-
[show abstract]
[hide abstract]
ABSTRACT: To describe a novel method for fragment evacuation after percutaneous lithotripsy of neobladder calculi.
The technique was developed using a Urovac bladder evacuator, which was attached to a standard 30F Amplatz working sheath.
The attachment of the Urovac evacuator to the Amplatz sheath rapidly evacuated large quantities of stone material. Careful attention should be paid to maintaining low-pressure irrigation by ensuring the bladder is not overly full and the Urovac device is not vigorously manipulated, to minimize the likelihood of bladder injury.
Percutaneous ultrasonic/hydraulic lithotripsy for large-volume neobladder calculi often results in a substantial burden of stone fragments that can be difficult to clear using standard techniques. Attaching a Urovac bladder evacuator to the 30F Amplatz sheath can simplify the management of this task.
Urology 08/2012; 80(2):474-6. · 2.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: As surgical technology continues to advance, stone baskets are becoming increasingly miniaturized. We performed a study to define the effect of miniaturized stone baskets on ureteroscope irrigation flow and deflection.
We compared the three smallest available stone baskets: Boston Scientific 1.3F OptiFlex, Cook 1.5F N-Circle, and Sacred Heart 1.5F Halo, measuring their effect on irrigant flow and deflection of three flexible ureteroscopes.
All devices adversely affected irrigation flow and active deflection of all of the ureteroscopes (P<0.05). The 1.3F device, however, exhibited significantly less of an effect on both parameters. Irrigation flow was 28% greater with the 1.3F device than it was for the 1.5F devices. The device's effect on active deflection was 43% less with the 1.3F device than it was for the 1.5F devices.
Any device placed through the working channel of a ureteroscope will have a deleterious effect on the ureteroscope's irrigant flow and active deflection. As the caliber of the device decreases, however, its effect on these parameters appears to be reduced. Our present data suggest that the 1.3F basket has significantly less of an effect on both the irrigant flow and deflection of a flexible ureteroscope than do the 1.5F devices.
Journal of endourology / Endourological Society 03/2012; 26(3):275-7. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To perform a multi-institutional study to characterize CT-detected complications after PNL. Computed tomography (CT) is commonly performed after percutaneous nephrolithotomy (PNL). One benefit of this imaging modality is the detection of procedure-related complications. Presently, the incidence of such complications is not well-defined.
PNL procedures performed at 5 stone referral centers between July 2007 and June 2008 were reviewed. All patients undergoing CT within 24 hours after surgery were selected for further analysis. All CT studies were reviewed by a staff radiologist.
One-hundred ninety-seven patients satisfied the study inclusion criteria. A body mass index >30 was present in 27.5% of patients. Treated stone burden was staghorn in 70 (35.5%), >2 cm in 72 (36.5%), and <2 cm in 55 (28%). Six treated renal units (3%) were ectopic; 45.4% of calculi were predominantly lower pole. Thoracic complications encountered were atelectasis in 88 (44.7%), pleural effusion in 17 (8.6%), pneumothorax in 3 (1.5%), hemothorax in 2 (1%), and hydrothorax in 1 (0.5%). Renal complications were perinephric hematoma in 15 (7.6%), collecting system perforation in 4 (2%), subcapsular hematoma in 3 (1.5%), urinoma in 2 (1%), and pseudoaneurysm in 1 (0.5%). There was 1 trans-splenic nephrostomy without splenic hematoma. No injuries to hollow viscera were detected. Two patients (1%) were found to have ascites.
Major post-PNL complications detected by CT are uncommon, and when encountered, they are generally amenable to conservative management.
Urology 01/2011; 78(2):291-4. · 2.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Nephrolithiasis is a highly prevalent condition with a high recurrence rate that has a large impact on the quality of life of those affected. It also poses a great financial burden on society. There have been great advancements in the surgical treatment of stone disease over the past several decades. The evolution of surgical technique appears to have overshadowed the importance of prevention of stone disease despite evidence showing medical therapies significantly decreasing stone recurrence rates. Herein we review the metabolic evaluation of stone formers with the use of specific blood and urine tests. We complete our discussion with a review of the medical management of stone formers providing both general recommendations as well as reviewing focused therapies for specific metabolic abnormalities and medical conditions.
Therapeutic Advances in Urology 02/2010; 2(1):3-9.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the likelihood of being diagnosed with, or treated for, an upper urinary tract calculus after gastric banding. Bariatric surgical procedures are being increasingly utilized in the treatment of patients with morbid obesity. Certain malabsorptive bariatric procedures have been associated with an increased risk for kidney stone formation. However, the kidney stone risk of gastric banding, a restrictive bariatric procedure, is unknown.
We identified 201 patients who underwent gastric banding and a control group of 201 obese patients who did not have bariatric surgery in a national private insurance claims database within a 5-year period from 2002-2006. All patients had at least 2 years of continuous claims data follow-up. Our 2 primary outcomes were the diagnosis and the surgical treatment of a urinary calculus.
