ABSTRACT
Objective: To discuss the management principles and skills for treatment of intractable ureterostenosis under ureteroscope. Methods: Our management experience on 19 patients with intractable ureteral stenosis was retrospectively analyzed. The 19 cases included urological TB-caused multiple ureteral stenosis, oncothlipsis to ureters from intestinal tract or gynecology, restenosis 3 months to 12 years after pelviureteric junction plasty, operative site stenosis after ureterolithotomy, double ureter back flow accompanied by stenosis, ureter imperforation after renal parenchyma lithotomy without placing double "J", ureter imperforation 3 months after extracorporeal shock-wave lithotripsy due to ureterolith, tubal bladder stoma stenosis after renal transplantation, restenosis after tubal bladder stoma due to distal ureterostenosis, and so on. All the patients were treated under ureteroscope. The management methods included: the Wolf 8/9. 8 CH12° and Wolf 6/7. 6 CH5° ureteroscope was used as a dilator to dilate the stenoses; balloon expanding under ureteroscope was used to dilate the stenoses; the ureter pliers was used to expand the stenoses to different directions; the cold knife was used to open the stenoses; if the diameter of stenoses were smaller than the that of the ureteroscopes, F4. 5 or F3 double "J" tubes were inserted guided by a wire under ureteroscope; and 2 or 3 weeks later, a larger tube or two tubes were introduced into the stenoses already dilated partly by the former tube. Results: Ureteroscopic method failed in treating 2 patients in our group and succeeded in treating all the other patients. The outcomes of patient were fine during 2 months to 3 years' follow-up. Conclusion: It is difficult to treat patients with intractable ureterostenoses. With good experience in manipulation of ureteroscope, the flexible application of several techniques according to the different conditions of different patients can guarantee successful treatment in most patients.
ABSTRACT
Objective:To discuss the management principles and skills for treatment of intractable ureterostenosis under ureteroscope.Methods:Our management experience on 19 patients with intractable ureteral stenosis was retrospectively analyzed.The 19 cases included urological TB-caused multiple ureteral stenosis,oncothlipsis to ureters from intestinal tract or gynecology,restenosis 3 months to 12 years after pelviureteric junction plasty,operative site stenosis after ureterolithotomy. double ureter back flow accompanied by stenosis,ureter imperforation after renal parenchyma lithotomy without placing double"J",ureter imperforation 3 months after extracorporeal shock-wave lithotripsy due to ureterolith,tubal bladder stoma stenosis after renal transplantation,restenosis after tubal bladder stoma due to distal ureterostenosis,and so on.All the patients were treated under ureteroscope.The management methods included:the Wolf 8/9.8 CH12?and Wolf 6/7.6 CH5?ureteroscope was used as a dilator to dilate the stenoses:balloon expanding under ureteroscope was used to dilate the stenoses;the ureter pliers was used to expand the stenoses to different directions;the cold knife was used to open the stenoses;if the diameter of stenoses were smaller than the that of the ureteroscopes,F4.5 or F3 double"J"tubes were inserted guided by a wire under ureteroscope; and 2 or 3 weeks later,a larger tube or two tubes were introduced into the stenoses already dilated partly by the former tube. Results:Ureteroscopic method failed in treating 2 patients in our group and succeeded in treating all the other patients.The outcomes of patient were fine during 9 months to 3 years'follow-up.Conclusion:It is difficult to treat patients with intractable ureterostenoses.With good experience in manipulation of ureteroscope,the flexible application of several techniques according to the different conditions of different patients can guarantee successful treatment in most patients.
ABSTRACT
BACKGROUND: The natural history of bacillary tuberculosis was studied in India and results showed that at the end of the 5-year period, 49% of the patients were dead, 33% were cured and 18% remained sputum-positive. The aim of this survey is to observe the natural course of the patients with intractable tuberculosis disease who were incurable with all drug regimens of the national tuberculosis programme(NTP). METHOD: Of the patients who have been found as intractable cases in Kang-Weon Province by the supervisory medical officer during the period from January 1,1987 to December 31,1992, 179 were eligible for this study. Sputum examination was done for those who were survived until October in 1993 at the Kang-Weon provincial laboratory of KNTA. 49 out of 179 patients were transferred to the private sectors and retreated with the combination of prothionamide, cycloserine, ofloxacin, enviomycin, etc. They seemed to have been bacteriologically cured, and so they were excluded from the study. Finally 130 patients were analyzed by modified life table method to calculate the fatality rate and the survival rate during the period of 7 years. RESULTS: 1) 80.8% of intractable cases were male and 19.2%,female. 2) More than 94% of intractable cases showed moderately or far advanced Tb findings on their X-rays at the time of registration at health centres. 3) The cumulative case-fatality rate was 19.74% at the end of 1-year period and has risen to 34.55% by the end of 4-year period(increasing by 4.9% a year on an average). The case-fatality rate has shown no appreciable rise since then until the end of 7-year period. 4) The case-survival rate was 80.26% at the end of 1-year period and has decreased to 65.45% by the end of 4-year period. And then there was no appreciable change in the survival rate until the end of 7-year observation. CONCLUSION: The case-survival rate of intractable cases was higher than that of untreated pulmonary tuberculosis patients and they may have risk of spreading multidrug resistant organisms. It is time we made an effort to improve case-management qualitatively.