ABSTRACT
Background: For shock wave lithotripsy has proven to be an effective, safe and truly minimally invasive option for the treatment of nephrolithiasis. Various technical factors as well as patient selection can impact the success of the procedure. Objective: The aim of this study was to identify the parameters on NCCT that may predict the success of shock wave lithotripsy (SWL) in ureteral stones. Patients and Methods: 102 patients who underwent SWL for ureteral stones at sayed Galal University Hospital from January 2015 to August 2018 diagnosed by non-contrasted computed tomography were studied. The failure was defined as remnant stones ï»4 mm. We assessed age, sex, body mass index, stone size, location, skin-to-stone distance (SSD), presence of JJ and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). Results: 102 patients with success rate 61.8%, stone size, stone density were significantly associated with outcome of SWL. While SSD, JJ and secondary signs (hydronephrosis, perinephric fat stranding and tissue rim sign) were insignificant. On multivariate analysis, stone size and stone density were the independent factors affecting the outcome of SWL. Conclusions: The study demonstrated that stone size and density are significant and independent predictors of outcome in patients with upper ureteral stones. However SSD and signs of impaction still have to be evaluated
Subject(s)
High-Energy Shock Waves , Lithotripsy , Patient Outcome AssessmentABSTRACT
Objectives To evaluate the radiological characteristics of renal stones on plain X-ray film of the kidneys; ureters and bladder (KUB) area as predictors of stone fragility during shock wave lithotripsy (SWL). Patients and Methods This prospective study included 336 patients who had a single renal pelvic stone =20 mm and were managed by SWL at 3 different centers. The patients were classified according to the radiological appearance of the stone on KUB film in terms of homogeneity; smoothness of the outline; and radiodensity in comparison to the last rib. The primary endpoint was the stone-free rate (SFR) within 3 months post-SWL. Multivariate regression analysis was used to compare the results. Results The overall SFR was 71.43. SFR was significantly higher in heterogeneous compared with homogenous stones (86vs. 53; p0.01) and in rough compared with smooth surface calculi (77vs. 61; p0.01). SFRs for stones with density less than; similar to or higher than that of the last rib were 82; 69and 56; respectively (p0.01). Multivariate analysis showed a positive proportional relationship between stone fragility (SWL outcome) and one or more favorable radiological criteria. Conclusion The radiological characteristics of renal calculi could predict their fragility after SWL. Stones which were heterogeneous; rough; or less dense than the last rib on KUB film were more likely to disintegrate during SWL
Subject(s)
Kidney Calculi , Lasers , Lithotripsy , Radiography , Ureter , Urinary BladderABSTRACT
La migration intravesicale du dispositif intra-uterin (DIU) par perforation uterine est une complication rare. Dans cette etude retrospective monocentrique; nous presentons notre experience de 5 cas colliges au sein de notre etablissement entre 2004 et 2009. L'age moyen de nos patientes est de 39 ans (32-48 ans). La symptomatologie clinique revelatrice etait dominee par le syndrome irritatif vesical. Le diagnostic a ete evoque sur le couple echo/AUSP; puis confirme par la cystoscopie. Le traitement a consiste en une lithotritie balistique du calcul avec extraction du sterilet par voie endoscopique chez 4 patientes et extraction chirurgicale chez une seule
Subject(s)
Case Reports , Intrauterine Device Migration , Lithotripsy , Urinary Bladder CalculiABSTRACT
