Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.
Although currently the number of patients is small and follow-up is short, this procedure appears to be effective in relieving both symptoms and obstruction in patients with lower-pole crossing vessels. Other benefits include shorter operative time, less blood loss, as well as no risk of anastomotic stricture and urine leak when compared with a dismembered pyeloplasty. The Double-J stent can be removed within a few days (typically 5 in our hands) or even shorter where logistically feasible. This reduces stent-related complications.
There are a number of graspers and baskets to snare and remove stones during percutaneous nephrolithotomy (PCNL). These instrumental techniques can, however, cause inadvertent trauma to the renal mucosa and can be time consuming. Increasingly, these graspers and baskets are disposable, which also has financial implications. We use a simple technique to flush out fragments from the kidney during PCNL. Once fragments have been identified as a size that can pass through the Amplatz sheath, a cut nasogastric tube is inserted through the sheath--if possible next to or behind the fragments. It is repeatedly moved forward and backward in a jerking motion while saline is instilled under some pressure to create some turbulence. This results in the mechanical flushing out of stone fragments. We have found this to be a safe, effective, and reliable technique of stone extraction during PCNL.
Background: Patients with prostate cancer can often have simultaneous upper and lower urinary tract pathologies. If the patient is elderly and unfit for any major surgery, treat-ment options are limited. Thermo-expandable shape-memory nickel-titanium alloy stents (MemokathTM) offer a minimally invasive solution in such cases and are available for long-term use in both, ureter strictures and prostatic outflow obstruction in patients deemed high risk for transurethral or open surgery. Surgical Technique: We present how we man-aged to exchange in a retrograde fashion a double J ureteric stent for a ureteric Memokath 051TM using metallic needle placed externally over the skin to mark the stricture in an elderly patient unfit for any invasive procedure in whom for the same reason we had previously inserted a prostate Memokath 028TM. This technique allows safe and efficient access to the upper urinary tract without removing the previously sited prostatic Memokath stent. Conclusion: In patients with a prostate stent, this technique allows safe access to the upper urinary tract to exchange a double J stent to a permanent Memokath stent without displacing or requiring re-insertion of a new prostate stent. This has cost and time saving implications as well as reducing patient morbidity and hospital visits due to regular stent exchange. The use of extracorporeal needles placed on the skin to mark and measure the length of the stricture is both an efficient and accurate way of placing the sheath through which a ureteric Memokath 051TM stent can be placed across the stricture.
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