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Paper Information

Title: 

DIFFICULT CASES OF URETERAL CALCULI AND TREATMENT WHITH URETEROSCOPIC LITHOTRIPSY

Type: PAPER
Author(s): YAZDANI M.*,KABIRI M.
 
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Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

PROPOSE: WE REPORT OUR EXPERIENCE WITH DIFFICULT CASES OF URETEROSCOPIC LITHOTRIPSY METHODS & MATERIALS: FROM MARCH 2000 THROUGH MARCH 2003, 78 PATIENTS (41 MEN, 28 WOMEN, AND 9 CHILDREN) WITH URETERAL CALCULI REQUIRED CHALLENGING URETEROSCOPIC PROCEDURES. MEAN PATIENT AGE WAS 35 YEARS (RANGE 2-79 YEARS) AND STONE SIZE RANGED FROM1 TO 2.4 CM (THE LATTER BEING A STEINSTRASSE). THE PATIENTS INCLUDED 20 CASES WITH STAGHORN CALCULI WHO HAD UNDERGONE EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY, 16 PATIENTS WHO HAD BEEN REFERRED BECAUSE OF FAILURE OF PREVIOUS URETEROSCOPIC LITHOTRIPSY AT OTHER MEDICAL CENTERS, 9 PATIENTS WITH ABNORMAL URETERAL ANATOMY (E.G. , PELVIC KIDNEY), 7 PATIENTS WITH STONE FORMATION ON DOUBLE J STENTS, 5 PREGNANT PATIENTS, 5 PATIENTS WITH RENAL TRANSPLANTS, AND 16 CHILDREN. TWELVE OF OUR PATIENTS HAD SOLITARY KIDNEYS. INTRACORPOREAL LITHOTRIPSY WAS PERFORMED USING THE SWISS LITHOCLAST.
RESULTS: FORTY-TWO (54%) OF OUR 78 PATIENTS BECAME STONE-FREE AFTER ONE URETEROSCOPIC LITHOTRIPSY PROCEDURE, WHILE 21 PATIENTS (27%) NEEDED A SECOND AND 12 (16%) NEEDED A THIRD URETEROSCOPIC PROCEDURE. OPEN URETEROLITHOTOMY WAS PERFORMED IN 3 PATIENTS (4%). A DOUBLE J STENT WAS PLACED IN 50% OF ADULT PATIENTS. CHILDREN WERE NOT STENTED POSTOPERATIVELY. MAJOR COMPLICATIONS (URETERAL AVULSION OR PERFORATION, SEPSIS) DID NOT OCCUR IN THIS SERIES.
DISCUSSION & CONCLUSION: WITH THE AVAILABILITY OF SMALLER, LESS TRAUMATIC URETEROSCOPES AND IMPROVED INTRACORPOREAL LITHOTRIPTORS, URETERAL CALCULI THAT REQUIRE TECHNICALLY CHALLENGING URETEROSCOPIC PROCEDURES CAN BE SAFELY DONE WITH ACCEPTABLE STONE-FREE RATES AND MINIMAL COMPLICATIONS.

 
Keyword(s): URETEROSCOPY, URETERAL CALCULI
 
 
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