Endourology & Laparoscopy

Abstract

showed in a randomized trial that a regimen of percussion, diuresis and inversion therapy in patients left with residual < 4 mm lower pole calyceal fragments after SWL resulted in an additional 40% of patients clearing fragments from the kidney compared with no further clearance in the observation group (1).In the current study, Chiong and associates randomized patients with lower pole stones to undergo 4 formal sessions of percussion, diuresis and inversion therapy starting 1-2 weeks after SWL versus no additional therapy and found a significant improvement in stone free rates in the treated group compared with the control group (63% versus 35%). Although the mean stone size in the 2 groups was 1 cm in the control group and 0.8 cm in the treated group, patients with stones up to 2 cm in size were included, a group that has previously been shown to respond poorly to SWL (2). As such, this regimen offers promise for improving stone free rates in a group of patients who have historically done poorly with SWL. Perhaps combining these mechanical maneuvers with pharmacotherapy using potassium citrate, which has been shown in a randomized trial to improve clearance of residual fragments after SWL of lower pole stones (3), will further improve treatment outcomes in this problematic patient group. J Endourol. 2005; 19: 603-7 Background and Purpose: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 62-year-old man with clinically localized prostate cancer underwent open radical prostatectomy that was complicated by rectal injury and subsequent RVF development. Conservative management failed, and the patient was referred for surgical correction.Technique: The operative steps consisted of (1) cystoscopy, (2) RVF catheterization, (3) ureteral catheterization, (4) five-port transperitoneal laparoscopic approach, (5) cystotomy, (6) opening of the fistulous