Purpose
The development of 1.9F or smaller electrohydraulic lithotripsy probes has facilitated the use of this form of lithotripsy via miniature rigid and flexible ureteroscopes. We report our experience with ureteroscopic intracorporeal lithotripsy using 1.9F electrohydraulic lithotripsy probes.Materials and Methods
A total of 45 patients (32 ureteral and 57 renal calculi) underwent retrograde rigid (microscopic to 6F short) or flexible (7.5 and 9.4F) ureteroscopy with electrohydraulic lithotripsy using 1.9F electrohydraulic lithotripsy probes. In 17 patients (38 percent) there were 37 lower pole caliceal calculi (41 percent). Stone size ranged from 3 to 30 mm. (mean 8.5).Results
Electrohydraulic lithotripsy resulted in successful fragmentation (that is 2 mm. or smaller fragments) in 98 percent of patients overall. It was successful after failure of HM-3 extracorporeal shock wave lithotripsy in 10 patients and after failed lithotripsy with the 140 mJ. tunable dye laser in 7. Electrohydraulic lithotripsy resulted in successful fragmentation of 94 percent of lower pole caliceal stones. No intraoperative complications and no significant ureteral or renal mucosal damage were noted. Fever developed postoperatively in 2 patients (4.4 percent) with negative urine cultures. Postoperatively an indwelling stent was placed for 2 weeks or less in 71 percent of patients and no stents were placed due to preoperative stenting in 29 percent. Average hospital stay was 0.8 days (range 0 to 4). Followup imaging in 38 patients (84 percent) at a mean of 8.7 months (range 2 to 28) revealed stone-free rates of 92 percent overall and 87 percent in patients with lower pole renal calculi. No patient had a ureteral or infundibular stricture postoperatively.Conclusions
The development of 1.9F or smaller electrohydraulic lithotripsy probes provides the urologist with a safe, highly effective and inexpensive method for performing intracorporeal lithotripsy throughout the entire upper urinary tract via rigid or flexible ureteroscopes. Furthermore, for the ureteroscopic treatment of lower pole renal calculi electrohydraulic lithotripsy is the only form of intracorporeal lithotripsy sufficiently malleable to allow routine access. 相似文献Purpose
To evaluate the feasibility and usefulness of extracorporeal lithotripsy endoscopically controlled by simultaneous flexible ureterorenoscopy (LECURS) and combined with Holmium laser lithotripsy for kidney stones surgery.Methods
Retrograde flexible ureteroscopy allowed stone visualization and intrarenal relocation when possible. Extracorporeal schock wave lithotripsy (ESWL) was performed under direct vision allowing constant focal zone adjustment for optimal stone fragmentation. Holmium laser lithotripsy was used simultaneously when necessary. Post-operative assessment included ultrasound at day one and abdominal CT scan 3 weeks later to evaluate for residual fragments.Results
Six patients with kidney stones were recruited including 3 with relative contraindication to ESWL. One patient had a stone beyond an infundibular stenosis and 2 had multiple stones in a horseshoe kidney with an uretero-pelvic junction (UPJ) stricture. A 100 % stone fragmentation rate was obtained. Post-operative ultrasound was normal in 5 patients and showed slight peri-renal infiltration in the other. One patient developed an obstructive pyelonephritis requiring antibiotics and changing a double J to a ureteral catheter. No other complications were noted. Three patients (50 %) were stone free after LECURS. Three patients underwent a second-look procedure for small (<3 mm) retained residual fragments. No damage was seen with the digital ureteroscopes, laser fibers or stone baskets.Conclusions
This initial experience with LECURS has shown to be feasible and safe. This opens the opportunity for further evaluation of this approach in order to improve outcomes of both approaches. 相似文献Objectives
The objectives of this study are to present our experience with retrograde intrarenal surgery for management of renal calculi in children less than 7 years old and to determine its safety and efficacy in this age group.Methods
Patient demographics, stone location and size, use of ureteral access sheath, stone-free status, complication rates, and follow-up were evaluated.Results
A total of 16 patients (9 boys and 7 girls; mean age, 4.2 years) underwent 17 procedures. The mean stone size was 11.5 mm (8-17 mm). Flexible ureteroscopy and laser lithotripsy were performed in all cases regardless of stone location. Dilation of the ureteral orifice was required in 5 cases (29.4%), and ureteral access sheaths were placed in 3 patients (17.6%). With a mean follow-up of 10.3 months, 88% of the children were stone free. The success rate for stones less than 10 mm was 100% and 81.8% for stones 10 mm or more (P < .05). There were no major complications, but there was 1 case of perforation and extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement.Conclusions
