1/18. In situ extracorporeal shock wave lithotripsy of ureteral calculi with the MPL-9000X lithotriptor.Within the wide armamentarium of urinary stone treatment modalities extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure. With the Dornier MPL-9000X lithotriptor one has the choice of ultrasound or fluoroscopic localization of calculi throughout the entire urinary tract. Except for the kidney, ultrasound guidance is preferred for calculi in the distal ureter, while fluoroscopy is generally used on the proximal two-thirds of the ureter. Between January and December 1990, 123 ESWL treatments were performed on 83 patients suffering from ureteral calculi with an average stone size of 9.3 x 6 mm. Median treatment parameters were 1,597 shock waves at 19.3 kv. for 43 minutes. For stones in the upper two-thirds of the ureter sedation analgesia was given, while ESWL on the pelvic ureter did not create intolerable pain. Of the treatments 69% were done on an outpatient basis. In situ ESWL treatment of urinary calculi was successful in 72 patients (86.7%), and 20 patients (24.1%) were treated with multiple treatment sessions. ESWL therapy for 47 stones in the distal ureter showed better results than for 33 stones plus 2 steinstrasse in the proximal part (95.5% versus 80% stone-free rate). Of 4 patients with mid ureteral calculi 2 could be rendered stone-free by ESWL alone. Auxiliary procedures, such as percutaneous nephrostomy or ureteral splints, had to be performed in 15.7%. Final endoscopic stone extraction was done in 7 cases and open surgery in 4, constituting a 13.3% failure rate for ESWL therapy. The results prove that the MPL-9000X lithotriptor is effective for primary noninvasive stone treatment.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/18. Multiple cystine stone formations on an indwelling ureteral stent treated by extracorporeal shock wave lithotripsy.Multiple large cystine stones formed on an indwelling ureteral stent used in the medical management of a 12-year-old boy with obstructing renal stones and cystinuria. Extracorporeal shock wave lithotripsy fragmented the cystine stones and allowed for extraction of the stent by cystoscopy.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/18. Comparison of flexible grasping forceps and stone basket for removal of retracted ureteral stents.BACKGROUND: Ureteral-stent dislocation can occur either during positioning or postoperatively. Grasping the distal end of the stent and removing it depends on the angulation between the extraction device and the stent, the size and length of the instrument, and the force of the branches and resistance of the dislocated stent. patients AND methods: Six cases of challenging stent removal are presented, and details of the surgical technique are described. By in-vitro testing, we investigated the deflection of flexible cystoscopes and ureteroscopes using forceps or a four-wire stone basket, the ability to grasp a stent depending on the angle between the stent axis and the extraction device, and the force that can be applied on the stent with the different devices. RESULTS: In all cases, it was possible to extract the stent with a stone basket. In an in-vitro setting, maximum extraction forces, measured with a macro scale, were 1.3 kg (cystoscopic forceps) and 0.4 kg (ureteroscopic forceps) until the forceps slipped off the stent. In the same setting, a rupture of the wires of the 1.9F stone basket occurred at 0.8 kg, whereas with a 2.4F basket, a force of 1.9 kg led to rupture of the stent, leaving the basket intact. CONCLUSIONS: Using a stone basket instead of grasping forceps in difficult cases of dislocated stents opens new possibilities for their cystoscopic and ureteroscopic removal. Because the superiority of the basket is counterbalanced by its higher costs, we suggest the basket extraction method only in difficult cases.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
4/18. Ureteroscopic removal of ureteral calculi in bilateral ureteral duplications.Two rare cases of ureteroscopic removal of impacted ureteral calculi in patients with partial and complete ureteral duplication are described. The procedural steps and problems encountered are discussed. Successful ureteroscopic stone extraction was obtained in the 2 patients.