Ureteroscopic stone manipulation during pregnancy

We report on 2 successful cases of ureteroscopic stone manipulation during pregnancy using the rigid ureteroscope. These 2 cases are reported to show the utility of this technique when applied to low ureteral stones presenting in third trimester of pregnancy. We believe this technique is safe, both for the mother and the fetus, when carefully applied to selected individuals.     

Ureteroscopic manipulation of stones in the ureter: four years experience

Our experience of 223 ureteroscopies and stone manipulations is reported. Stone removal was successful in 82% of the cases whereof the stones were pushed back into the renal pelvis and subsequently managed with percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy in 24%. For distal stones the success rate was 88%. Reasons for failure were acute obstruction of the ureter and previous surgery or irradiation to the pelvis. In six cases (4%) strictures requiring treatment developed secondary to ureteroscopy. Ureteroscopy can be a tedious and difficult procedure with a considerable learning time. In experienced hands the rate of serious complications is low and the procedure is an alternative in the treatment of ureteric stones, especially in the distal part of the ureter.     

Right renal stone on the trajectory of upper left ureter

We report a 52-year-old woman with a right renal pelvic stone, mimicking a left upper ureteral stone in a kidney-ureter-bladder film. Computed tomography detected the exact anatomical location of the stone, which was not possible by intravenous urography and ultrasonography. In this study, we discuss diagnostic modalities of the urinary calculi in the light of the literature.     

后腹腔镜在输尿管切开取石术中的应用

目的探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。方法2006年12月至2009年9月,对66例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,以4-0人工合成可吸收线（SAS）间段缝合输尿管切口。结果66例手术均获成功,无中转开放手术,结石清除率100％。术后创腔引流液量少,无一例发生尿漏。3-5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1-33个月,平均16.3个月,超声复查显示肾积水明显好转或消失,无结石复发。结论后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小,疗效好、术后恢复快等特点,明显优于开放手术及其他手术,值得推广应用。     

Ureteroscopic resection of a fibrous polyp of the ureter]

From a new case of fibroepithelial polyp in a 41 year old woman, we reviewed literature on this rare and benign pathology, for which differential diagnosis with malignant tumor is most often obtained surgically. We emphasize both diagnostic and therapeutic advantages of endoscopic approach of this lesion.     

经腹直肌外侧缘直切口在输尿管取石术中的应用

为评估经腹直肌外侧缘直切口在输尿管中、中段取石术中的应用价值，报告经腹直肌外侧缘直切口取石５６例，结果除２例分离过程中出现腹膜损伤外，其余手术顺利，与同期经腰或腹部斜切口取石术进行比较，其平均手术时间、术后平均住院天数、术后切口痛，两者均有显著性差异（Ｐ〈０．０５）。认为经腹直肌外侧缘直切口具有组织损伤小，术后恢复快、无后遗切口痛等优点，是一种新的治疗输尿管上、中段结石的手术径路。     

Ureteroscopic injuries to the upper urinary tract

Kaufman reported a severe ureteral injury following ureteroscopy in 1984. His commentary summarizes the important messages in this article well: The intent of this report is not to denegrate the splendid advances in nephroscopy and ureteroscopy, but rather to introduce a sobering message that the patient must be informed of the inherent risk of such procedures and that the urologist must be wary of the problems that might occur. Problems have been known ever since endoscopic instrumentation was first introduced, and every experienced urologist has had his share of problems associated with stone extraction and other endoscopic procedures. Traditional teaching in urology has been to eschew manipulation of stones in the upper two thirds of the ureter because the lumbar ureter is mobile and more easily damaged by instrumentation than the pelvic segment. Endoscopic visualization of stones in the upper ureter allowing accurate grasping of calculi would appear at first to provide an element of security heretofore unachievable, but urologists nonetheless should be mindful of the hazards of any type of stone extraction from the upper ureter. Urologists must be ready and equipped to handle emergencies associated with new instruments and techniques, and the patients must be apprised of the exigencies. "Caveat emptor" (buyer beware) could not be a more apt or timely maxim in our specialty. Ureteroscopy has greatly aided many patients, and a large number of urologists have integrated this procedure into their daily practices.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of hip flexion on the course of the ureter. Ureteroscopic implications

Early experience with the rigid ureteroscopy has identified two regions of the ureter that can be difficult to negotiate, the first at the vesicoureteric junction and the second anterior to the iliac bifurcation. Placing the patient in varying degrees of lithotomy has been proposed to overcome these problems. In this study the effects of these alterations of hip flexion on the course of the ureter have been studied by radiographs in patients undergoing ureteroscopy. The lower ureter was demonstrated to possess two curves, an upper curve at the iliac bifurcation which straightens with increasing degrees of lithotomy and a lower vesical curve in the pelvis which is unaltered by patient position. These findings and their clinical significance are described.     

