Use of magnetic internal ureteral stents in pediatric urology: retrieval without routine requirement for cystoscopy and general anesthesia.

In children the use of internal ureteral stents has the added morbidity of requiring general anesthesia for stent retrieval. Magnetically tipped ureteral stents were developed to allow easy retrieval without the need for anesthesia or cystoscopy. For pyeloplasty we generally do not use a stent or nephrostomy tube but we treated 7 children 2 1/2 months to 11 years old in whom we believed there was an indication for stenting and in whom we used a magnetically tipped stent. The catheters were removed with a magnetically tipped catheter retriever without the need for anesthesia in 6 of the 7 cases and cystoscopy was not required in any case. Our initial impression is that when stenting is advised the magnetically tipped ureteral stent appears to be a good alternative, especially in children, since it avoids the need for anesthesia and cystoscopic retrieval.

Initial experience with therasonic lithotriptor.

Piezoelectric shock wave lithotripsy has been shown to offer a low-cost, safe, anesthesia-free yet effective means of disintegrating urinary calculi. The Therasonic lithotriptor combines proprietary piezoelectric shock wave technology for effective stone fragmentation with a multi-purpose urologic table and both fluoroscopic and ultrasound imaging for accurate stone localization and real-time treatment monitoring. From December 1, 1988 to November 15, 1989, 138 patients with 172 calculi were treated (94.2% were intrarenal, 5.8% were in ureter). All stones greater than or equal to 4 mm were considered suitable for treatment. Lithotripsy was performed under intravenous sedation except when ancillary procedures were necessary. For evaluation of device effectiveness, 94 patients were available with follow-up greater than or equal to thirty days. Successful fragmentation (stone free or residual debris less than or equal to 4 mm) was achieved in 97 percent of patients. The retreatment rate for stones 0.5-2.0 cm was 11 percent, and the overall retreatment rate was 21.2 percent regardless of stone size. Complications were minimal, transient, and resolved spontaneously.

Impotence following childhood priapism.

Priapism in childhood, although an uncommon event, generally is believed to be associated rarely with future impotence in adulthood. These beliefs may be a reflection of under-reporting or a lack of long-term followup. We present a case of a 23-year-old impotent man who had a history of priapism as an 8-year-old child. Even though a review of the literature reveals that impotence following childhood priapism is an infrequently reported phenomenon we believe its incidence to be significant and since it can occur aggressive treatment is essential.