After gastric banding, the diagnosis of an upper urinary tract calculus occurred in 3 subjects (1.49%), as compared with 12 subjects (5.97%) in the comparison cohort (P = .0179). One subject in each cohort (0.50%) underwent a surgical procedure for the treatment of an upper urinary tract (P = 1.0000).
Gastric banding is not associated with an increased risk for kidney stone disease or kidney stone surgery in the postoperative period. Additional long-term studies are required to confirm these findings.
Urology 09/2009; 74(4):746-9. · 2.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Flexible ureteroscopes are fragile devices, and the costs associated with their repair and replacement can be considerable. Although surgical use can degrade ureteroscope function, the cleaning and sterilization process can also cause great damage. We performed a study to define the effect of having the urology nursing staff process and sterilize all ureteroscopes, rather than the central processing core; the total repair cost and cost per use were analyzed.
From April 2007 to March 2008, all ureteroscopes were processed by the urology nursing staff. We analyzed the average cost per use as a measure of the effectiveness of this strategy. For all endoscopic stone removal cases, a flexible ureteroscope is opened onto the operative field; therefore, after every endoscopic procedure, the flexible ureteroscope needs processing and sterilizing. The number of times each ureteroscope was processed and the type and cost of repairs were recorded.
From April 2007 to March 2008, 11 ureteroscopes were processed 478 times; average uses before repair was 28.1. Seven ureteroscopes were returned for repair because of: loss of deflection (2); loss of fiberoptic bundles (2); failed leak test (3). No ureteroscope damage was because of processing. The total repair cost in this 12-month period was $57,664.50. Amortizing repair costs over use gives a value of $120.63 cost per use.
Training the urology nursing staff to clean and sterilize ureteroscopes is a reasonable means to reduce processing-related damages.
Journal of endourology / Endourological Society 06/2009; 23(6):903-5. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although experimental evidence suggests that the rate of shock wave delivery can affect the outcome of shock wave lithotripsy, clinical studies produce conflicting results. We performed a systematic review and meta-analysis to define the effect of shock wave rate on the outcome of shock wave lithotripsy.
A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing SWL treatment at 60 shocks per minute to 120 shocks per minute were included in the analysis. Data from 4 trials (589 patients) were pooled. The primary outcome measure was treatment outcome (success, failure), as defined by the authors of the source studies. The difference in the proportion of patients with a successful treatment outcome was compared between the 60 and 120 shocks per minute groups as a risk difference, and risk differences were pooled across the 4 trials with a fixed effects model.
Patients treated at a rate of 60 shocks per minute had a significantly greater likelihood of a successful treatment (risk difference 10.2, 95% CI 3.7-16.8, p = 0.002).
Our meta-analysis suggests that patients treated at a rate of 60 shocks per minute have a significantly greater likelihood of a successful treatment outcome than patients treated at a rate of 120 shocks per minute.
The Journal of urology 02/2008; 179(1):194-7; discussion 197. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 32-year-old healthy woman from China was diagnosed with a bladder mass during pelvic ultrasonography, carried out during the work-up of a miscarriage. Cystoscopy by the Department of Obstetrics and Gynecology confirmed the presence of a bladder mass, after which she was referred to our department for evaluation and management. The patient was asymptomatic at presentation. She denied urologic symptoms and did not have a history of smoking or industrial exposure to carcinogens.
Laboratory test results and urine studies were unremarkable. Cytology revealed benign cells with numerous micro-organisms. Intravenous pyelography revealed a 1 x 2 cm filling defect in the mid posterior bladder compatible with a mass. There were no upper urinary tract defects. We performed cystoscopy with transurethral resection of the bladder tumor.
Pathology revealed cystitis glandularis.
The patient was followed up with repeat cystoscopy after 4 months; there was no evidence of recurrence. She was scheduled for surveillance after a further 3 months, but was lost to follow-up.
Nature Clinical Practice Urology 07/2007; 4(6):341-5. · 4.07 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Overactive bladder syndrome (OABS) is a widely recognized syndrome with symptoms that can include urinary urgency, frequency, nocturia, and incontinence. Although there may be several causative factors for OABS, detrusor overactivity is the most common. In addition, urinary incontinence can also be due to a distinct but equally bothersome condition underactive bladder syndrome, or detrusor underactivity. The incomplete bladder emptying that characterizes detrusor underactivity often arises from impaired contractile function of the detrusor muscle. The variations in etiologies of the two syndromes necessitate patient evaluations tailored to individual symptom presentation. Increased awareness of the differences between the manifestations of OABS and underactive bladder syndrome call for specific approaches to the management of bladder dysfunction.
Nature Clinical Practice Urology 01/2005; 1(2):78-84; quiz 109. · 4.07 Impact Factor
