Mechanical impactor employing Nitinol probes to fragment human calculi: fragmentation efficiency with flexible endoscope deflection.

The Browne Pneumatic Impactor (BPI; Browne Medical Systems, Minneapolis, MN) is a new mechanical lithotripter that relies on a pneumatically driven metal probe. It can be employed through both rigid and actively deflectable flexible endoscopes. Prior in vivo studies have shown excellent fragmentation of hard human calculi while employing the BPI with active endoscope deflection of as much as 45 degrees.

Laparoscopic cutaneous ureterostomy: technique for palliative upper urinary tract drainage.

Extensive pelvic carcinomatosis often results in bilateral ureteral obstruction and renal parenchymal loss. Percutaneous nephrostomies can be used for palliative means but may be poorly tolerated. Laparoscopic techniques can be applied to obtain a more permanent urinary diversion.

Endoscopic management of the symptomatic caliceal diverticular calculus.

Caliceal diverticular calculi are most often asymptomatic and of little clinical significance. In certain cases they may be associated with flank pain, pyuria and chronic urinary tract infections. Treatment has evolved from open surgical techniques to a purely endoscopic approach.

The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi.

Objectives: To compare extracorporeal shock-wave lithotripsy (ESWL) with endoscopic lithotripsy to establish the more efficacious and cost-effective treatment for ureteral calculi.

Methods: The records of 112 patients with primary ureteral calculi treated at one center with either ESWL or endoscopic lithotripsy were retrospectively reviewed. Follow-up data at 1 and 3 months were obtained in all patients.

The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures.

Objectives: To define those patients with upper urinary tract calculi who are more likely to have an unsuccessful outcome from extracorporeal shock-wave lithotripsy (ESWL).

Methods: A critical prospective analysis of 121 patients, referred to two university centers after ESWL had been exhausted as a treatment modality for upper urinary tract calculi, was performed. Patients were subdivided into the following groups: failure to clear fragments, failure to fragment, difficulty in calculus localization, and failure due to inherent upper urinary tract obstruction.