F.X. Keeley

Characterization of urinary symptoms in patients with ureteral stents

OBJECTIVES To prospectively assess the prevalence and bother of various urinary tract symptoms caused by indwelling ureteral stents using validated questionnaires. METHODS The study consisted of 60 patients with unilateral ureteral stents. Of these, 30 patients were asked to complete the International Prostate Symptoms Score questionnaire, with additional questions on dysuria, hematuria, and loin pain. The remaining 30 patients were asked to complete the International Continence Society questionnaire. These patients were also asked to complete frequency volume charts and undergo uroflowmetry studies. The questionnaires were completed with a stent in situ and 6 weeks after its removal. RESULTS Forty-eight patients (36 men and 12 women, mean age 52.8 years) completed the study. A large proportion (80%) of patients reported one or more urinary symptoms. Analysis of the IPSS data revealed impaired global quality of life owing to these urinary symptoms. The responses to additional questions on dysuria and hematuria showed a statistically significant difference, but most International Prostate Symptoms Score questions did not. The results of the International Continence Society study identified storage symptoms, incontinence (60%), and bladder pain (80%) as important bothersome problems. The results of the frequency volume charts were in agreement with the storage symptoms. CONCLUSIONS Patients with indwelling ureteral stents have a wide range of urinary symptoms that affect their quality of life. Storage symptoms, bladder pain, and hematuria pose a major bother. None of the existing questionnaires covered the entire range of symptoms. The results are useful in better understanding the urinary symptoms associated with stents and in providing patient counseling.

Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones

Objective To report a prospective, randomized study to determine whether prophylactic extracorporeal shockwave lithotripsy (ESWL) is justified as a treatment for small, asymptomatic calyceal stones.

A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts

To present the results of a minimally invasive treatment of symptomatic simple renal cysts, and to propose an algorithm for their management.

Conventional and alternative methods for providing analgesia in renal colic.

Opioid analgesics and NSAIDs remain the mainstay of treatment for acute renal colic. Opioid analgesics, e.g. morphine and pethidine, are highly effective during the acute episode. Various preparations are available but the intravenous form has the most rapid onset of action and the advantage that the dose may be titrated to effect. However, prolonged use may cause dependence and tolerance. Side-effects are common, including nausea, vomiting, constipation and drowsiness, and larger doses can cause respiratory depression and hypotension. The data are conflicting for the effect of opiates on ureteric tone; results generally indicate an increase or no effect [4]. Ideally, an alternative to opiates would be preferred, as increased ureteric tone is thought to be counterproductive in acute renal colic and the side-effects of opiates can be problematic.

Cost analysis of flexible ureterorenoscopy

The development of ureteroscopy, in the first instance with rigid ureteroscopes, and subsequently with flexible ureteroscopes, has been a huge contribution to the non‐operative removal of urinary tract calculi. Access can be gained to stones in the ureter and to many in the kidney. Two reports presented in this section examined aspects of ureteroscopy; the cost of the procedure, and whether stenting of the ureter is required after removing ureteric stones by this means.

Flexible ureteroscopes: a user's guide

Objective  To compare, quantitatively and qualitatively, four small‐diameter flexible ureteroscopes.

Hand-assisted laparoscopic nephrectomy: complications related to the hand-port site: COMPLICATIONS WITH HAND-ASSISTED LAPAROSCOPIC NEPHRECTOMY

Objective  To evaluate the early results of hand‐assisted radical nephrectomy and nephroureterectomy in our institution.

The development and validation of a patient-information booklet on ureteric stents

Objective To report a scientific approach incorporating patient preferences towards the development of a patient‐information booklet about ureteric stents.

Endoluminal ultrasonography before retrograde endopyelotomy: can the results match laparoscopic pyeloplasty?

In this paper, the authors assess whether endoluminal ultrasonography is helpful when carried out before retrograde endopyelotomy, and ask whether it can help to produce results comparable to laparoscopic pyeloplasty. They found that endopyelotomy was not as good in the presence of crossing vessels, despite using endoluminal ultrasonography, and they propose that laparoscopic pyeloplasty should be used in this situation.

Safe flexible ureterorenoscopy with a dual‐lumen access catheter and a safety guidewire

Flexible ureterorenoscopy has gained widespread acceptance in the diagnosis and management of upper tract pathology. We have performed over 250 ̄exible ureterorenoscopic procedures since November 1997. Herein we describe the technique and the subtle differences that have to be incorporated when undertaking this procedure for either diagnostic or therapeutic purposes. The indications are for procedures requiring use of the ̄exible ureterorenoscope for investigating or treating upper tract pathology.