Patrick T. Hunter

Hawkins-hunter retrograde transcutaneous nephrostomy: A new technique

Retrograde nephrostomy, a new technique to aid in stone management, has been performed successfully in dogs. It has also been used without complication in a human patient to help remove a renal stone percutaneously under local anesthesia. The technique consists of placing a coaxial catheter over a guidewire under fluoroscopy into the exact calyx desired and advancing a long needle out to the skin to establish a transcutaneous tract. The advantages of the technique include increased control and precision of tract placement, efficient working angles for percutaneous stone removal, and the ability to perform the procedure under local anesthesia.

Preoperative Angioinfarction of Localized Renal Cell Carcinoma Using Absolute Ethanol

A total of 25 patients with renal cell carcinoma underwent angioinfarction of the tumor using absolute ethanol. An average of 15 ml. absolute ethanol was injected into the main renal artery through a balloon occlusion catheter. Complete cessation of renal arterial flow could be demonstrated in all cases. The post-embolization syndrome of pain, nausea, vomiting, hypertension and fever was minimal compared to other methods of renal artery occlusion. Of the patients 21 underwent post-infarction transabdominal radical nephrectomy without intraoperative or postoperative complications attributable to the injection of absolute ethanol. No damage to extrarenal tissue was noted at operation. Subsequent surgical dissection was facilitated, particularly in cases of large tumors when control of the renal pedicle often is difficult. Median blood loss was 725 ml. In light of recent reports concerning the benefit of angioinfarction and nephrectomy in metastatic disease a similar approach may be applicable to localized disease. This pilot study shows the safety of preoperative angioinfarction with absolute ethanol and may be used as a reference for future randomized prospective studies comparing angioinfarction and nephrectomy to nephrectomy alone for localized renal cell carcinoma.

Retrograde Nephrostomy and Percutaneous Calculus Removal in 30 Patients

We used a new technique, retrograde nephrostomy, to provide intrarenal access for percutaneous calculus removal in 30 consecutive patients. Under fluoroscopic control, we maneuvered cystoscopically a 5F and 9F coaxial catheter pair over a guide wire into the calix selected for nephrostomy. Then, a sheathed 20 to 21 gauge needle was passed through the 9F catheter into the flank to create the nephrostomy. Eight patients were given general and 22 intravenous sedation and local anesthesia for nephrostomy placement and calculus removal. Retrograde nephrostomy and subsequent calculus removal were completed successfully in 90 and 83 per cent of the 30 patients, respectively. There were 6 complications and 3 failures among the first few patients due to inferior equipment and inexperience with the technique. Over-all, we found that retrograde nephrostomy provided reliable, precise intrarenal access and we believe that it could become an alternative technique to aid in percutaneous calculus removal procedures.

The Ureteral Access System: A Review of the Immediate Results in 43 Cases

The ureteral access set was used 43 times during an 18-month period between 1984 and 1985. Stones lodged throughout the ureter and in the renal pelvis were extracted with a success rate of 51 per cent. Of the upper tract strictures 92 per cent were dilated successfully. Filling defects were diagnosed in 88 per cent of the cases. Foreign bodies were retrieved, Double-J stents were placed and biopsies were successful in each case. Ureteral perforation in 28 per cent of the cases was caused by the dilator in 8 of 12 (19 per cent over-all). The technique and short-term results are discussed. Long-term followup data are not yet available.

The Role of Urate and Allopurinol in Stone Disease: A Review

In the past 20 years, many investigators have endeavored to shed light on the role of urate and allopurinol in stone disease. This discussion attempts to define what has been established.

Acute Mechanical Dilation of the Ureter: An Experimental Study

Forty-three kidney donor ureters were mechanically dilated in vitro with Van Buren sounds to an average of 21.2F. Thirty-three of these ureters, with an average pre-dilation diameter of 11.3F, could be dilated an additional average of 10.6F. The average dilated/nondilated diameter ratio in these ureters was 1.9. These experimental data suggest an undilated pelvic ureteral diameter and a manually dilated ureteral diameter of approximately the same size cited in the clinical literature.

Retrograde nephrostomy in 100 patients

SummaryRetrograde nephrostomy is a new nephrostomy technique whereby the urologist passes a needle from inside the kidney to the flank to create the nephrostomy. The technique was successfully performed in 96 of 100 patients and provided intrarenal access for percutaneous calculus removal in 92 of 100 patients. Thirty-four complications resulted which included pneumothorax, renal hemorrhage, urinary extravasation and infection, collecting system perforation and ileus. The technique has been used by four staff and six training urologists, appears easy to learn and may provide an alternative to conventional antegrade nephrostomy techniques in the future.

New monofilament basket for bladder calculi.

Successful stone manipulation was facilitated with the new monofilament basket in experimental situations and in patients. Advantages over other baskets include: in vivo adjustability, reduced mucosal trauma, ability to irrigate and aspirate through the basket, and ability to pass lithotriptor electrodes within the basket. Basket modifications under study might prove useful within the ureter, renal pelvis, and biliary tree.