N.J. Stavropoulos

Subcapsular Hematoma due to ESWL: Risk Factors

A study of 4,247 Shockwave lithotripsy treatment was performed to identify and analyze the risk factors for the development of post-extracorporeal shock-wave lithotripsy hematomas. The Dornier HM-3 and HM-4 lithotriptors were used. We recognized 23 hematomas in 23 patients (0.54%). Various factors were examined to identify the certain predisposing risk factors. There was no correlation of sex, age, stone number, stone size, stone location, number of shock waves and voltage used with the occurrence rate of hematoma. We found that patients with pre-existing hypertension and especially those with poor control of it had a significantly increased incidence of perinephric hematoma.

Extracorporeal Shock Wave Lithotripsy in 5 Patients with Aortic Aneurysm

PURPOSE The safety and efficacy of extracorporeal shock wave lithotripsy (ESWL*) in patients with an aortic aneurysm were assessed. MATERIALS AND METHODS Five patients with an aortic aneurysm and symptomatic renal (4) or upper ureteral (1) lithiasis underwent ESWL with either an HM3 or HM4 lithotriptor. RESULTS The procedure was well tolerated in all patients. The stone was fragmented completely in the 4 patients with renal lithiasis, while 1 with ureteral lithiasis also required ureteroscopic extraction of the stone fragments. CONCLUSIONS For patients with symptomatic renal stones and an aortic aneurysm ESWL may be the treatment of choice.

Influence of Digital Examination, Cystoscopy, Transrectal Ultrasonography and Needle Biopsy on the Concentration of Prostate-Specific Antigen

The influence of various prostatic manipulations, including digital rectal examination, cystoscopy, transrectal ultrasonography and transrectal needle biopsy, on the serum prostatic-specific antigen (PSA) levels in 170 men, were examined. We found that digital rectal examination, cystoscopy and transrectal ultrasonography had no significant effect on PSA levels, except for transrectal needle biopsy, which caused an immediate increase of serum PSA in 96.2% of the patients lasting more than 2 weeks in 42.3% of the cases. In conclusion, serum PSA determination after digital rectal examination, after cystoscopy and after transrectal ultrasonography is accurate and reliable. On the other hand, we must wait about 6 weeks after needle biopsy before measuring PSA in the serum of patients with prostatic diseases.

Extracorporeal shock wave lithotripsy monotherapy for bladder stones

This report presents our initial experience in 36 patients with bladder stones, treated by extracorporeal shock wave lithotripsy. Minute fragmentation and uncomplicated evacuation occurred in 26 patients (72%). Mean treatment duration was 55 minutes. Mean number of shock waves was 3600 and electrical discharge averaged 24 kV per shock wave. No morbidity, during or after treatment, was encountered in these patients. The treatment was performed without the use of anaesthesia on an outpatient basis.

The Swiss Lithoclast: An Ideal Intracorporeal Lithotripter

We report our early experience with a new device for endoscopic stone disintegration: the Swiss lithoclast. This device was used to treat 200 patients with stones in kidney, ureter, and bladder. Its effectiveness was 100% when the stone could be approached irrespective of size or composition, and no complication was encountered.

Renal Cell Carcinoma Presenting as a Large Abdominal Mass with an Extensive Peritoneal Metastasis

We report a case of renal cell carcinoma with an extensive intraperitoneal metastasis at the time of diagnosis. This type of metastasis is very rare for renal cell carcinoma and is identified in only 1% of the metastases at autopsy. The findings of computed tomography are presented.

Extracorporeal Shock Wave Lithotripsy of Radiolucent Urinary Calculi Using the Dornier HM-3 and HM-4 Lithotriptors

Between September 1992 and June 1995, 33 patients with radiolucent urinary calculi were treated in our hospital using Dornier HM-3 and HM-4 lithotriptors. There were 11 caliceal stones, 13 in the renal pelvis, and 9 in the ureter. Stone localization was achieved in only 30 patients using intravenous urography or retrograde urography through a ureteric catheter during the procedure. All patients were treated on an outpatient basis, without anesthesia. During the 1st month following extracorporeal shock wave lithotripsy, the patients received alkalization. The overall stone-free rate at 3 months was 90%. The time of radiation exposure was in the range of the opacified stones. Extracorporeal shock wave lithotripsy using Dornier HM-3 and HM-4 lithotriptors proved to be an effective procedure to treat radiolucent urinary calculi when localization of the stone is possible.

Extracorporeal Shock Wave Lithotripsy of Middle Ureteral Calculi: Ventral Shock Wave Application

A total of 150 patients presenting with stone in the middle iliac ureter were treated with extracorporeal shock wave lithotripsy using a Dornier HM-4 lithotriptor. For adequate radiological stone visualization and excellent fragmentation, the prone position was used in all patients. In 45 patients (30%) an ureteral stent was placed before treatment. The overall success rate was 82% (123 of 150 patients). All patients were treated on an outpatient basis without anesthesia.

Transrectal needle aspiration versus transperineal needle biopsy in diagnosis of prostatic carcinoma

Fine-needle aspiration of the prostate was compared to transperineal biopsy in 86 patients with suspected prostatic carcinoma. Aspiration was found to have a sensitivity of 98.6% while no complications were seen. Initial core needle biopsy compared to the final histological diagnosis in this study showed a sensitivity of 84.5%. Fine-needle aspiration of the prostate is a safe, inexpensive and accurate diagnostic method in prostatic carcinoma. Our findings suggest that prostatic aspiration should be used more widely as an initial diagnostic procedure for suspected prostatic cancer.

A rare case of gigantic calyx dilatation manifested as renal ectopia

We present a very rare case of gigantic hydrocalycosis which was caused by an obstructed stone. It was so large that it displaced the rest kidney into the contralateral lumbar fossa giving the appearance of a crossed ectopic kidney.