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Treatment of Ureteral Stones by Ureteroscopy
Calculi 764
765
IN-SITU ESWL AS FIRST CHOICE THERAPY FOR UPPER AND DISTAL URETERAL CALCULI. A. Schmidt*, K. Lutz*, U. Hath*, P. Bub''; Stuttgart, FRG (Presentation to be made by A. Schmidt) In a one year period (July 1985 to July 1986) we treated 250 patients with upper ureteral and 111 patients with distal ureteral stones. In situ-ESWL was performed when ever possible for both categories of ureteric calculi; Retrograde mobilization (UC/URS) by use of an ureteral catheter was only performed (1) if in situ-ESWL failed, (2) in case of positioning or locating problems, and in emergency cases. Antegrade URS was performed if retrograde mobilization failed. For in situ-ESWL of distal ureteral stones (since February 1986) a specific positioning technique was used. Upper ureteral calculi Different procedures ---N Sucesstul % - In situ-ESWL T47 122 - 82 - UC/URS+ ESWL 46 42 91 - Antegrade URS 20 19 95 - Retrograde URS 9 6 66 - Conservative 26 Surgery 2
REMOVAL OF UPPER URETERAL AND RENAL CALCULI UNDER RETROGRADE FIBEROPTIC CONTROL, Yoshio Aso, Masaru Nakano*,
Distal ureteral calculi -=---rrls"i tu-ESWL
-
Zeiss-loop Retrograde URS Conservative Surgery
Different procedures 8
66 30 12
31
43 21
75 65 70
Yoshihisa Ohtawara*, Nobutaka Ohta*, Kazuo Suzuki*, Atsushi Tajima*, Hamamatsu, Japan (Presentation to be made by
Dr. Aso) This report describes the early clinical trial of removal of 12 upper ureteral, 8 renal pelvic and 1 staghorn
calculi
by our new operative fiberoptic nephrouretero-
scopes.
We made two types of fiberoptic nephrouretero-
scopes measuring 3.5 (XURF-3Cl0) and 4.5 mm (XURF-2.0) in diameter, which have an adequate working channel for auxiliary instruments and irrigation. At the beginning
(from cases No. 1 to No. 10) when we had not established the dilating method of the ureter and used mostly a XURF3Cl0 fiberscope with a basket catheter, the success ratio of the stone retrieval was 60%. However, after the establishment of the ureteral dilating method, and the use
of an electrohydraulic lithotripter with a XURF-2.0 nephroureteroscope, a stone was successfully removed in 9 (82%)
out of the 11 cases.
It should be noted that the success
ratio was 100% in the latest 9 cases. Recently, excellence of a rigid ureteropyeloscope, the percutaneous procedure
(PCN) and extracorporeal shock wave lithotripsy (ESWL) has been widely recognized in the removal of the upper urinary tract calculi. However, each of them has a few drawbacks. A rigid scope showed a low success ratio in the retrieval of upper ureteral and renal calculi. It is useless once a
stone in the upper ureter is pushed up to the kidney during manipulation, PCN and ESWL cover the drawbacks of a rigid
A success rate of 75-82 % justifys the non-invasive in situ-ESWL as first choice therapy for al I ureteral calculi.
scope. But they also have a few shortcomings which include the high cost of instruments and devices especially in ESWL, necessity to form an artificial tract and insert an occlusion catheter to prevent an outflow of stone fragments in PCN, frequent necessity of staged procedures in PCN and ureteral impaction with stone fragments in ESWL. In order to overcome these drawbacks, the stone retrieval with our new nephroureteroscopes is highly recommended.
766
767
3
ANTEGRADE URETEROSCOPY AND ULTRASOUND LITHOTRIPSY FOR IMPACTED UPPER 2/3 URETERAL STONES. R. John Honey, Toronto, Ontario, Canada (Presentation to be made by Dr. Honey) This poster describes the use of percutaneous antegrade ureteroscopy with ultrasound lithotripsy for the removal of difficult impacted upper ureteral stones. The procedure entails the passage of the 11 Frigid ureteroscope via a percutaneous puncture in the middle or upper calyceal group. The puncture was above the 12th rib in 17 cases and above the 11th rib in two. With this technique, it may be possible to reach stones as low as the iliac vessels. Fifty-two patients had stones below the UP junction and above the iliac vessels. In 21 cases, the stone could not be manipulated back up into the collecting system. In 10 cases, the stone was extracted from above with a stone basket under direct vision and in 9 cases, it was necessary to fragment the stone in-situ with the ultrasound probe. Two patients required a ureterolithotomy; in one case, there was an unnegotiable stricture above the stone and in the other case previous renal surgery limited mobility of the kidney. No patients required transfusion and there were no cases of pneumothorax. There was one small ureteral perforation which sealed within five days and one of the cases with a supra 11th rib puncture had a small pleural effusion not requiring treatment.
