A comparative study of morbidity and symptom severity among double-J stented patients with and without tamsulosin administration

Background: The insertion of a double-J (DJ) stent is considered a routine and necessary urological procedure. The symptoms produced by the stent are predominantly irritative in nature and the use of alpha blockers like tamsulosin have shown considerable in treating the stent associated symptom. Aim of the study was to assess tamsulosin's impact on ureteral stent-associated morbidity. Methods: A comparative cross-sectional study. All the patients with ureteric calculi admitted in the department of urology, Narayana Hospital, Nellore, Andhra Pradesh. Results: A total of 80 patients who met the inclusion criteria, were divided into two groups. Group A receiving placebo and group B receiving tamsulosin 0.4 mg. Among the study population, there was statistically significant difference between the means of parameters between the groups during the stent removal. The means of group B were significantly lower than the means of group A which shows that tamsulosin is very effective in managing the pain and also the stent related morbidity. Conclusions: Tamsulosin is very effective in managing the pain and also the stent related morbidity, which was measured by international prostate symptom score (IPSS) score – both obstructive and irritative. The quality of life was suggestively better in tamsulosin group.

Minimally invasive therapeutic modalities for pediatric urolithiasis: A single center experience from the Philippines

Introduction@#There is a limited data on the incidence of pediatric urolithiasis in the Philippines as well as studies on how it is managed. With the advent of endourology, there is already an evident shift from open stone surgery to minimally invasive surgery as first line in the treatment of pediatric urolithiasis. A tertiary referral center in the country caters to most pediatric urolithiasis cases in the country and offers the different minimally invasive modalities outlined in the latest guidelines. This study aimed to review the different minimally invasive therapeutic modalities for pediatric urolithiasis and its outcomes in the past ten years in a tertiary referral center in the Philippines.@*Methods@#This retrospective study was conducted through charts review of all pediatric patients (0-18 years) who underwent stone surgery from January 2012 to December 2022. Demographic and clinical data, stone characteristics, types of stone surgery, and outcomes were obtained.@*Results@#A total of 87 pediatric patients (54 boys, 33 girls) with 105 urolithiases were analyzed. The patients had a mean age of 13 years, with an interquartile range (IQR) spanning from 6 to 18 years. Among them, 62.07% were male, while 37.93% were female. The most prevalent symptom reported was flank pain, affecting 41.38% of the patients, followed by urinary tract infections (UTI) (11.49%) and gross hematuria (8.05%). For the management, 82.86% of the patients underwent minimally invasive stone procedures with extracorporeal shockwave lithotripsy (ESWL) as the most common procedure (44.76%) and ureterolithiases as the most common stone (43.81%). On the other hand, 17.14% of the subjects underwent open stone surgery done mostly on cystolithiases and large ureterolithiases (38.89% each). All patients recovered and were discharged post operatively.@*Conclusion@#The institution practices minimally invasive approaches in the majority of pediatric patients with urolithiasis. Open stone surgery is reserved for patient with large complex stones and those with anatomic abnormalities.

Role of preoperative assessment of serum sodium in transurethral resection of prostate to avoid transurethral resection of prostate syndrome: a comparative study

Background: Transurethral resection of prostate syndrome (TURP) syndrome is an iatrogenic complication caused by absorption of the irrigating fluid which is used to distend the bladder during surgery.Methods: A total of 100 patients with benign prostatic hyperplasia (BPH) were taken for study. Study was done in tertiary care centre in Gujarat from January 2016 to December 2017. They were evaluated pre-operative and post-operative for sodium concentration.Results: In this study most of the patients i.e. 32 were seen in age group 61- 65 years.31% cases have developed hyponatremia out of 6% were having serum sodium level <125 mEq/l. 56% of cases were having prostate gland <40 cc. In 70% cases, TURP was completed within 60 minutes, while 30% cases required more than 60 minutes time. 13 were seen in age group 51 to 60 years, means 40.62% patients of this age group (13/32) and 12 patients were seen in age group 71-80 years, means 52.17% patients of this age group (12/23) were having post-operative hyponatremia. Out of 31 patients, 20 patients (64.52%) were having prostate size more than 60 cc and 11 patients (35.48%) were having prostate size between 46 to 60 cc.Conclusions: From present study, it is concluded that electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigation fluid. It was also noticed that chances of electrolyte derangement are higher in patients with co-morbid conditions.

