Concha L. Riera F. Vigués 《Actas urologicas espa?olas》2018,42(5):316-322
Objectives
To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi.Materials and methods
This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24 Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up.Results
During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 228 mm2 (IQR 134-389); median operative time, 150 minutes (IQR 97-180); and median hospital stay, 5 days (IQR 5-15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete tesolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26-46).Conclusions
Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience. 相似文献11.
Ahmed Adam 《The African Journal of Urology》2018,24(4)
Objective
We aimed to describe a novel method to attain direction and control of the guidewire at the fingertip. This will serve to allow for ease of guidewire placement during open and combined open and endoscopic surgery.Subjects and methods
Over a gloved hand, a ureteric catheter is placed over the index finger, with the distal tip over the distal end of the index finger. Thereafter, adhesive tape is applied over the ureteric catheter (over the proximal, and middle phalanges) to allow for ease of flexion of the index finger. A second glove is then covered over the first one, with care not to rotate or dislodge the fixated ureteric catheter. A small hole is cut at the distal end of the glove, at the tip of the ureteric catheter to allow the guidewire to exit. The guidewire is advanced easily and can now be directed using the ‘loaded’ fingertip.Results
An easily manipulated system of guidewire insertion, with fingertip mobility and dexterity is obtained utilizing everyday consumables in a simple to perform fashion.Conclusion
A simple, novel method to allow flexibility and stress-free maneuvering to pass a guidewire, in open or combined open and endoscopic urological surgery is described. 相似文献12.
13.
Zhangqun Ye Guohua Zeng Huan Yang Kun Tang Xiaochun Zhang Hong Li Weibing Li Zhong Wu Lingwu Chen Xingfa Chen Xiankui Liu Yaoliang Deng Tiejun Pan Jinchun Xing Shusheng Wang Yue Cheng Xiaojian Gu Wenxi Gao Hua Xu 《European urology》2018,73(3):385-391
Background
Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones.Objective
To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo.Design, setting, and participants
We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin.Intervention
Participants were randomly assigned (1:1) into tamsulosin (0.4 mg) or placebo groups for 4 wk.Outcome measurements and statistical analysis
The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events.Results and limitations
Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p < 0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5 mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p < 0.001), required lower use of analgesics compared with placebo (p < 0.001), and significantly relieved renal colic (p < 0.001). No differences in the incidence of adverse events were identified between the two groups.Conclusions
Our data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5 mm, but no effect for stones ≤5 mm.Patient summary
In this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic. 相似文献14.
H. Alazaby M. Khalil R. Omar A. Mohey T. Gharib A. Abo-Taleb E. El-Barky 《The African Journal of Urology》2018,24(2):146-151
Objective
To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopy (F-URS) and laser lithotripsy as a treatment option for multiple renal stones greater than 1 cm.Patients and methods
Between June 2015 and February 2017, 42 patients who were treated with RIRS via F-URS and laser lithotripsy were evaluated. Stones were divided into two categories according to stone burden, 11–20 mm and 21–30 mm. Patient's demographics, stones characteristics, operative outcomes and complications were evaluated prospectively. Stone free rate (SFR) was determined 4 weeks postoperatively using findings on non-contrast computed tomography (NCCT).Results
Mean stones burden was 25.7 mm (range from 1.3 to 30 mm), 8 patients had 11–20 mm stones burden with SFR 100% and 34 had 21–30 mm stone burden with SFR 91.2%. The overall SFR was 92.8%. Multiple stones were two in 31 patients (73.8%), three in 9 (21.4%) and four in 2 (4.8%). Regarding stone number per kidney and SFR, SFR was 100%, 77.7% and 50% for kidneys with two, three and four stones respectively. In terms of stone location in the pelvi-calyceal system and corresponding SFR, there were renal pelvic stones in 6 (14.3%) patients with 100% SFR, upper calyx and or mid calyx and or renal pelvis in 12 (28.6%) with SFR 91.6% and lower calyx with or without other locations in 24 with SFR 91.6% also. Complications were minor and included, UTI in 3 patients (7.1%), hematuria of 4 days duration in 2 (4.8%), severe DJ stent irritative symptoms in one (2.4%) and minor ureteral perforations in one (2.4%).Conclusion
RIRS via F-URS and laser lithotripsy is a safe and effective treatment option with high success rate for patients with multiple renal stones of 11–30 mm stone burden. It is indicated when other stone treatment modalities contraindicated or have failed. However, for complex or challenging stones, staged procedures may be required. 相似文献15.
J.?Langenauer P.?Betschart L.?Hechelhammer S.?Güsewell H.?P.?Schmid D.?S.?Engeler D.?Abt V.?Zumstein
Objectives
To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi.Materials and Methods
NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics.Results
Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters.Conclusions
Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.16.
