Alan D. Jenkins

Initial Experience with Extracorporeal Shock Wave Lithotripsy in Children

The clinical experience is presented of 4 United States centers at which extracorporeal shock wave lithotripsy was used for the treatment of renal calculi in 38 children 12 months to 16 years old. Patient characteristics, treatment specifics and followup data are detailed. Complete fragmentation of calculi was obtained in 97 per cent of those treated, with a 5 per cent complication rate. This experience demonstrates that with proper safeguards, extracorporeal shock wave lithotripsy can be performed safely and effectively in the pediatric population.

Optimal blood use in genitourinary surgery.

The most commonly performed urologic surgical procedure is transurethral resection of the prostate. We reviewed the crossmatching and transfusion records of 226 patients who had undergone transurethral prostatectomy at our hospital from 1977 through 1979. Only 13 patients (5.8 per cent) received a transfusion. The crossmatched-to-transfused ratio was 21.5. Preoperative ABO-Rh typing and antibody screen are safe and cost-effective alternatives to preoperative crossmatching of blood for uncomplicated transurethral prostatectomy.

The Effects of Cyproterone Acetate on the Elements in the Intraluminal Fluids of the Testis and Epididymis of the Rat

Spermatozoal maturation and the integrity of the epididymis are dependent on the action of androgen. Micropuncture techniques and electron probe microanalysis were used to investigate the effect of cyproterone acetate on the concentrations of seven elements in intraluminal fluids of the testis, rete testis, and epididymis. After 4 weeks of treatment with cyproterone acetate, the sodium concentration rose in the corpus epididymidis (74.4 +/- 5.4 to 102 +/- 6 mmol/L, p less than 0.01). The concentration of potassium rose in seminiferous tubular fluid (33.9 +/- 2.7 to 49.4 +/- 4.4 mmol/L, p less than 0.01) and caput epididymidal fluid (15.9 +/- 1.4 to 25.7 +/- 0.9 mmol/L, p less than 0.01) after 8 weeks of cyproterone acetate treatment. The chloride concentration rose in the caput (23.7 +/- 0.8 to 65.4 +/- 12.5 mmol/L, p less than 0.01) and distal cauda (39.4 +/- 4.6 to 74.7 +/- 10.8 mmol/L, p less than 0.01) epididymidis after 8 weeks of treatment. Cyproterone acetate had no effect on the concentrations of phosphorus, calcium, and magnesium. The sulfur concentration rose in seminiferous tubular fluid (4.3 +/- 0.3 to 7.3 +/- 0.3 mmol/L, p less than 0.01) and distal cauda fluid (5.3 +/- 0.5 to 14.0 +/- 1.6 mmol/L, p less than 0.01) after 8 weeks of treatment with cyproterone acetate. Four weeks of treatment also increased the sulfur concentration in the distal cauda (6.8 +/- 1.6 to 13.4 +/- 1.5 mmol/L, p less than 0.01). Cyproterone acetate treatment did not affect the concentration of any element in rete testis fluid or serum.

Percutaneous Transrenal Placement of Indwelling Ureteral Catheters

Indwelling ureteral catheters can be used for long-term drainage of the upper urinary tract in the management of distal ureteral obstruction. Ureteral catheters cannot always be passed cystoscopically in a retrograde manner. However, it may be possible to place an indwelling ureteral catheter through a percutaneous nephrostomy in an antegrade fashion. This technique and exemplary patients are discussed.

Is Extracorporeal Shock Wave Lithotripsy Monotherapy a Rational Approach to Large Renal Calculi

The advent of extracorporeal shock wave lithotripsy (ESWL†), percutaneous nephrostolithotomy (PCNL), and ureteroscopic lithotripsy has revolutionized the treatment of surgically active urolithiasis. The availability of these new technologies has led to diverse opinions as to their exact roles in treating specific urinary calculi. An example of these divergent opinions is the treatment of large renal calculi. Most authorities prefer “sandwich” therapy of large renal stones: percutaneous ultrasonic debulking, ESWL of any retained large fragments, and percutaneous removal of the resultant small particles. Other urologists, especially those in Western Europe, advocate one or more ESWL treatments as the sole therapy of large renal calculi. This paper will present the rationale for the latter approach.

Sonographic Detection of Ureteral Calculi in Patients with Normal Excretory Urography

We report 3 cases of nonobstructing distal ureteral calculi diagnosed by sonography in which excretory urography was normal. In each case sonography was performed because of high clinical suspicion for a ureteral stone. In 2 patients a stone was impacted at an edematous ureteral orifice. All 3 patients subsequently passed the stone spontaneously. A high resolution ultrasound examination should be performed on patients with a history suggestive of ureteral calculus despite a normal excretory urogram.

University of Virginia Lithostar Experience: Preliminary Report

The Siemens Lithostar system consists of a motorized patient table, two integral electromagnetic shock wave generators, and biplane fluoroscopy for stone localization. Shock wave coupling is through water-filled bellows attached to the shock tubes. Seven of the first 30 patients (21%) required more than one treatment, even though the mean stone size was less than 13 mm. Seven other patients had poor fragmentation: all had 4 mm to 5 mm fragments. The mean number of shock waves delivered was 3,100.