TREATMENT OF UREl'ERAL STONES BY UREI'EROSCOPY
Jobst Pastor*, Jurgen Graff*, Peter Mach*, Lothar Hertle*, Peter-J. Funke*, Claus Fischer*, Wolfgang Diederichs*, Theodor Senge, Herne, FRG (Presentation to be made by Dr. Senge) Fran July 1984 until September 1986 3315 ESWL, 363 percutaneous nephrolithotanies (PCNL) and 286 ureteroscopies (URS) were performed at our department. In 1984 open surgery was necessary in 132, in 1985 in 45 and in 1986 in 7 patients for all stone locations. The treatment of choice for ureteral stones is ESWL and URS. A retrospective study of 417 stone treatments by ESWL alone showed successfull stone removal in 94%. Stones treated by ureteroscopy were located in the intramural and pelvic ureter in 64% and in upper ureteral segment in 36%. In 72%, a ureteral stone was diagnosed primarily, in 28% of the cases ureteroscopy was necessary for secondary ureteral stones after PCNL and ESWL. A retrograde URS was done in 96%, an antegrade URS in 4%, a diagnostic URS for ureteral pathology was necessary in 3.5% of all cases. Stone retrieval was successful in 72%. The stone was dislodged into the renal collecting system in 14% of the cases, followed by PCNL or ESWL during the same anesthetic procedure. 9.5% required a second ureteroscopy and sanetirnes also other endourologic procedures like percutaneous nephrostany or loop extraction. Open surgery was necessary in 4.5% and had to be performed mainly in the beginning of this series. Since January 1986, 136 ureteroscopies were done with only one case of open surgery. In 91.1%, · no canplications were observed; 8.9% showed sane extravasation, which resolved after ureteral stenting. Serious canplications like avulsion of the ureter did not occur, however, we had one patient with a long distal ureteral stricture that finally required a ureteroneocystostany. Mean operative time was 35 min with a range fran 5-135 min. Ureteral stents were used after URS in 40% for 1-3 days and PCN was necessary before or after URS in 23.5%.
295A
765
IN-SITU ESWL AS FIRST CHOICE THERAPY FOR UPPER AND DISTAL URETERAL CALCULI. A. Schmidt*, K. Lutz*, U. Hath*, P. Bub''; Stuttgart, FRG (Presentation to be made by A. Schmidt) In a one year period (July 1985 to July 1986) we treated 250 patients with upper ureteral and 111 patients with distal ureteral stones. In situ-ESWL was performed when ever possible for both categories of ureteric calculi; Retrograde mobilization (UC/URS) by use of an ureteral catheter was only performed (1) if in situ-ESWL failed, (2) in case of positioning or locating problems, and in emergency cases. Antegrade URS was performed if retrograde mobilization failed. For in situ-ESWL of distal ureteral stones (since February 1986) a specific positioning technique was used. Upper ureteral calculi Different procedures ---N Sucesstul % - In situ-ESWL T47 122 - 82 - UC/URS+ ESWL 46 42 91 - Antegrade URS 20 19 95 - Retrograde URS 9 6 66 - Conservative 26 Surgery 2
REMOVAL OF UPPER URETERAL AND RENAL CALCULI UNDER RETROGRADE FIBEROPTIC CONTROL, Yoshio Aso, Masaru Nakano*,
Distal ureteral calculi -=---rrls"i tu-ESWL
-
Zeiss-loop Retrograde URS Conservative Surgery
Different procedures 8
66 30 12
31
43 21
75 65 70
Yoshihisa Ohtawara*, Nobutaka Ohta*, Kazuo Suzuki*, Atsushi Tajima*, Hamamatsu, Japan (Presentation to be made by
Dr. Aso) This report describes the early clinical trial of removal of 12 upper ureteral, 8 renal pelvic and 1 staghorn
calculi
by our new operative fiberoptic nephrouretero-
scopes.
We made two types of fiberoptic nephrouretero-
scopes measuring 3.5 (XURF-3Cl0) and 4.5 mm (XURF-2.0) in diameter, which have an adequate working channel for auxiliary instruments and irrigation. At the beginning
(from cases No. 1 to No. 10) when we had not established the dilating method of the ureter and used mostly a XURF3Cl0 fiberscope with a basket catheter, the success ratio of the stone retrieval was 60%. However, after the establishment of the ureteral dilating method, and the use
of an electrohydraulic lithotripter with a XURF-2.0 nephroureteroscope, a stone was successfully removed in 9 (82%)
out of the 11 cases.
