626
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Abstract
The modern day treatment of UPJO with retrograde endopyelotomy continues to evolve as experience and knowledge progress. Use of the straight lateral incision and selective use of spiral CT angiogram has refined treatment decisions with retrograde endopyelotomy further. The authors' decision-oriented approach offers guidelines for the practicing urologist. Ultimately, it is up to the urologist and the patient to select the best approach for each clinical scenario.
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627
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Abstract
In selected cases, RIRS management of calyceal diverticula and its related problems has been shown to be more efficacious than ESWL monotherapy and avoids the potential complications and discomfort of percutaneous and laparoscopic procedures. The advent of the Holmium laser energy source, with innovations such as the flexible ureteroscope and the tipless stone basket, have expanded the role of RIRS in the management of calyceal diverticula and associated problems. Presently, RIRS is the initial treatment choice for the management of low to moderate stone burdens that are contained in calyceal diverticula or trapped behind any narrowed intrarenal segment (e.g., infundibular stenosis). If repair of the stenotic segment is not successful, thereby excluding stone treatment, then under the same anesthesia, the patient undergoes a percutaneous antegrade renal surgery. The authors feel that the percutaneous approach as a first choice is more suitable for posteriorly located diverticula with a large stone burden. In selected cases of anteriorly located diverticula with large stone burdens, the laparoscopic approach is more expedient.
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628
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Székely JG, Villányi K, Battyány I. Technical aspects of percutaneous renal biopsy now. Nephron Clin Pract 2000; 79:106. [PMID: 9609473 DOI: 10.1159/000045002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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629
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De Baere T, Lagrange C, Kuoch V, Morice P, Court B, Roche A. Transcatheter ethanol renal ablation in 20 patients with persistent urine leaks: an alternative to surgical nephrectomy. J Urol 2000; 164:1148-52. [PMID: 10992355 DOI: 10.1097/00005392-200010000-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluate the efficacy of transcatheter ethanol renal ablation for destruction of a unilateral, poorly functioning kidney with persistent urinary leaks from fistulas or a nephrostomy tube. MATERIALS AND METHODS From January 1992 to January 1999, 19 females and 1 male with a history of pelvic neoplasms, which were responsible for ureteral leaks through the nephrostomy tube in 13 cases or fistulas in 7, were treated with transcatheter ethanol renal ablation. Serum creatinine ranged from 60 to 140 micromol./l. (mean 90), and function of the involved kidney determined by diethylenetetraminepentaacetic acid scintigraphy in 16 patients or by morphological imaging in 4 was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After epidural anesthesia or intravenous sedation renal ablation was performed by catheterization of the renal artery and injection of 1. 5 to 12 ml. (mean 4.6) absolute ethanol, and completed by proximal occlusion with coils and absorbable gelatin sponge. RESULTS Arterial flow was interrupted in all cases. Urinary flow ceased in 2 days in 18 of 20 patients, and drains were removed. Two patients had residual urine that was successfully treated with additional embolization. No complications occurred. CONCLUSIONS Transcatheter ethanol renal ablation is safe and effective, and permits an in situ nephrectomy that can replace surgical nephrectomy for treatment of urinary leaks.
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630
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Tahmaz L, Yalçin O, Yağci S, Sağlam M, Erduran D, Harmankaya C. [Isolated ureteropelvic junction laceration following blunt body trauma]. ULUSAL TRAVMA DERGISI = TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY : TJTES 2000; 6:266-70. [PMID: 11813484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The purpose of the study is to investigate the radiologic and clinical treatment methods following the rarely seen UPJ laceration due to blunt body trauma. In this study there are eight patients with isolated UPJ laceration, admitted to Gülhane Military Medicine Academy, Firat University Medical Faculty Urology department, and Elaziğ Military Hospital Urology Service. They are one child (12 years old) and 7 adults (6 male, 1 female) ranged 18-61 years old. Abdominal USG(Ultrasonography), IVP(Intravenous Pyelography), abdominal CT(Computed Tomography), and retrograde-antegrade pyelography were used for diagnosis. They were treated with percutaneous nephrostomy, double J stent implantation and reconstructive open surgical procedures. All patient were cured with the culmination of urinary extravasation and ureteropelvic patency.
