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The Simple Loop Catheter for Ureteric Calculus Retreival
Calculi 772
773
PRELIMINARY RESULTS WITH TOPICAL AMINOPHYLLINE AS AN ADJUNCT TO PERCUTANEOUS SURGERY. *David F. Green,*Morton Glickman and Robert M. Weiss, New Haven, CT, Yale Univ School of Medicine, Spasm of the upper urinary tract may make access to and extraction of stones difficult and mimic stricture disease of the uretropelvic junction (UPJ). These new problems have arisen with the advent of endourologic techniques. We present our initial results with the topical use of aminophylline, a methylxanthine and known phosphodiesterase inhibitor, in 11 patients (0.8 - 70 yrs of age) in whom upper urinary tract spasticity was a significant problem. Six patients appeared to have high grade or complete UPJ stenosis in association with renal stones. Installation of 2-3 cc of aminophylline via nephrostomy demonstrated a normal diameter ureter in all six. Three patients were treated with intrarenal aminophylline to improve access to peripherally placed stones. The treatment improved access in 2, with no effect on the third. Two patients appeared to have total exclusion of the UPJ, one after dismembered pyeloplasty, the other after percutaneous incision of the UPJ. Intrarenal aminophylline produced no opening of the UPJ, yet follow up nephrostograms several weeks later showed patency of the UPJ. Our initial results suggest methylxanthine induced phosphodiesterase inhibition may be
NINETY-NINE STONES IN NINE MONTHS. EXPERIENCES OF THE RIGID URETEROPYELOSCOPE IN SAUDI ARABIA. Peter Ekman, Naresh D. Sharma*, lmtiaz Husain*, and Saleh R. Al Faqih*, Riyadh, Saudi Arabia. (Presentation to be made by dr. Ekman.)
of value in differenting spasm secondary to a stone from
ureteral scarring and improve access to peripherally placed renal stones. It appears ineffective in documenting the patency of the UPJ following pyeloplasty or pyelotomy as this is probably a result of extravasation or edema rather than spasm. The ability of aminophylline to relax urinary tract smooth muscle appears to be due in part to inhibition of phosphodiesterase activity with a resultant increase in cyclic AMP.
Since the introduction of the ureteroscope at the University Hospital in Riyadh, all patients with ureteric disorders needing surgical intervention have been consecutively subjected to attempts with the rigid ureteropyeloscope. In 9 months 98 ureteroscopic procedures were carried out in 83 patients. Four of these had suspect ureteric tumors and three patients were treated for obstructing "steinstrasse" following ESWL-treatment of renal stones. The remaining 76 patients were treated for a total of 99 stones varying in size from 6 to 100 mm as largest diameter. In six cases the stone manipulations failed. Seventy stones were recovered transurethrally (22 following ultrasonic disintegration) and 23 stones were mobilized back into the kidney for percutaneous removal or ESWL-treatment. One of the patients with a "steinstrasse" was a failure whereas all patients with suspect ureteric tumors were successfully investigated. More than one ureteroscopic procedure was required in 9 patients before a successful result was achieved. The final success rate was 91%. Open surgery was carried out in 5 patients (6%). Immediate complications were few, but two patients have subsequently developed strictures necessitating surgical correction. The use of a safety guide wire, indwelling throughout the procedure, has been a valuable aid towards a safe and successful procedure.
