ABSTRACT
This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients' demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.
Subject(s)
Contrast Media , Intraoperative Complications/epidemiology , Ureteral Calculi/diagnosis , Ureteroscopy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Incidence , Infant , Lithotripsy/adverse effects , Lithotripsy/methods , Male , Middle Aged , Preoperative Period , Radionuclide Imaging/methods , Retrospective Studies , Statistics, Nonparametric , Tomography, X-Ray Computed/methods , Ureteral Calculi/surgery , Ureteroscopy/adverse effects , Urography/methods , Young AdultABSTRACT
This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Contrast Media , Intraoperative Complications/epidemiology , Ureteral Calculi/diagnosis , Ureteroscopy/methods , Incidence , Lithotripsy/adverse effects , Lithotripsy/methods , Preoperative Period , Retrospective Studies , Radionuclide Imaging/methods , Statistics, Nonparametric , Tomography, X-Ray Computed/methods , Ureteral Calculi/surgery , Ureteroscopy/adverse effects , Urography/methodsABSTRACT
PURPOSE: To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. METHODS: Fifty cases of unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n=25), and another group underwent laparoscopic ureterolithotomy under general anesthesia (n=25). Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. RESULTS: Operation was successfully performed in all 50 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 49.0±10.7 min and 41.8±8.0 min (t=2.68, P=0.00999), respectively, their hospitalization time was 2.8±1.3 days vs. 2.9±0.8 days (t =-0.40, P=0.69413), and stone clearance rate was 88.0 percent (22/25) vs. 100 percent (25/25). Stone moved to the renal pelvis in three cases in the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL). All patients were followed up for more than three months, and no serious complications such as ureterostenosis occurred. CONCLUSIONS: Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is one safe and effective treatment on unilateral upper ureteral stones.(AU)
OBJETIVO: Comparar os efeitos curativos da litotripsia ureteroscópica e a ureterolitotomia laparoscópica para cálculos unilaterais altos e pesquisar as indicações e resultados. MÉTODOS: Cinquenta casos de cálculos unilaterais altos foram distribuídos aleatoriamente em dois grupos: um grupo submetido a litotripsia ureteroscópica com laser holmium sob anestesia epidural ou lombar (n=25) e outro grupo submetido a ureterolitotomia laparoscópica sob anestesia geral (n=25). Duplo-J stent foi rotineiramente instalado em ambos os grupos. Comparou-se o tempo operatório, tempo de hospitalização pós-operatória, nível de desaparecimento dos cálculos e complicações pós-operatórias. RESULTADOS: Atos operatórios nos 50 casos sem ocorrências e nenhum ato convertido. Nos grupos por ureteroscopia e laparoscopia, o tempo operatório médio foi 49,0±10,7 minutos e 41,8±8,0 minutos (t=2,68, P=0,00999) respectivamente, tempo de hospitalização foi 2,8±1,3 dias vs. 2,9±0,8 dias (t=0,40, P=0,69413) e o nível de desaparecimento dos cálculos foi 88.0 por cento (22/25) vs. 100 por cento (25/25). Cálculo deslocado para pelve renal em três casos no grupo ureteroscópico e cálculos residuais foram removidos por litotripsia por onda de choque extracorpóreo (ESWL). Todos pacientes foram seguidos por mais de três meses e não ocorreram complicações sérias como estenoses ureterais. CONCLUSÕES: A ureterolitotomia laparoscópica teve maior nível desaparecimento dos cálculos e tempo operatório menor comparado à litotripsia ureteroscópica A ureterolitotomia laparoscópica é um tratamento seguro e efetivo para cálculos ureterais unilaterais altos.(AU)
Subject(s)
Animals , Ureteral Calculi/diagnosis , Lithotripsy , Ureteroscopy , Laparoscopy , Urethra/anatomy & histologyABSTRACT
Urinary lithiasis is one fo the most frequent disorder of the urinary tract, predominant in males and in their formation are involucrate many factors such as age, inheritance, diet, scant ingestion of fluids and sedentarity. Extracorporeal lithotripsy has become the method of choice for urinary lithiasis. The objective of this report is to present the author's experience with the treatment of urinary lithiasis using extracorporeal wave lithotripsy. From 1997 through 2005 we have treated 1456 patients suffering renouretheral lithiasis with our equipment Triper compac. Successful results were obtained in 96 por ciento in interior uretheral calculi, 94 por ciento for medial calculi and 96 por ciento for upper calculi. Several references related to this procedure are commented in the article
Subject(s)
Humans , Kidney Calculi/diagnosis , Kidney Calculi/therapy , Ureteral Calculi/diagnosis , Ureteral Calculi/therapy , LithotripsyABSTRACT
