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The Greenberg Retractor for Endourologist
Calculi 716
717
EXPERIENCE WITH THE FIRST EXTRACORPOREAL SHOCK WAVE LITHOTRIPTER UNIT IN CANADA. Martin G. McLaughlin, Seek L. Chan, *V. Allen Rowley, *Joachim H. Burhenne, *Edward
ULTRASONIC EVALUATION IN EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY, *Bruce R. Baumgartner, *Harvey V. Steinberg, Samuel S. Ambrose, Kenneth N. Walton, *Michael E. Bernardino, Atlanta, GA. (Presentation to be made by Dr. Baumgartner) • Real time ultrasonography (US) was performed on 100 consecutive patients the day preceding and/or at 24 and 48 hours after extracorporeal shock wave lithotripsy (ESWL) therapy to evaluate renal stone detection by US and to evaluate changes in the calculi following ESWL. These 100 patients had 105 kidneys treated; 18 kidneys with more than three stones were not included. The other 87 kidneys had 111 stones; 104 were radiopaque. Pre-ESWL US was not available for six stones. Sixty-eight stones (65%) were
A. Gofton, Vancouver, B.C., Canada
{Presentation to be
made by Dr. McLaughlin) In November 1985 the first shock wave lithotripsy unit in Canada was placed at the Vancouver General Hospital. Since that time we have treated over 1200 patients. Our experience with the use of this machine will be presented. To date greater than 80% of the patients have been treated as outpatients with few major complications. Our experience with patient selection, the liberal use of ureteral stents, debulking of large stones with percutaneous nephrolithotripsy, and the follow-up tests will be fully discussed. This unit was the first one placed in Canada, and the experience gained
~
from interprovincial cooperation between the health
were in the ureter or ureteropelvic junction (UPJ) and
ministries and the coordination of placement of further units in Canada will be fully discussed.
only 6 were in the calyces. The two other stones not demonstrated were both large, and one was nonopaque.
visualized and 37 were not. Of those not seen, 10 were 5 mm. in maximum diameter and of the larger stones 19
Comparison of US pre- and post-ESWL in 81 kidneys revealed no change in 38 (47%), more stones or fragments detected in 23 (28%), fewer stones or change in location in 12 (15%) and decreased size of the original stone in 8 (10%). The ability of US to detect renal calculi seems related not only to stone size but location. Hydronephrosis was detected by pre-ESWL US in 16 kidneys (20%). After ESWL the hydronephrosis did not change in 7, decreased or resolved in 8 and increased in only 1. Hydronephrosis was noted to develop after ESWL in 21 (26%) other kidneys. Pre- and post-ESWL hydronephrosis found by US must be considered in conjunction with the clinical picture and other radiographic studies.
718 SMALL CALICEAL STONES: LITHOTRIPSY JUSTIFIED?
719 IS EXTRACORPOREAL SHOCK WAVE
Sharron Mee,* San Francisco, California
Of 350 patients treated by extracorporeal shock wave lithotripsy (ESWL), we analyzed 18 with nonobstructive small caliceal stones associated with lumbar or flank pain. Size (less than l cm) and location of the stone did not explain the severity of the symptoms, nor would they have been an indication for open or percutaneous stone removal. Follow-up consisted of a sonogram and
KUB on the first post-operative day, KUB two weeks after treatment, and KUB and/or IVP three months after treatment for patients with persistent stones. After ESWL, 11 of 18 patients achieved complete relief of pain, Eight of these 11 were documented to be stonefree, Of the 7 in whom pain persisted, 4 we re stone-free and experienced significant alleviation of the severity and frequency of their pain, Thus, 15 of 18 patients (85%) achieved significant relief of pain after ESWL, In two patients with persistent pain, residual stones were documented (the third patient did not return for followup). One complication occurred--a perirenal hematoma that resolved spontaneously.
