ESWL treatment with ventral shock-wave application: therapy of iliac and distal ureteral calculi.

Because of the interposition of bony structures, extracorporeal shock-wave lithotripsy (ESWL) of middle or iliac ureteral calculi is not feasible in the conventional supine position. By a slight modification of the patient's couch allowing the prone positioning of the patient, 22 patients with calculi covered by bony structures were thus treated. The success rate of 95 percent without complications is promising and renders ESWL therapy as an alternative to ureteroscopic extraction of mid and iliac ureteral calculi.

[Clinical experiences with extracorporeal shockwave lithotripsy]. / Klinische Erfahrungen mit der extrakorporellen Stosswellenlithotripsie (ESWL).

Clinical experience with 2738 patients treated by extracorporeal shock wave lithotripsy between March 1985 and December 1988 is reported. All treatments were performed with the Dornier HM-3 lithotriptor. 34% of the patients needed auxiliary measures, consisting primarily of urological manipulation to improve urinary drainage or for better localization and/or focussing of the stones. Severe complications were rare; urosepticemia occurred in 0.3%, 2 patients had to undergo nephrectomy because of abscessing pyelonephritis, and there was one death due to recurrent pulmonary embolism in a patient with polycythemia vera. ESWL was used for stones in the entire upper urinary tract. The stone free rate for pelvic calculi smaller than 2 cm was 79% three months after treatment; a further 16% showed desintegrated material smaller than 5 mm, augmenting the success rate to 95%. The success rate dropped to 74% for very large renal stones of more than 4 cm. A stone free rate of 84-96% was ascertained for ureteral calculi 3 months after ESWL. Absolute contraindications for ESWL are acute pyelonephritis, coagulation disorders and pregnancy. The patients must tolerate anesthesia, as most treatments with this lithotriptor must be carried out under peridural or general anesthesia and only in a few exceptional cases is treatment in sedoanalgesia possible. ESWL is now generally accepted in view of its negligible invasiveness, low morbidity and the high success rate. Modern treatment of urinary calculi is inconceivable without considering ESWL.

[Treatment of distal ureteral calculi with extracorporeal shockwave lithotripsy: experiences with 310 cases]. / Die Behandlung distaler Harnleitersteine mit ESWL: Erfahrung mit 310 Fällen.

Distal ureteral calculi are approached by ureterorenoscopy by most authors. With increasing experience ESWL of distal ureteral calculi gained in importance. The success rate of 96.2% in a large series of 310 consecutive patients treated in this manner, confirmed the results of other authors. Excluding women of child-bearing age and very large calculi (greater than 2 cm) the ESWL is a suitable treatment modality of distal ureteral calculi.

Treatment of distal ureteral calculi with extracorporeal shock wave lithotripsy. Experience with 264 cases.

Ureteroendoscopy is used by most authors to approach distal ureteral calculi. With increasing experience extracorporeal shock wave lithotripsy (ESWL) of distal ureteral calculi has gained importance. The success rate of 96% in a large series of 264 consecutive patients treated in this manner, confirmed the results of other authors. Excluding women of child-bearing age and very large calculi (over 2 cm), ESWL is a suitable treatment modality for distal ureteral calculi.

Extracorporeal shock wave lithotripsy for large renal stones. To what size is extracorporeal shock wave lithotripsy alone feasible?

The complications after extracorporeal shock wave lithotripsy (ESWL) for large renal calculi could be reduced by insertion of ureteral stents. In a prospective study, the critical stone size for ESWL combined with ureteral stenting was looked for. Sixty consecutive patients entered the study, 17 patients suffered from renal calculi with a length of greater than 4 cm and a width of greater than 3 cm (group 1), and in 43 patients the calculi measured between 4 x 3 and 2.5 x 1.5 cm2 (group 2). ESWL was performed with the Dornier apparatus HM-3. A ureteral stent was placed immediately before ESWL. In group 1 with very large stones, significantly more obstructive problems were encountered. Three months after ESWL, only 6 of 14 (43%) were free of stones or with stone material likely to discharge spontaneously. In group 2, a success rate of 25 of 29 (86%) was noticed, which was considered satisfactory. For most stones greater than 4 x 3 cm2 the combination of percutaneous nephrolithotomy and ESWL seems to be the preferred treatment.