Ureteral reconstruction: small intestine submucosa for the management of strictures and defects of the upper third of the ureter

PURPOSE: We evaluated the effectiveness of small intestine submucosa in ureteral reconstruction. MATERIALS AND METHODS: We report an experimental study in 6 female pigs weighing between 50 and 60 pounds. The animals were anesthetized, midline laparotomy was performed and two-thirds of the diameter of the upper third of the left ureter were incised parallel to the ureteral axis, leaving intact only a third of the ureteral wall for a segment of 7 cm. A 5Fr double-J*; stent was positioned to secure patency at all times. The created gap was then bridged with an small intestine submucosa patch in a cylindrical format, which was subsequently sutured to the proximal and distal ureteral segment. The right ureter served as our control and simple intubated Davis ureterotomy was performed. RESULTS: All animals survived the whole followup of 7 weeks. Histologically there was evidence of epithelial regeneration along the segments reconstructed with small intestine submucosa, supported by a well vascularized collagen and smooth muscle background. There was no evidence of foreign body reaction to the graft material. In vivo patency was confirmed by retrograde pyelography in the bridged ureters 7 weeks after the initial procedure. All the ureters without an small intestine submucosa bridge had ureteral stenosis without evidence of epithelial regeneration. CONCLUSIONS: The use of small intestine submucosa is a novel, effective material for the scaffolding of ureteral defects and/or strictures of the upper ureteral segment in the pig model.     

Ureteroscopic manipulation of ureteral calculi: Experience in a regional hospital

ObjectiveWe report our experience in the treatment of ureteral calculi by ureteroscopic stone manipulation (URS-SM).Materials and methodsIn 2009, 420 patients with ureteral calculi underwent a total number of 438 URS-SMs with a lithoclast, holmium laser, or both. All patients were evaluated by plain radiography, sonography, and excretory urography prior to the operation. Follow-up studies included plain film and sonography that were done immediately and 2 weeks after the operation.ResultsThe overall stone-free rate was 95.4%. According to the location of the stones, respective success rates for upper, middle, and lower ureteral stones were 88.4%, 97%, and 100%. The most common cause of failure was stone migration (4.5%).ConclusionUreteroscopic lithotripsy is a trustworthy procedure for treating ureteral calculi of different sizes at all levels, and it can be efficaciously and safely performed in expert hands.     

The impact of pelvicaliceal features on problematic lower pole stone clearance in different age groups

Aim Our aim was to evaluate the impact of pelvicaliceal variables in pediatric and adult age groups who underwent SWL for lower caliceal calculi. Methods 25 pediatric and 78 adult patients treated with extracorporeal shock wave lithotripsy (SWL) between 1996 and 2004 were enrolled into the study after exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery. Lower pole infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW) and pelvicaliceal volume were measured from pre-SWL intravenous urography. The pelvicaliceal stone load (PSL) index implicating the stone burden of each patient described as the relationship between stone volume and total estimated pelvicaliceal volume for stone-bearing kidney was also calculated. Results Sixty-eight percent of adult and 80% of pediatric patients became stone-free after SWL. The statistical insignificance between PSL index (p = 0.097) of two groups shows that both groups shared a similar stone burden. According to SWL outcome, mean IPA values of stone-free and residual patients were 46.85° and 30° in pediatric group, respectively (p = 0.01), whereas these values were 48.08° and 43.06° in the adult group, respectively (p = 0.352). In the pediatric age group, stone-free and cumulative success rates increased with increasing IPA but this correlation was statistically insignificant (p: 0.263). Conclusions Lower caliceal anatomy has a higher impact on stone clearance after SWL in pediatric patients and urologists can expect better SWL outcomes from pediatric population with solitary lower caliceal stone than adults under the same conditions.     

急诊输尿管镜钬激光碎石治疗输尿管下段结石急性肾绞痛

目的:探讨急诊输尿管镜钬激光治疗因输尿管下段结石导致急性肾绞痛的效果。方法:报告130例应用输尿管镜钬激光碎石治疗因输尿管下段结石导致的急性肾绞痛患者的临床资料。结果:3例进镜失败,1例因输尿管下段狭窄输尿管镜无法到达结石部位手术失败,余126例均碎石成功,并于术后当天有效缓解肾绞痛。肾绞痛缓解率97%,碎石成功率97%,4周后结石排净率96%。结论:急诊行输尿管镜钬激光碎石术对治疗因输尿管下段结石导致的急性肾绞痛是一种安全、高效的方法,并可有效排石,可作为本病的首选治疗。