Background: The study was designed to find out the radiation protection practices of radiologists and other staff involved in the first extra-corporeal shock wave lithotripsy in Nigeria, performed at Igbinedion Hospital and Medical Research Centre, Okada. Methodology: Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure in local and international journals with interest in precautions to reducing radiation exposure. Results: Only lead apron and lead gloves were used by the radiologists for radiation protection and shielding during fluoroscopy procedures. The fluoroscopy was the screen type with TV monitor. Multiple sessions were used in several patients with multiple pre- and post- treatment radiographic studies including contrast studies with average of two sessions per patient. All the patients were adults aged between 26 and 65 years with mean age of 42.5 years. 627-6000 shock waves were delivered over 45-135 minutes at intensity of 143-19KV depending on patients build and the size of the stones. The sizes of the patients varied from very obese with large bulk to slim built. Radiation monitoring of the staff and patients was not done. Staff believed that radiation effect from the lithotripsy procedure was low therefore adequate radiation monitoring and radiation reducing alteration in the procedure was rarely adopted. Conclusion: Extended fluoroscopy time, multiple fluoroscopy examinations, multiple treatment sessions and multiple x-ray examinations which increased both the patients/' and staff/'s radiation exposures were noted. Proper radiation protection and monitoring of patients and staff are necessary to avoid the risks from low-level exposure to radiation such as in ESWL
Subject(s)
Lithotripsy , Nigeria , Radiation ProtectionABSTRACT
Objective: To compare the efficacy and safety of electrohydraulic and Holmium laser lithotripsy in the treatment of bladder and/or urethral stones in children. Materials and Methods: Between January 2000 and January 2006; 112 children (102 boys and 10 girls) aged between 2 and 13 years presented to our department with vesical (n=72) and urethral (n=40) stones. Previous surgery for bladder stones was reported in 28/112 (25) cases. The stone burden ranged from 4-22 mm. The stones were radiolucent in 12 (10.7) cases. Multiple bladder and combined urethral and vesical stones were recorded in 14 (12.5) cases. The children were divided into two groups according to the treatment modality: 50 children (Group A) were treated by electrohydraulic lithotripsy (EHL) using either pediatric cystoscopes or the short ureteroscope; 7 F; while in 62 children (Group B) Holmium laser was used through a 7.5 F pediatric endoscope without any modification. Follow up range was 1-1.5 years. Results: In Group A; disintegration was successful in 48/50 (96) cases. The mean operative time was 18.3 minutes. The urethral catheter was maintained for 24-72 hours (mean 36 hours). Conversion into open surgery was necessary in two cases. No other major operative or postoperative complications were encountered. In Group B; complete disintegration was achieved in all cases including impacted urethral stones. The mean operative time was 15.7 minutes. The urethral catheter was left for one day only in 36 (58.1) cases. Conclusion: In our series; Holmium laser lithotripsy used for the treatment of bladder or urethral stones in children caused no complications and achieved slightly better results than electrohydraulic lithotripsy. Nevertheless; electrohydraulic lithotripsy remains an effective and a viable option despite its rare - yet sometimes serious - complications
Subject(s)
Child , Holmium , Lithotripsy , Urinary BladderABSTRACT
Objective The majority of vesical calculi in adults can now be treated transurethrally with the use of different lithotriptors. The aim of this article was to study the effectiveness of the Egyptian pneumatic lithotriptor through a rigid cystoscope in the treatment of vesical calculi. Patients and Methods Fourteen adult patients (12 males and 2 females) had single urinary bladder stones. Mean stone diameter was 20 mm. Through a cystoscopic sheath; a modified ureteric catheter was introduced into the bladder. Using the Egyptian pneumatic lithotriptor - KH. YG2; the pneumatic probes (rigid or flexible) were passed through the catheter for stone disintegration. Results Successful stone disintegration was recorded in 13 patients (92.9) where the patients were stone-free at the end of the procedure. Failure of stone fragmentation occurred in one case (7.1). The stone was removed surgically. Its chemical composition was found to be calcium oxalate monohydrate. The average time of cystolithotripsy was 35 minutes. Hospitalization ranged from 12 to 24 hours which was longer (2 to 4 days) for those patients who had undergone other procedures. Minor complications such as mild hematuria (100) and cystitis (21.4) were observed. No major complications were noted. Conclusion The use of the Egyptian lithotriptor during cytoscopy has been found to be an effective; easy; safe and economical method for the treatment of vesical stones