Retrograde intrarenal surgery is a safe and effective method for the treatment of intrarenal calculi, and it achieves reasonable results with minimal complications in children less than 7 years old. 相似文献Purpose
We prospectively studied the usefulness of contrast material to facilitate extracorporeal shock wave lithotripsy (ESWL†) of ureteral calculi in situ.Materials and Methods
Followup was available for 67 consecutive patients with ureteral calculi treated in situ (without ureteral catheterization) on an unmodified Dornier HM-3 lithotriptor. In 30 patients radiographic contrast material was administered to facilitate targeting of calculi. Intraoperative obstruction was determined by the lack of passage of contrast material beyond the calculus during treatment. Immediate postoperative obstruction was defined as prolonged retention of contrast material on a postoperative radiograph.Results
Passage of contrast material beyond the calculus was note noted in 9 of 26 evaluable patients, 5 of whom appeared to have obstruction on postoperative radiography. Of these 5 patients 3 required immediate hospitalization for pain control, compared to none of those without intraoperative obstruction. The stone-free rates after ESWL, including success following adjunctive measures or repeat ESWL, were 83, 100 and 87% for calculi in the proximal, middle and distal ureter, respectively. Neither use of contrast material, nor intraoperative or postoperative obstruction altered the eventual success of ESWL.Conclusions
The administration of intravenous contrast material during ESWL allows for effective treatment of ureteral calculi that otherwise could not be imaged adequately without ureteral catheterization, and provides information valuable for short-term prognosis. 相似文献Purpose
We compared our experience with ureteroscopic stone basket manipulation under fluoroscopic guidance to ultrasound ureterolithotripsy for distal ureteral stone removal.Materials and Methods
Retrospectively, we analyzed the medical records of 981 patients with ureteral calculi between January 1994 and December 1995, of whom 483 (49%) were treated for stones in the lower ureter and constituted our study group. The decision of when to perform lithotripsy (group 2) versus a basket procedure (group 1) was based on a prospective nonrandomized study and both groups were compared historically. All 322 patients in group 1 (mean age 49 years, range 14 to 86) primarily underwent ureteroscopic stone basket manipulation using the 4-wire Segura* basket. If the calculus could not be removed with the basket and another procedure was necessary, the case was considered a failure. The 161 patients in group 2 (mean age 37 years, range 14 to 74) underwent initially ultrasound ureterolithotripsy for stone fragmentation followed or not by removal of the fragments with the basket. Stone size did not differ significantly between groups 1 (mean 0.9 cm., range 0.6 to 1.7) and 2 (mean 0.8 cm., range 0.7 to 2.0). Ureteroscopy was performed in both groups with epidural anesthesia and on an outpatient basis in the majority of cases.*Van-tec, Spencer, Indiana.Results
The stone-free rate after 1 procedure was 98.1 and 95.6% in groups 1 and 2, respectively. For group 2 versus group 1 the operative time was longer (mean 50, range 25 to 90 versus mean 19 minutes, range 11 to 40, respectively, p <0.001), the complication rate was greater (16.1 versus 4.3%, respectively, p <0.001) and average hospital stay was longer (2.1 versus 0.15 day, respectively, p <0.001).Conclusions
Ureteroscopic stone treatment with basket manipulation under fluoroscopic guidance or ultrasound ureterolithotripsy provided a high stone-free rate. However, stone removal with the basket manipulation technique should be considered the first choice for treatment of small distal ureteral calculi based on the minimal morbidity, and short operative and recovery times. 相似文献Purpose
The continued evolution of stone treatment modalities, such as endourologic procedures, open surgery and shock wave lithotripsy, makes the assessment of continuous outcomes are essential. Pediatric urolithiasis are an important health problem allover the world, especially in Middle East region. We evaluate the safety, efficacy and factors affecting success rate and clearance of stones in children treated with shock wave lithotripsy.Patient and methods
