Rigid and flexible ureteroscopy. Apropos of 200 consecutive cases

191 patients underwent a total of 200 ureteroscopies. Indications for these were as follows: ureter stones (172 cases); ureteral anomalies undiagnosed by other methods (20 cases); therapeutic ureteroscopy (8 cases). Stones: ureteroscopy for stones was carried out using either a rigid instrument (156 cases) or a flexible ureteroscope (16 cases). The localization of the stones was pelvic (123 cases), iliac (18 cases) or lumbar (10 cases). The stones were either removed directly using the basket under visual control (74/139 cases), or removed by ultrasonic/laser fragmentation (65/139 cases). As regards the rigid ureteroscope, success rates were 89% (139/156); 15 patients required additional therapy. Repeated ureteroscopic interventions always provided positive results. As concerns flexible ureteroscopy, we only had one positive result; 15 failure cases warranted repeated additional treatments. In three instances, failure with flexible ureteroscopy was corrected by using the rigid device during the same surgical period. We observed a single case of major complication in this series, i.e., a laterovesical urinoma which necessitated surgical drainage and was linked to the lack of ureteral drainage following ureteroscopy. Diagnostic ureteroscopic examinations: in 20 instances, ureteroscopy allowed to diagnose with precision the ureteral abnormality. No complication was reported following diagnostic ureteroscopy. Therapeutic ureteroscopy: such interventions were carried out to introduce a guide into the renal cavities (3 cases); to remove a double J stent, the lower extremity of which had moved up into the ureter (3 cases); or to carry out endoscopic ureterotomy (2 cases). Ureteroscopy is a safe and reliable method for the treatment of ureteral stones, and more particularly of stones localized in the distal part of the ureter.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rigid ureteroscopy for the treatment of ureteral calculi in children

PURPOSE: We assess the safety and efficacy of rigid ureteroscopy for the treatment of pediatric ureterolithiasis. MATERIALS AND METHODS: The records of 33 children with an average age of 7.4 years (range 9 months to 15 years) treated with rigid ureteroscopy between May 1995 and July 2003 were reviewed. In 35 ureteral units use of a rigid 6.9 to 10Fr ureteroscope was planned for treating stones at various levels of the ureter. Stones were located in the upper ureter in 6 cases, middle ureter in 3 and lower ureter in 26. Dilatation of the ureteral orifice was necessary in 11 cases. RESULTS: Stone size varied from 3 to 10 mm (mean 5.3). In 33 patients (94%) all stone fragments were removed successfully. Stones were fragmented with pneumatic lithotripsy in 20 cases and removed by forceps without fragmentation in 13. In 1 child an upper ureteral stone migrated up to the kidney during ureteroscopy but following extracorporeal shock lithotripsy therapy she was rendered stone-free. In another child it was not possible to remove the stone. In a 9-month-old female patient with bilateral stones it was not possible to enter the left ureter because of a tight orifice resistant to balloon dilation. At the end of the procedure a 3 or 4Fr ureteral or a 4.8Fr Double-J (Medical Engineering Corp., New York, New York) stent was left in place for 3 days to 3 weeks in 12 cases. There were no cases of ureteral perforation. Of the patients 31 were followed for 1 to 36 months. No incidence of vesicoureteral reflux was detected in 9 who underwent postoperative cystography. CONCLUSIONS: After becoming experienced and meticulously working with finer instruments in adults, rigid ureteroscopy can be a safe and efficient treatment for ureteral stones in every location in children.     

Rigid ureteroscopy for ureteral stones: factors associated with intraoperative adverse events

PURPOSE: To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy. PATIENTS AND METHODS: We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables. RESULTS: Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones >5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications. CONCLUSIONS: Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.     