Subject(s)
Cystoscopy , Lithotripsy , Urinary Bladder Calculi/therapyABSTRACT
Objectives: To evaluate the role of transvaginal ultrasound (TVUS) in studying the anatomical bases of genuine stress urinary incontinence (SUI) and understanding the causes of success and failure of operations aiming at the treatment of incontinence. Patients and Methods: This study included 15 continent females (Group I, healthy control) and 46 patients complaining of SUI (Group II). All cases were subjected to full history, physical examination, urodynamic evaluation and TVUS examination. In 42 patients of Group II, TVUS was repeated one year after treatment of incontinence, while four patients were lost to follow-up. In 36 of these 42 cases (85.7%), treatment was successful (Group IIIa), while treatment had failed and SUI had persisted or recurred within one year in six cases (Group IIIb, 14.3%). We used TVUS to measure the bladder-symphysis distance (BS), the rotational angle(RA), the bladder neck motility (BNM) and the vertical bladder neck descent. Results: While the mean BS was insignificantly shorter in Group II compared to Group I (2.24 ± 0.7cm versus 2.4 ± 0.5 cm, p = 0.08), the mean RA, BNM and vertical bladder neck descent were significantly larter in Group II (115 ± 17o 29 ± 16o 1.4 ± 0.4 cm for Group II versus 94 ± 15o 20 ± 5o 0.34 ± 0.4 cm for Group I). The comparison between Groups I and II showed that the TVUS-measured parameters correlated well with the clinical condition. A comparison between Group IIIa (BS = 2.2 ± 1 cm, RA = 100 ± 19o BNM = 22 ± 4o and vertical bladder neck descent = 0.38 ± 0.5 cm) and Group IIIb (BS = 2.2 ± 0.5 cm, RA = 117 ± 16o, BNM = 30 ± 9o and vertical bladder neck descent = 1.4 ± 0.3 cm) showed that the TVUS-measured parameters correlated well with the surgical outcome. Conclusions: TVUS is a valuable tool for the diagnosis and postoperative evaluation of SUI and may help in understanding the causes of success and failure of surgical treatment of SUI
Subject(s)
Lithotripsy , Ultrasonography, Interventional , Urinary Incontinence, StressABSTRACT
Objective This study was carried out to evaluate the safety and efficacy of holmium:YAG laser in the treatment of ureteral calculi in adults. Patients and Methods Between April 1999 and November 2000; one hundred and seven patients presented to the urology department of Assiut university with symptomatic ureteral stone disease in different locations. The patients were divided into three groups according to the stone location which was determined radiologically. Group I included 38 patients with stones located in the upper third of the ureter; Group II included 19 patients with stones located in the middle third of the ureter and Group III included 50 patients with stones located in the lower third of the ureter. Lithotripsy was done in all patients using the Holmium:YAG laser machine. The stone-free status was checked three months after the procedure. Patients with residual stones were scheduled for another session. Results In Group I; 38 patients with 38 stones underwent 39 procedures for intracorporeal lithotripsy. Eight patients presented with obstructive anuria and elevated blood urea and serum creatinine. Complete stone fragmentation was achieved in 37 cases; while in one case the stone migrated to the kidney and was treated by ESWL. In Group II; 19 patients underwent 20 procedures. Re-treatment after three weeks was necessary in one case due to ureteral wall injury and minimal extravasation. Four patients presented with obstructive anuria; while in 6 patients the stones were impacted. Complete fragmentation could be achieved in all cases. In Group III; 50 patients underwent 51 procedures. A re-treatment session was required in one patient after three months due to a residual stone (5 mm) detected during follow up. In eleven cases the stones were impacted; and one patient had bilateral lower ureteral stones treated in the same session. Out of 50 patients with 55 stones; 54 stones (98.1) were completely fragmented and cleared in a single session. Conclusion Holmium:YAG laser lithotripsy is a safe and effective modality for the treatment of ureteral stones.Key Words Holmium:YAG laser; ureter; lithotripsy