Management of forgotten double-J stent in a tertiary care center with ten years of experience: a retrospective study

Background: Forgotten double-J (DJ) stents is documented commonly in urological cases with consequences varying from encrustation, UTIs, pyelonephritis, hydronephrosis and non-functioning kidney. This study aimed to present the experience of managing patients with forgotten DJ stents (>3 months) over a period of ten years.Methods: The study conducted a retrospective review of patients with forgotten DJ stents from January 2009 to December 2019. The details reviewed included indications for stent placement, indwelling time, presenting complaints, reason for non removal, radiological investigations, management techniques, and complications.Results: 52 patients with forgotten DJ stents for >3 months were reviewed. Mean age was 32.1 years. The majority were literate (73.1%). Ureteroscopy was the most common primary surgery performed (53.8%). The mean indwelling time was 38.96 months. Presence of the ureteric stone, bladder stone, and renal stone was observed in 45 (86.5%), 42 (80.7%), and 28 (53.8%) patients, respectively. The DJ stent was fragmented in 13.4% of the patients. The commonest complaints were pain (88.4%) and dysuria (63.4%). The stents were managed by combinations of various endourological techniques including cystoscopic stent retrieval (CPE), PCNL, URSL, ESWL with cystoscopic stent retrieval, PCLT (percutaneous cystolithotripsy). Cystolithotomy was used for very large bladder stones. Nephrectomy was needed in 2 cases due to nonfunctional kidneys while one required open ureterolithotomy and stent retrieval after failure of endoscopic approach.Conclusions: Forgotten DJ stents have severe consequences and management approach requires combination of various endourological procedures with ESWL, URSL, PCNL, open ureterolithotomy and cystolithotripsy.

Minimal invasive management of rare case of ureterocoele with stone: a diagnostic challenge

Ureterocoele is a cystic dilatation of the lower part of the ureter. One of its presentations in the adult population is the presence of a stone, usually a solitary stone, inside the ureterocoele. Authors present a rare case of Ureterocoele with stone in it managed with transurethral deroofing and cystolitholapaxy. This work has been reported in line with the SCARE criteria.

A clinical study of surgical management of benign ureteric stricture.

Background: Although incidence of ureteric stricture, in general population, is not known, proper evaluation of and treatment is essential to preserve the renal function and rule out malignancy. Strictures of the upper urinary tract are either congenital or acquired. With the exception of primary UPJ obstruction, most ureteral strictures are acquired and usually are iatrogenic. Before the development of endourological instruments and techniques, ureteral strictures were managed by open repair. The management of uretric stricture has changed dramatically over the last decade in conjunction with new developments in endourology. Material and methods: This bi-directional study was performed on 30 patients, diagnosed as a benign ureteric stricture by various modalities of diagnosis, which underwent open or laparoscopy surgical procedures. Data, with respect to patient’s demographic information, etiology, mode of presentation, stricture location and length, diagnostic modalities, operative procedures and their follow-up were recorded, analyzed and plotted on master chart. Various surgical treatment modalities are used according to length and location of strictures like: Upper and midreteric stricture: Ureteroureterostomy 2-3 cm, Uretero calycostomy/ pyeloureterostomy for long upper ureteric stricture, 4-5 cm with intra renal or scarred pelvis, Buccal mucosal graft ureteroplasty. Lower ureter: Ureteroneocystostomy 4-5 cm, Psoas hitch 6-10 cm, Boari flap 12-15 cm, Ileal ureter replacement for long segment defect > 10-15 cm, in every patient, we keep closed drainage system. Usually, drain was removed after 72 hours. We were keeping double j stent in every patient, which were removed after 1 month. Follow up the patient after 21 days of double j stent removal and thereafter 6 monthly for 2 years, then every yearly for 5 years Results: Among 30 patients, main causes are genitourinary TB 8 (26.66%), Iatrogenic 8 (26.66%). 46% strictures involve, lower ureter with length >3-5 cm, which correlates with characteristics of tuberculosis, involving multiple sites and long segment of ureter, 54% stricture involving upper ureter are < 3-5 cm which correlates with iatrogenic and impacted ureteric calculus related strictures. Among 30 patients, with 33 renal units 2 patient’s surgery failed, among which one required nephrectomy, and another required redo surgery, one patient who lost follow up was also considered as a failure. Conclusion: In era of endourology and minimal invasive surgery, open reconstructive surgery has its own place.

Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy

PURPOSE: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. RESULTS: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100 percent targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. CONCLUSIONS: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.

Endourological Management of Forgotten Encrusted Ureteral Stents

PURPOSE: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. MATERIALS AND METHODS: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. RESULTS: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. CONCLUSION: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Experiencia en el tratamiento endoscópico de la litiasis ureteral / Experience in the endoscopic treatment of ureteral stones

Objetivos: La endourología con procedimientos menos invasivos ha sustituido la cirugía convencional en el manejo de algunas patologías, con una baja morbilidad y altos índices de resolución. El progreso de la ureteroscopia con disminución del calibre del instrumental y mejoría de los sistemas ópticos y accesorios han permitido mejor acceso y visión del tracto urinario, disminuyendo los índices de complicaciones. Material y Método: análisis retrospectivo de nuestra experiencia en el abordaje ureteroscópico de lalitiasis ureteral durante el período febrero 2004 - diciembre 2005. Se definió el éxito de la cirugía según la fragmentación completa de la litiasis y la desobstrucción respectiva. Resultados: Se realizaron 50 cirugías, distribuidas en rango etareo 18-83 años, 28 pacientes de sexo masculino y 22 de sexo femenino. El tamaño litiásico abordado varió de 0,5 -2 cm. Se logró la fragmentación completa del cálculo en 92 por ciento de los casos, en 2 pacientes se logró fragmentación parcial y en otros 2 no se logró el acceso por migración de la litiasis. Se describen como complicaciones las inherentes al procedimiento, hematuria, perforación ureteral localizada y 1 caso de falsa vía. Conclusiones: La ureterolitotomia endoscópica resulta un procedimiento seguro y eficaz en la resolución de la litiasis ureteral distal con baja morbilidad asociada, la disponibilidad de la litotripsia intracorporea permite mayor flexibilidad en la indicación de esta técnica. Constituye nuestra modalidad de elección, considerando la poca disponibilidad de litotripsia extracorpórea.

Introduction: Endourology has replaced conventional surgery in management of several urological diseases, with a low morbidity and excellent results. The progress of ureteroscopy with reduced and improved instruments and more advanced optical systems have allowed better access and vision of the urinary tract, reducing the rates of complications. Material and Methods: Retrospective analysis of our experience in the ureteroscopic management of ureteral stones during the period from February 2004 - December 2005. Succesful surgery was define We define as successful according to both the fragmentation of the stones and resolution of obstruction. Results: Fifty surgeries were performed in patients with an age range 18-83 years. Male to female ratio was 3/2. Stone tone size ranged from 0.5 to 2 cm. Complete fragmentation was achieved in 92 percent of the cases, 2 patients achieved partial fragmentation and in one case we experienced migration of stone and the procedure was not completed. The complications rate observed I the series was low. Conclusions: Endourological management of ureteral stones is safe and effective for the resolution of distal ureteral calculi with low morbidity. Availability of intracorporeal lithotripsy allows greater flexibility in the indication of this technique. In our hands this woud be the technique of choice.

Holmium Laser for the Treatment of Upper Urinary Tract Diseases:Report of 101 Cases / 中国微创外科杂志

