Parenchymal-sparing surgery for small renal cell cancer: are there any reasonable arguments?
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
B Veillon
Publications and source records attributed to B Veillon.
Piezoelectric extracorporeal lithotripsy by ultrashort waves with the EDAP LT 01 device.
A total of 433 extracorporeal lithotripsy procedures was performed for renal, ureteral and bladder stones by means of a system of ultrasonographic detection and piezoelectric destruction in 386 patients. The stones were detected easily in 87 per cent of the patients, difficult to detect in 10 per cent and impossible to detect in 3 per cent. Mean duration of treatment was 35 minutes. Mean number of piezoelectric waves was 2,700 at 1.25 per second. With a frequency of 1.25 to 5 per second, extracorporeal lithotripsy was performed without any local, regional or general anesthesia, and without premedication in 210 patients. Of the 217 patients with a renal stone reviewed at 3 months 161 (74 per cent) had successful results and 56 (26 per cent) failed therapy. Thirty patients (14 per cent) underwent 2 or 3 sessions. The morbidity was low: 2 per cent of the patients suffered ureteral obstruction, 1.5 per cent had subcapsular hematoma and 4 per cent had fever. No significant modifications of laboratory tests were necessary and no patient suffered renal failure. Of the stones 31 in the lumbar ureter, 15 in the pelvic ureter and 8 in the bladder were treated, with success rates of 87, 46 and 50 per cent, respectively. A total of 103 patients was treated on an outpatient basis. This outpatient treatment, together with the low cost and minimal maintenance of the apparatus, and the absence of anesthesia constitute a new progress in the treatment of renal stones.
Equipment Design↗
Outpatient extracorporeal lithotripsy of kidney stones: 1,200 treatments.
1,200 extracorporeal lithotripsies have been performed in 816 patients. 58% of the stones had a diameter of 3-10 mm, 41% measured between 11 and 20 mm and 1% were larger than 20 mm. The patients were all treated on an outpatient basis without either anesthesia or analgesia. The mean time spent at the lithotripsy center was 2 h: the mean treatment time was 46 min, i.e. 3,450 shocks at a frequency of 1.25/s. 530 patients were reviewed after 3 months. Overall, 64% of them were stone free. These results varied between 73% for stones less than 10 mm in diameter and 43% for stones larger than 20 mm in diameter. 69% of the patients presenting with a single stone were stone free at 3 months. The best results were obtained in upper caliceal stones (78%) and the least satisfactory results were obtained in the lower caliceal stones (68%). The complication rate was low: renal colic in 18% of cases, fever in 2% of cases. Altogether, 13 disobstructions were required, namely 12 endoscopic and 1 surgical. 33% of patients were retreated without admission to hospital. Outpatient extracorporeal piezoelectric lithotripsy is indicated for renal pelvic or caliceal stones less than 20 mm in diameter situated in a nonobstructed renal cavity, in a noninfected patient without any particular risk factors. 85% of patients are currently treated at the lithotripsy center on an outpatient basis.
Adult↗
Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: a randomized study.
Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).
Humans↗
[Extracorporeal piezoelectric lithotripsy by ultra-short waves using the EDAP LT01 device].
Three hundred and sixty one extracorporeal lithotripsies for renal, ureteric and bladder stones have been performed by means of a system of ultrasonographic detection and piezoelectric destruction (EDAP LT01). The localisation of the stone is achieved by a 5 MHz real time sectorial transducer situated in the centre of a small dish containing 320 piezoelectric elements concentrated in a source 5 mm wide by 15 mm high. The pressure recorded in vitro is 900 bars. The stone is easily detected in 87.2% of cases, difficult to detect in 10% of cases and impossible to detect in 28% of cases. By using a frequency of 1.25 to 5 per second, extracorporeal lithotripsy can be performed without any local, regional or general anaesthesia and without premedication in the 120 patients with a renal stone, reviewed between 1 and 3 months, 88 (73%) were considered to be complete successes. Ten (8%) were considered to be failures and 19 (21%) were considered to be partial successes. The best results were obtained in stones of the renal pelvis less than 20 mm in diameter. These results relate to a mean series which must take into account the successive improvements made to the lithotripter. Today, stone fragmentation is obtained in 93% of cases. Thirty six stones of the lumber and pelvic ureter were treated with success rates of 93% and 50%, respectively. Six bladder calculi were treated with a 50% success rate. Forty two patients were treated without being admitted to hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
Diathermy↗
[Prevention of postoperative infections in non-endoscopic urologic surgery by a single dose of cefotiam].