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631
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Tahmaz L, Kilciler M, Yağci S, Sağlam M, Erduran D, Harmankaya C. [Missed ureteral injuries following surgical exploration with percutaneous nephrostomy and drainage treatment]. ULUSAL TRAVMA DERGISI = TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY : TJTES 2000; 6:284-7. [PMID: 11813488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malaise, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionally, Urinoma is drained percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrostomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary- flep and ureteroneocystostomy and at one ureteroureterostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous drainage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.
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632
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Gökçe G, Kiliçarslan H, Ayan S, Hocaoğlu SS, Gültekin EY. [Treatment plans and results in iatrogenic ureteral injuries]. ULUSAL TRAVMA DERGISI = TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY : TJTES 2000; 6:271-4. [PMID: 11813485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We treated 19 patients with iatrogenic ureteral injuries during a 10-year period. Gynecological operations were the most common surgical procedures (52.6%). The diagnosis of ureteral injury was made immediately in 6 patients and was delayed 14 to 180 days in 13. Five of the 6 injuries recognized during the operation were repaired successfully at the time of injury; one patient resulted a nephrectomy. Seven of the lately recognized 13 patients were treated with percutaneous nephrostomy and the first treatment. The two patients were made ureteroneocystostomy, one was made ureteroureterostomy and one had ureterolysis in the other five patients. We observed ureteral stenosis in the three patients after the operation follow ups. The treatment was achieved with the endourological approach at these patients. Finally, we recommend percutaneous nephrostomy as a first treatment choice in the lately recognized iatrogenic ureteral injuries, while the immediate diagnosis and treatment of iatrogenic ureteral injuries, are severely important.
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633
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Ben-Ami H, Lavy A, Behar DM, Ginesin Y, Fischer D, Edoute Y. Left hydronephrosis caused by Crohn disease successfully treated conservatively. Am J Med Sci 2000; 320:286-7. [PMID: 11061356 DOI: 10.1097/00000441-200010000-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 35-year-old man who presented with fever, diarrhea, and a left abdominal mass. Diagnostic studies confirmed Crohn disease and revealed an abdominal mass obstructing the left ureter with hydroureter and hydronephrosis. The patient was successfully treated conservatively, with corticosteroids and mesalamine, A review of the literature indicates a predominance of right ureteral involvement in Crohn disease, associated with a high incidence of ileocecal disease. Most of these patients were treated surgically, with resection of ileocecal lesion and/or ureterolysis. Ureteral obstruction as a complication of Crohn disease is discussed, with emphasis on conservative treatment.
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634
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Johansson S, Schönebeck J. [A case report. The phenomenon with the purple catheter bag]. LAKARTIDNINGEN 2000; 97:4142-3. [PMID: 11068381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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635
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Scherrer A, Mellot F, Botto H, Lebret T. [Quiz. Urolithiasis, CT and lithotripsy guidelines]. JOURNAL DE RADIOLOGIE 2000; 81:1052-3. [PMID: 10995491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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636
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Martin JH, Rosser CJ, Linebach RF, McCullough DL, Assimos DG. Are coagulation studies necessary before percutaneous nephrostomy? TECHNIQUES IN UROLOGY 2000; 6:205-7. [PMID: 10963488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE Performance of coagulation studies for patients undergoing percutaneous nephrostomy (PCN) has been advocated by some investigators. We performed a retrospective study to assess this practice. MATERIALS AND METHODS The medical records of 180 patients subjected to PCN for various reasons between October 1991 and July 1998 were reviewed. This represents a subset of patients in whom PCN was performed by an experienced interventional radiologist at our institution. Patients were excluded if they had a history of active liver disease, hematologic or bleeding disorder, current use of heparin or warfarin, or platelet count <100,000. The remaining 160 patients were separated into two groups. Group 1 consisted of 153 patients with a normal prothrombin time (PT) and partial thromboplastin time (PTT). Group 2 comprised 7 patients with an abnormal PT or PTT. Demographic and laboratory data including PT, PTT, complete blood, and platelet counts were analyzed to determine if a hemorrhagic complication could be predicted by an abnormal PT or PTT. RESULTS In group 1 the mean PT was 12.2 seconds and the mean PTT was 25.0 seconds; in group 2 the mean PT was 13.9 seconds and the mean PTT was 30.3 seconds. The hemorrhagic complication rates were not statistically different between the two patient cohorts (p = .203). Demographic and standard laboratory data were not predictive of abnormal coagulation parameters. CONCLUSIONS Screening coagulation studies are unnecessary in the standard patient subjected to PCN.