Objective To investigate the efficacy of Holmium laser for upper urinary tract diseases.Methods A total of 101 patients with urinary tract stricture or calculus in the lower or middle ureter were treated with holmium laser by ureteroscopy from January 2005 to June 2007 in our hospital.For the patients with stones in the upper urinary tract or the kidney,percutaneous nephrolithotripsy(PNL) with holmium laser by ureteroscopy was performed.Results No patients developed perforation,urinary leakage,or infection after the operation.In the 23 cases of ureteral stricture,6 were cured,10 were improved,5 were failed,and 2 were deteriorated or even developed hydronephrosis.The two who were deteriorated after the operation was converted to open surgery because of pain in the kidney area and refractory infection.They were cured after resection of the strictured segment and end-to-end anastomosis.Follow-up was available for 3 to 24 months(mean,12 months);none of the patients had recurrence during the period.In the 40 patients with lower or middle ureteral stones,nephrolithotripsy was completed successfully in all but 7,in whom the stones moved into the kidney during the procedure.These 7 patients were then cured by extracorporeal shock wave lithotripsy.The 40 patients were followed up for 3 to 18 months(mean,15),none of them had recurrence.In the 24 cases of upper urinary tract stones and 14 patients with renal calculus,the stones were removed completely by the first PNL in 36;2 patients received a second operation after indwelling renal cannula for 1 week because of intraoperative hemorrhage.These 38 patients achieved a follow-up of 3 to 24 months(mean,18),no one of them showed residual stones,or recurrent calculus or stricture of the ureter.Conclusions Holmium laser by ureteroscopy is safe,effective,and minimally invasive for patients with upper urinary tract disorders.The treatment is worth being used thanks to a low rate of intra-and postoperative complications.

Recent advances in endourology / 北京大学学报(医学版)

Endourology has developed very quickly during the past decades. For transurethral therapy of diseases of lower urinary tract, it has been gradually accepted by both urologists and patients for plasmatic electrocautery resection, holmium laser and electrochemical enucleation of benign prostatic hyperplasia. Flexible ureteroscope has been widely used for examination of upper urinary tract for unknown urinary bleeding and micronephrostomy has achieved great success for percutaneous nephrolithotripsy. Laparoscope has become very popular and can be used to perform most of the operations in the field of urology.

The Outcome of Endourologic Treatment for Benign Ureteral Strictures / 대한비뇨기과학회지

PURPOSE: We reviewed the results of endoureterotomy and balloon dilation for benign ureteral strictures to determine the efficacy of these procedures. MATERIALS AND METHODS: We treated 19 patients who had benign ureteral stricture by retrograde endoureterotomy or balloon dilation followed by placement of a 6-8Fr stent for 6 weeks. Mean follow up period was 14 months (6-27 months). Eight patients were treated by endoureterotomy using cold knife under direct vision and 11 patients were treated by balloon dilation. The causes of ureteral strictures were abdominal surgery in 8 patients, urinary tuberculosis in 6 patients, radiation therapy in 2 patients, rigid ureteroscopy in 2 patients and periureteral abscess in 1 patient. The length of strictures was shorter than 1cm in 14 patients and over 1cm in 5 patients. The etiology of strictures was ischemic origin in 11 patients and nonischemic in 8 patients. One patient had poor ipsilateral renal function (<25%). RESULTS: The overall success rate was 78.9% (15/19). The success rate of balloon dilation was 81.8% (9/11) and that of endoureterotomy was 75% (6/8). No significant complication such as high fever or sepsis was observed. Strictures shorter than 1cm had 92.9% (13/14) success rate while strictures over 1cm had 40% (2/5) success rate (p <0.05). The nonischemic strictures had better success rate (87.5%) compared to ischemic strictures (72.7%) without statistical significance. CONCLUSIONS: We would suggest the use of balloon dilation or endoureterotomy as the initial treatment of benign ureteral stricture regarding the safety and efficiency. The better outcome would be expected in the strictures shorter than 1cm in length.

The Role of Endourologic Management for Tuberculous Ureteral Stricture / 대한비뇨기과학회지

PURPOSE: Tuberculous ureteral stricture causing a progressive obstructive uropathy is a common complication of renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral stricture. MATERIALS AND METHODS: Seventy seven patients (84 renal units) with tuberculous ureteral strictures were analysed respectively. We evaluated the final outcome of involved kidneys according to the two different managements; medication only versus medication plus ureteral stenting or medication plus PCN. RESULTS: In our series, nephrectomy rate was about 51%. In cases treated with medication only, the nephrectomy rate was about 73%. While the nephrectomy rate was about 34% when treated with medication plus early ureteral stenting or PCN. The rate of reconstructive surgery for ureteral strictures was significantly different between the cases treated with medication only (8%) and medication plus early ureteral stenting or PCN (49%). Moreover, spontaneous resolution of the ureteral strictures was noted in 6 out of 12 renal units which had strictures in the course of medical therapy and were managed with early ureteral stenting. CONCLUSIONS: Early ureteral stenting or PCN in patients with tuberculous ureteral stricture may increase the opportunity for later reconstructive surgery and decrease the possibility of renal loss.

