Malachy J. Gleeson

The Use of Alloplastic Biomaterials in Bladder Substitution

The complexity of a total alloplastic prosthetic bladder is evident when one considers the fact that total alloplastic hearts have been applied clinically, although to a limited extent, for several years, whereas prosthetic bladders are still at the investigational stage in animals. 1 The ideal alloplastic bladder should be easy to implant surgically; preserve renal function; provide adequate urinary storage; allow volitional, complete evacuation of urine; be biocompatible; be resistant to extraluminal infection; be tolerant of intraluminal infection; deter intraluminal infection; discharge urine per urethram, and be mechanical reliable 2

Treatment of staghorn calculi with extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy

Between August 1983 and August 1987, 72 staghorn calculi were treated in 66 patients. Treatment was with percutaneous nephrolithotomy (PCNL) in 30, extracorporeal shock-wave lithotripsy (ESWL) in 18, combination PCNL-ESWL in 23, and nephrectomy in 1. Complications occurred in 59 percent of patients and were twice as common after PCNL as after ESWL. Radiologic follow-up on 69 kidneys (97%) showed 58 percent were stone-free, 15 percent had residual sand or matchheads less than 5 mm, 17 percent had residual fragments of 5-15 mm, and 10 percent had greater than 15 mm residual stone burden. With a mean follow-up of thirty months, 2 of 40 stone-free patients had persistent asymptomatic Proteus urinary tract infections, and 4 of 22 patients with residual calculi less than or equal to 15 mm required additional operative treatment.

Comparative in vitro encrustation studies of biomaterials in human urine.

A new dynamic in vitro human urine model was developed to compare biomaterial encrustation. The model incorporates a capacity to study seven biomaterials, a daily urine inflow of 500 ml, a reservoir capacity of 700 ml, and a turnover rate of four days. Encrustation studies performed for 2 weeks in sterile and infected (Proteus Vulgaris) urine on segmented polyether polyurethane, polyester polyurethane, silicone (Mitsui), silicone (Dow Corning), biothane, biolor 1 and biolor 11 demonstrated that biolor 11 (silicone-carbon composite) caused the least encrustation. Encrustation analysis showed brushite in the sterile model and struvite and ammonium acid urate in the infected mode I. Biolor II should have beneficial applications in catheters, stents and prosthetics which come in contact with urine.

Effect of unprocessed wheat bran oncalciuria and oxaluria in patients with urolithiasis

Seventeen hypercalciuria patients (8 control, 9 treatment) with a history of urolithiasis were randomly selected to receive low-calcium, low-oxalate diets with or without the addition of 30 g of dietary fiber as unprocessed wheat bran. Diet alone resulted in a 5.6 percent decrease in calciuria compared with a 23.5 percent decrease with the addition of the fiber. The addition of hydrochlorothiazide and potassium citrate further reduced calciuria by 40.4 percent and 34.5 percent, respectively. Oxaluria was decreased 21.4 percent by diet alone compared with 3.9 percent in the diet and fiber treatment group. Patient compliance to diets was good, and no complications resulted from fiber intake.

Percutaneous endoscopic treatment of cholelithiasis

SummarySurgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous trans-hepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

A Prosthetic Urinary Bladder—Why Not?

After cystectomy, bladder function is replaced with conduits and pouches constructed from autogenous bowel segments. These methods work reasonably well but not ideally.

The Treatment of Renal Stones by Lithotripsy: Indications, Limits, Results, Complications

Extracorporeal shockwave lithotripsy (ESWL) was introduced clinically in 1980, eight years after renal calculi were successfully destroyed in vitro using shock waves (1, 2). To date, more than 500,000 patients have been treated worldwide and ESWL, either alone or in conjunction with percutaneous nephrolithotomy (PCNL), has replaced open surgery as the ideal mode of treatment for the vast majority of symptomatic renal calculi. Herein, we have reviewed the treatment results, the complications and the limits of ESWL therapy with the Dornier HM3 lithotriptor. This task is complicated by the lack of uniformity between different published series and the absence of substratification of patient populations with regards to stone site, size and multiplicity. We have also briefly outlined the characteristics of the various “second generation lithotriptors” which are available worldwide.