Lasertripsy in the treatment of ureteral lithiasis

We submit our experience with laser treatment for ureteral lithiasis. We used the laser Candela MDL 2000 for the treatment of 62 lithiases (40 at the pelvic ureter, 16 at the iliac ureter and 6 at the lumbar ureter) in 58 patients. A semi-rigid Dretler or Gautier multiscope were used. Of the 62 calculi complete fragmentation was not achieved in 4 and they were ascended to the renal pelvis for subsequent ESWL. In 51% of the patients the ureteral catheter was left for 24 hours, and a double-J stent was used in two cases. Complications: 2 simple perforations of the ureter that were solved by means of a double-J stent; occasionally petechiae on the ureteral wall and two cases of rupture of the laser fibre tip that was easily removed with a forceps.     

Percutaneous endourologic treatment of obstructive ureteral lithiasis in renal transplant

Donor graft lithiasis is a unusual complication of renal transplantation, however, it is associated to a high morbidity. This pathology is due to several causes such us: metabolic factors, infectious disease, drugs, foreign bodies or transferred in the donor graft. The objective of the treatment is to remove the lithiasis without damaging the renal unit. We report the successful percutaneous anterograde treatment of an ureteral obstructive hard calculi, in renal allograft.     

High energy shock waves in the treatment of delayed and nonunion of fractures

Summary The treatment of delayed and nonunion of fractures by a single extracorporeal dose of high energy shock waves generated in a water medium and focused on the fracture site is reported. The shock waves break up sclerotic bone by producing microfissures and numerous bony fragments because of the difference in impedance between bone (and calculi) and soft tissues. Osteogenesis is stimulated and contributed to union in 70 out of 82 fractures within a reasonable time. Treatment was given as an outpatient with regional anaesthesia; there were no side effects or complications.

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Résumé Présentation d'une méthode nouvelle de traitement des pseudarthroses et des retards de consolidation, non invasive, non chirurgicale et pouvant être réalisée en une seule séance, sous anesthésie régionale, sans hospitalisation. Les auteurs utilisent des ondes de choc de haute énergie, générées en milieu aqueux, qui traversent les parties molles et atteignent le foyer de fracture. Du fait de la différence d'impédance entre l'os (ou les calculs) et les tissus mous, le choc brise les extrémités osseuses sclérosées, produisant des micro-fissures et de multiples petits fragments osseux, ce qui stimule l'ostéogénèse. La consolidation a été obtenue dans des délais raisonnables dans 70 cas sur 82. Il n'y a eu ni effets indésirables, ni complications.

     

Prognostic factors of spontaneous expulsion in ureteral lithiasis

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment.ObjectivesTo evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone.Material and methodsA retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance.Results34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR= 1,823, p=0,013), size (<5 mm, OR=3,37, p<0,02), and medication (combination of alpha blockers and NSAIDs, OR= 8,70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0,006) and medication (p<0,001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8,21 (95% CI 3.37–20,01) the possibilities of spontaneous expulsion.ConclusionsSize of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.     

Elective treatment of ureteral stones with extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy was used as an elective treatment in 128 ureteral stones. Of the 108 with adequate follow-up, 88% were successfully disintegrated. Ureteral catheters proved to be particularly useful for more precise stone localization and as a mechanical means to push the calculi inside the renal cavities or to create a fluid interface around them, in order to increase the efficiency of the shock waves. When ureteral catheters were used a success rate of 95.5% was observed, as opposed to 82.8% when stents were not used (p less than 0.05).     

Ureteroscopic treatment of ureteral lithiasis with pneumatic lithotripsy: analysis of 287 procedures in a public hospital

Ureteroscopes and different lithotripsy methods have greatly improved the urologists ability to treat ureteral stones, regardless of their location in the ureter. We retrospectively reviewed our experience with ureteroscopic pneumatic lithotriptor in 287 patients with ureteral calculi. Ureteroscopic stone treatment was performed between October 1999 and May 2004. Of 221 patients with distal ureteral calculi, 209 (group 1), and 58 of 66 patients with upper ureteral calculi (group 2) were treated successfully by ureteroscopy alone. In group 1, seven migrated stones (to the upper urinary tract) were successfully treated by ESWL later. There were five-treatment failures due to ureteral perforation which consequently required open ureterolithotomy. In group 2, there were five patients with migrated stones; two of them were sent to a percutaneous nephrolithotomy center because of previously unsuccessful ESWL attempts. Three of these with migrated stones were treated by ESWL later. In three patients, we switched to open ureterolithotomy because of ureteral rupture that required surgical repair. Ureteroscopic pneumatic lithotripsy is a safe and effective treatment modality for ureteral calculi.     

