We present details of our current techniques for skin graft urethroplasty. We believe that careful attention to the details of these operative techniques is important to their success. The changes from our previous reports include: 1) preparation of patch grafts with rounded ends, 2) preparation of tube grafts with fishmouth spatulation, 3) fixation of the stent catheter to the anterior abdominal wall, 4) leaving a stent catheter inlying for 2 weeks and replacing with a smaller catheter if a voiding cystourethrogram shows extravasation, 5) fixation of the graft during preparation by dermatome adhesive, 6) irrigation of the wound with irrigant before closure and 7) urodynamic flow study for non-invasive postoperative followup.
Lithotripsy treatment of urinary tract calculi initially excluded patients with cardiac pacemakers. Continued research and clinical study of patient outcomes has promoted a change in that initial concept. The Oklahoma Lithotripsy Center has successfully treated 20 patients with various types of pacemakers. No significant cardiovascular events occurred during treatment. Patients should be evaluated before the procedure by a cardiologist, and dual-chamber pacemakers should be reprogrammed to the single-chamber mode. Patients who cannot tolerate this should not undergo SWL. Rate-responsive pacemakers should be programmed to the non-rate-responsive (VVI) mode. The pacemaker should be at least 5 cm from the blast path. With these precautions and careful monitoring, SWL can be performed safely in most patients with pacemakers.
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