Acute extracorporeal shockwave lithotripsy for ureteric stones - 7-years' experience from a busy district general hospital.

OBJECTIVES: To demonstrate the efficacy and cost-effectiveness of acute extracorporeal shockwave lithotripsy (ESWL) for ureteric stones we present our experience of ESWL in 530 ureteric stone cases, in the largest UK series we are aware of to date. ESWL is underutilised in ureteric stone management. The Getting It Right First Time (GIRFT) report showed just four units nationally treated >10% of acute ureteric stones with ESWL. Despite guideline recommendations as a first-line treatment option, few large volume studies have been published. PATIENTS AND METHODS: Retrospective review of prospectively collected data between December 2012 and February 2020 was performed. Data relating to patient demographics, stone characteristics, skin-to-stone distance, and treatment failure were collected. Cost analysis was conducted by the Trust's surgical financial manager. Multivariable analyses were performed to assess for predictors of ESWL success. RESULTS: A success rate of 68% (95% confidence interval 64%-72%) at 6 weeks was observed (n = 530). The median (interquartile range) number of treatment sessions was 2 (1, 2). Stone diameter was observed to be a predictor of ESWL success. The small number of stones treated of >13 mm or >1250 HU had an ~50% chance of successful treatment. Acute ureteric ESWL was less costly than acute ureterorenoscopy, consistent with findings from previous NHS studies. CONCLUSION: Acute ESWL is a safe, reliable, and financially viable treatment option for a wider spectrum of patients than reflected in international guidelines based on our large, heterogenous series. In the coronavirus disease 2019 (COVID-19) era, with theatre access reduced and concerns over aerosol generating procedures, acute ESWL remains an attractive first-line treatment option.

Minimally invasive surgical options for ureteropelvic junction obstruction: A significant step in the right direction.

Open pyeloplasty is the gold standard treatment for adult ureteropelvic junction obstruction (UPJO) with published success rates consistently over 90%. In recent years, the management of UPJO has been revolutionized by the introduction of endoscopic procedures and laparoscopic techniques. We analyzed the long-term results of endoscopic and other minimal access approaches for the treatment of UPJO.Early results for endopyelotomy were promising but long-term results were not encouraging. Laparoscopic pyeloplasty technique is well defined and duplicates the surgical principles of conventional open pyeloplasty. With such a large variety of minimally invasive procedures for the treatment of UPJO available, the treatment choice for UPJO must be based on the success and morbidity of the procedures, the surgeon's experience, the cost of the treatment, and the patient's choice. We feel that with the technological advances in instrumentation coupled with a decrease in cost and improved training of urological surgeons, laparoscopic pyeloplasty may evolve to be the new "gold" standard for the treatment of UPJO.

Urolithiasis in the horseshoe kidney: a single-centre experience.

OBJECTIVE: To report the operative management and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidney and treated at one centre. PATIENTS AND METHODS: We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 15-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. RESULTS: In all, 55 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 60 renal units in 47 patients. Five patients had extracorporeal shock wave lithotripsy (ESWL), two had flexible ureteroscopy and one had a laparoscopic pyelolithotomy for a stone extending into the isthmus. PCNL was used for large stones (mean digitized surface area = 614.32 mm(2)) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures, completely cleared in two-thirds of patients treated by ESWL, and in both who had flexible ureteroscopy and the one treated with laparoscopic pyelolithotomy. Complications were minimal, with 15% minor and 3% major complications in the PCNL group only. CONCLUSION: Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

Surgical technique for the delayed removal of superglue from the male urethra.

The insertion of foreign bodies into the male urethra is not an uncommon urological presentation. Superglue is a material that can potentially cause significant complications if instilled into the urethra. We describe a successful case of delayed (six months) removal of superglue from a 39 year old male's urethra having failed to remove the material at initial presentation.

Laparoscopic pyeloplasty: our new gold standard.

BACKGROUND AND PURPOSE: Laparoscopic pyeloplasty has developed as a successful minimally invasive alternative to open surgery for management of ureteropelvic junction obstruction (UPJO). Reported medium-term success rates match those of open surgery at more than 90%. We present our complete experience to date with the laparoscopic pyeloplasty procedure. PATIENTS AND METHODS: A retrospective review of all patients who have undergone laparoscopic pyeloplasty at our institution was performed. RESULTS: Between July 2001 and March 2008, 118 patients underwent laparoscopic pyeloplasty. Mean operative time was 205 minutes, and mean hospital stay was 4.7 days. A crossing vessel was found in 33 patients, and 9 patients needed pyelolithotomy for concomitant stone disease. There were no major complications. Mean followup was 12.38 months (range 3-60 mos) with 94.5% free of obstruction on radiologic imaging. CONCLUSIONS: Laparoscopic pyeloplasty is a safe and effective management option for UPJO with excellent short-to medium-term results. It is a versatile operation, applicable to most cases of UPJO. Laparoscopic pyeloplasty has now superceded open surgery in our center as the gold standard surgical management for UPJO.