Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

La chirurgie endoscopique bilaterale et simultanee du haut appareil dans le traitement des lithiases renales et ureterales

Objective: To assess the outcome of simultaneous bilateral endoscopic surgery in the management of renal and ureteral lithiasis. Patients and Methods: Five patients were reviewed retrospectively. Two patients underwent bilateral simultaneous ureteroscopy for ureteral calculi; on two others bilateral simultaneous PCNL was performed in treatment of renal lithiasis. In one patient bilateral simultaneous ureteroscopic extraction of ureteral calculi was done prior to bilateral PCNL for renal lithiasis. Ureteral stenting was performed in all patients. In those patients who underwent PCNL a nephrostomy was done. Results: In all patients who had undergone PCNL the outcome was considered satisfactory. One of them had residual stones of less than 3 mm in both kidneys; which required only surveillance. Another patient had residual calculi in both kidneys with a diameter of 6 and 7 mm respectively. In this patient a complementary ESWL was necessary. The last patient was stonefree after the procedure. The results of simultaneous bilateral ureteroscopy assessed one month after the procedure with a plain abdominal film and renal ultrasonography were excellent since all patients were free of stones. An important haemorrhage complicating a PCNL was treated by embolization. Conclusion: Simultaneous bilateral endoscopic surgery of the upper urinary tract is a good alternative after failure of ESWL for renal and ureteral lithiasis. The risks and complications of the procedure are comparable to those of endoscopic unilateral surgery of the upper tract

[Is there an age limit for organ donors?]. / Existe-t-il un âge limite pour le don d'organes?

Nowadays organ transplantations suffer from a lack of donors. Thus the waiting list of patients is constantly growing. Several ways to increase organ procurement are being evaluated. About 50% of cerebral deaths are related to vascular cerebral in patients older than 60 years. For the last few years, organs have been harvested from these patients despite their age. As the quality of the grafts is reduced, transplantation of one kidney may be insufficient whilst transplantation of the two kidneys to the same recipient is technically possible. We report here a case of a 44-year-old patient who was transplanted with two kidneys in September 2000. The donor was 85-year-old patient who died after prolonged cardiac arrest. Kidney biopsy showed a 16% rate of sclerotic glomeruli and mild interstitial fibrosis. The creatinine clearance estimated by the Cockcroft formula was 50 mL.min-1. The double kidney transplantation was successful, without any surgical or anaesthetic complication. Restoration of urine production was immediate. Three months after the transplantation, creatinine clearance was 80 mL.min-1. This observation gives the opportunity to discuss the criteria for organ harvesting in patients with cerebral death. Donor age should not remain anymore a systematic contra indication for kidney or liver donation. Renal function, macroscopic examination and histological findings seem more important for making a decision in taking the graft. Double transplantation, here the second case in France, has been performed for several years in other countries, and has permitted to expand the pool of donors, thus increasing the number of transplanted patients.

[Balloon catheter parieto-renal dilatation in percutaneous kidney surgery]. / La dilatation pariéto rénale au ballonnet dans la chirurgie percutanée du rein.

OBJECTIVE: To compare two techniques of parieto-renal dilatation for percutaneous surgery: Alken dilators and balloon catheter. MATERIAL AND METHODS: This prospective, non-randomized study was conducted between July 1999 and April 2000 in 20 patients undergoing percutaneous renal surgery. 10 patients were dilated with a balloon catheter (NephroMax, Boston Scientific) and the other 10 patients were dilated with Alken metal dilators. Statistical analysis was performed with the Mann-Whitney test. RESULT: The dilatation time and x-ray exposure time were shorter during balloon catheter dilatation (statistically significant difference) and the two techniques were associated with a comparable morbidity. CONCLUSION: Balloon catheter parieto-renal dilatation significantly decrease dilatation and x-ray exposure times and very considerably simplifies this operative step, essential to the success of percutaneous surgery.

[Outpatient treatment of pelvic ureteral calculi with extracorporeal lithotripsy. Report of a series of 200 patients consecutively treated]. / Traitement ambulatoire des calculs de l'uretère pelvien par lithotritie extra corporelle. A propos d'une série de 200 patients traités consécutivement.

OBJECTIVE: To demonstrate the feasibility of first-line outpatient treatment of symptomatic stones of the pelvic ureter (sometimes immediately following an episode of renal colic), without anaesthesia, by extracorporeal shock-wave lithotripsy using a latest generation apparatus (EDAP LT02) with concomitant dual guidance. PATIENTS AND METHODS: The mean age of the patients was 45 years. The mean stone diameter was 7 mm (range: 3 to 25 mm). Lithotripsy was performed under dual ultrasound and fluoroscopic guidance. All patients were reviewed at 3 months with follow-up and x-rays. RESULTS: Fragmentation was considered to be complete in 79% of cases, partial in 10.5% of cases and absent in 10.5% of cases. Overall, 87% of stones were completely eliminated at 3 months. The only complication was fever of 38.5 degrees C requiring urinary tract drainage and subsequent ureteroscopy. Complementary treatment was necessary in 26 cases: ureteroscopy (n = 20), alkalinization (n = 1), Dornier ESWL (n = 5). CONCLUSION: ESWL by EDAP LT02 allows first-line outpatient treatment of stones of the pelvic ureter with a satisfactory success rate.