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637
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Borboroglu PG, Kane CJ. Current management of severely encrusted ureteral stents with a large associated stone burden. J Urol 2000; 164:648-50. [PMID: 10953117 DOI: 10.1097/00005392-200009010-00007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We review our recent experience with encrusted retained ureteral stents associated with a large stone burden as well as current endoscopic options available for management. MATERIALS AND METHODS One man and 3 women presented to our department between May 1998 and April 1999 for treatment of an encrusted retained ureteral stent. One patient had a history of 3 episodes of ureteral stent encrustation during the last 6 years. We reviewed the management of these stents and the associated stone burden. RESULTS Average patient age was 32.5 years (range 25 to 41). Average interval that the encrusted stent remained in place was 7 months (range 3 to 12). In the 3 women pregnancy was associated with the retained stent. All patients required 2 to 6 endourological approaches (average 4.2) performed at 1 or multiple sessions to render them stone-free and stent-free. Postoperatively sepsis in 1 case necessitated a prolonged intensive care unit stay with eventual recovery. CONCLUSIONS Successful management of a retained encrusted stent requires combined endourological approaches. Percutaneous nephrostolithotomy and ureteroscopy are often necessary for treating a severely encrusted stent and the associated stone burden.
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638
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Abstract
PURPOSE The Dornier MFL-5000* is a multifunctional lithotriptor unit that has been purported to be highly efficacious for treating stones. Our experience led us to believe that the actual success rates are not as high as those reported by others. We objectively reexamined the efficacy of this device and factors contributing to treatment success or failure. MATERIALS AND METHODS We retrospectively reviewed the records and x-rays of 105 consecutive patients treated with extracorporeal shock wave lithotripsy (ESWL*) using the MFL-5000 during an 18-month period from September 1997 to March 1999. One patient was excluded from study due to a stone within a caliceal diverticulum. Patients were divided evenly by gender and stone laterality. In 70% of cases a stent was placed preoperatively to relieve obstruction and/or facilitate the passage of calculous fragments. The majority of stones (70%) were 10 mm. or less. Treatment success was determined by examining x-rays done preoperatively and at a median of 4 weeks postoperatively. RESULTS ESWL was successful in only 47% of our patients, defined as residual stone fragments 2 mm. or less. A secondary procedure was required in 27% of the patients, including repeat ESWL in 6, ureteroscopic stone manipulation in 14, percutaneous tube placement in 1 and percutaneous nephrolithotripsy in 7. Factors contributing to secondary procedures and poor stone clearance were a stone burden of greater than 100 mm.2 and mid pole location (p = 0.0242 and 0.016, respectively). Poor stone fragmentation and clearance were noted despite significantly more shocks delivered (p = 0.0122). Only a small stone burden of 50 mm.2 or less responded well to ESWL (p = 0. 0142). CONCLUSIONS These results compel us to reconsider the effectiveness of the Dornier MFL-5000 lithotriptor. We encourage groups at other institutions to reexamine and report their success rates. We recommend the use of this lithotriptor only for a stone burden of 50 mm.2 or less.