Urinary lithiasis is one fo the most frequent disorder of the urinary tract, predominant in males and in their formation are involucrate many factors such as age, inheritance, diet, scant ingestion of fluids and sedentarity. Extracorporeal lithotripsy has become the method of choice for urinary lithiasis. The objective of this report is to present the authors experience with the treatment of urinary lithiasis using extracorporeal wave lithotripsy. From 1997 through 2005 we have treated 1456 patients suffering renouretheral lithiasis with our equipment Triper compac. Successful results were obtained in 96 por ciento in interior uretheral calculi, 94 por ciento for medial calculi and 96 por ciento for upper calculi. Several references related to this procedure are commented in the article(AU)
Subject(s)
Humans , Ureteral Calculi/diagnosis , Ureteral Calculi/therapy , Kidney Calculi/diagnosis , Kidney Calculi/therapy , LithotripsyABSTRACT
Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy.
Subject(s)
Suture Techniques , Ureteral Calculi/surgery , Urologic Surgical Procedures/methods , Cohort Studies , Female , Follow-Up Studies , Humans , Jamaica , Length of Stay , Lithotripsy, Laser/methods , Male , Minimally Invasive Surgical Procedures/methods , Postoperative Complications , Retrospective Studies , Treatment Outcome , Ureteral Calculi/diagnosis , Ureteroscopy/methodsABSTRACT
Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy
Subject(s)
Humans , Male , Female , Ureteral Calculi/surgery , Urologic Surgical Procedures/methods , Suture Techniques , Postoperative Complications , Ureteral Calculi/diagnosis , Retrospective Studies , Cohort Studies , Jamaica , Lithotripsy, Laser/methods , Minimally Invasive Surgical Procedures/methods , Treatment Outcome , Follow-Up Studies , Length of Stay , Ureteroscopy/methodsABSTRACT
El objetivo del presente trabajo es evaluar la efectividad de la tomografía computada helicoidal (TC) sin contraste oral ni endovenoso para la detección y el manejo de los pacientes con sospecha clínica de urolitiasis. Se estudiaron 60 pacientes con presunción diagnóstica de cólico renoureteral. A todos se les efectuó tomografía computada helicoidal sin contraste oral ni endovenoso. La tomografía computada fue leída para la presencia o ausencia de litiasis. El diagnóstico definitivo fue efectuado mediante seguimiento en todos los casos. Con los resultados obtenidos el valor predictivo positivo de una tomografía computada es del 98 por ciento y la certeza global un 93 por ciento. En los pacientes con sospecha de litiasis, debido a que la TC de árbol urinario es sencilla, eficaz y sin contraindicaciones, debe formar parte del protocolo de estudio de éstos pacientes
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Awards and Prizes , Urinary Bladder Calculi , Kidney Calculi , Ureteral Calculi , Urinary Calculi , Colic/etiology , Kidney Diseases , Urinary Bladder Calculi/diagnosis , Kidney Calculi/diagnosis , Ureteral Calculi/diagnosis , Urinary Calculi/diagnosis , Diagnostic Errors , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
El objetivo del presente trabajo es evaluar la efectividad de la tomografía computada helicoidal (TC) sin contraste oral ni endovenoso para la detección y el manejo de los pacientes con sospecha clínica de urolitiasis. Se estudiaron 60 pacientes con presunción diagnóstica de cólico renoureteral. A todos se les efectuó tomografía computada helicoidal sin contraste oral ni endovenoso. La tomografía computada fue leída para la presencia o ausencia de litiasis. El diagnóstico definitivo fue efectuado mediante seguimiento en todos los casos. Con los resultados obtenidos el valor predictivo positivo de una tomografía computada es del 98 por ciento y la certeza global un 93 por ciento. En los pacientes con sospecha de litiasis, debido a que la TC de árbol urinario es sencilla, eficaz y sin contraindicaciones, debe formar parte del protocolo de estudio de éstos pacientes (AU)
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged , Awards and Prizes , Colic/etiology , Kidney Diseases , Urinary Calculi/diagnostic imaging , Kidney Calculi/diagnostic imaging , Ureteral Calculi/diagnostic imaging , Urinary Bladder Calculi/diagnostic imaging , Urinary Calculi/diagnosis , Kidney Calculi/diagnosis , Ureteral Calculi/diagnosis , Urinary Bladder Calculi/diagnosis , Diagnostic Errors , Sensitivity and Specificity , Predictive Value of TestsABSTRACT
Os cálculos uretrais primários são raros no ocidente. O seu desenvolvimento freqüentemente está associado a alterações prévias do fluxo urinário, como divertículos uretrais, áreas de estenose ou corpos estranhos impactados. Os autores relatam um caso de um paciente de 77 anos de idade que se apresentou com queixa de retenção urinária aguda e dor na região genital. O diagnóstico de uretrolitíase foi feito e, mediante estudos radiográficos, um objeto estranho, cilindro de madeira, foi identificado no interior do cálculo.