[Laparoscopic resection of a bladder diverticulum]. / Résection laparoscopique d'un diverticule de vessie.

The authors report a case of laparoscopic resection of a bladder diverticulum performed at the same time as endoscopic treatment of its presumed cause. Dissection of the diverticulum, particularly its neck, and dissection of diverticula of the ureter and vas deferens are facilitated by magnification of the video image. This approach is only indicated in particular anatomical sites (posterior). The results of this technique must be compared with those of conventional treatments.

In situ extracorporeal shock wave lithotripsy for acute renal colic due to obstructing ureteral stones.

The purpose of the present study was to evaluate in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of obstructing ureteral stones causing acute renal colic. In situ ESWL with an EDAP LT-02 piezo-electric lithotriptor was used in a prospective study to treat 67 patients with obstructing ureteral stones causing acute renal colic. Patients were treated without anesthesia on an out-patient basis or during a one-day hospital stay. The overall one month stone-free rate was 94% (94% for proximal stones and 95% for distal stones). The overall success rate after a single ESWL session was 81%. Treatment was well tolerated in 90% (60/67) of patients. There was one case of non-obstructive pyelonephritis and one of ureteral edema. These rates compare well with published reports for delayed treatment in patients without renal colic. Immediate ESWL for cases of acute renal colic due to obstructing ureteral stones is an effective treatment strategy that warrants wider consideration.

[Vesico-ureteral reimplantation on psoas bladder in lesions of the pelvic ureter. Review of 50 patients]. / Réimplantation urétéro-vésicale sur vessie psoïque dans les lésions de l'uretère pelvien. Revue de 50 patients.

Between 1979 and 1991, the authors performed 50 psoas bladder ureterovesical reimplantations for lesions of the pelvic ureter. 90% of very good results were obtained with this technique at the cost of a low morbidity. This series confirms the influence of previous pelvic radiotherapy on the postoperative complication rate. On the basis of the excellent results in this series, confirmed by those reported in the literature, this technique can be proposed as treatment of choice for lesions of the pelvic ureter when suture-resection or simple reimplantation cannot be performed after failure of endoluminal dilatation in patients with a life expectancy greater than 6 months to one year.

[First clinical experience with extracorporeal lithotriptor EDAP LT.02]. / Première expérience clinique du lithotriteur extracorporel EDAP LT.02.

A preliminary study of the EDAP LT.02 extracorporeal lithotriptor is presented. The apparatus includes a double isocentric detection system (ultrasonographic and radiological), facilitating the in situ treatment of ureteric stones. Seventy patients with a total of 89 urinary stones were treated by primary extracorporeal lithotripsy (ECL) with no preliminary selection. 69 stones (77.5%) were located in the kidney and 20 stones (22.5%) were situated in the ureter. Anaesthesia was only required in 2 cases. The patients received an average of 1.2 lithotripsy sessions. Out of the 70 patients treated, there were 46 (66%) complete successes, 12 (17%) partial successes and 12 (17%) failures [corrected].

[Should adrenalectomy be performed systematically as part of radical nephrectomy for renal cancer? Review of 119 cases]. / La surrénalectomie doit-elle être systématique lors de la néphrectomie élargie pour cancer du rein? Revue de 119 dossiers.

Systematic histological examination of 119 operative specimens of radical nephrectomies performed for renal cell carcinoma revealed adrenal invasion in 6 cases (5.04%). Preoperative computed tomography visualised the adrenal lesions with a sensitivity of 100%. Adrenal involvement was due to either contiguous invasion (3 cases) or metastatic spread (3 cases). Other visceral or lymph node metastases were detected in every case. The mean survival of patients with an adrenal lesion was 16.5 months. These data and those reported in the literature suggest the value of systematic adrenalectomy as part of radical nephrectomy.

[Functional analysis of micturition and continence after a Hautmann type enterocystoplasty (27 patients)]. / Analyse fonctionnelle de la miction et de la continence après entérocystoplastie de type Hautmann (27 patients).

Twenty seven patients treated by Hautmann enterocystoplasty completed a detailed questionnaire concerning the quality of their micturition and continence. The mean capacity of the neobladder was 250 cc with a diurnal interval between micturitions of about 3 hours. 79% of patients experienced an urge to micturate. The mean frequency of nocturnal micturition was 1.6. Diurnal continence was perfect in 100% of patients, while nocturnal continence was excellent in 78% of cases and good in 18% of cases, while one patient (4%) suffered from nocturnal incontinence. Hautmann enterocystoplasty is therefore an excellent technique for bladder replacement, ensuring diurnal and nocturnal continence for the great majority of patients.