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639
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Rabii R, Joual A, Bennani S, Hafiani M, el Mrini M, Benjelloun S. [Stab wound to the left solitary kidney: report of a case]. ANNALES D'UROLOGIE 2000; 34:232-5. [PMID: 10994141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A forty-four-years old man with a left solitary kidney presented a stab wound in the left lumbar region. Upon admission, the patient was hemodynamically stable, the abdominal ultrasonography showed a small perirenal hematoma and the intravenous pyelography was normal. Two days later, he had no hematuria and was discharged from the hospital, with a computed tomography scan control two weeks later. Unfortunately, seven days later, the patient was admitted to emergency for left lumbar pain, a 40 degrees C fever and pyuria. The creatinine level was 72 ng/mL, and the computed tomography scan showed a large urohematoma. The patient was operated and required partial upper polar nephrectomy for distorted upper pole with infected hematoma. A large hematoma was removed and a nephrostomy tube was introduced. The renal function returned to normal six days postoperatively and the nephrostomy tube was removed after nephrostogram at 12 days. Concerning this uncommon case, we emphasize the advantage of the computed tomography scan and the necessity of emergency management in a patient with solitary traumatic kidney.
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640
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See WA. Continuous antegrade infusion of adriamycin as adjuvant therapy for upper tract urothelial malignancies. Urology 2000; 56:216-22. [PMID: 10925081 DOI: 10.1016/s0090-4295(00)00612-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the feasibility, efficacy, and toxicity of antegrade chemotherapy delivered continuously as adjuvant treatment for patients with upper tract transitional cell carcinoma. METHODS During a 6-year interval, 12 patients with upper tract transitional cell malignancies underwent continuous antegrade intraluminal infusion chemotherapy (CAIIC) with adriamycin. After placement of percutaneous access and surgical treatment of the primary lesion, patients received 5-day cycles of CAIIC. Patients received between two and four treatment cycles at 2-week intervals. After therapy, patients with no evidence of residual disease were then monitored long-term with retrograde pyelography and upper tract cytology. RESULTS Twelve patients underwent a total of 35 5-day cycles of CAIIC. No patient experienced hematologic and/or local/regional toxicity during or after drug infusion. Three patients were treated for upper tract carcinoma in situ, and 9 patients had discrete exophytic tumors. Two patients died (treatment unrelated) before a final assessment of therapeutic outcome, leaving 10 patients available for evaluation of the therapeutic response. One patient with carcinoma in situ and 5 of 7 patients with discrete upper tract tumors remained disease free after surgery and adjuvant therapy. Both patients with discrete tumors in whom therapy failed had residual gross disease after primary surgical treatment. CONCLUSIONS CAIIC using adriamycin was well tolerated for periods of up to 5 days over multiple cycles. Early data suggest a limited efficacy in treating patients with gross residual disease. The efficacy of this approach in preventing the recurrence of upper tract disease after surgical ablation awaits further assessment.
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641
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Abstract
OBJECTIVES During the past 10 years, numerous reports around the world have documented the safety and success rate of antegrade endopyelotomy. We describe the classic endopyelotomy in conjunction with some new alternatives for making the incision. TECHNICAL CONSIDERATIONS Antegrade endopyelotomy is performed through the 0.5-in. incision of the percutaneous nephrostomy created by way of an upper or middle calix. Using the hook-shaped cold knife, an endopyelotome is positioned, and the entire procedure can be performed under direct vision, which determines the exact position, depth, and extent of the incision. The ureteropelvic junction (UPJ) obstruction is incised in a posterolateral position, and the hook is withdrawn from the proximal ureter. Using nephroscopic scissors, a small full-thickness puncture is made into the renal pelvis and then the scissors is opened, under constant visual control, until it reaches the peripelvic space. The section of the pelvic wall is completed with the scissors running through the UPJ, without any interchange of the nephroscope. A holmium laser has been also used, with the 365-microm fiber introduced through a stent-pusher. Under direct vision, the UPJ is incised with fiber, permitting observation and coagulation of bleeding from small vessels. After the procedure, either a 14-8.2F endopyelotomy stent or a 14-7F tapered endoureterotomy stent is placed over the guidewire. CONCLUSIONS Percutaneous antegrade endopyelotomy is a safe and effective treatment of UPJ obstruction for most patients, regardless of the method used to perform the incision.