We report on the results of a randomized study of 1 g céfotiam flash pre-operative antibioprophylaxis to prevent post-operatory infection complications in non-endoscopic urologic surgery. Thirty-seven patients (17 controls and 20 treated) have had a prostatic adenomectomy: treatment has lead to decrease the number of post-operatory wall complications (47% vs 20%) and hospitalisation staying (p less than 0.03). Seventy-eight patients have had a urologic surgery with lumbar or abdominal incision (37 treated and 41 controls). In this group, there was not gain on post-operatory infections complications nor on hospital staying, since this surgery has a little number of infections complications. During the study, we have not noted an abnormal part of cefotiam resistant germs.
Adult↗
[Piezo-electric lithotripsy technic with echographic guidance (EDAP LT 01)].
Piezo-electric extracorporeal lithotripsy with ultrasonographic detection is performed with the following material according to the following technique: 1) A mobile firing head connected to the lumbar region by a simple inflatable cushion filled with sterile water. At the centre of the firing head, a 5 MHz real time transducer is used to locate the stone. 320 piezo-electric elements, arranged around the transducer, can induce, when focussed, a pressure of about 900 bars at the focal point in vitro. The focus is 15 mm X 5 mm. The generators are electronic. 2) The technique requires: understanding of ultrasonography in order to precisely locate the stone which, when it is intrarenal, is only missed in 1% of cases in our experience. Stones of the iliac ureter are not visible. Treatment requires the patient's confidence so that, due to the quality of the piezo-electric wave, no anaesthesia is necessary. The firing time should be relatively long (45 min to 1 hr) in order to ensure good fragmentation. 26% of patients require retreatment. Secondary complications are rare (3% of endoscopic treatments). The technique is now proposed in 90% of cases without admission to hospital. The simplicity of the manipulation of the apparatus must not mask the fact that it is a technique which requires perfect mastery. Only urologists familiar with stone pathology and who are able to treat the complications of lithotripsy by endoscopy or by surgery should perform extracorporeal lithotripsy.
Humans↗
[Obstruction of the upper excretory tract associated with primary urinary infection. Diagnosis, treatment and course. Apropos of 196 cases].
The association of upper urinary tract obstruction and urinary tract infection is a relatively common disease which requires early diagnosis and systematic treatment. The diagnosis of this disease can be difficult as many patients present with totally asymptomatic forms which may be revealed suddenly and totally unpredictably by an episode of severe infection. 196 (16%) of the 1,225 patients operated between January 1977 and June 1985 for upper urinary tract obstruction also presented with urinary tract infection at the time of admission. Suggestive urological signs were present in only 49% of the patients and infectious signs were present in 39%. 26 patients had acute renal failure and 9 presented at least 3 signs of severity. The bacteria most frequently isolated were E. coli (29% of M.S.U.s and 11% of blood cultures) and Proteus mirabilis (30% of M.S.U.s and 11% of blood cultures). Treatment always consisted of a combination of surgery and antibiotic therapy. Surgery was conservative in only 71% of patients at the first operation. 23 patients required specific symptomatic treatment due to the presence of signs of severity. Renal function, evaluated on the basis of the serum creatinine, was considerably improved by treatment, particularly in patients with acute renal failure on admission. In terms of bacteriological results, 92% of patients were discharged from hospital with sterile urine. 20% of the patients reviewed as outpatients had persistent urinary tract infection, generally caused by Proteus mirabilis. Three patients (1.5%) died, including 2 from the initial infectious syndrome.
Acute Kidney Injury↗
Can transabdominal ultrasonography of the bladder replace cystoscopy in the followup of superficial bladder tumors?
