Endopyelotomy: review of results and complications.

Percutaneous endopyelotomy augmented by balloon dilation was performed on 27 of 40 patients for the treatment of symptomatic, primary ureteropelvic junction obstruction. Percutaneous ultrasonic lithotripsy was performed simultaneously on 12 of 27 patients (44%) for associated calculi. After endopyelotomy 24 of 27 patients became asymptomatic (clinical success rate 89%).

Pulsed dye laser fragmentation of ureteral calculi: a review of the first 50 cases performed at Virginia Mason Medical Center.

During the preceding 2 1/2 years 50 patients have undergone laser fragmentation of ureteral calculi at our medical center. Of these 50 patients 48 (96%) became free of stones without the need for an open operation: 44 (88%) were managed in 1 setting and 4 required adjunctive extracorporeal shock wave or ultrasonic lithotripsy, or a repeat session with the laser. Two patients (4%) eventually required an open operation: 1 required ureterolithotomy for a large impacted stone overlying the bony pelvis after a ureteroscope could not be advanced to this level and 1 had a good initial result with the laser but a persistent ureteral stricture developed and he required ureteroureterostomy 4 months later.

Suppressed antidonor MLC responses in renal transplant candidates conditioned with donor-specific transfusions that carry the recipient's noninherited maternal HLA haplotype.

Forty-seven patients with end-stage renal disease were entered into a donor-specific transfusion protocol consisting of three infusions of whole blood every two weeks prior to transplantation. Fourteen of the patients became sensitized following transfusion and were not transplanted. Thirty-one patients received a transplant from the DST donor and have an estimated two-year graft survival of 97%, three-year survival of 88%, and four-year survival of 69%.

Ureteropelvic junction obstruction: treatment with percutaneous endopyelotomy.

The authors review their experience with percutaneous endopyelotomy in the treatment of ureteropelvic junction obstruction. Twenty-four patients with symptoms of ureteropelvic junction obstruction underwent excretory urography, which revealed nonspecific narrowing in several cases. Angiography was performed in 14 patients suspected of having a vessel crossing at the junction, but such a vessel was found in only four, who subsequently underwent dismembered pyeloplasty.

Total prostatectomy for clinically localized prostatic cancer: long-term results.

The fate of the first 52 patients with clinically localized prostate cancer who underwent total perineal prostatectomy at our clinic and have been followed for a minimum of 15 years is reviewed to evaluate the long-term impact of this operation on the disease. None of these patients received any adjuvant therapy. Nine patients (17 per cent) had recurrence and 5 (10 per cent) died of disease during this interval.

Endopyelotomy for primary repair of ureteropelvic junction obstruction.

A total of 12 patients underwent primary repair of ureteropelvic junction obstruction between November 1, 1985 and December 31, 1986. Ten patients underwent percutaneous incision of the ureteropelvic junction (endopyelotomy) as the initial effort to correct the obstruction. Two patients with ureteropelvic junction obstruction associated with an aberrant lower pole renal artery underwent dismembered pyeloplasty (Anderson-Hynes) via a flank incision.

Extracorporeal shock-wave lithotripsy (ESWL) of pelvic kidney calculus. Use of C-arm fluoroscopy for correct patient positioning.

Extracorporeal shock-wave lithotripsy (ESWL) is the preferred treatment modality for renal and upper ureteral calculi. It is usually reserved, however, for urinary tract calculi above the iliac crest of the bony pelvis. A calyx calculus in a pelvic kidney was successfully treated with ESWL by using a C-arm fluoroscope to simulate the exact direction of the shock waves.

Impact of extracorporeal shock wave lithotripsy on percutaneous stone procedures.

Extracorporeal shock wave lithotripsy (ESWL) is now the primary urologic treatment for symptomatic renal calculi; it is responsible for a substantial decrease in percutaneous stone removal procedures. Three hundred patients treated since ESWL became available are compared with the preceding 300 patients who were treated percutaneously. Since it became available, ESWL has been used alone on over 90% of patients.

Caliceal calculi.