Transurethral Resection of the Prostate in Emergency Treatment / 中国微创外科杂志

Objective To investigate the effect of transurethral resection of prostate(TURP) on patients with benign prostatic hyperplasia(BPH) in emergency treatment.MethodsA total of 37 cases of BPH were treated emergently with TURP in our hospital from January 2000 to December 2007.The blood pressure and serum glucose of the patients were controlled before the procedure.Lithotripsy was performed on the cases with bladder stones.ResultsIn our patients,no blood transfusion,surgery-related death,massive hemorrhage,or transurethral resection syndrome occurred.The blood loss ranged from 100 to 400 ml with a mean of 180.BPH was confirmed by pathological examination after the operation.Two patients were diagnosed as having prostatic cancer and thus received bilateral testectomy and intermittent androgen deprivation therapy.The two patients were followed up for 12 months;during the period none of them had dysuria,and laboratory examination showed the level of specific prostatic antigen ranged from 0 to 4 ng/ml.In the other patients,3 developed urinary stricture in 1 to 3 months after the treatment,and then was cured by dilating the urinary tract regularly for 3 months.A mean of 9-month(3 to 24) follow-up was available in our patients.The reexamination carried out during the follow-up sowed that the maximum urine flow rate increased [(8.2?3.3) ml/s vs(19.3?3.1) ml/s,t=-5.435,P=0.000] and the IPSS [(22.5?5.1) vs(5.3?1.2),t=7.136,P=0.000] and QOL [(4.5?1.1) vs(2.0?0.7),t=2.494,P=0.000] scores decreased significantly after the operation.ConclusionsFor the BPH patients with indications for emergency treatment,TURP is effective.However,the operation should be performed by experienced surgeons since it is not a regular treatment.Prostatic cancer should be excluded during the operation.

Endourologic Treatment of the Upper Urinary Tract Obstruction in the Advanced Cancer Patients / 대한비뇨기과학회지

Palliative endourologic treatment was done in 94 cases for ureteral obstruction secondary to advanced malignancy The average survival was 4.2 months. The obstruction were caused by metastases or invasion of cancer in all patients. First we tried to insert a double J stent(STENT), when it failed percutaneous nephrostomy(PCN) was performed. Initially 16 patients were treated by STENT and 8 patients by PCN. The SIENT was changed 2.2 times on the average in all patients. 75% of the patients who had been treated by STENT experienced only one or two times of STENT changes before dying. Patency period of the STENT was 57.6 days on the average. The patency period was shorter in the patients who showed gross hematuria at the time of STENT insertion. Although survival was not so long, 60.6% patients were able to return to their homes. The endourologic management of the upper urinary tract obstruction will play a more important role and offer a better quality of life for end stage cancer patients.

The experiences of endourologic management and extracorporeal shock wave lithotripsy to the complications in horseshoe kidneys / 대한비뇨기과학회지

Due to recently advanced endourologic development. most patients with complications in horsehoe kidney can be managed with endourologic treatment and ESWL. From June 1986 to June 1990, 26 kidney units in 23 patients with horseshoe kidney were evaluated. They were treated in 6 kidney units with open surgery, 6 kidney units with endoscopic surgery, 6 kidney units with ESWL, 2 kidney units with combination of percutaneous nephrolithotomy and ESWL and 1 kidney units with combination of nephrolithotomy and ESWL, respectively. Of 14 kidney units with endourologic management and ESWL, the complications in 13 kidney units were managed successfully. The percutaneous nephrolithotomy, endopyelotomy and ureterorenoscopic management in horseshoe kidneys do not carry a greater risk than that reported for normal kidneys. In ESWL, focal pointing of the calculi may be difficult due to increased distance between the flank and renal calculi. But without major technical modification, stones in a horseshoe kidney may be treated by ESWL. In conclusion, most patients with calculi or obstruction in horseshoe kidneys can be managed primarily with endoscopic surgery or ESWL.

