Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less.

Purpose: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial.

Materials And Methods: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS.

A prospective, randomized, double-blinded placebo-controlled comparison of extended release oxybutynin versus phenazopyridine for the management of postoperative ureteral stent discomfort.

Objectives: Ureteral stents commonly cause lower urinary tract and flank discomfort. We evaluated the use of extended release oxybutynin versus phenazopyridine versus placebo for the management of ureteral stent discomfort after ureteroscopy.

Methods: Each of 60 patients who received a unilateral stent after ureteroscopy was given a blister pack containing 21 unmarked capsules of either extended release oxybutynin 10 mg, phenazopyridine 200 mg, or placebo in a prospective, randomized, and double-blinded fashion.

Medical management of common urinary calculi.

Nephrolithiasis is a common condition affecting nearly 5 percent of U.S. men and women during their lifetimes.

Metabolic abnormalities associated with calyceal diverticular stones.

Objective: To review the metabolic analyses of patients with calyceal diverticular stones who had surgical treatment of their calculi and to examine the effect of selective medical therapy on stone recurrence, as recent reports suggest that metabolic abnormalities contribute to stone development.

Patients And Methods: In all, 37 patients who had endoscopic treatment of symptomatic calyceal diverticular calculi were retrospectively reviewed. Stone composition and initial 24-h urine collections (24-h urinary volumes, pH, calcium, sodium, uric acid, oxalate, citrate, and the number of abnormalities/patient per collection) were compared with 20 randomly selected stone-forming patients (controls) with no known anatomical abnormalities.

Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less.

Purpose: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial.

Materials And Methods: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS.

PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model.

Background And Purpose: Laparoscopic bipolar instruments are commonly employed to cauterize and divide tissue. A next-generation bipolar device has been developed that employs vapor pulse coagulation energy. We assessed the vessel-sealing capability of this device and quantified thermal spread during application.

Laparoscopic hand-assisted nephrectomy for crossed fused ectopia with polycystic kidney disease.

Polycystic kidney disease occurring in individuals with crossed fused renal ectopia is an extremely rare occurrence. The treatment of individuals with this condition is a unique surgical challenge for the operating physician. Today's advances in laparoscopic techniques provide us with new and innovative ways of performing complex procedures while subjecting patients to relatively minimal surgical trauma.

Hand-assisted laparoscopic nephrectomy: the transfer of experience to a new academic center.

Background And Purpose: Hand-assisted laparoscopic nephrectomy (HALN) has become widely used for the management of localized renal masses and for simple nephrectomy [corrected] Centers of excellence have slowly disseminated this surgical approach throughout academic institutions and private practices. The transfer of this technique to inexperienced surgeons and centers has not been well studied. We examined our outcomes for HALN with an experienced surgeon (DMA) [corrected] at a new academic center.

Adrenergic regulation of salt and fluid secretion in human medullary collecting duct cells.

Transepithelial salt and fluid secretion mediated by cAMP in initial inner medullary collecting ducts (IMCDi) may be important for making final adjustments to urine composition. We examined in primary cultures of human IMCDi cells the effects of adrenergic receptor (AR) agonists and antagonists on intracellular cAMP levels, short-circuit current (I(SC)), and fluid secretion. Epinephrine (1 microM), norepinephrine (1 microM), and isoproterenol (10 nM) individually increased intracellular cAMP levels 57-, 2-, and 25-fold, respectively, and stimulated I(SC) 3.

Internet based multi-institutional clinical research: a convenient and secure option.

Purpose: As randomized, prospective trials have become an integral part of clinical research, multi-institutional, collaborative research has become a necessity. However, it may be cumbersome for participants at remote facilities to participate because the submission and compilation of data and results are at times lengthy processes. Internet based clinical studies have been found to be a rapid, easily accessible, safe and secure method of performing multi-institutional trials.

Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy.

Background And Purpose: Percutaneous stone removal has replaced open renal surgery and has become the treatment of choice for large or complex renal calculi. However, patients with large bilateral stone burdens still present a challenge. Simultaneous bilateral percutaneous nephrolithotomy (PCNL) has been demonstrated to be a well-tolerated, safe, cost-effective, and expeditious treatment.

Adrenal pseudocyst: a unique case with adrenal renal fusion, mimicking a cystic renal mass.

