ABSTRACT
Laser lithotripsy with mini-ureteroscopes is a minimally invasive method to fragment ureteral calculi. This study reviewed the efficacy and morbidity of outpatient laser lithotripsy for the treatment of ureteral calculi. The 248 patients were initially treated by outpatient ureteroscopy and laser lithotripsy with the Candela pulsed-dye laser over a period of 3 1/2 years. Thirty-six patients had prior unsuccessful fragmentation of ureteral calculi by SWL. Twenty-eight patients had undergone unsuccessful ureteroscopy with attempted basket extraction or attempted fragmentation with methods other than laser. Calculi were located in the upper ureter in 31% and in lower ureter in 69% of these patients. The 1-month stone-free rate was 92% for upper ureteral calculi and 96% for lower ureteral calculi, with an overall success rate of 94.7%. Ninety per cent of the patients were discharged the same day and 96% within 23 hours. Hospital admission was needed in only 4% of patients. Parenteral analgesia was required in 18% of patients, and major complications occurred in 0.8%. The combination of mini-ureteroscopes and laser lithotripsy is an effective method for fragmentation of ureteral calculi in outpatients with low morbidity and few complications.
Subject(s)
Lithotripsy, Laser/instrumentation , Ureteral Calculi/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Care , Child , Female , Humans , Male , Middle Aged , UreteroscopyABSTRACT
Lasertripsy of upper urinary tract calculi after unsuccessful extracorporeal lithotripsy (SWL) or ureteroscopy (Group 1; N = 26 patients, 36 calculi) was compared with primary lasertripsy (Group 2; N = 56 patients, 79 calculi). Access to calculi was achieved by a Candela miniscope or flexible ureteroscope, and laser fragmentation was performed with the Candela pulsed-dye laser. Laser alone or laser plus 1.9F basket extraction produced a stone-free rate of 80.6% in Group 1 and 79.8% in Group 2. Additional treatment methods were needed in similar proportions of both groups and in most patients consisted of SWL of fragments displaced into the kidney. The laser fragmentation failures rates were 2.8% in Group 1 and 7.6% in Group 2. One-month stone-free rates and major complication rates were similar in the two groups. Lasertripsy after unsuccessful SWL or ureteroscopy was as effective as primary lasertripsy.
Subject(s)
Lithotripsy, Laser , Lithotripsy , Ureter/pathology , Urinary Calculi/therapy , Endoscopy , Female , Humans , Lithotripsy/adverse effects , Lithotripsy, Laser/adverse effects , Male , Middle Aged , Treatment Outcome , Urinary Calculi/pathologyABSTRACT
A variety of complications have been described after placement of a Stamm gastrostomy in infants and children, including gastric volvulus, pancreatitis, jaundice, gastroduodenal mucosal intussusception with gastric outlet obstruction, and even aortogastric fistula. However, this is the first report of pyeloduodenal fistula after Stamm gastrostomy in a 4 1/2-month-old boy. The child successfully underwent nonoperative therapy; he was treated by withdrawing the gastrostomy tube (Foley catheter) from the renal pelvis, bowel rest, and total parenteral nutrition. After the case presentation is a brief review of this rare entity, with its clinical presentation and pathophysiological differences between adult and pediatric cases. Various treatment options, both operative and nonoperative, are also described.
Subject(s)
Duodenal Diseases/etiology , Gastrostomy/adverse effects , Intestinal Fistula/etiology , Intubation, Gastrointestinal/adverse effects , Kidney Diseases/etiology , Urinary Fistula/etiology , Duodenal Diseases/epidemiology , Humans , Infant , Intestinal Fistula/epidemiology , Kidney Diseases/epidemiology , Kidney Pelvis , Male , Urinary Fistula/epidemiologyABSTRACT
A case of ureterosciatic hernia is presented with 3-dimensional computerized tomography reconstruction of the pelvis. The anatomical defect is defined. A total of 13 previously reported cases and the options for surgical repair are reviewed.
Subject(s)
Image Processing, Computer-Assisted , Tomography, X-Ray Computed/methods , Ureteral Diseases/diagnostic imaging , Hernia/diagnostic imaging , Hernia/epidemiology , Humans , Male , Middle Aged , Ureteral Diseases/epidemiology , Ureteral Obstruction/etiologyABSTRACT
The management of cholelithiasis with gallstone pancreatitis in the heart transplant candidate is a difficult problem. Biliary tract surgery in the heart transplant candidate presents an additional set of clinical risks in view of extensive heart disease. We report the cases of three patients with symptomatic cholelithiasis with gallstone pancreatitis who were successfully operated on while awaiting cardiac allografts. Each patient was preoperatively prepared with (1) a lumbar epidural catheter for postoperative pain control with epidural opioids, (2) a balloon-tipped (Swan-Ganz) catheter and arterial line for perioperative monitoring, and (3) an intraaortic balloon pump for circulatory support with full heparinization after epidural catheter placement. In addition, preoperative optimization of cardiovascular function with pharmacologic agents was carefully achieved for 6 to 12 hours before surgery. All three patients had stable intraoperative courses, with less than a 300 ml blood loss. Their postoperative outcomes were without surgical complication. We think that biliary tract surgery may be safely accomplished in the heart transplant candidate with careful, appropriate preparation and meticulous surgical technique. We also present our management algorithm for heart transplant patients with cholelithiasis before and after operation.
