RESUMO
For chronic malignant and benign ureteral obstruction, the metal construction of the Resonance ureteral stent has been developed to maintain ureteral patency for up to 12 months, obviating the need for the frequent exchange required for conventional plastic ureteral stents. We report our experience placing tandem Resonance stents (TRS) in a single ureter of patients who failed management with a single Resonance stent. A retrospective review of patients who had TRS for management of ureteral obstruction between February 2014 and May 2017 was performed. Seven renal units from four patients with a median age of 62 years were managed with TRS. All but one renal unit was successfully managed with TRS initially. Hydronephrosis resolved in 80% of renal units at a median of 33 days, and creatinine reached its nadir a median of 38 days after placement, with a median improvement of 0.68 ng/mL. However, the median length of management with TRS was only 123.5 days with one exchange, and there was an overall success rate of 28.5% at 1 year. TRS placement is a feasible option for short-term management in a challenging population that would like to avoid nephrostomy and has failed other modalities.
RESUMO
We report a case of traumatic Foley catheter placement and manipulation that resulted in a large, symptomatic, vena cava air embolism confirmed on computed tomography. To the best of our knowledge, our report represents the first case of a large, symptomatic, vena cava air embolism as a direct result of Foley catheter trauma. The included computed tomography images are unique in that they simultaneously show an improperly positioned Foley catheter and a large vena cava air embolism.
Assuntos
Cateterismo/efeitos adversos , Cateterismo/instrumentação , Embolia Aérea/etiologia , Veia Cava Inferior/lesões , Humanos , Masculino , Adulto JovemRESUMO
OBJECTIVES: To compare the success rates, cost effectiveness, and efficiency of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones. METHODS: In a retrospective manner, 220 patients who underwent treatment for proximal ureteral stones were included in the study. The patient records, radiographs, and billing statements of all patients treated for upper ureteral stones between January 1997 and June 2001 at Scott and White Memorial Hospital were reviewed. The patients were placed into two treatment groups according to the method of their stone's initial treatment. The stones were categorized as less than 1 cm and 1 cm or greater. RESULTS: A total of 111 patients were in the ESWL group, 73 of whom had stones less than 1 cm, and 109 patients in the URS group, 81 of whom had stones less than 1 cm. In the URS group, 91% were successfully treated with one treatment intervention, and 55% of the ESWL group were successfully treated with their initial intervention (P <0.0001). Of the patients with URS failure, all but one was treated successfully with a second URS. Of the patients with ESWL failure, 52% were treated successfully by subsequent URS. The remaining patients with ESWL failure were treated with repeat ESWL, with a 62% success rate. The efficiency quotient for stones less than 1 cm for URS and ESWL was 0.79 and 0.51, respectively. For stones 1 cm or greater, URS had an efficiency quotient of 0.72 and ESWL of 0.46. The URS group required fewer days to be stone free (8 versus 25.5 days, P <0.0001). No statistically significant difference was found in the overall complication rates (P = 0.43). URS had significantly lower charges for the initial procedure (7575 dollars versus 9507 dollars, P <0.0001). The total charges were also lower for URS (9378 dollars versus 15,583, dollars P <0.0001). Complications were similar in the two groups. The URS group had two ureteral strictures. CONCLUSIONS: The results of this study indicate that URS is more efficient and cost-effective for stones up to and larger than 1 cm with similar complication rates compared with ESWL.