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642
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Springer RM. Precise placement of tract anesthesia for percutaneous biliary drainage and nephrostomy. J Vasc Interv Radiol 2000; 11:938-9. [PMID: 10928536 DOI: 10.1016/s1051-0443(07)61815-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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643
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Weintraub JL, Pappas GM, Romano WJ, Kirsch MJ, Spencer W. Percutaneous reduction of ureterosciatic hernia. AJR Am J Roentgenol 2000; 175:181-2. [PMID: 10882271 DOI: 10.2214/ajr.175.1.1750181] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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644
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Soto Delgado M, Varo Solís C, Bachiller Burgos J, Beltrán Aguilar V. [Percutaneous nephrostomy as management technique of obstructive uropathy: review of 105 cases]. Actas Urol Esp 2000; 24:568-72. [PMID: 11011447 DOI: 10.1016/s0210-4806(00)72504-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
105 percutaneous nephrostomies in 73 patients. Indication for nephrostomy was obstruction in the drainage system in all cases. Nephrostomy was bilateral in 24 cases. Reasons for nephrostomy were: lithiasis in 35 cases, carcinoma of the bladder in 17, post-surgical iatrogenic stenosis in 13, prostate carcinoma in 9, cancer of the rectum in 9, infection in 5, neoplasia of the upper urinary tract in 5, retroperitoneal fibrosis in 3, glandular cystitis cystica in 3, ovarian cancer in 3, congenital in 2, lymphoma in 1. Six case were single-kidney patients. Renal puncture through the lower calyceal group was the preferred approach. Purulent urine was extracted in 10 cases. Complications of nephrostomy included haematuria in 34 cases, contrast extravasation in 8, fever in 6, 1 case of death due to septic shock, 2 perirenal haematoma (nephrectomy was required in 1 case), and catheter detachment in 5 cases. All patients showed improvement of both clinical signs and symptoms, and lab results.
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645
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Giddens JL, Grotas AB, Grasso M. Stone granuloma causes ureteropelvic junction obstruction after percutaneous nephrolithotomy and antegrade endopyelotomy. J Urol 2000; 164:118-9. [PMID: 10840437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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646
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Peréz LM, Netto JM, Batista LR, Burns JR. Successful management of a large xanthine calculus by percutaneous nephrolithotomy after failed SWL in a 5-year-old boy. J Endourol 2000; 14:439-41. [PMID: 10958567 DOI: 10.1089/end.2000.14.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 5-year-old child with a xanthine calculus resistant to SWL was made stone free by percutaneous ultrasonic lithotripsy.
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647
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Pappas P, Stravodimos KG, Mitropoulos D, Kontopoulou C, Haramoglis S, Giannopoulou M, Tzortzis G, Giannopoulos A. Role of percutaneous urinary diversion in malignant and benign obstructive uropathy. J Endourol 2000; 14:401-5. [PMID: 10958560 DOI: 10.1089/end.2000.14.401] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We evaluated the feasibility and effectiveness of percutaneous urinary diversion in patients with obstructive uropathy. PATIENTS AND METHODS A total of 206 percutaneous nephrostomies (PCNs) (right-sided in 54, left in 56, and bilateral in 48) were performed in 102 male and 57 female patients 18 to 94 years old. In 125 patients, malignancy was the underlying cause of the obstruction and in 30, benign disease. In four patients, the cause remained unknown. In most patients (N = 154), the access was guided with both ultrasound and fluoroscopy. RESULTS Percutaneous nephrostomy was successful in 158 patients (99%). Antegrade ureteral stenting was attempted in 48 patients with a success rate of 81%. Fifteen days postprocedure, the mean urea and creatinine concentrations had declined from 160.8 mg/mL to 63 mg/mL and from 6.9 mg/dL to 2.2 mg/dL, respectively. In 66% of the patients, renal function returned to normal. In 28%, it improved with no need for hemodialysis, while in 6%, there was no improvement. Advanced age and prostate cancer were negative predictive factors for the improvement of renal function, whereas the BUN and creatinine concentrations before the procedure and performance of unilateral v bilateral nephrostomies were not. We did not have severe complications. Three patients received transfusions, and in one patient, a urinoma was drained percutaneously. Patients with malignancy had a median survival of 227 days. CONCLUSION Percutaneous urinary diversion under radiologic guidance is a safe and effective procedure for patients with obstructive uropathy.
