Objective To review our experience with laparoscopic ureterolithotomy. Patients and methods Since 1993, we have performed laparoscopic ureterolithotomy in 14 patients with ureteric stones. Laparoscopy was carried out in nine patients as a salvage procedure after failed ureteroscopy (six), shock wave lithotripsy (two), or both (one), and in five patients as a primary procedure for large stones (mean 27.2 mm, range 18–40). Patients in the former group had already undergone a mean of 1.88 procedures (range 1–4). Laparoscopic ureterolithotomy was carried out via a transperitoneal approach. Associated ureteric strictures were incised at the time of ureterotomy. Results All procedures were completed laparoscopically and all patients were rendered stone‐free after a single procedure. The mean operative duration was 105 min. Ureteric strictures were incised in three patients, in two of whom dilatation was subsequently required; all three had a successful result. There were three minor complications. Conclusions Laparoscopic ureterolithotomy can be a safe and effective procedure; it should be considered as a primary procedure for large mid‐ and upper ureteric stones.
Objective To investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high‐energy magnetic fields to propel an impactor to fragment calculi. Patients and methods The records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi‐rigid ureteroscope, through which a 3 F EKL probe was passed. Results A total of 148 stones (mean stone size 11.5 mm, range 6–40) in 121 patients were treated using the EKL. One patient was lost to follow‐up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed‐dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone‐free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock‐wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent. Conclusion EKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi‐rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of ≥4 mm after EKL.
Ankle arthritis can lead to disabling pain and loss of function. While arthrodesis surgery leads to reliable pain relief, it is associated with development of degenerative joint disease in adjacent joints. The success of hip and knee arthroplasty has led to interest in developing a total ankle arthropalsty. Unfortunately, this has, historically, been associated with poor results. This is due to a failure to appreciate joint biomechanics and optimial fixation techniques. In this article, we describe the evolution in design of ankle arthoplasty. We comment upon differing generations of designs and introduce the reader to differing outcomes between these implants.
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