[Extracorporeal shockwave lithotripsy: experience with 1000 treatments]. / Die extrakorporale Stosswellenlithotripsie (ESWL): Erfahrungen nach 1000 Behandlungen.

6 1/2 years after the first clinical trials in Munich, extracorporeal shockwave lithotripsy is a well established method for the treatment of urinary tract calculi. The number of open surgical interventions in urolithiasis has therefore markedly diminished. In hospitals with lithotriptors open surgical procedures are less than 1% today. In the first 16 months the Department of Urology at the University of Berne performed 1000 treatments with a kidney stone lithotriptor. The treatment was successful in 93.8%, a result comparable with those of other stone centres. During the last few months the indication for the treatment has been considerably enlarged. The new lithotriptors differ in several respects from the standard model by Dornier, though basically the principle of shockwaves remains unchanged.

Bilateral testicular germ cell tumors.

Patients with testicular tumors have an increased risk of a second tumor in the opposite testicle. The surgeon should ensure careful follow-up, possibly with testicular biopsies if the opposite testicle is maldescended or atrophied. In addition, the patient should examine the testicle carefully and regularly. Hormonal substitution is mandatory.

Alpha- and beta-adrenoceptors on cultured glial cells.

The action of alpha- and beta-adrenoceptor agonists and antagonists has been studied on the membrane potential of glial cells in cultured rat central nervous system. Noradrenaline and the alpha-agonist phenylephrine caused a depolarization which was reversibly blocked by the alpha-antagonist phentolamine. In contrast, the beta-agonist isoprenaline hyperpolarized the glial membrane. This hyperpolarization was not associated with measurable changes in membrane resistance and was antagonized by the beta-blocker atenolol. These results suggest that the glial depolarization is mediated by activation of alpha-receptors, whereas the hyperpolarization is due to stimulation of beta-receptors. The existence of alpha- and beta-adrenoceptors on glial cells is further supported by autoradiographic studies showing binding of noradrenaline and alpha- and beta-antagonists to astrocytes.

Evidence for the existence of alpha- and beta-adrenoceptors on cultured glial cells--an electrophysiological study.

The action of adrenergic alpha- and beta-agonists and antagonists has been studied on the membrane potential and resistance of glial cells of cultured rat central nervous system. Noradrenaline and the alpha-adrenoceptor stimulating agents phenylephrine and clonidine (10(-7) to 10(-4)M) depolarized the glial membrane, whereas the beta-agonist isoprenaline caused a hyperpolarization at low concentrations (10(-7) and 10(-6)M). The effects of noradrenaline and phenylephrine were reversibly blocked by the alpha-antagonist phentolamine, whereas those of isoprenaline were antagonized by the beta-blocker atenolol. Atenolol did not affect the depolarization by noradrenaline. The glial depolarization induced by the alpha-agonists was not the consequence of a change in the extracellular K+-concentration unlike that produced by amino acid transmitters. The present results, together with those of biochemical and autoradiographic binding studies, suggest that alpha- and beta-adrenoceptors occur on glial cells and that the glial depolarization is mediated by alpha-receptors, whereas the hyperpolarization is due to activation of beta-receptors.

Effects of substance P on neurones and glial cells in cultured rat spinal cord.

Substance P caused a depolarization of cultured spinal neurones which was often accompanied by a decrease in membrane conductance. The peptide usually had no effect on the membrane potential and resistance of glial cells. In contrast to the depolarization by glutamate, which is associated with an influx of Na+ and an efflux of K+, the action of substance P may be due to a decrease of the K+-conductance.

Efflux of potassium from neurones excited by glutamate and aspartate causes a depolarization of cultured glial cells.

The time course of the depolarization of cultured astrocytes and neurones by glutamate and aspartate corresponds well with the increase of the extracellular K+ concentration ([K +]0) measured with an ion-sensitive microelectrode placed in the close vicinity of the cells tested. It is concluded that the depolarization of glial cells is caused by an efflux of K+ from neighbouring neurones during their excitation by the amino acids.