Management of cystinuric patients: an observational, retrospective, single-centre analysis.

Objective: A critical appraisal of the management of patients with cystine stones treated in our unit in the past 6 years and to analyze the outcome of multimodality therapies.

Study Design: An observational, single-centre retrospective study.

Methods: We reviewed the records of all patients with stones referred to our centre over a 6-year period from 1998 to 2005.

A randomized controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy.

Objective: We present results from the first randomized controlled trial of human vs. telerobotic access to the kidney during percutaneous nephrolithotomy.

Methods: To compare (a) human with robotic percutaneous needle access and (b) local robotic with trans-Atlantic robotic percutaneous needle access, we used a validated kidney model into which a needle was inserted 304 times.

Multimodal management of urolithiasis in renal transplantation.

Objective: To report the largest single series of renal transplant patients (adults and children) with urolithiasis, assess the risk factors associated with urolithiasis in renal transplant recipients, and report the outcome of the multimodal management by endourological and open procedures.

Patients And Methods: The records of all patients undergoing renal transplantation between 1977 and 2003 were reviewed. In all, 2085 patients had a renal transplant at our centre and 21 (17 adults and four children) developed urinary tract calculi.

Defining the learning curve for percutaneous nephrolithotomy.

Purpose: To define the learning curve for percutaneous nephrolithotomy (PCNL) using three potential surrogate markers of surgical expertise.

Materials And Methods: The learning curve of an endourologist with no previous experience at performing solo PCNL was studied. Three putative parameters of expertise were reviewed, namely, operating time, fluoroscopic screening time, and radiation dose.

Percutaneous nephrolithotomy in early pregnancy.

Most cases of urolithiasis in pregnancy are managed conservatively either with ureteric stents or percutaneous nephrostomy tubes, which need to be changed at regular intervals. Definitive management of the stone is usually delayed till after delivery. We describe a patient who presented with pyonephrosis in the fifth week of gestation, due to a stone obstructing the right ureteropelvic junction.

Prolonging the life of the flexible ureterorenoscope.

The lifespan of medical equipment must be maximised to ensure cost-effectiveness. Flexible ureterorenoscopes have become widely used in the diagnosis and treatment of urolithiasis. They are relatively expensive and current literature shows that they require frequent repair and replacement.

Flexible ureterorenoscopy: prospective analysis of the Guy's experience.

Objective: To report our outcomes with small diameter, actively deflectable flexible ureterorenoscopy from a prospective database.

Patients And Methods: 114 flexible ureterorenoscopies were performed in 105 patients (mean age, 49.5 years; range, 19-85 years; 71 males, 34 females) over a 9-month period.

Treatment of urolithiasis in the morbidly obese.

Background: Morbidly obese patients with urolithiasis present a therapeutic and diagnostic challenge to the Urologist. Management is reported and potential difficulties discussed.

Methods: Morbidly obese patients (body mass index > or = 40kg/m2) with stone disease were identified by retrospective review.

Testis-sparing surgery for benign and malignant testicular tumours.

We report the technique of testis-sparing surgery in three young men with testicular tumours, two of which were found to be benign (Leydig cell tumour and benign teratoma) and one malignant (seminoma) on frozen section and final pathological evaluation. The principles of clamping the spermatic cord with a soft bowel clamp, testicular cooling with ice slush, tumour enucleation with clear margins, meticulous haemostasis and frozen section analysis were followed. Testicular preservation was successful in the patients with benign disease.

Management of encrusted ureteral stents impacted in upper tract.

Objectives: To present our series of patients with ureteral stent encrustation and give indwelling times and management. Encrustation is one of the most serious complications of ureteral stents.

Methods: A retrospective review was undertaken of all encrusted stents during a 4-year period.

Have stent-related symptoms anything to do with placement technique?

Purpose: To determine whether incorrect placement of an indwelling stent plays any role in the causation of irritative voiding symptoms and loin pain.

Patients And Methods: Sixty patients with ureteral calculous disease were prospectively requested to analyze the symptoms that they encountered 1 week after stent insertion via a questionnaire handed out at their discharge from the hospital. The answers were analyzed with reference to the intravenous urogram performed at presentation and the plain radiograph taken immediately after stent insertion.

To stent or not to stent? That is still the question.

Background And Purpose: Most patients are stented after ureteroscopy for stone extraction. This practice necessitates a second procedure to remove the stent, with its inherent morbidity. The aim of our study was to determine whether routine stenting of the ureter is really necessary after ureteroscopy.

Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates.

Over a period of 57 months, 404 patients with distal ureteral calculi were treated by in situ SWL on a Storz Modulith SL 20 lithotripter and 163 by ureteroscopy (URS) and Swiss Lithoclast stone fragmentation. The case notes on these patients were reviewed for comparison of the initial stone number and individual length and for the calculation of the stone-free, treatment, retreatment, secondary procedure, and complication rates. Complete data were available on 447 patients.

Microwave hyperthermia in benign prostatic hypertrophy: a controlled clinical trial.

Objective: To compare the effects of microwave hyperthermia in benign prostatic hypertrophy (BPH) to sham treatment.

Patients And Methods: The trial included 96 patients with proven symptomatic bladder outflow obstruction (BOO) caused by BPH. Patients underwent a full subjective and objective assessment (including urodynamics) before inclusion and again 3 and 6 months later.

Extracorporeal shock wave lithotripsy with the Storz Modulith SL20: the first 500 patients.

Our initial experience of extracorporeal shock wave lithotripsy (ESWL) with the Storz Modulith SL20 is reported. A total of 500 patients with 551 renal and 120 ureteric stones, mean diameter 11.9 mm, underwent 746 treatments; 68.

Transurethral resection syndrome. A prospective study.

Significant hyponatraemia has been reported following transurethral prostatectomy (TURP) in 11-41% of cases. The majority of previous studies have been performed retrospectively. A prospective study was undertaken of 100 patients undergoing TURP.

First UK consensus conference on lithotriptor terminology--1989.

Recommended definitions to be used in the reporting of results of lithotripsy treatment are presented. It is suggested that these are the minimum requirements for reporting such treatment.

Microbiological study of bladder tumors, their histology and infective complications.

The microbiology of bladder tumors and the infective complications of transurethral resection (TURBT) were studied prospectively in 51 patients. Patients taking antimicrobials were excluded. Those with significant preoperative bacteriuria were included in the study when results of the preoperative urine specimen were unavailable at the time of operation.

Transitional cell carcinoma of the renal pelvis and ureter.

In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was greater than 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post-operative radiotherapy did not improve survival.

Reappraisal of the role of radical radiotherapy and salvage cystectomy in the treatment of invasive (T2/T3) bladder cancer.

One hundred and eighty-two patients with invasive (T2/T3) bladder cancer were treated by radical radiotherapy at the London Hospital between 1974 and December 1985. Cystectomy was reserved for patients whose tumours either did not respond completely to radiation or recurred later, provided they were fit for surgery and had not developed distant metastases. The overall corrected 5-year survival rate was 40%; 75 patients responded to radiation and did not relapse during the period of follow-up; 20 patients had an initial response to radiation but subsequently relapsed, with a 5-year survival rate following relapse of 20%.