Between 2005 and 2010, a total of 500 children with stones in the upper urinary tract at different locations were treated by Extracorporeal shock wave lithotripsy (ESWL) in our department, Sohag University, Egypt. We have used the Siemn??s Lithostar Modularis machine, Germany. A total of 371 boys and 129 girls with the average age of 8.63?±?5?years, and a range from 9?months to 17?years were included in this study. Diagnosis of their urinary calculi was established either by the use of abdominal ultrasound, plain X-ray, intravenous urography, or CT scan. The stones were located in the kidney in 450 (90%) patients; 298 (66%) pelvic, 26 (5.7%) upper calices, 57 (12.6%) mid calices, and lower calices in 69 (15.3%) patients. The average of their stone sizes was 12.5?±?7.2?mm. The other 50 children their stone were located in the proximal ureteral stones in 35 patients (70%); middle third in 5 (10%) patients and in the distal ureter in 10 (20%) patients. The average ureteral stone size was 7.5?±?3.2?mm. All children were treated under general anesthesia with adequate lung and testes shielding using air foam. We treated the distal ureteral stones of young children in the supine position through greater sciatic foramen and lesser sciatic foramen as the path of shockwave instead of prone position, which is not a comfortable or natural position and could adversely affect cardiopulmonary function especially under general anesthesia. Localization was mainly done by ultrasound, and X-ray was only used to localize ureteral calculi. For follow-up, we have used abdominal ultrasound, plain X-ray, and CT scan if needed to confirm stone disintegration and clearance.Results
The overall success rate for renal and ureteral calculi was 83.4 and 58.46%, respectively. The re-treatment rate was 4% in renal group and 28% for the ureteral group. No serious complications were recorded in our patients. Minor complications occurred in 15% of our patients; renal colic was reported in 10% of our treated patients, and repeated vomiting was reported in 5% that respond to antiemetics. In the renal group; children with history of pervious urologic surgical procedures had low success rate of stone clearance after ESWL. In the ureteral group stone burden, stone location, had a significant impact on stone clearance outcome.Conclusion
This study showed that SWL in pediatric age group for both renal and ureteral stone is cost effective, safe with an acceptable re-treatment rate; however children with large stone burden or previous urologic surgery have low success rate. 相似文献Background
Retrograde intrarenal surgery (RIRS) is a known option for the treatment of upper tract calculi with an excellent success. However, the reports of RIRS in prepubertal children are limited. In this study, we evaluated the factors which affected the success rate and the complications of RIRS at renal stone treatment in childhood.Methods
We retrospectively reviewed the records of children under 14 years old who underwent RIRS for renal stone disease between January 2009 and December 2012. Patients’ age, gender, body mass index (BMI), stone size, stone location, stone number, intraoperative complications, stone free status, postoperative complications were recorded.Results
There were 80 ureterorenoscopic procedures performed in 58 renal units of 47 children (23 males and 24 females). The patients’ ages ranged from 8 months to 14 years (mean age 4.7 ± 3.4 years). There was a difference in the distribution of symptoms in age groups. UTI was higher in the 1–4 years age group, abdominal pain was seen mostly in children aged 5–14 years. Multiple stones (included staghorn stone) were noted in 60.4% of patients. In 27.6% of patients, ureteral stones were accompanied by renal stones in our series. In the infancy group, cystine and staghorn stones were more frequently seen, mostly bilateral. After a single ureteroscopic procedure for intrarenal stones in children, we achieved stone free status in 50.9% of the ureters (n = 26). After the repeated sessions, the stone clearance rate reached to 85.1%.Conclusion
Retrograde intrarenal surgery can be used as a first line therapy to treat renal stones in children. This is especially important if an associated ureteral stone is present that requires treatment; or in patients with cystinuria, which is not favorably treated with ESWL. Complications were seen more frequently in patients with cystine stones. Extravasation was noted more frequently in patients admitted with UTIs. There was a significant relationship between the conversion to open procedures and the age groups, with most procedures occurring in infancy. The parents should be informed about the probability of multiple procedures to achieve stone free status. 相似文献Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations.
Methods88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020).
ResultsOverall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1–3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependant on the stone location. No laser induced complications were noticed.
ConclusionsThe use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size.
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