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/18. Real-time, multiplanar computerized tomography: a new diagnostic modality used in the detection and endoscopic removal of a distal ureteral fibroepithelial polyp and adjacent calculus.Ureteral fibroepithelial polyps are rare benign mesodermal tumors that occur predominantly in the upper ureter. We report on a patient with a fibroepithelial polyp in the distal ureter that resulted in entrapment of a calculus and partial obstruction of the collecting system. Preoperatively, diagnosis by standard radiographic methods, such as excretory urogram, retrograde pyelogram and conventional computerized tomography with and without contrast enhancement, was not possible because of the close proximity of the fibroepithelial polyp, the ureteral calculus and calcifications in the adjacent internal iliac artery. The new diagnostic modality of real-time, multiplanar computerized tomography imaging using the Sun/Pixar computer system and the 2D/3D Orthotool software was used to make the correct preoperative assessment. Subsequently, the patient underwent ureteroscopic resection of the polyp and extraction of the calculus. A year later she was free of symptoms and there was no evidence of regrowth of the polyp. To our knowledge this is the first report to describe the use of real-time, multiplanar computerized tomography imaging as an effective diagnostic modality in the genitourinary tract. In addition, this is the first ureteral fibroepithelial polyp reported in the literature to be associated with a ureteral calculus and to be excised endoscopically with no recurrence on long-term followup.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/18. Combination extracorporeal shock wave lithotripsy and percutaneous extraction of calculi in a renal allograft.Renal calculi are a well documented although uncommon complication of kidney transplantation and may be associated with significant morbidity in this immunosuppressed population with a single functioning kidney. We describe a patient who presented with 2 episodes of staphylococcal bacteremia associated with a ureteral structure and struvite calculi involving the calices, renal pelvis and proximal ureter of a cadaveric renal allograft. The patient was treated successfully with a combination of extracorporeal shock wave lithotripsy, percutaneous extraction and balloon dilation of the ureteral stricture. Renal transplant function was not altered postoperatively. In selected cases shock wave lithotripsy can be used as effective adjunctive therapy in a renal allograft harboring stones.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
7/18. Ureterorenoscopy in the treatment of ureteral stones.Ureterorenoscopy rendered the endoscopic removal of ureteroliths possible. Big distal ureteroliths which do not pass spontaneously and for which ureterolithotomy is unavoidable, are treated by means of ureterorenoscopy which makes ultrasonic disintegration or stone extraction with a Dormia loop possible, and this under optical control too. The different techniques and strategies are presented. In animal experiments alterations of the urothelium after exposure to ultrasound were examined. There is the possibility to combine ureterorenoscopy with the percutaneous method of litholapaxy or ESWL when treating ureteroliths in the upper part of the ureter which do not pass spontaneously.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/18. Forceps extraction of ureteral stones.ureteroscopy and pyeloscopy in association with ultrasonic lithotripsy for extraction of ureteral stones has, in most instances, eliminated the need for open surgical intervention. Four ureteral stones were successfully extracted by the technique described using flexible cup biopsy forceps introduced through a Teflon sheath. This method was used when basket extraction, ureteroscopy, and other forms of endoscopic stone manipulation were unsuccessful. Two ureteral stones were removed by the transurethral route, and two were removed through a percutaneous nephrostomy tract. There has been little morbidity with this procedure, and patients have returned to normal activity within several days of hospital discharge.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |
9/18. Transurethral vesicovaginal extraction of stone: nonoperative approach for intramural ureteral calculi in women.Herein we describe a new technique for the removal of an impacted intramural ureteral calculus in a female patient. The stone was extracted by digital manipulation with the index finger of one hand in the bladder and the index and middle fingers of the other hand in the vagina. The relative ease of performing the procedure and the absence of any immediate and long-term postoperative morbidity and complications warrant further use of this technique.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
10/18. Use of coagulum for displaced ureteral calculi.At the time of distal ureterolithotomy the urologic surgeon is faced occasionally with the complication of a displaced ureteral calculus that has migrated proximally through a dilated ureter. We report such a case and offer an alternative method of injection and extraction of a cryoprecipitate coagulum through the ureterotomy. This technique may eliminate the need for an additional incision or a possible second operative procedure.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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