Sarthak Sinha Grace Yoon Wisoo Shin Jeff A. Biernaskie Duncan Nickerson Vincent A. Gabriel 《Burns : journal of the International Society for Burn Injuries》2018,44(2):263-271
Background
Randomized controlled clinical trials (CTs) are gold standard tools for assessing interventions. Although burn CTs have improved care, their status, publication frequency, and publication quality are not known.Objectives
(1) Characterize burn CTs by analyzing location, completion status, temporal trend, and funding sources. (2) Assess quality of trial reporting.Data sources
CT records were obtained from ClinicalTrials.gov and WHO’s CT Registry (searched May 2017). Publications were obtained from PubMed, Google Scholar, OVID MEDLINE, and ClinicalTrials.gov (searched June 2017).Publication appraisal
23-item rubric adapted from CONSORT and ICH E3 guidelines.Results
738 burn CTs were identified globally, of which majority were publically-funded (77%), ongoing (52%), and assessed behavioral, pharmacological, device-based, dietary-based, and biological/procedural interventions. Amongst the ended trials, 69 (28%) published their findings. Significantly fewer industry-funded trials published findings (14% vs 33% publically-funded). Quality of reporting was suboptimal, and most underreported categories were trial phase, severity, and sample size estimation.Limitations
Incomplete, outdated, and non-registered CTs which are difficult to track.Conclusions
Burn trials are proliferating in number, location, and interventions assessed. Only a small proportion are published and quality of reporting is suboptimal.Implications of key findings
Burn researchers should aim to register and report on all clinical trials regardless of outcome. Superior a priori design can reduce precocious termination and mandatory reporting of data fields can improve quality of reporting.Systematic review registration number: CRD42017068549. 相似文献17.
Background
Reconstruction of extensive penoscrotal defects is a surgical challenge. Resurfacing defects in highly complex three-dimensional structures and restoring their function are an essential part of the reconstruction of penoscrotal regions.Objective
We describe a technique using internal pudendal artery perforator (IPAP) pedicled propeller flaps created from the gluteal fold. This could be a reliable surgical option that maintains a natural looking scrotal pouch with minimal donor site morbidity and optimal sexual activity.Design, setting, and participants
We retrospectively reviewed data for 10 consecutive patients who had undergone penoscrotal reconstruction using IPAP pedicled propeller flaps between January 2011 and March 2015.Surgical procedure
The IPAP was identified using a hand-held Doppler ultrasound device. This was the pivot around which the flap was internally rotated more than 90° in a tension-free manner. The long axis of the flap was centred on the gluteal fold to provide a better-orientated donor site scar.Measurements
Complications and patient satisfaction with respect to size, colour match, scar appearance, and sexual activity were evaluated.Results and limitations
Anatomic and aesthetic penoscrotal reconstruction was performed without any major complications in the follow-up period (mean, 19.7 mo). The mean width of the IPAP pedicled propeller flaps was 6.7 cm, and the mean length was 11.7 cm. Partial distal flap necrosis occurred in only one case, and healed spontaneously. All of the patients were satisfied with the cosmetic and functional results.Conclusions
On the basis of reliable perforators, donor site morbidity, flap thickness, and a better orientated scar, our technique using IPAP pedicled propeller flaps created from the gluteal fold could be a reasonable surgical option for extensive penoscrotal reconstruction.Patient summary
The creation of pedicled propeller flaps using an internal pudendal artery perforator could be a reliable surgical option for reconstruction of extensive penoscrotal defects. The approach yields functional and aesthetically acceptable surgical results. 相似文献18.
Sarah-Claude Provençal Suzie Bond Elie Rizkallah Ghassan El-Baalbaki 《Burns : journal of the International Society for Burn Injuries》2018,44(8):1870-1881
Background
Evidence from clinical trials suggests psychological interventions should be considered as an adjunct to medications.Objective
The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of clinical hypnosis on pain, anxiety and medication needs during wound care in adults suffering from a burn injury.Data sources
Medline, PsychINFO, CINAHL, Embase, ISI, SCOPUS, Cochrane, and Proquest databases were searched for randomized controlled trials comparing hypnosis to other interventions during dressing change in adult patients.Data synthesis
Two independent reviewers extracted relevant articles and assessed their methodological quality. Only six studies met the inclusion criteria and were described in detail. Available data was pooled with Revman 5.3.Results
For the primary outcome, we found a statistically significant difference in pain intensity ratings favoring hypnosis (MD = ?8.90, 95% CI ?16.28, ?1.52). For the secondary outcomes, there was a statistically significant difference in anxiety ratings favoring hypnosis (MD = ?21.78, 95% CI ?35.64, ?7.93) and no difference in medication usage (MD = ?0.07, 95% CI ?0.32, 0.17).Conclusion
These results suggest that hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature. 相似文献19.
Introduction
A circumcaval ureter is a rare congenital anomaly in which the ureter passes behind inferior vena cava. VUR is rarely found in association with retrocaval ureter. Diagnosis and management are difficult. To our knowledge, we report a second case of retrocaval ureter with ipsilateral VUR.Observation
A 9-year-old child was admitted with complaints of right renal pain. After workup a diagnosis of retrocaval ureter with VUR was made. He underwent ureteroureterostomy with excision of retrocaval segment and is being managed conservatively for low grade VUR.Conclusion
In a child presenting with retrocaval ureter we should look for associated VUR. The problem is similar to pelviureteric junction obstruction and ipsilateral reflux. The management is to deal with obstruction first, followed by extravesical ureteric reimplanation or subureteric teflon injection for reflux. 相似文献20.