Implantable direct intravenous access: technic, complications, outcome. Apropos of 237 cases

From june 1983 to december 1987, 441 direct accesses were implanted, 237 intravenous, 51 intraperitoneal and 153 intra-arterial. The surgical procedure, the indications, the post-operatory and later complications and the issue of the direct intravenous accesses implanted by the same surgical team are presented. 237 direct access implants were placed intravenously in 228 patients. There are many indications for implanting direct access: absence of a superficial venous network, continuous chemotherapy, preservation of the superficial venous network, thrombosis of the hepatic artery after, inoperable hepatic metastasis (jaundice). Direct venous access was implanted for many pathologies essentially for breast cancer (120 cases), large bowel cancer (36 cases). Surgical procedure for direct intravenous access is easy with catheter's control with fluoroscopy monitoring. Only rarely did any later complication occur when using the direct intravenous access (12 cases) representing 5% of all complications. Certain precautions should be taken to reduce the number of complications. Prophylactic antibiotic therapy, surgical procedure for implanting the direct access excision of excess fatty subcutaneous tissue, minutious skin disinfection, heparinization, avoid using the chamber for blood sampling, use intra-arterial direct access. Direct access is used either for sequential chemotherapy or for continuous protocols which vary in length.     

Flexible ureteroscopy. Diagnostic and therapeutic significance. Apropos of 15 cases

The authors analyse the results of a preliminary report of 15 cases of ureteric stones treated by flexible ureterorenoscopy and one case of radiolucent renal stone in the left lower renal calyx. Stone fragmentation was complete in 11 cases with 1 small residual fragment in the lower ureter, 1 perforation was immediately operated without any further complication and in one case, it was impossible to advance into the ureter. Flexible ureterorenoscopy is valuable for diagnosis of filling defects in the lower calyx and for treatment of stones in the upper and middle ureter.     

Endometriosis and ureteral stenosis. Apropos of 4 cases

If endometriosis is particularly well known by Gynecologists, ureteral complications of this disease are very rare. We have had the occasion to observe four cases of ureteral stenosis by extrinsic compression of a pelvic endometriosis, and about these four cases, we have reviewed one hundred and fifty six cases in literature. We have emphasize that the fibrosis provoked by endometriosis can look like a neoplastic lesion, and get involved in very heavy therapeutic gestures. We insist on the fact that every endometriosis discovered should be on surgery of kidneys and ureters.     

Rigid ureteroscopy for the treatment of ureteric calculi: experience in 120 cases

Over a 1-year period, rigid ureteroscopy has been used to retrieve ureteric calculi in 120 patients. The technical details, causes of failure and the complications are described. An initial success rate of 78% was obtained. It was concluded that ureteroscopy should replace blind procedures for the extraction of ureteric stones.     

输尿管电切镜在输尿管梗阻性疾病治疗中的应用

目的　探讨输尿管电切镜在输尿管梗阻性疾病治疗中的应用价值。方法　对 2 0 0 0年 11月至 2 0 0 2年 10月收治的 5例输尿管癌、2例原发性输尿管息肉、12例输尿管炎性息肉及 5例输尿管狭窄患者 ,采用R .Wolf输尿管电切镜治疗。术后输尿管内留置双J管引流 4～ 8周 ,输尿管癌患者术后配合膀胱灌注化疗。结果　所有患者术后均恢复正常 ,随访 3个月～ 2 .5年 ,无 1例复发。结论　输尿管电切镜治疗输尿管梗阻性疾病具有创伤小、恢复快等优点 ,是一项安全、有效的腔内新技术。     

Treatment of ureteral calculi with rigid ureteroscopy. Report of 67 cases

PURPOSE: To evaluate the results obtained by rigid ureteroscopy to treat ureteral calculi. MATERIALS AND METHODS: Between May 1998 and September 2000, 63 patients underwent 67 rigid ureteroscopies (URS) with three endoscopic retreatments and one bilateral URS, for 48 distal, ten mid and nine proximal ureteral calculi. RESULTS: After URS 77.6% of the patients were free of the stones. Success rate was respectively 85.4%, 60% and 55.5% in distal, mid and proximal uretero. Morbidity was 10.4% and there have been one stricture treated by endoscopy. CONCLUSION: Our series demonstrates that rigid URS is safe and effective procedure to treat distal, ureteral calculi. Thus, it should be considered a treatment of choice for distal ureteral calculi.     