We describe an unusual adrenal pseudocyst mimicking radiologically and clinically renal mass. The cyst measured 12 cm in diameter and had a fibrotic external envelope that was fused with the renal capsule. The possible diagnostic pitfalls encountered in this case are discussed.

Ureteroscopy for benign hematuria.

Any patient presenting with hematuria of unknown origin should undergo a thorough history, physical examination, and laboratory and radiographic work-up. All attempts should be made to exclude malignancy. Renal hemangiomas are the most likely cause of chronic benign hematuria, particularly in young patients.

Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation.

Background And Purpose: New-generation flexible ureteroscopes allow the management of proximal ureteral and intrarenal pathology with high success rates, including complete removal of ureteral and renal calculi. One problem is that the irrigation pressures generated within the collecting system can be significantly elevated, as evidenced by pyelovenous and pyelolymphatic backflow seen during retrograde pyelography. We sought to determine if the ureteral access sheath (UAS) can offer protection from high intrarenal pressures attained during routine ureteroscopic stone surgery.

Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size.

Background And Purpose: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for managing large renal calculi. Investigations have recently focused on reducing the morbidity of the procedure and improving postoperative patient comfort by using smaller endoscopic instruments. We sought to evaluate the effect of a smaller percutaneous drainage catheter on postoperative pain.

Biochemical profile of stone-forming patients with diabetes mellitus.

Objectives: To test the hypothesis that stone-forming patients with type II diabetes (DM-II) have a high prevalence of uric acid (UA) stones and present with some of the biochemical features of gouty diathesis (GD).

Methods: The demographic and initial biochemical data from 59 stone-forming patients with DM-II (serum glucose greater than 126 mg/dL, no insulin therapy, older than 35 years of age) from Dallas, Texas and Durham, North Carolina were retrieved and compared with data from 58 patients with GD and 116 with hyperuricosuric calcium oxalate urolithiasis (HUCU) without DM.

Results: UA stones were detected in 33.

Assessment of stricture formation with the ureteral access sheath.

Objectives: To analyze the long-term incidence of ureteral stricture formation in a series of patients in whom a new-generation ureteral access sheath was used. A new generation of ureteral access sheaths has been developed to facilitate ureteroscopic procedures. However, some have questioned their safety and whether the device might cause significant ureteral trauma.

Clinical efficacy of a combination pneumatic and ultrasonic lithotrite.

Purpose: A new combination pneumatic/ultrasonic intracorporeal lithotriptor has been developed for percutaneous applications. It combines the stone clearing efficiency of an ultrasonic device with the fragmentation strength of a pneumatic probe into a single handpiece. We present our early clinical experience with this device in a prospective, randomized comparison a combination pneumatic/ultrasound lithotrite and standard ultrasonic lithotripsy.

Ureteral access sheath facilitates inspection of incision of ureteropelvic junction.

Purpose: The Acucise (Applied Medical, Rancho Santa Margarita, California) electrocautery balloon is a highly successful device used in managing congenital and secondary ureteropelvic junction obstruction. Correct orientation of the cutting wire is essential during insertion of the Acucise catheter to avoid injury to crossing vessels. Moreover, confirmation of the lateral ureteropelvic junction incision is typically verified by fluoroscopic identification of extravasated contrast material.

Durability of the medical management of cystinuria.

Purpose: Cystinuria is an autosomal recessive disorder of dibasic amino acid transport in the kidney that leads to an abundance of cystine in the urine. This molecule is poorly soluble in urine and it is prone to crystallization and stone formation at concentrations above 300 mg./l.

Techniques to maximize flexible ureteroscope longevity.

Objectives: To assess methods to improve the longevity and durability of flexible ureteroscopes by using the ureteral access sheath, 200-microm holmium laser fiber, and nitinol baskets or graspers during routine ureteroscopic procedures. Despite adequate advances in fiberoptics and endoscope design, the decreased size of currently available flexible ureteroscopes makes damage inevitable after repeated use. However, new auxiliary tools may be able to enhance ureteroscope durability.

Routine postoperative imaging is important after ureteroscopic stone manipulation.

Purpose: Improved fiber optics and advanced intracorporeal lithotripsy devices have significantly decreased the incidence of complications during ureteroscopic procedures. Despite recent reports suggesting that radiographic imaging may not be necessary in all individuals after routine ureteroscopy silent obstruction may develop in some, ultimately resulting in renal damage. We determined the incidence of postoperative silent obstruction at our institution and assessed the need for routine functional radiographic studies after ureteroscopy.