774
775
TEST! NG OF A PROTOTYPE 3FRENCH ELECTDHYDRAULI C ELECTF:ODE FOR TREATMENT OF URETERAL CALCULI. *F1-ank P.Begun, Stephen C.Jacobs, and Russel K.Lawscin, Milv,aukee, ~II (Presentatic,n tcr be made by Di-. Begun) Recent advances in technc, logy have imprc,ved our ab i 1 i ty to treat urinary tract calculus disease without the need for cipen surgical procedures. E>:tracorpoi-eal shc,ck wave lithotripsy (ESWL) is presently the treatment of choice for renal calculi, however, a significant failure rate has bee11 reported for upper u,-eteral stones. ESvlL is contraindicated for treatment of lower ureteral calculi. Ureteral manipulation and/or rigid urete\-oscopy co:1n be used to treat most of these cases, however, difficulty negotiating the ureteral orifice and distal ureter contributes to a significant failure rate. In addition, many c,f these stcines are impacted in the ui-eter and cannot be manipulated with conventional baskets or graspers. We have tested a prototype nmdel 3F No.-thgate F:esearch Electrohydraul ic Electrode ( Mcirthgate Reseai-ch, Plattsburgh, NY). This device has a ccia>:ial arrangement identical to the larger electrode used for ti-eatment of bladder calculi and uses the same SD-1 model power source. The electrode has been L1sed v1ith the Van-Tee (Van-Tee Cc1., Spencer, IN) and Reiche.-t (Warne;--Lambe.-t Inc., South Bi-idge, MA) 9F fle>;ible rn-ete1-oscopes and easily fits through the working port of these instruments. The 3F electrode can be fired at a setting of 5Q.! volt:s, unlike the 5F or larger electrc,des that cannot be reliably fired at (71!f vc, l ts. This 1c,wer voltage prevents the explosive generation of shock waves at the tip and reduces the chances c,f ureteral injury. The electrc,de~s safety has been proven in Ltse on several patients 11,i th impacted stones. It can be used to disintegrate t.weteral calculi v,ithout damage to the mucosa or underlying muscle. The use of the 3F e!ectrc,hydraul ic electrode with flexible ureteroscopy represents a significant new modality for treatment of upper tract calculus disease.
THE SIMPLE LOOP CATHETER FOR URETERIC CALCULUS
RETREIVAL,*Gurinder S,Kochhar, New Delhi. (Presentation to be made by Dr,Kochhar), This is a series of 100 patients of ureteric calculus disease in whom endoscopic retreival was attempted using a simple loop catheter improvised from a round tip# 6 Fr. ureteral catheter & a length of nylon, This loop catheter can be used for calculi any where in the W'eter (except those at or just below the pelviW'eteral junction) & also for multiple or impacted calculi, There were 142 calculi in these 100 patients & 105 involved W'eters, 21 patients had more than one calculus in the same W'eter, the maximum number being four, 60% of the patients had impacted calculi with back-presW'e changes evident on the intravenous urogram, The majority of patients were taken up under caudal anaesthesia and the total number of attempts in 100 patients was 120, Satisfactory passage of the loop catheter was achieved in 66J
297A
773
PRELIMINARY RESULTS WITH TOPICAL AMINOPHYLLINE AS AN ADJUNCT TO PERCUTANEOUS SURGERY. *David F. Green,*Morton Glickman and Robert M. Weiss, New Haven, CT, Yale Univ School of Medicine, Spasm of the upper urinary tract may make access to and extraction of stones difficult and mimic stricture disease of the uretropelvic junction (UPJ). These new problems have arisen with the advent of endourologic techniques. We present our initial results with the topical use of aminophylline, a methylxanthine and known phosphodiesterase inhibitor, in 11 patients (0.8 - 70 yrs of age) in whom upper urinary tract spasticity was a significant problem. Six patients appeared to have high grade or complete UPJ stenosis in association with renal stones. Installation of 2-3 cc of aminophylline via nephrostomy demonstrated a normal diameter ureter in all six. Three patients were treated with intrarenal aminophylline to improve access to peripherally placed stones. The treatment improved access in 2, with no effect on the third. Two patients appeared to have total exclusion of the UPJ, one after dismembered pyeloplasty, the other after percutaneous incision of the UPJ. Intrarenal aminophylline produced no opening of the UPJ, yet follow up nephrostograms several weeks later showed patency of the UPJ. Our initial results suggest methylxanthine induced phosphodiesterase inhibition may be
NINETY-NINE STONES IN NINE MONTHS. EXPERIENCES OF THE RIGID URETEROPYELOSCOPE IN SAUDI ARABIA. Peter Ekman, Naresh D. Sharma*, lmtiaz Husain*, and Saleh R. Al Faqih*, Riyadh, Saudi Arabia. (Presentation to be made by dr. Ekman.)
of value in differenting spasm secondary to a stone from
ureteral scarring and improve access to peripherally placed renal stones. It appears ineffective in documenting the patency of the UPJ following pyeloplasty or pyelotomy as this is probably a result of extravasation or edema rather than spasm. The ability of aminophylline to relax urinary tract smooth muscle appears to be due in part to inhibition of phosphodiesterase activity with a resultant increase in cyclic AMP.