Our experience of surgery for common bile duct lithiasis. Apropos of 370 cases]

We report a series of 370 common bile duct stones in which the diagnosis was made preoperatively in 56% of cases. We performed: choledochotomy with Kehr drainage in 70% of cases, biblio-intestinal anastomosis in 20%, transcystic extraction with drainage via the same route in 7%, surgical sphincterotomy in 2%. The global mortality was 2.7% related to preexisting deficiency states. The residual stone rate was 5.6%.     

Postoperative eventrations. Apropos of 247 surgically treated cases

The 247 eventrations operated upon concerned 230 patients (60% women and 40% men) mean age 54.5 years. Eventrations were large (collar greater than 10 cm) in 18, 5% and were in the median line in 81%. Serial laparotomies by the same approach had been performed in 21%, the principal causes of eventration being biliary and gynecologic surgery. Parietal sepsis developed in 31,5% of cases after operation for the original affection. Classical favoring factors found included obesity (51%), multiparity (42% of women) and chronic lung disease (14%). Preoperative preparation involved the use of Goni Moreno's progressive pneumoperitoneum in 18,5% of patients. Procedures used were parietal repair by raphe (22%), the same but with the addition of a dacron prosthesis (6%) or the large dacron tulle prosthesis for wide reinforcement of the visceral sac (67% of cases). Early sepsis was a slightly more frequent occurrence after dacron tulle, predisposing factors being the prosthesis itself, a previous history of parietal sepsis, swabs and the number of Redon tubes. After use of dacron tulle complications were mainly also hematoma (3.2%) and skin necrosis (2,6%). Postoperative course in general was uncomplicated in 91% of the 247 operations. Follow up of 67% of operated patients for a mean of 5 1/2 years showed recurrence in 50% of raphe procedures and 18.5% of prosthesis implantations; factors of aseptic recurrence (16,5%) were multiparity and chronic lung disease. Delayed sepsis after dacron tulle use affected 8% of patients and were related to chronicity of early sepsis, nonresorbable sutures and sepsis complicating the primary laparotomy. Doming of the parietal wall was noted in 4% of cases repaired by prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radical reconstructive hemorrhoidectomy. Apropos of a new technic

On the basis of personal experience of the surgical treatment of hemorrhoidal lesions of the third stage, the Authors describe a new technique for radical hemorrhoidectomy. Sixty-one patients (67% males and 33% females) affected by hemorrhoidal lesions of the third (96%) and second (2%) stage were treated using this method at the INRCA Surgical Centre in Ancona. 19% of patients also suffered from chronic anal fissure which were treated by internal lateral sphincterotomy. No major complications were observed, although minimum postoperative bleeding (17%) and a congestive edematous suffusion (20%) were observed, as was the partial leakage of the mucous-cutaneous suture in 7% of cases. The follow-up after 24 months of 50 patients revealed only one relapse (2%) and persistent soiling for approximately 90 days in 22% of cases.     

Mechanical circular colorectal anastomosis using a transanal approach. Apropos of a series of 51 cases

Automatic circular suture forceps offer new technical possibilities for the confection of colorectal anastomosis. A retrospective study was conducted in 51 patients, representing a homogeneous group of anastomoses performed by the same surgeon using the same operative technique and with routine review by barium enema examination on the 8 th postoperative day. Technical difficulties during operation were encountered in 10 patients (19.6%) requiring supplementary sutures in 3 cases and protective colostomies in 3 others. Review examinations revealed anastomotic dehiscence in 7 cases (13.7%), only 3 (5.9%) of these radiologic fistulae provoking clinical manifestations, and only one of these (1.9%) necessitating recovery operation. Perfect compliance with conditions of use of the mechanical forceps and a minute technique identical to those of manual sutures produced excellent early result with circular mechanical suturing using EEA forceps when compared with manual suturing methods. This was particularly true in Goligher's series in which there were 51% of radiologic fistulae. Under certain difficult conditions, the use of EEA forceps simplifies performance of a colorectal anastomosis, mechanical anastomosis using the circular forceps constituting an undeniable technical progress in colorectal surgery with conservation of anal sphincter.