ABSTRACT
OBJECTIVE: The aim of the present article is to summarize the results we obtained treating children with urolithiasis over the last 30 years and to perform an analysis on the basis of the these results and relevant details according to national and international experience. METHODS: Retrospective and descriptive statistical analysis of the 30 year experience in our clinics. The study was performed with a sample size of 178 children treated with urolithiasis that underwent 221 procedures. These procedures include ESWL, ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). CONCLUSIONS: We conclude in this study that ESWL in children was the most appropriate procedure for renal and proximal and middle-third ureteral lithiasis. Kidney stones measuring 2 to 3 cm can be treated without additional procedures or combined approaches. In contrast cystine stones caused the major problems for fragmentation. Moreover, the use of double J catheters increased the need for ESWL when catheter calcification occurred and endoscopic removal was impossible. The benefits of this method must be individually assessed both for the benefit of the temporary placement as well as for the expectation of permanence. We conclude that URS is the best choice for distal-third ureteral lithiasis and some cases of proximal and middle- third ureteral lithiasis. This enables for simultaneous treatments, ureteral dilatation and unexpected diagnoses. In particular, rigid ureteroscopy offers adjuvant options to ESWL with great therapeutic potential and easy handling. In consequence, to our good results and cost-benefit balance using ESWL and rigid URS (even combined), the use of flexible URS for renal lithiasis has been reduced. In general community units like ours, the combined PCNL has been indicated for particular complex cases, and open or laparoscopic surgery was not necessary in any case.
Subject(s)
Kidney Calculi/therapy , Lithotripsy , Ureteral Calculi/therapy , Child , Hospitals , Humans , Retrospective StudiesABSTRACT
OBJECTIVE: To review the different methods of contact lithotripsy by intracavitary direct contact or very close approximation of different rigid and flexible energy-transmitting devices (probes, fibers, etc.). METHODS: The systems commonly used, as well as those that have fallen into disuse or have not been developed further, are briefly described. RESULTS: Although no contact lithotripsy system is clearly superior over another, in our experience the electrokinetic system (Walz) is highly effective and simple to use. CONCLUSIONS: Contact lithotripsy permits stone disintegration and removal of fragments during the same surgical procedure. It improves the rate of completeness of stone removal and permits earlier functional recovery of the obstructed renal unit.
Subject(s)
Lithotripsy/methods , Urinary Calculi/therapy , HumansABSTRACT
OBJECTIVE: To report an uncommon case of ureteral duplication with a single intramural trajectory and a third ureter arising from the medial ureter, corresponding to the inferior pyelon, opening at the level of the bladder neck and containing a calculus measuring 10 mm along its longest axis, lodged in a saccular dilatation. The etiopathogenesis of this rare anomaly is briefly reviewed and discussed. METHODS/RESULTS: Diagnosis was established endoscopically and pyelographically. Endoscopic resolution was not possible, but stone removal was successfully achieved by conventional surgery using the least invasive approach possible. The patient is asymptomatic 24 months postoperatively. CONCLUSION: Although infrequent, this condition should be suspected in those "unclear' cases seen in day-to-day urological practice. Symptoms of the associated pathology are more common than those arising from the anomaly. Treatment should be specific to each case, as least invasive as possible and should aim at symptomatic resolution.
Subject(s)
Ureter/abnormalities , Ureteral Calculi/complications , Adult , Humans , MaleABSTRACT
OBJECTIVES: To report an uncommon endourological complication that was also resolved by endourological methods. METHODS/RESULTS: We report on a patient with a right solitary kidney, radiolucent renal stone and an indwelling double-J catheter. While removing the double-J catheter after ESWL, it broke at the level of its distal third. The proximal two thirds remaining in the ureter were successfully removed by ureteroscopy after several attempts by ureteroscopy and percutaneous nephroscopy. CONCLUSIONS: Except for special circumstances, most of the endourological complications can be resolved by an endourological procedure.
Subject(s)
Ureteroscopy , Urinary Catheterization/instrumentation , Equipment Failure , Humans , Male , Middle AgedABSTRACT
OBJECTIVES: The present study reviews our experience and analyzes the results achieved with extracorporeal shock wave lithotripsy in the treatment of urinary calculi in children. METHODS: From 1985 to 1995, 36 children, with ages ranging from 5 months to 14 years, were treated by ESWL, and in some cases by combination therapy (percutaneous nepholithectomy and/or ureteroscopy). RESULTS: Excellent results were achieved in 74.9% of the patients; of these, 52.7% were stone-free 2 to 90 days after treatment. CONCLUSIONS: Extracorporeal shock wave lithotripsy is the treatment of choice in children with urinary lithiasis, although there are some exceptions. The method of evaluation and treatment in children are the same as in the adult patients.
Subject(s)
Lithotripsy , Urinary Calculi/therapy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
OBJECTIVE: To determine the efficacy of the intraurethral mesh in the treatment of infravesical obstruction in patients at high surgical risk unamenable to other treatment modalities. METHODS: We evaluated 13 patients with obstruction and at high risk for conventional surgery (TURP) who underwent insertion of the Memotherm intraurethral prosthesis. RESULTS: The procedure was performed rapidly with scant morbidity and the patients were discharged from the hospital early. Improvement, evaluated by the IPSS-L, was referred by 84.6% of the patients at 45 weeks follow up. Post-treatment improvement was evidenced by the absence of postvoiding residual urine at ultrasound in 69.2% of the patients and improved flowmetry in 84.6% of the patients. The early post-treatment complications included hematuria with irritative symptoms (80% of the patients). The mesh prosthesis had migrated in 15%, but could be repositioned. No case required removal of the prosthesis. CONCLUSIONS: This method affords a rapid and atraumatic solution for obstructed patients at high surgical risk. The material (heat sensitive nitinol) and the design of the mesh facilitate repositioning in the few cases in whom this had been required.
Subject(s)
Stents , Urinary Bladder Neck Obstruction/therapy , Aged , Aged, 80 and over , Cystoscopy , Follow-Up Studies , Humans , Male , Middle Aged , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/therapy , Stents/adverse effects , Surgical Mesh/adverse effects , Urethra , Urinary Bladder Neck Obstruction/diagnosis , Urinary Bladder Neck Obstruction/etiologyABSTRACT
OBJECTIVES: The present article briefly reviews the history of endoscopic access to the ureter, since visualization of the ureter was first attempted until the procedure was developed by Pérez-Castro in 1979. METHODS/RESULTS: The development of the rigid ureteroscopes, the difficulties arising from the anatomical structures during endoscopy that require ureteral dilatation, the anatomy of the juxtavesical segment of the ureter and the pathologies that may alter it, and the present and future indications of ureteral dilatation are discussed. Patient preoperative evaluation is briefly described and one of the techniques of ureteral dilatation is analyzed. Finally, a brief summary comparing the different techniques is given. CONCLUSIONS: The technique of choice for ureteral dilatation must be simple, easy to perform, low-cost and one which reduces the iatrogenic lesions and shortens the duration of hospital stay.