Transabdominal ultrasonography of the bladder was performed on 100 patients 3 to 9 months after endoscopic resection of stage Pa or Pl transitional cell carcinoma of the bladder. In 81 patients there was a close correlation between the results of suprapubic ultrasonography and cystoscopy. In 19 patients the ultrasonography results were incorrect: 4 had false positive and 15 had false negative findings. Specificity for the diagnosis of recurrence was 90 per cent and sensitivity was 74 per cent. Transabdominal ultrasonography combined with cytology studies should be part of the diagnostic approach for recurrent superficial bladder tumors. When performed before cystoscopy these studies should reduce greatly without eliminating the frequency of this investigation.
Abdomen↗
Urinary tract infection in percutaneous surgery for renal calculi.
Percutaneous extraction of renal stones is associated with a risk of infection, which sometimes can be severe as a result of the intraoperative introduction of a ureteral catheter, the nephroscopy itself and the fact that a nephrostomy tube sometimes is left in place. It generally is accepted that patients with a preoperative urinary tract infection should be covered during the operation by an appropriate antibiotic. However, the need for routine prophylactic antibiotic treatment in patients with sterile urine preoperatively still is a subject of debate. We report the bacteriological results of 126 cases of percutaneous extraction of renal stones. Of the patients 107 had sterile urine preoperatively and deliberately did not receive prophylactic antibiotics so that the mechanisms of urinary tract infection after percutaneous nephrolithotomy could be studied. Of these patients 37 (35 per cent) suffered a postoperative urinary tract infection, usually owing to Escherichia coli, streptococcus or staphylococcus. The responsible organism was isolated in the bladder urine only in 22 cases, in the nephrostomy tube in 2 and in both sites in 13. Eleven patients (10 per cent) presented with a fever of 38.5C or more. All of the infected patients received appropriate antibiotic therapy and there were only 2 bacteriological failures on long-term followup (5 per cent). A total of 19 patients had a urinary tract infection preoperatively. All 19 patients received appropriate antibiotic therapy starting at least 24 hours preoperatively and continuing for a minimum of 3 weeks. Five patients (26 per cent) presented with a fewer but there were no serious septic complications. All of the patients were discharged from the hospital with sterile urine and there was only 1 long-term bacteriological failure (5 per cent). Both patients with Pseudomonas infection were cured. The risk of clinical infection following percutaneous nephrolithotomy is low despite the fact that 35 per cent of the patients have bacteriuria postoperatively, provided a careful bacteriological examination is performed preoperatively and the patients with urinary tract infection are treated appropriately. These results are in favor of short-term prophylactic antibiotics adapted to the bacterial ecology.
Anti-Bacterial Agents↗
[Anterograde ureteroscopy in the extraction of lumbar ureteral calculi].
Antegrade ureteroscopy can be used to extract certain lumbar ureteric stones in which the only alternative treatment is surgery. The technique of caliceal puncture is that of percutaneous nephrostomy: the ureteroscope is introduced through the Amplatz tube. The ureteric stone is removed by a basket probe, two-pronged forceps or hydroelectric shattering, 16 patients have undergone antegrade ureteroscopy; a rigid ureteroscope was used in 9 cases (2 residual fragments including 1 which migrated) and a flexible ureteroscope was used in 7 cases (3 failures). The overall success rate for the technique of 68% should improve with better selection of the indications (stone with a maximum diameter of 12 mm without retraction of the adjacent ureter and without kinking of the excretory tract) and with greater experience of the operators.
Endoscopy↗
[Technic of flexible cystoscopy].
After brief training, flexible cystoscopy allows complete investigation of the vesical cavity in the surgeon's office. In particular, this technique facilitates the examination of the anterior wall and the base of the bladder. The low flow rate of the irrigating channel prohibits the use of this technique in cases with severe haematuria.
Cystoscopes↗
[Removal of ureteral calculi by uteroscopy].