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648
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Trotteur G, Stockx L, Dondelinger RF. Sedation, analgesia and anesthesia for interventional radiological procedures in adults. Part I. Survey of interventional radiological practice in Belgium. JBR-BTR : ORGANE DE LA SOCIETE ROYALE BELGE DE RADIOLOGIE (SRBR) = ORGAAN VAN DE KONINKLIJKE BELGISCHE VERENIGING VOOR RADIOLOGIE (KBVR) 2000; 83:111-5. [PMID: 11025921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A questionnaire was mailed to 217 interventional radiologists to evaluate current practice in analgesia and sedation in adults. Response rate was 15% (33/217). Diagnostic angiography was performed with local anesthesia in 94% to 99%; for PTA, local thrombolysis or stent placement, light sedation was added in 0.1%. Premedication was given in 43% of diagnostic angiographies and in 68% of therapeutic procedures. Radiologists consulted an anesthesiologist before administration of intravenous sedation, always in 54% of cases, occasionally in 19% and never in 27%. General anesthesia with artificial ventilation was applied in 56% of TIPS, in 70% of aortic stent grafting and in 82% of neuroradiological interventions. Intravenous sedation was applied given in 53% of percutaneous biliary drainage, in 42% of bile duct dilatation or stenting, in 40% of percutaneous nephrostomy and in 72% of ureteral balloon dilatation. Patient monitoring during an interventional procedure was always carried out by an anesthesiologist in 52% of cases. 21% of radiologists never visited the patient before a therapeutic procedure, and 36% never did so after completion of a procedure. This survey showed that high standard practice of sedation and analgesia, with the assistance of anesthesiologists, is underused by interventional radiologists in Belgium.
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MESH Headings
- Adult
- Analgesia
- Anesthesia, General
- Anesthesia, Local
- Anesthesiology
- Angiography
- Angioplasty, Balloon, Coronary
- Aorta/surgery
- Belgium
- Bile Duct Diseases/therapy
- Blood Vessel Prosthesis Implantation
- Brain Diseases/diagnosis
- Catheterization
- Conscious Sedation
- Drainage
- Humans
- Interprofessional Relations
- Monitoring, Physiologic
- Nephrostomy, Percutaneous
- Portasystemic Shunt, Transjugular Intrahepatic
- Practice Patterns, Physicians'
- Preanesthetic Medication
- Radiology, Interventional
- Respiration, Artificial
- Stents
- Thrombolytic Therapy
- Urethral Diseases/therapy
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649
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Clayman RV. Nephroscopy sheath characteristics and intrarenal pressure: human kidney model. J Urol 2000; 163:1616. [PMID: 10798923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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650
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Masuda H, Nobuhisa S, Ueda H, Katsuoka Y, Okano H. [A case of xanthogranulomatous pyelonephritis presenting with the flank subcutaneous mass]. HINYOKIKA KIYO. ACTA UROLOGICA JAPONICA 2000; 46:331-3. [PMID: 10876757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A 51-year-old female exhibited fever, left flank pain and left flank mass in March, 1993. Drip infusion pyelography (DIP) revealed a non-functioning left kidney with shadows of calculi, and abdominal computerized tomography (CT) showed renal calculi and multilocular cystic lesions in the left kidney extending through the perinephric space into the mass on the left flank. Percutaneous nephrostomy and percutaneous drainage were performed, followed by left nephrectomy. Histopathological findings revealed xanthogranulomatous pyelonephritis. There have been a few case reports of xanthogranulomatous pyelonephritis forming nephrocutaneous fistula in the back.
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