Primary nonobstructive caliceal calculi were removed by nephrostolithotomy in 51 patients. Among the patients with caliceal stones indications for removal included pain in 36 (71 per cent), associated infection in 11 (21 per cent), progressive stone growth in 2 (4 per cent), hematuria in 1 (2 per cent) and flight status eligibility in 1 (2 per cent). Over-all, 300 patients have undergone percutaneous removal of upper urinary tract calculi, with a 97 per cent success rate.

Adjuvant radiotherapy following radical prostatectomy: results and complications.

Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year followup. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not.

Radiation dose to personnel during percutaneous renal calculus removal.

Radiation dose to the radiologist and other personnel was measured during 102 procedures for percutaneous removal of renal calculi from the upper collecting system. A mobile C-arm image intensifier was used to guide entrance to the kidney and stone removal. Average fluoroscopy time was 25 min.

Efficacy of radical prostatectomy for stage A2 carcinoma of the prostate.

Optimal management of men with diffuse incidental prostatic cancer (Stage A2) is an unresolved issue. Current forms of therapy include radical prostatectomy, external beam radiation therapy, and no treatment. Long-term results with curative therapy have been unreported because of the relatively recent substaging of Stage A into incidental and diffuse disease.

Percutaneous ultrasonic versus surgical removal of kidney stones.

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized.

Upper ureteral calculi: extraction via percutaneous nephrostomy.

Symptomatic calculi in the upper ureter are usually removed using surgical and endoscopic techniques. Extraction via percutaneous nephrostomy was successful in 35 of 37 patients using sequentially the techniques of retrograde catheter push, basket sheath exchange, and steerable loop-snare. In 12 patients, the calculus was dislodged into the renal pelvis by the retrograde ureteral catheter; extraction was then easily done.

Kidney stone removal: percutaneous versus surgical lithotomy.

Percutaneous removal of most urinary tract calculi may be performed as a 1-stage effort with techniques and skills developed recently in the specialties of urology and radiology. Ultrasonic fragmentation of most calculi was done to permit their extraction. Percutaneous ultrasonic lithotripsy was performed on 250 consecutive (a single exception) patients bearing stones that required removal.

Percutaneous removal of caliceal calculi.

Of 170 patients who underwent percutaneous nephrostolithotomy, 61 had stones located in a calix. Direct access to the calix containing the calculus optimizes removal. Special maneuvers during and after percutaneous stone removal (e.

Radiation exposure to patient and urologist during percutaneous nephrostolithotomy.

Radiation exposure to the patient and urologist was determined during 60 procedures for percutaneous removal of calculi from the upper collecting system. For male patients the average radiation dose at the surface of the testis was 160 mrem (1.6 mSv.

Ultrasonic renal lithotripsy. Single-stage percutaneous technique and adjuvant radiological procedures.

Single-stage percutaneous ultrasonic disintegration and removal of renal calculi was attempted in 67 patients (80 calculi) and proved successful in 65 (97%). Extraction was achieved during the initial session in 52 patients (78%) and required either an adjuvant radiological procedure or repeat nephroscopy in 13. Single-stage removal combines the skills of the radiologist and urologist and is successful in the majority of cases.

Morbidity of radical perineal prostatectomy following transurethral resection of the prostate.

Radical prostatectomy in patients who have had prior transurethral resection of the prostate has been reported to result in significant morbidity. From 1974 to 1982, 30 patients who had had previous transurethral resection of the prostate underwent radical perineal prostatectomy for localized prostatic cancer. Operative time and blood loss were similar to a group of patients who had not had prior transurethral resection of the prostate.

Mitomycin C intravesical therapy in noninvasive bladder cancer after failure on thiotepa.

Mitomycin C 40 mg in 40 ml water was administered intravesically every week for 8 consecutive weeks to 60 patients with superficial bladder cancer. All patients had failed treatment with intravesical thiotepa and had evaluable disease. An objective response of 50% or greater reduction in measured tumor mucosal involvement was obtained in 68% of patients.

Ultrasonic destruction of kidney stones.

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized.