Joaquim de Almeida Claro

Ureteroscopic stone removal in the distal ureter. Why change

PURPOSE We compared our experience with ureteroscopic stone basket manipulation under fluoroscopic guidance to ultrasound ureterolithotripsy for distal ureteral stone removal. MATERIALS AND METHODS Retrospectively, we analyzed the medical records of 981 patients with ureteral calculi between January 1994 and December 1995, of whom 483 (49%) were treated for stones in the lower ureter and constituted our study group. The decision of when to perform lithotripsy (group 2) versus a basket procedure (group 1) was based on a prospective nonrandomized study and both groups were compared historically. All 322 patients in group 1 (mean age 49 years, range 14 to 86) primarily underwent ureteroscopic stone basket manipulation using the 4-wire Segura* basket. If the calculus could not be removed with the basket and another procedure was necessary, the case was considered a failure. The 161 patients in group 2 (mean age 37 years, range 14 to 74) underwent initially ultrasound ureterolithotripsy for stone fragmentation followed or not by removal of the fragments with the basket. Stone size did not differ significantly between groups 1 (mean 0.9 cm., range 0.6 to 1.7) and 2 (mean 0.8 cm., range 0.7 to 2.0). Ureteroscopy was performed in both groups with epidural anesthesia and on an outpatient basis in the majority of cases. RESULTS The stone-free rate after 1 procedure was 98.1 and 95.6% in group 1 and 2, respectively. For group 2 versus group 1 the operative time was longer (mean 50, range 25 to 90 versus mean 19 minutes, range 11 to 40, respectively, p < 0.001), the complication rate was greater (16.1 versus 4.3%, respectively, p < 0.001) and average hospital stay was longer (2.1 versus 0.15 day, respectively, p < 0.001). CONCLUSIONS Ureteroscopic stone treatment with basket manipulation under fluoroscopic guidance or ultrasound ureterolithotripsy provided a high stone-free rate. However, stone removal with the basket manipulation technique should be considered the first choice for treatment of small distal ureteral calculi based on the minimal morbidity, and short operative and recovery times.

Blood pressure changes after extracorporeal shock wave lithotripsy in normotensive patients

To evaluate the blood pressure changes caused by extracorporeal shock wave lithotripsy 102 patients 5 to 81 years old (mean age 40 years) with normal blood pressure and kidney lithiasis were monitored during a mean period of 22 months. There were 61 male (group 1) and 41 female (group 2) patients. Patients were evaluated by measurement of the diastolic pressure and the average arterial pressure before and after lithotripsy. Hypertension was considered when the diastolic pressure was greater than 90 mm. Hg for 2 weeks. The amount of shock waves applied in each case ranged from 1,250 to 6,000, with a mean of 4,000 shock waves at a median intensity of 18.1 kv. The incidence of hypertension after extracorporeal shock wave lithotripsy was 3.92%, which is similar to that of a normal population, although the diastolic pressure was statistically higher after treatment in both groups. In the male patients the diastolic pressure increased from 79.26 (+/- 9.7) to 81.47 (+/- 10.1) mm. Hg and in female patients it ranged from 76.58 (+/- 8.3) to 79.26 (+/- 9.9) mm. Hg. Similarly, the average arterial pressure was equally higher in the female group, ranging from 89.88 to 91.75 mm. Hg. In the male group the difference was not statistically significant, despite an increase from 94.5 to 95.8 mm. Hg.

Lumbar ureteric stones: Which is the best treatment?

We reviewed retrospectively 145 patients presenting ureteral calculi above the iliac crest. According to the treatment three groups were established. Group 1 was represented by 24 patients submitted to posterior ureterolithotomy; group 2, 100 patients treated by endourologic procedures; and group 3, 21 patients treated by extracorporeal shock-wave lithotripsy (ESWL). Success rate considered as complete removal of all calculous material was 100 percent in the posterior ureterolithotomy group, 92 percent in the endourologic group, and 94.7 percent in the ESWL group. Hospitalization, anesthesia, and complication rates were minimal in patients submitted to ESWL. One may conclude that ESWL is the treatment of choice for lumbar ureteric calculi.

Mini-incisions by lombotomy or subcostal access in living kidney donors: a randomized trial comparing pain, safety, and quality of life

Abstract:  Objectives:  The aim of this study was to compare two mini‐incision techniques and judge the impact on the quality of life, pain, and safety of living kidney donors.

Congenital diverticulum of male urethra

Congenital diverticulum of the male urethra is an uncommon condition. Urinary tract infection, urethral obstruction, and disturbances in micturition are the most common symptoms. Six cases of congenital diverticulum of the male urethra were studied with regard to diagnosis and treatment. Four patients underwent endoscopic treatment of the diverticulum. The procedure is simple and rapid, with low incidence of complications and high rates of success.

Oral or Intravesical Bacillus Calmette-Guerin Immunoprophylaxis in Bladder Carcinoma

A total of 71 patients with superficial transitional cell carcinoma underwent transurethral resection of bladder tumor. All patients had stage pTa or pT1 transitional cell carcinoma or carcinoma in situ without other concurrent malignancies. The patients were assigned to 3 treatment groups: control group--transurethral resection discontinued within the study, oral bacillus Calmette-Guerin (BCG) group--transurethral resection of bladder tumor plus BCG (Moreau) and intravesical BCG group--transurethral resection of bladder tumor plus BCG. Of 9 patients in the control group 8 (89%) experienced tumor recurrence during a mean followup of 20 months. Of the 28 patients in the oral BCG group 11 (39.3%) had recurrence during a mean followup of 36 months. Of the 34 patients in the intravesical group 6 (18%) had recurrence in a 24-month mean followup. The incidence of complications was higher in the intravesical (41.2%) than in the oral BCG group (28.5%). These results show that intravesical BCG is a more effective immunotherapy; however, oral BCG can be used in patients who do not accept intravesical BCG administration.

Giant Perineal Solitary Fibrous Tumor: A Rare Case Report

Background. Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor that was initially described from the pleura but currently arises at almost every anatomic site. It is usually benign, and surgical resection is curative. SFT involving the perineum is extremely rare. This is the third case report of a perineal SFT in the literature. Case Presentation. We reported an uncommon case of a 64-year-old man presenting with a huge perineal mass that started growing 3 years before his arrival in our service. He was asymptomatic. A contrast-enhanced CT scan revealed a heterogeneous well-circumscribed perineal mass with soft-tissue density. Invasion of the surrounding organs, distal metastasis, and lymph node swelling were absent. The complete resection of mass was done successfully. The specimen was a 23.0 × 14.0 × 8.0 cm encapsulated tumor. Mass weight was 1,170 g. After pathological analysis, we confirmed that the mass was a solitary fibrous tumor. The diagnosis was based on clinical findings and histological morphology and immunohistochemistry study. Conclusion. SFTs are usually indolent tumors with a favorable prognosis. The perineal location is extremely rare. Complete resection of the mass is the treatment of choice.

Perioperative and 90-day complication rates in patients with localized prostate cancer treated with high intensity focused ultrasound (HIFU): A prospective case series study.

e17083Background: Localized prostate cancer (PC) has been treated with radical prostatectomy, radiotherapy, or active surveillance. Recently, focal treatment was introduced as an alternative option...

Outcomes of more than 1 000 percutaneous nephrolithotomies and validation of Guy's stone score

To present the experience with percutaneous nephrolithotomy (PCNL) at a high‐volume Brazilian centre and to evaluate Guys stone score (GSS) as a predictor of success and complications in PCNL.

MP68-05 SINGLE SURGEON EXPERIENCE WITH RETAINED ENCRUSTED STENTS: COMBINED ENDOUROLOGICAL APPROACH AND MODIFIED GRADING SYSTEM

Despite their common use, there is limited data on long-term safety of UAS use. We sought to evaluate the observed rates of ureteral stricture following ureteroscopy with UAS compared to cases without UAS. METHODS: In a retrospective review, we identified 378 consecutive patients with a new diagnosis of nephrolithiasis managed with ureteroscopy between January 2014 and May 2015. Both the use of UAS and the specific sheath size were assessed (12/14 Fr or 14/16 Fr). The Cook Flexor sheath was used in all cases. Patients were evaluated for ureteral stricture based on post-operative imaging including ultrasound, CT, MRI, and/or renal scan up to one year after surgery. Patients were excluded from the study if they underwent a concurrent percutaneous or open stone surgery, did not have appropriate follow-up imaging, or had post-operative hydronephrosis or obstruction due to another etiology. RESULTS: Of the 378 patients, 141 were excluded, primarily for inadequate post-operative imaging; 237 patients were included in the final analysis. The mean age was 54 years, with 106 women and 131 men. Of these, 81 (34.1%) cases included the use of an access sheath, with 12/14 UAS used in 39 cases and 14/16 UAS used in the remaining 42 cases. There were three (1.2 %) ureteral strictures, with mean time to diagnosis of 11 weeks. All cases occurred in the UAS group (p 1⁄4 0.039) along the proximal ureter/ureteropelvic junction. When stratified by sheath size, two of the 39 cases using a 12/14 sheath developed a stricture, compared with one stricture in the 14/16 group (p 1⁄4 0.6). Of the three patients with stricture, two were managed with prolonged stenting whereas the last one was lost to follow-up. CONCLUSIONS: While the overall ureteral stricture rate was low (1.2 %) after ureteroscopy, there was a statistically significant increase in stricture rate with UAS. Limitations of this study include the low sample size and lack of control of confounders such as pre-stent status. Large, prospective, randomized studies are required to definitively evaluate the effect of UAS on stricture formation.