It should be noted that the success
ratio was 100% in the latest 9 cases. Recently, excellence of a rigid ureteropyeloscope, the percutaneous procedure
(PCN) and extracorporeal shock wave lithotripsy (ESWL) has been widely recognized in the removal of the upper urinary tract calculi. However, each of them has a few drawbacks. A rigid scope showed a low success ratio in the retrieval of upper ureteral and renal calculi. It is useless once a
stone in the upper ureter is pushed up to the kidney during manipulation, PCN and ESWL cover the drawbacks of a rigid
A success rate of 75-82 % justifys the non-invasive in situ-ESWL as first choice therapy for al I ureteral calculi.
scope. But they also have a few shortcomings which include the high cost of instruments and devices especially in ESWL, necessity to form an artificial tract and insert an occlusion catheter to prevent an outflow of stone fragments in PCN, frequent necessity of staged procedures in PCN and ureteral impaction with stone fragments in ESWL. In order to overcome these drawbacks, the stone retrieval with our new nephroureteroscopes is highly recommended.
766
767
3
ANTEGRADE URETEROSCOPY AND ULTRASOUND LITHOTRIPSY FOR IMPACTED UPPER 2/3 URETERAL STONES. R. John Honey, Toronto, Ontario, Canada (Presentation to be made by Dr. Honey) This poster describes the use of percutaneous antegrade ureteroscopy with ultrasound lithotripsy for the removal of difficult impacted upper ureteral stones. The procedure entails the passage of the 11 Frigid ureteroscope via a percutaneous puncture in the middle or upper calyceal group. The puncture was above the 12th rib in 17 cases and above the 11th rib in two. With this technique, it may be possible to reach stones as low as the iliac vessels. Fifty-two patients had stones below the UP junction and above the iliac vessels. In 21 cases, the stone could not be manipulated back up into the collecting system. In 10 cases, the stone was extracted from above with a stone basket under direct vision and in 9 cases, it was necessary to fragment the stone in-situ with the ultrasound probe. Two patients required a ureterolithotomy; in one case, there was an unnegotiable stricture above the stone and in the other case previous renal surgery limited mobility of the kidney. No patients required transfusion and there were no cases of pneumothorax. There was one small ureteral perforation which sealed within five days and one of the cases with a supra 11th rib puncture had a small pleural effusion not requiring treatment.
TREATMENT OF UREl'ERAL STONES BY UREI'EROSCOPY
Jobst Pastor*, Jurgen Graff*, Peter Mach*, Lothar Hertle*, Peter-J. Funke*, Claus Fischer*, Wolfgang Diederichs*, Theodor Senge, Herne, FRG (Presentation to be made by Dr. Senge) Fran July 1984 until September 1986 3315 ESWL, 363 percutaneous nephrolithotanies (PCNL) and 286 ureteroscopies (URS) were performed at our department. In 1984 open surgery was necessary in 132, in 1985 in 45 and in 1986 in 7 patients for all stone locations. The treatment of choice for ureteral stones is ESWL and URS. A retrospective study of 417 stone treatments by ESWL alone showed successfull stone removal in 94%. Stones treated by ureteroscopy were located in the intramural and pelvic ureter in 64% and in upper ureteral segment in 36%. In 72%, a ureteral stone was diagnosed primarily, in 28% of the cases ureteroscopy was necessary for secondary ureteral stones after PCNL and ESWL. A retrograde URS was done in 96%, an antegrade URS in 4%, a diagnostic URS for ureteral pathology was necessary in 3.5% of all cases. Stone retrieval was successful in 72%. The stone was dislodged into the renal collecting system in 14% of the cases, followed by PCNL or ESWL during the same anesthetic procedure. 9.5% required a second ureteroscopy and sanetirnes also other endourologic procedures like percutaneous nephrostany or loop extraction. Open surgery was necessary in 4.5% and had to be performed mainly in the beginning of this series. Since January 1986, 136 ureteroscopies were done with only one case of open surgery. In 91.1%, · no canplications were observed; 8.9% showed sane extravasation, which resolved after ureteral stenting. Serious canplications like avulsion of the ureter did not occur, however, we had one patient with a long distal ureteral stricture that finally required a ureteroneocystostany. Mean operative time was 35 min with a range fran 5-135 min. Ureteral stents were used after URS in 40% for 1-3 days and PCN was necessary before or after URS in 23.5%.
295A