Ureteral stones can now be removed endoscopically, using a ureteroscope. This instrument, provided with a direct optic system and an operating tube, is introduced under general anaesthesia after the ureteral opening has been dilated and is pushed up until it reaches the stone which is then removed by means of a basket catheter or a forceps. Voluminous stones can be shattered in situ by ultrasounds or hydroelectric shock waves. Forty-three stones, representing 72% of all attempts, were removed by this method from 30 patients. There were 6 failures due to impassable vesico-ureteral opening, ureteral flexure and wedged in or ascended stone, and 4 complications including 2 cases where the basket catheter went under the mucosa and 1 case each of secondary urinoma and ureteral clotting. There was no perforation nor overt septic complication. Most stones were larger than 10 X 4.5 mm and were located in the pelvic or iliac part of the ureter. Infected stones can be removed endoscopically under antibiotic treatment and provided a draining catheter is left in place. Ureteroscopy notably reduces the need for ureteral lithotomy.
Endoscopy↗
Colonic perforation during percutaneous nephrolithotomy.
Of 250 cases of percutaneous nephrolithotomy perforation of the left colon has been observed in 2 men with mobile kidneys. The clinical signs were rectal hemorrhage with shock in 1 case and passage of gas through the nephrostomy tract in the other case. The perforation was not suspected during the nephrolithotomy. Both patients were treated surgically. In view of the risk of colonic perforation during percutaneous nephrolithotomy, great care should be taken during puncture. This risk is increased in cases with an excessively lateral tract or when the anatomical relationships are modified in subjects with mobile kidneys. Surgical repair is required when the perforation is intraperitoneal or when there is a risk of complications. Simple surveillance is only justified when the perforation is extraperitoneal and when there is no risk of complications.
Adult↗
[Technic, failures and complications in the extraction of ureteral calculi using a rigid ureteroscope].
The authors describe the technique for the removal of ureteral stones by ureteroscopy. They stress the need to use perfectly suitable instruments (ureteroscope, baskets and ultrasound or hydro-electric lithotrites), and the importance of extreme gentleness in the manipulations and great patience. The time taken to perform a simple ureterostomy should not be compared to the time necessary for a complex endoscopic extraction. The quality of the dilatation counts for three quarters of the success. Fluoroscopic monitoring facilitates the operation. Ureteral drainage is necessary in the case of a long or fairly traumatic operation, or if there is urinary infection. With these precautions, rigid ureteroscopy can be used for three quarters of ureteral stones. Only one serious complication was registered: the rupture of the pelvic ureter during the extraction of a voluminous lumbar stone.
Cystoscopy↗
[Passage of cefotiam into prostatic tissue].
20, 30 and 90 minutes after a single intravenous injection of 2 g of cefotiam prostatic tissue and serum samples were taken from 12 patients who underwent transabdominal prostatectomy for prostatic adenoma. Cefotiam was assayed by HPLC. Mean serum and prostatic concentrations were respectively 157 +/- 39 mg/ml and 42 +/- 23 mg/g at 20 mn, 77 +/- 52 mg/ml and 54 +/- 2 mg/g at 30 mn, 36 +/- 21 mg/ml and 16 +/- 18 mg/g at 90 mn. Elimination half-life of cefotiam was 1 h 39 mn for serum and 1 h 10 mn for prostatic tissue. These findings confirm the satisfactory diffusion of cefotiam within prostatic tissue, although saturation occurs after 30 mn. Treatment of prostatitis by cefotiam can be expected to give excellent results.
Adenoma↗
[Correct use of ureteral guide wires].
A knowledge of the correct use of ureteral guides-wires has become a necessity for most endo-urological manipulations. The basic guide-wire must be from 32 to 150 cm in length, and be sufficiently robust and flexible. Fluoroscopic control of the manipulation of the guide is essential. Numerous minor incidents may arise in the course of the maneuver, and these must be anticipated.
Endoscopes↗
[Bladder tumors: prognostic value of surface antigens and carcinoembryonic antigens. A retrospective study].
Seven patients presenting with recurrent diffuse, non-infiltrating tumors of the bladder were treated for several years by repeated endo-urethral resection, because radical exeresis was not possible. Each operative specimen was subjected to examination of the ABH blood-group antigens, pneumo-14 precursor, and carcino-embryonic antigens. The authors emphasize the prognostic interest of such studies.
Antigens, Surface↗