Subject(s)
Humans , Male , Aged , Ureteral Calculi/diagnosis , Ureteral Calculi/etiology , Urinary Retention/complications , Urethral ObstructionABSTRACT
Se evaluan en el presente estudio un total de 65 pacientes a los que se le habían colocado catéteres uretrales doble "J" o pig-tail por patologías litiásicas o no. Se estudiaron sus indicaciones, control, seguimiento, sintomatología adversa, complicaciones y tratamiento. Consideramos que los catéteres doble "J" son eficaces en el posoperatorio de cirugías endourológicas, pueden ser usados como monoterapia en las litiasis obstructivas y son útiles en las uronefrosis por compresión de la vía excretora, pero que su permanencia prolongada favorece las complicaciones
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Urinary Diversion/adverse effects , Urinary Diversion/statistics & numerical data , Urethra/pathology , Urethra/surgery , Urinary Catheterization/adverse effects , Urinary Catheterization/statistics & numerical data , Ureteral Calculi/surgery , Ureteral Calculi/diagnosisABSTRACT
Se evaluan en el presente estudio un total de 65 pacientes a los que se le habían colocado catéteres uretrales doble "J" o pig-tail por patologías litiásicas o no. Se estudiaron sus indicaciones, control, seguimiento, sintomatología adversa, complicaciones y tratamiento. Consideramos que los catéteres doble "J" son eficaces en el posoperatorio de cirugías endourológicas, pueden ser usados como monoterapia en las litiasis obstructivas y son útiles en las uronefrosis por compresión de la vía excretora, pero que su permanencia prolongada favorece las complicaciones(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Urinary Catheterization/adverse effects , Urinary Catheterization/statistics & numerical data , Urethra/surgery , Urethra/pathology , Urinary Diversion/adverse effects , Urinary Diversion/statistics & numerical data , Ureteral Calculi/surgery , Ureteral Calculi/diagnosisABSTRACT
Shock-wave extracorporeal lithotripsy (SWEL) is admittedly the choice method for most ureteral calculi (UC). Treatment of 1.674 UC was carried out with a Lithostar (Siemens). Endourologic support manoeuvres (ESM) were used in 11.7% patients. To determine their statistical influence on treatment's result variables such as site, size, calculus density, obstruction and functionality of the renal unit, as well as presence of ureteral malformation, were analyzed. With an average of 1.3 sessions (9100 waves) success rate was 91.8% cases. Only the variables of size, obstruction and function showed statistical significance, thus identifying through a multistep logistic regression test the subgroup of calculi less likely to succeed (calculi > 1 cm2, with severe uropathy and functional annulment or delay). Complication were rare (7.5%) and minimally relevant. We conclude than SWEL is the first choice treatment for UC regardless the location. Ureteroscopy (UR) should be considered as the first option particularly in distal (iliopelvic ureter), obstructive calculi and those of difficult radiological study.
Subject(s)
Lithotripsy , Ureteral Calculi/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Lithotripsy/statistics & numerical data , Male , Middle Aged , Treatment Outcome , Ureter/abnormalities , Ureteral Calculi/diagnosisABSTRACT
From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.