Peter H. Petritsch

In Situ Extracorporeal Shock Wave Lithotripsy of Ureteral Calculi with the MPL-9000X Lithotriptor

Within the wide armamentarium of urinary stone treatment modalities extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure. With the Dornier MPL-9000X lithotriptor one has the choice of ultrasound or fluoroscopic localization of calculi throughout the entire urinary tract. Except for the kidney, ultrasound guidance is preferred for calculi in the distal ureter, while fluoroscopy is generally used on the proximal two-thirds of the ureter. Between January and December 1990, 123 ESWL treatments were performed on 83 patients suffering from ureteral calculi with an average stone size of 9.3 x 6 mm. Median treatment parameters were 1,597 shock waves at 19.3 kv. for 43 minutes. For stones in the upper two-thirds of the ureter sedation analgesia was given, while ESWL on the pelvic ureter did not create intolerable pain. Of the treatments 69% were done on an outpatient basis. In situ ESWL treatment of urinary calculi was successful in 72 patients (86.7%), and 20 patients (24.1%) were treated with multiple treatment sessions. ESWL therapy for 47 stones in the distal ureter showed better results than for 33 stones plus 2 steinstrasse in the proximal part (95.5% versus 80% stone-free rate). Of 4 patients with mid ureteral calculi 2 could be rendered stone-free by ESWL alone. Auxiliary procedures, such as percutaneous nephrostomy or ureteral splints, had to be performed in 15.7%. Final endoscopic stone extraction was done in 7 cases and open surgery in 4, constituting a 13.3% failure rate for ESWL therapy. The results prove that the MPL-9000X lithotriptor is effective for primary noninvasive stone treatment.

Uric acid calculi: Results of conservative treatment

A total of 140 patients with uric acid diathesis have been treated for the last five years with a standardized mixture of sodium and potassium citrate and citric acid (Uralyt U) together with forced fluid intake and, if necessary, the addition of allopurinol. The results have been encouraging; 80 per cent of the patients showed complete dissolution of the stones and relief of symptoms.

Renal autotransplantation: Further use of a new perfusate

Abstract Totally ischemic canine kidneys were protected during periods of normothermic in vivo exposure known to be lethal (two and three hours) by means of initial perfusion with cold hyperosmolar intracellular electrolyte solutions containing no additives. The solutions are believed to exert their protective effects by preventing the rapid and profound alterations of intracellular electrolytes and water that occur when a kidney is rendered ischemic. The method described herein does not rely upon continuous renal cooling or metabolic inhibition of the ischemic kidney and does not limit operative accessibility.

Ex vivo renal surgery. Further use of a new perfusate.

Abstract Ex vivo renal operations were performed in fifteen dogs to determine the efficacy of a new ex vivo renal preservation technic. The method described and illustrated in this report proved to be simple and requires neither continuous renal cooling nor continuous renal perfusion. A single initial perfusion of the totally ischemic canine kidney with a new hyperosmolar intracellular electrolyte solution was able to offer cellular protection from the otherwise lethal effect of ambiothermic exposure for up to five hours without significant loss of renal function. Pre- and postoperative serum creatinine levels were assessed to determine renal function. Ex vivo renal surgical technics have important potential application when in situ repair is too hazardous or its effect uncertain.

Urinary calculous disease in childhood.

Reviewed are 56 cases of children suffering from urinary calculous disease between 1970 and 1977; 27 were female and 29 male. The age distribution was from one month to fourteen years. In 34 per cent of the children urodynamic disorders were responsible for stone formation, 23 per cent had identifiable metabolic disorders, and in 43 per cent the cause of stone formation was unknown. Urinary infection was present in 60 per cent of the patients. Forty-five of the 56 children (80 per cent) had to undergo surgery. After surgery 78 per cent remained stone free, while 16 per cent had recurrent stones, only half requiring a second operation. In cases of active stone disease, especially in the group with underlying metabolic disorders, specific therapeutic measures have been applied and the patients regularly investigated afterward.

Renal artery stretching and renovascular hypertension An experimental study

Abstract Renovascular hypertension was produced in rabbits by affixing one kidney to the iliac fossa to produce traction on the renal artery. Hyperplasia of the juxtaglomerular apparatus was seen in the kidney in which the renal artery was stretched, whereas no juxtaglomerular apparatus hyperplasia was witnessed in the untouched kidney of rabbits. Whether traction on the renal artery is a sole or contributing factor to the pathogenesis of fibrous dysplasia of the arterial wall remains a moot point.

Extrakorporale Nierenchirurgie unter Anwendung einer neuen Konservierungsmethode

Extracorporeal renal operations were performed in 12 dogs to determine the efficacy of a new renal preservation method. Serveral ex vivo surgical techniques are described, illustrated and the literature reviewed. A single perfusion of the totally ischemic kidney with a new hyperosmolar intracellular electrolyte solution provided sufficient protection from the otherwise lethal effect of 5 hours ambiothermic exposure. Pre- and postoperative serum creatinine levels were assessed to determine renal function.

In-vivo and ex-vivo renal preservation

SummaryA new renal perfusate of modified intracellular electrolyte composition made hyperosmolar with mannitol and requiring no additional additives was successfully used to preserve canine kidneys “ex-vivo” for 48 hours by initial perfusion and hypothermic storage. The new perfusate was also successful in protecting totally ischemic canine kidneys from the lethal effect of two-hours of normothermic exposure “in-vivo”. — The preservation technique is uncomplicated, the materials involved are inexpensive, and the preservation apparatus is readily transportable.