Endoscopic treatment of ureteral lithiasis. Our experience with 360 retrograde uretero-renal endoscopies in the last ten years

Presentation of results and complications obtained in 360 procedures of transuretral ureterorenoscopy (URS) in ureteral lithiasis performed in our unit from january 1990 to august 2000 in 354 patients: 55% female and 45% male. A rigid ureteroscopy Storz 10.5 Ch. was used and intracorporeal lithotripsy was necessary in 17.31% of cases. URS indications were always treatment of ureteral lithiasis, pelvic ureter localization in most cases (70.33%) being 93.05% the percentage of overall success and with a significant decrease when the calculus was located in the upper third of the ureter. Serious complications were only 3.05% of cases and endoscopic surgery was necessary in three cases of ureteral stenosis. In our experience, URS is our technique of choice for treatment of lower and medium third of the ureter where the percentage of success we have obtained were 98.99% and 95.83% respectively.     

Extracorporeal shock waves in the treatment of nonunions

BACKGROUND: Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of nonunions. To date, no prospective, randomized trial has been conducted to show the efficacy of this form of treatment. METHODS: This study was performed to determine the value of extracorporeal shock wave therapy for nonunions. Previous published results in the literature and our own clinical results were analyzed and related to the natural history of bony union. RESULTS: No study has proven that extracorporeal shock wave therapy improves bone healing. Clinical studies reporting the acceleration of union after application of shock waves instead seem to misinterpret the natural history of bony union. CONCLUSION: No evidence supports the treatment of pseudarthroses with extracorporeal shock waves. A randomized, prospective, clinical trial with a control group has to be performed before a final decision can be made regarding this indication for extracorporeal shock wave therapy.     

冲击波治疗骨不连的研究

目的 通过体外冲击波疗法（ｅｘｔｒａｃｏｒｐｏｒｅａｌ ｓｈｏｃｋ ｗａｖｅ ｔｈｅｒａｐｙ,ＥＳＷＴ）治疗兔胫骨骨不连,以探求一种新的非手术治疗骨不连的方法。方法 选择健康雄性大耳白兔３０只,以改进的“切除截骨骨不连模型”制作兔右胫骨骨不连,１２周后经Ｘ光片证实为肥大型骨不连２６只,随机分为２组。治疗组１３只兔行体外冲击波骨不连断端冲击治疗,对照组不行冲击波波治疗,但均继续外固定机分为２组。治疗     

Cytotoxicity of high energy shock waves: methodologic considerations

In vivo and in vitro experimentation with high energy shock waves (HESW) is necessary to further our understanding of the biologic effects and potential application of this novel energy form. Factors are identified which are critical to the design and subsequent interpretation of HESW experimentation. First, the nature of the containment vessel and the presence or absence of acoustic interfaces are shown to significantly alter the outcome of cell suspension experiments. Second, the effects of HESW are shown to differ markedly for cells in suspension versus cells in tissue making comparisons between the two uncertain. Finally, the need for appropriate negative controls is demonstrated with in vivo experiments to control for the generalized toxicity which occurs when small animals are exposed to such an intense force distributed over a relatively large area. These findings affect the interpretation of previously reported work which investigated the cytotoxic potential of HESW.     

Effect of high energy shock waves on tumor cells

Summary Exposure of bladder tumor cell strain HT-1197, chronic bonemarrow leukemic cell strain K-562, and African green-turtle normal kidney cell strain Vero to high energy shock waves resulted in ultrastructural changes and a reduction in cell viability as determined by ³H-thymidine incorporation assay and flowcytometer. K-562 was the most sensitive while Vero was the most resistant to the high energy shock wave. By flowcytometry using anti BrdU antibody, described K-562 in the S phase was found to be inhibited by the exposure. Electron microscopy revealed destruction of microvilli over the cell surface and swollen mitochondria in K-562 and HT-1197. These effects were related to the number of high energy shock wave exposures. Our study demonstrates that a high energy shock wave has an anti-tumor effect in vitro.     

Anuria due to lithiasis associated with septic shock.

During 18 months 38 patients with anuria due to lithiasis were admitted in our department, 8 of them developed septic shock. Twenty eight patients were cured using different procedures and were released from the hospital with normal urinary output. Ten patients died, 6 of them from septic shock, which has a high mortality rate. Emergency restoration of urinary flow, correction of fluid and electrolyte imbalance, massive antibiotherapy may improve results.