ABSTRACT
Between November 1990 and March 1992, 150 patients at 10 United States institutions were treated with transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for the relief of bladder outlet obstruction secondary to benign prostatic hypertrophy. The TULIP system incorporates ultrasound visualization with a 90-degree angle, side-firing laser to effect coagulation necrosis of prostate tissue. The overall preoperative prostate volume in this TULIP study was 40 cc and all types of prostatic enlargement, including median lobe obstruction, were treated. There were no intraoperative complications, with no hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. Hospital stay averaged 1.7 days and 83% of the patients went home after a 1-night stay. We evaluated 63 patients at 6 months after the TULIP procedure. Mean symptom scores decreased from 18.8 to 6.1, for a 68% improvement. The mean peak flow increased from 6.7 ml. per second preoperatively to 11.9 ml. per second, for a 78% improvement. Overall, 87% of the patients exhibited at least 50% improvement in either the symptom score or peak flow parameter, while 49% of the patients demonstrated at least a 50% improvement in both parameters.
Subject(s)
Laser Therapy/instrumentation , Prostatectomy/instrumentation , Prostatic Hyperplasia/surgery , Urinary Bladder Neck Obstruction/surgery , Equipment Design , Follow-Up Studies , Humans , Laser Therapy/methods , Male , Prostatectomy/methods , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/physiopathology , Treatment Outcome , Ultrasonography , Urethra , Urinary Bladder Neck Obstruction/etiology , Urinary Bladder Neck Obstruction/physiopathology , UrodynamicsABSTRACT
A new intraoperative use of the ureterorenoscope is described for open stone surgery. A mid ureteral stone that had moved back into the kidney was retrieved successfully through a ureterotomy incision, avoiding further procedures.
Subject(s)
Endoscopy , Ureteral Calculi/surgery , Adult , Humans , Kidney , Male , Radiography , Ureter , Ureteral Calculi/diagnosis , Ureteral Calculi/diagnostic imagingABSTRACT
During the past seven years, 14 pregnant patients were admitted to our hospital for treatment of ureteral calculus. During this same period, 22,495 deliveries were performed, for an incidence of one calculus per 1,600 pregnancies. Eleven patients spontaneously passed the calculus, ten prior to delivery and one patient postpartum. Three patients required an operation, two antepartum and one patient postpartum. No maternal or fetal complications occurred. Management of urinary calculi during pregnancy must be individualized and should be based upon location of the stone, degree of obstruction, presence or absence of infection, general condition of the patient and stage of pregnancy. Surgical intervention to remove obstructing calculi is not contraindicated during pregnancy.