These results indicate that small, nonobstructive caliceal stones can be responsible for persistent, severe flank pain, Because ESWL is an effective, noninvasive treatment for caliceal stones, it is justified as a therapeutic trial for patients in whom the correlation between a small caliceal stone and flank plan is indeterminable,
THE GREENBERG REl'RACTOR FOR ENIJOOROr..cx;IST: Gary Karlin, M.D. * and Charles Liliby, M.D. ,New Hyde Park, N.Y. (Presentation to be made by Dr, Karlin*) The Greenberg retractor was originally developed for neurosurgery but has been rcodified for use in endourology. It is a rrechanical support system which surrounds the operative site in a multisteered fashion giving the endourologist increased biotechnical options. The Greenberg systems consists of attaching instrurrents to ball and cable retractor anns and securing them to a frarrelfA'.lrk around the operative site. The retractor anns can fix the nephroscope and carrera at one specific site thereby freeing one of the urologists hands. This reduces fatigue and helps particularly in a teaching program where one can fix the position of instrurrents and allow the resident to visualize that exact area. The resident can then use the lithotriptor in one location without all
283A
717
EXPERIENCE WITH THE FIRST EXTRACORPOREAL SHOCK WAVE LITHOTRIPTER UNIT IN CANADA. Martin G. McLaughlin, Seek L. Chan, *V. Allen Rowley, *Joachim H. Burhenne, *Edward
ULTRASONIC EVALUATION IN EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY, *Bruce R. Baumgartner, *Harvey V. Steinberg, Samuel S. Ambrose, Kenneth N. Walton, *Michael E. Bernardino, Atlanta, GA. (Presentation to be made by Dr. Baumgartner) • Real time ultrasonography (US) was performed on 100 consecutive patients the day preceding and/or at 24 and 48 hours after extracorporeal shock wave lithotripsy (ESWL) therapy to evaluate renal stone detection by US and to evaluate changes in the calculi following ESWL. These 100 patients had 105 kidneys treated; 18 kidneys with more than three stones were not included. The other 87 kidneys had 111 stones; 104 were radiopaque. Pre-ESWL US was not available for six stones. Sixty-eight stones (65%) were
A. Gofton, Vancouver, B.C., Canada
{Presentation to be
made by Dr. McLaughlin) In November 1985 the first shock wave lithotripsy unit in Canada was placed at the Vancouver General Hospital. Since that time we have treated over 1200 patients. Our experience with the use of this machine will be presented. To date greater than 80% of the patients have been treated as outpatients with few major complications. Our experience with patient selection, the liberal use of ureteral stents, debulking of large stones with percutaneous nephrolithotripsy, and the follow-up tests will be fully discussed. This unit was the first one placed in Canada, and the experience gained
~
from interprovincial cooperation between the health
were in the ureter or ureteropelvic junction (UPJ) and
ministries and the coordination of placement of further units in Canada will be fully discussed.
only 6 were in the calyces. The two other stones not demonstrated were both large, and one was nonopaque.
visualized and 37 were not. Of those not seen, 10 were 5 mm. in maximum diameter and of the larger stones 19
Comparison of US pre- and post-ESWL in 81 kidneys revealed no change in 38 (47%), more stones or fragments detected in 23 (28%), fewer stones or change in location in 12 (15%) and decreased size of the original stone in 8 (10%). The ability of US to detect renal calculi seems related not only to stone size but location. Hydronephrosis was detected by pre-ESWL US in 16 kidneys (20%). After ESWL the hydronephrosis did not change in 7, decreased or resolved in 8 and increased in only 1. Hydronephrosis was noted to develop after ESWL in 21 (26%) other kidneys. Pre- and post-ESWL hydronephrosis found by US must be considered in conjunction with the clinical picture and other radiographic studies.
718 SMALL CALICEAL STONES: LITHOTRIPSY JUSTIFIED?
719 IS EXTRACORPOREAL SHOCK WAVE
Sharron Mee,* San Francisco, California
Of 350 patients treated by extracorporeal shock wave lithotripsy (ESWL), we analyzed 18 with nonobstructive small caliceal stones associated with lumbar or flank pain. Size (less than l cm) and location of the stone did not explain the severity of the symptoms, nor would they have been an indication for open or percutaneous stone removal. Follow-up consisted of a sonogram and
KUB on the first post-operative day, KUB two weeks after treatment, and KUB and/or IVP three months after treatment for patients with persistent stones. After ESWL, 11 of 18 patients achieved complete relief of pain, Eight of these 11 were documented to be stonefree, Of the 7 in whom pain persisted, 4 we re stone-free and experienced significant alleviation of the severity and frequency of their pain, Thus, 15 of 18 patients (85%) achieved significant relief of pain after ESWL, In two patients with persistent pain, residual stones were documented (the third patient did not return for followup). One complication occurred--a perirenal hematoma that resolved spontaneously.
These results indicate that small, nonobstructive caliceal stones can be responsible for persistent, severe flank pain, Because ESWL is an effective, noninvasive treatment for caliceal stones, it is justified as a therapeutic trial for patients in whom the correlation between a small caliceal stone and flank plan is indeterminable,
THE GREENBERG REl'RACTOR FOR ENIJOOROr..cx;IST: Gary Karlin, M.D. * and Charles Liliby, M.D. ,New Hyde Park, N.Y. (Presentation to be made by Dr, Karlin*) The Greenberg retractor was originally developed for neurosurgery but has been rcodified for use in endourology. It is a rrechanical support system which surrounds the operative site in a multisteered fashion giving the endourologist increased biotechnical options. The Greenberg systems consists of attaching instrurrents to ball and cable retractor anns and securing them to a frarrelfA'.lrk around the operative site. The retractor anns can fix the nephroscope and carrera at one specific site thereby freeing one of the urologists hands. This reduces fatigue and helps particularly in a teaching program where one can fix the position of instrurrents and allow the resident to visualize that exact area. The resident can then use the lithotriptor in one location without all
283A