Routine radiologic surveillance for obstruction is not required in asymptomatic patients after ureteroscopy.

OBJECTIVE: A retrospective medical record review was performed with the goal of determining the need for radiologic evaluation after ureteroscopy. PATIENTS AND METHODS: Of 183 patients undergoing ureteroscopic procedures at our institution between 1989 and 1993, 131 underwent postoperative radiologic studies capable of diagnosing ureteral obstruction. Of these patients, 110 (84%) were asymptomatic after the procedure, and radiologic procedures capable of displaying obstruction were performed at a median of 60 days (mean 73 days; standard deviation 189 days) after ureteroscopy. RESULTS: None of these asymptomatic patients displayed obstruction at the time of the routine follow-up radiologic procedure. Of those 21 patients (16%) who experienced flank pain subsequent to ureteroscopy, 13 were found to have ureteral obstruction secondary to ureteral calculus. One patient (1/131 or 0.8%) was found to have a ureteral stricture, which occurred after a full-thickness ureteral injury. All cases of postoperative obstruction were heralded by a concomitant display of flank pain. CONCLUSION: Routine postoperative radiologic studies are not necessary in surveillance for obstruction in the asymptomatic postureteroscopy patient, as obstruction should become evident by virtue of flank pain. The exception to this practice may be in patients experiencing a ureteral perforation intraoperatively, who may be at greater risk of stricture.

Pyelocutaneous fistula after SWL of xanthogranulomatous pyelonephritic kidney: case report.

A 75-year-old woman formed a pyelocutaneous fistula after four extracorporeal lithotripsies over 10 months with continued stenting. Xanthogranulomatous pyelonephritis was confirmed at nephrectomy. Preprocedure renal function studies with culture and eradication of infection are advisable before SWL.

Cost and efficacy of extracorporeal shock wave lithotripsy versus ureteroscopy in the treatment of lower ureteral calculi.

We retrospectively reviewed the extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy experience relative to cost and efficacy of a group of practitioners skilled in the use of both procedures for the treatment of lower ureteral stones. Although the initial success rate was higher with ureteroscopy, no significant difference could be found in final success or complication rates. The cost of ESWL was approximately 60% higher than that for ureteroscopy (mean $7,320.26 versus $4,568.47, p less than 0.005). Given the current restraints on resources, and the equal efficacy and morbidity of both procedures, ureteroscopy must be considered the procedure of choice in the management of lower ureteral stones.

Use of indomethacin suppositories in the prophylaxis of recurrent ureteral colic.

To determine the effects of indomethacin suppositories in the relief of acute colic and prevention of recurrent colic, we instituted a prospective double-blind, placebo-controlled protocol. Patients were randomized to receive either 50 mg. indomethacin or placebo suppositories every 8 hours and all patients received prescriptions for supplemental narcotics to be used on an as needed basis. Relief of colic was assessed by counting the total number of supplemental narcotics used by each patient per 24 hours during the study period, which was defined as until passage of the calculus or 5 days. There were 41 patients entered into the study protocol and complete followup was available for 26. Mean calculus size was 3.4 mm. in the indomethacin group versus 3.1 mm. in the placebo group. All 13 patients in the control group had recurrent episodes of colic and 8 of these 13 had more than 1 recurrent episode. Five patients in the placebo group required admission to the hospital for control of pain. In contrast, only 4 of the 13 patients in the treatment group had colic and only 1 had more than 1 episode of colic. No patient in the active drug group required admission to the hospital for control of pain. Over-all the ratio of supplemental narcotic used by the placebo group versus the indomethacin group was 7.6:1 (p less than 0.005). The mean interval time to passage of the calculus was slightly lower in the indomethacin group (89 versus 82 hours) but this difference was not statistically significant (p greater than 0.10). Our data strongly support the use of indomethacin suppositories in the prevention of recurrent colic secondary to ureteral calculi.

The crush syndrome: a complication of urological surgery.

A few cases of the crush syndrome occurring postoperatively have been reported. We present a case of the crush syndrome involving the gluteal compartment secondary to prolonged duration of the patient in the right lateral decubitus position during a urological operation. A review of the literature demonstrates that prompt diagnosis is essential to avoid catastrophic results. The essentials of diagnosis, treatment and prevention are reviewed.

Hypercalcemia and discoid lupus erythematosus-like syndrome associated with renal cell carcinoma.

Multiple systemic manifestations of renal cell carcinoma have been reported. The first case of a discoid lupus erythematosus-like syndrome and the third reported case of hypercalcemia associated with an elevated serum prostaglandin E2 level in a patient with renal cell carcinoma is presented herein.

Increased physical growth after successful antireflux operation.

Gross vesicoureteral reflux with infection can retard renal growth. Resumption of renal growth or even accelerated growth has been reported after successful surgical repair of reflux in children. No published reports examining the effect on physical growth are available. The preoperative and postoperative physical growth curves were examined in 35 consecutive pediatric patients undergoing ureteroneocystostomy for reflux. The significant (average 81%) increase in the postoperative physical growth percentile is presented and discussed.

Enuresis: evaluation of perplexing symptom.

The child with enuresis is a common problem facing the urologist. We have done a retrospective study of 182 enuretic children seen at our Clinic from January, 1970, to December, 1975. There was a 10.4-per cent incidence of vesicoureteral reflux. In only 58 per cent of the children with reflux were positive urine cultures demonstrated. There were no significant complications in studying these children under general anesthesia. Therefore, we believe an aggressive approach is justified.

Torsion of undescended testis.

Torsion of an undescended testis is uncommon. When encountered, this entity represents a surgical emergency and must be dealt with immediately. A report of 2 cases, one in a five-month-old child and the other in a twelve-year-old mentally retarded child, is made and the pertinent literature is reviewed.