The experiences of endourologic management and extracorporeal shock wave lithotripsy to the complications in horseshoe kidneys / 대한비뇨기과학회지

Due to recently advanced endourologic development. most patients with complications in horsehoe kidney can be managed with endourologic treatment and ESWL. From June 1986 to June 1990, 26 kidney units in 23 patients with horseshoe kidney were evaluated. They were treated in 6 kidney units with open surgery, 6 kidney units with endoscopic surgery, 6 kidney units with ESWL, 2 kidney units with combination of percutaneous nephrolithotomy and ESWL and 1 kidney units with combination of nephrolithotomy and ESWL, respectively. Of 14 kidney units with endourologic management and ESWL, the complications in 13 kidney units were managed successfully. The percutaneous nephrolithotomy, endopyelotomy and ureterorenoscopic management in horseshoe kidneys do not carry a greater risk than that reported for normal kidneys. In ESWL, focal pointing of the calculi may be difficult due to increased distance between the flank and renal calculi. But without major technical modification, stones in a horseshoe kidney may be treated by ESWL. In conclusion, most patients with calculi or obstruction in horseshoe kidneys can be managed primarily with endoscopic surgery or ESWL.

The Management of Urinary Tuberculosis for Preservation of Renal Function / 대한비뇨기과학회지

During the period 1985-1989, 101 patients of urinary tuberculosis were treated at our hospital. Fifty-one of these patients were found to have obstructive dilatation of the urinary tract on pyelography. We reviewed these cases according to treatments for preservation of renal function. Twelve of these 51 cases were managed by chemotherapy only despite of the presence of obstructive dilatation. Eighteen of 51 cases required reconstructive treatment by partial nephrectomy (2), reimplantation of ureter into bladder (3), ileocystoplasty (2) and ileal conduit urinary diversion (1). In 24 of 51 cases, endourologic procedures were performed by stent indwelling (13), ureteral dilatation (7), endopyelotomy or endoinfundibulotomy (4). Seven cases had permanently a percutaneous nephrostomy to prevent further deterioration in renal function. In the cases that were managed only medically, 3(25.0%) improved, but, in reconstructive surgeries, improvement was noted in all cases and surgical morbidity was low. In 19 endourologic cases (79.2%), there has been a substantial improvement in renal function. Thus, in order to save more kidneys from destruction by tuberculosis despite of modern drug treatment, surgical or endourologic interventions are required when scar or stricture threatens to obstruct urinary flow.

Reconstructive Surgery and Endourologic Procedure for Renal Tuberculosis / 대한비뇨기과학회지

Although the rates of tuberculosis cases are continuing decline with advent of newer drugs, sporadic cases of urinary tuberculosis still occur. During last 5 years, we experienced 22 cases of reconstructive surgery and 18 cases of endourologic procedures for preservation of renal function. The following results were obtained: 1. Reconstructive surgeries including ureteroneocystostomy etc. were underwent in 22 cases and improvement were noted in 18 cases. 2. In 18 endourologic cases, there has been a substantial improvement in renal function, decrease in upper tract dilatation and relief of symptom. Average indwelling duration was 2.4 months and the mean number of dilatation per patient was 1.8 time. 3. Endopyelotomy and direct ureterotomy with ureteroscope are useful modalities in multiple ureteral stricture or upper ureter stricture. 4. It should be emphasized that percutaneous antegrade stent indwelling was more easier than retrograde technique especially in failure cases.

Endourologic Treatment of Pediatric Calculus Disease / 대한비뇨기과학회지

The causes of pediatric urolithiasis are urinary tract infection as a result of urinary stasis, metabolic diseases and idiopathic origin. Geographically the incidence is higher in Asia than in any other parts of the world. Most recently, PNL was started to be applied not only for adult cases but also for pediatric urolithiasis. Our group was successful in treating two pediatric urolithiasis patients of 4 and 6 years of age by endourologic technique. In 4 year old male patient, renal stone and lower ureter stone were combined and severe hydronephrosis were present. PNL and URS were done simultaneously for this case. In 5 year old male patient, renal pelvis stone was treated by PNL. The compositions of the stones were calcium phosphate and calcium oxalate, respectively. The postoperative hospitalization was 5 days in both cases and they were discharged without any problem. In both cases, follow up IVP`s were done. We are reporting these two cases to two the successful treatment with adult endoscopes.