11/70. holmium laser for management of ureterocele calculi.BACKGROUND AND OBJECTIVES: Although most ureteral calculi will pass spontaneously, those in a ureterocele will usually not pass beyond the stenotic orifice. We address both the stone and the underlying anatomic abnormality of a ureterocele using the holmium:YAG laser. STUDY DESIGN/MATERIALS AND methods: We report the first use of the holmium laser to treat ureteral calculi and the ureteroceles responsible for their retention. RESULTS: Two patients have been successfully treated using the described procedure. CONCLUSIONS: The flexibility to treat both the underlying anatomic abnormality and the resultant stone with a single minimally invasive device makes the holmium laser ideal in this situation.- - - - - - - - - - ranking = 1keywords = procedure (Clic here for more details about this article) |
12/70. Double J stent forgotten for 7 years: a case report.Ureteral stents are an integral part of urologic practices. Nonetheless, stents that migrate, fragment, or are forgotten pose management and legal dilemmas. We report the case of a "forgotten" stent, which migrated upward into the right renal pelvis, concomitant with a ureteral stone. The "forgotten" stent was placed 7 years previously during right ureteral stone treatment. The patient finally underwent nephroscopic stent retrieval and ureteroscopic ureteral stone removal. The final plain X-ray demonstrated no stone fragment or residual double J stent fragment. The patient withstood the procedure well and was free of symptoms thereafter.- - - - - - - - - - ranking = 66698.374695776keywords = ureteroscopic, procedure (Clic here for more details about this article) |
13/70. holmium: YAG laser rescue for a stuck stone basket.A 35-year-old man with left lower ureteric stone underwent ureteroscopic stone removal. holmium: YAG laser lithotripsy was used to break the stone and to remove a larger fragment a 3 Fr. steel wire stone basket was introduced through the ureteroscope. However, during removal the basket with the stone became impacted in the intramural part of the ureter. All attempts to dislodge the stone and the basket failed. Laser fiber was introduced through the second channel of the ureteroscope bridge and the laser activated at settings of 0.5J and 10Hz. Pulverization of the stone did not free the basket and hence 2 wires of the stuck basket were cut with the laser. This enabled the basket to be freed and easily removed.- - - - - - - - - - ranking = 66697.374695776keywords = ureteroscopic (Clic here for more details about this article) |
14/70. Use of percutaneous nephrostomy in hydronephrosis of pregnancy.Traditional methods of urinary diversion in pregnancy include retrograde passage of ureteral catheter or stents and operative nephrostomy. These techniques are, however, associated with the use of anesthesia, are technically difficult to perform, and may induce labor. We report the use of percutaneous nephrostomy in four pregnant patients, two with obstruction due to ureteral calculi and two with infected hydronephrosis. The procedure provided rapid relief from pain and pyosepsis, and allowed uneventful continuation of the pregnancy to full-term, with preservation of renal function.- - - - - - - - - - ranking = 1keywords = procedure (Clic here for more details about this article) |
15/70. ureterolithiasis after Cohen re-implantation--case report.BACKGROUND: In the past decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation. If ureteroscopy becomes necessary, the transverse position of the ureter makes ureteric access often impossible. CASE PRESENTATION: We present the case of a young man who not only suffered from urolithiasis due to hyperparathyroidism, but also further jeopardized his treatment by omitting the fact that as a child he underwent Cohen reimplantation of the right ureter. CONCLUSIONS: This case illustrates the particular difficulties the endoscopist may face in this group of patients. patients with difficult ureteric access, abnormal anatomy, or those with known cross-trigonal ureteric reimplantations should be managed in a specialised endourology unit.- - - - - - - - - - ranking = 65289.005052582keywords = ureteroscopy (Clic here for more details about this article) |
16/70. female fertility following extracorporeal shock wave lithotripsy of distal ureteral calculi.This study was prompted by a spontaneous abortion in a 21-year-old woman following extracorporeal shock wave lithotripsy (ESWL ) of a distal ureteral calculus. To our knowledge, it is the first clinical retrospective study on the possible adverse effects of ESWL to the female reproductive tract. We analyzed treatment data and radiation exposure of 84 women in the reproductive period, and surveyed the patients by questionnaire, to which 67 (79.8%) responded. After ESWL 57 women (85.1%) practiced some form of contraception, while 10 childless women attempted to become pregnant. overall 7 children with no malformations or chromosomal anomalies were born to 6 patients. Miscarriages were noted in 3 patients (4.5%) but they occurred at least 1 year after ESWL. Our data suggest that ESWL of lower ureteral calculi is a safe and effective procedure, and does not affect female fertility or lead to increased teratogenic risk.- - - - - - - - - - ranking = 1keywords = procedure (Clic here for more details about this article) |