Since the introduction of the ureteroscope at the University Hospital in Riyadh, all patients with ureteric disorders needing surgical intervention have been consecutively subjected to attempts with the rigid ureteropyeloscope. In 9 months 98 ureteroscopic procedures were carried out in 83 patients. Four of these had suspect ureteric tumors and three patients were treated for obstructing "steinstrasse" following ESWL-treatment of renal stones. The remaining 76 patients were treated for a total of 99 stones varying in size from 6 to 100 mm as largest diameter. In six cases the stone manipulations failed. Seventy stones were recovered transurethrally (22 following ultrasonic disintegration) and 23 stones were mobilized back into the kidney for percutaneous removal or ESWL-treatment. One of the patients with a "steinstrasse" was a failure whereas all patients with suspect ureteric tumors were successfully investigated. More than one ureteroscopic procedure was required in 9 patients before a successful result was achieved. The final success rate was 91%. Open surgery was carried out in 5 patients (6%). Immediate complications were few, but two patients have subsequently developed strictures necessitating surgical correction. The use of a safety guide wire, indwelling throughout the procedure, has been a valuable aid towards a safe and successful procedure.
774
775
TEST! NG OF A PROTOTYPE 3FRENCH ELECTDHYDRAULI C ELECTF:ODE FOR TREATMENT OF URETERAL CALCULI. *F1-ank P.Begun, Stephen C.Jacobs, and Russel K.Lawscin, Milv,aukee, ~II (Presentatic,n tcr be made by Di-. Begun) Recent advances in technc, logy have imprc,ved our ab i 1 i ty to treat urinary tract calculus disease without the need for cipen surgical procedures. E>:tracorpoi-eal shc,ck wave lithotripsy (ESWL) is presently the treatment of choice for renal calculi, however, a significant failure rate has bee11 reported for upper u,-eteral stones. ESvlL is contraindicated for treatment of lower ureteral calculi. Ureteral manipulation and/or rigid urete\-oscopy co:1n be used to treat most of these cases, however, difficulty negotiating the ureteral orifice and distal ureter contributes to a significant failure rate. In addition, many c,f these stcines are impacted in the ui-eter and cannot be manipulated with conventional baskets or graspers. We have tested a prototype nmdel 3F No.-thgate F:esearch Electrohydraul ic Electrode ( Mcirthgate Reseai-ch, Plattsburgh, NY). This device has a ccia>:ial arrangement identical to the larger electrode used for ti-eatment of bladder calculi and uses the same SD-1 model power source. The electrode has been L1sed v1ith the Van-Tee (Van-Tee Cc1., Spencer, IN) and Reiche.-t (Warne;--Lambe.-t Inc., South Bi-idge, MA) 9F fle>;ible rn-ete1-oscopes and easily fits through the working port of these instruments. The 3F electrode can be fired at a setting of 5Q.! volt:s, unlike the 5F or larger electrc,des that cannot be reliably fired at (71!f vc, l ts. This 1c,wer voltage prevents the explosive generation of shock waves at the tip and reduces the chances c,f ureteral injury. The electrc,de~s safety has been proven in Ltse on several patients 11,i th impacted stones. It can be used to disintegrate t.weteral calculi v,ithout damage to the mucosa or underlying muscle. The use of the 3F e!ectrc,hydraul ic electrode with flexible ureteroscopy represents a significant new modality for treatment of upper tract calculus disease.
THE SIMPLE LOOP CATHETER FOR URETERIC CALCULUS
RETREIVAL,*Gurinder S,Kochhar, New Delhi. (Presentation to be made by Dr,Kochhar), This is a series of 100 patients of ureteric calculus disease in whom endoscopic retreival was attempted using a simple loop catheter improvised from a round tip# 6 Fr. ureteral catheter & a length of nylon, This loop catheter can be used for calculi any where in the W'eter (except those at or just below the pelviW'eteral junction) & also for multiple or impacted calculi, There were 142 calculi in these 100 patients & 105 involved W'eters, 21 patients had more than one calculus in the same W'eter, the maximum number being four, 60% of the patients had impacted calculi with back-presW'e changes evident on the intravenous urogram, The majority of patients were taken up under caudal anaesthesia and the total number of attempts in 100 patients was 120, Satisfactory passage of the loop catheter was achieved in 66J
297A