17/70. In situ extracorporeal shock wave lithotripsy of ureteral calculi with the MPL-9000X lithotriptor.Within the wide armamentarium of urinary stone treatment modalities extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure. With the Dornier MPL-9000X lithotriptor one has the choice of ultrasound or fluoroscopic localization of calculi throughout the entire urinary tract. Except for the kidney, ultrasound guidance is preferred for calculi in the distal ureter, while fluoroscopy is generally used on the proximal two-thirds of the ureter. Between January and December 1990, 123 ESWL treatments were performed on 83 patients suffering from ureteral calculi with an average stone size of 9.3 x 6 mm. Median treatment parameters were 1,597 shock waves at 19.3 kv. for 43 minutes. For stones in the upper two-thirds of the ureter sedation analgesia was given, while ESWL on the pelvic ureter did not create intolerable pain. Of the treatments 69% were done on an outpatient basis. In situ ESWL treatment of urinary calculi was successful in 72 patients (86.7%), and 20 patients (24.1%) were treated with multiple treatment sessions. ESWL therapy for 47 stones in the distal ureter showed better results than for 33 stones plus 2 steinstrasse in the proximal part (95.5% versus 80% stone-free rate). Of 4 patients with mid ureteral calculi 2 could be rendered stone-free by ESWL alone. Auxiliary procedures, such as percutaneous nephrostomy or ureteral splints, had to be performed in 15.7%. Final endoscopic stone extraction was done in 7 cases and open surgery in 4, constituting a 13.3% failure rate for ESWL therapy. The results prove that the MPL-9000X lithotriptor is effective for primary noninvasive stone treatment.- - - - - - - - - - ranking = 2keywords = procedure (Clic here for more details about this article) |
18/70. Laparoscopic ureterolithotomy.We describe the successful laparoscopic removal of a distal ureteral cystine stone not amenable to ureteroscopic or medical therapy. This approach offers an alternative to open ureterolithotomy in patients when less invasive measures fail.- - - - - - - - - - ranking = 66697.374695776keywords = ureteroscopic (Clic here for more details about this article) |
19/70. Clinical features determining the fate of a long-term, indwelling, forgotten double J stents.We review our experiences with forgotten stents and investigate the potential factors determining the degree of encrustation. Our series consists of nine cases of forgotten stent that had remained indwelling for more than 1 year (mean 36.1 months). We describe and compare their various clinical parameters in terms of encrustation. In addition, we briefly summarize our management schemes. All patients showed few stent related irritative symptoms. Six cases showing minimal or no encrustation shared the common feature of urine hypotonicity. Cystoscopic pullout was possible in these cases. The remaining three cases showed moderate to severe encrustation around the stent which required multiple procedures. pyuria was observed in all cases and two patients had a history of urolithiasis. Finally, all cases were rendered stent and stone free. The fate of forgotten stents was dependent on the amount of encrustation around the stent. In our study, lithogenic history and presence of pyuria were associated with moderate to severe encrustation. Interestingly, patients showing urine hypotonicity tended to have a minimal encrustation on their stents and the stents were easily removed. Therefore, in patients with an impaired renal concentrating ability and a poor medical condition, the duration of indwelling stents might be safely prolonged if the patient has no risk factor for encrustation. As patients with forgotten stents are less likely to complain of stent related symptoms, thorough education of patients is important to prevent stent related complications.- - - - - - - - - - ranking = 1keywords = procedure (Clic here for more details about this article) |
20/70. Retroperitoneoscopic pyelolithotomy as initial treatment for upper urinary tract large stone.We report a case in which retroperitoneoscopic pyelolithotomy was the procedure selected to treat a large stone in the upper urinary tract. A 71-year-old woman who had multiple cerebral infarction and dementia was admitted with a persistent high fever unresponsive to antibiotics. The diagnosis was pyelonephritis and urosepsis associated with ureteral calculus. A large calculus(3.0 x 2.0 cm)was found in the left ureter at the L3 level. She underwent nephrostomy of the left side. After the patient's general condition had improved, surgery was performed successfully with an uneventful recovery. The findings in this case confirm that retroperitoneoscopic surgery allows removal of a large stone in a single, minimally invasive procedures.- - - - - - - - - - ranking = 2keywords = procedure (Clic here for more details about this article) |
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