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Biomedical subjects

C Türk

Publications and source records attributed to C Türk.

8 recordsLinked to original sources
PubMed1995

[Urolithiasis in children].

Urolithiasis is rare in childhood (about 1%) and commonly associated with urinary tract infection. Like in adults ESWL is the minimally invasive treatment and therefore primary therapeutic approach. However, the passage of stone debris is less complicated than in adults and auxiliary measures are seldom needed. There is no evidence of soft tissue damage after ESWL, but in aspect of the growing organ lithotriptors with small focal zone and ultrasound location system are preferable. Obstructive anatomical abnormalities, if so, must be treated simultaneously. For prevention a strict antibiotic (longterm) therapy, according repeat antibiograms, and exclusion of metabolic disease are essential. Medication as well as special diets must be handled carefully or avoided as they might induce growth disorders.

Child↗
PubMed1994

Management of ureteric stones.

Based on experience with over 2,000 patients, the treatment of ureteric stones today relies on extracorporeal shock wave lithotripsy (ESWL) in situ and ureteroscopy with semirigid, ultrathin ureteroscopes combined with pneumatic or laser lithotripsy. All stones in the upper and larger stones in the distal third of the ureter are preferably treated by ESWL in situ, whereas smaller stones in the distal ureter are better treated by endoscopy. Midureteric stones continue to be the domain of primary ureteroscopy; in cases of moderate obstruction in asymptomatic patients, it may also be acceptable to wait for the stone to pass into the distal ureter spontaneously to be treated by ESWL in situ there. Manipulation of the stone back into the kidney and treating it by ESWL there (push back/ESWL) offers no advantage over ESWL in situ, as results are not better yet morbidity is higher. 'Blind' instrumentation has lost all justification, and incisional ureteric lithotomy is no longer indicated but in exceptional cases.

Endoscopy↗
PubMed1992

Management of ureteric calculi (minimally invasive therapy of ureteric stones).

As documented with results obtained in 1685 patients the treatment of ureteric stones is today based on ESWL in situ and ureteroscopy with semirigid, ultrathin ureteroscopes and laser lithotripsy. All stones in the upper third of the ureter and larger stones in the distal third of the ureter are preferably treated with ESWL in situ whereas smaller stones in the distal ureter are better treated endoscopically. Midureteric stones remain the domain of primary ureteroscopy; with moderate obstruction in the asymptomatic patient it may also be acceptable to wait for the stone to pass into the distal ureter spontaneously to be treated by ESWL in situ there. Manipulating stones back into the kidney and treating them by ESWL there (pushback/ESWL) offers no advantage over ESWL in situ, as the results are similar, yet morbidity is higher. Blind instrumentation and open surgery have lost all justification.

Endoscopy↗
PubMed1990

ESWL and endourology on the same table: a feasible concept?

Within 26 months a total of 4,126 procedures were performed on the ESWL multipurpose table. Forty percent of the procedures were comprised of endourology, 25% functional urinary tract radiology, and 37% ESWL therapy. Biplane fluoroscopy is an extraordinary help for percutaneous interventions. A further advantage is the possibility to perform endourology and ESWL in one session without having to transport the patient. This has facilitated pre- and post-operative ancillary measures in a total of 35.3%. Seventy-six percent of stones greater than 15 mm were managed via indwelling stents. In situ ESWL for ureteral stones has become the therapy of choice in more than 80% of patients due to the availability of radiological localization systems and a complication and failure rate of 20% for the push-and-smash procedure. The multipurpose table is equally successful as the piezoelectric system for ESWL therapy. Drawbacks include operational inconvenience with percutaneous interventions and the necessity to change patient position during ureterorenoscopy and retrograde pyelography. The multipurpose unit used is a valid compromise for ESWL and percutaneous endourology. For purely diagnostic interventions, a standard x-ray table is preferred.

Adolescent↗
PubMed1989

[Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].

Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.

Aged↗
PubMed1989

Piezoelectric extracorporeal shock wave lithotripsy in children.

Piezoelectric lithotriptors have by far the smallest focal zone of all lithotriptors. By pinpointing this high pressure zone onto the stone with continuous visualization by ultrasonography throughout treatment, the volume of the kidney exposed to potentially harmful pressures is minimized and radiation hazards are avoided. We treated in this manner 33 renal and 8 ureteral stones in 25 renoureteral units of 22 children 4 months to 14 years old. No child required any other type of primary stone treatment during this period. Piezoelectric lithotripsy is painless and anesthesia was needed in only 11 children too young to cooperate. With a retreatment rate of 40 per cent, all stones were fragmented completely. After treatment only 48 per cent of the children had transient hematuria, which always subsided within 24 hours. Of the children 14 per cent required analgesics and 5 per cent had fever in the postoperative period. One child needed temporary nephrostomy drainage. Otherwise, the passage of stone debris was remarkably smooth and after 3 months 96 per cent of the renoureteral units were free of calculi. Evidence of soft tissue damage, such as skin ecchymosis, perirenal hematoma or retardation of renal growth, was not observed.

Child↗
PubMed1988

Painless piezoelectric extracorporeal lithotripsy.

A total of 693 stones in 438 renoureteral units from 426 patients 4 months to 84 years old was treated with a mobile piezoelectric lithotriptor using ultrasound stone localization. Of the units 37 per cent had solitary stones smaller than 1.5 cm. in diameter, (group 1), 32 per cent had multiple stones up to this size (group 2), 21 per cent had stones 1.6 to 2.5 cm. in diameter (group 3) and 10 per cent had calculi larger than 2.5 cm. in diameter (group 4). No sedation or analgesics were necessary in 96.2 per cent of the treatments. Of all stones 97.2 per cent were disintegrated, with 39 per cent of the units requiring repeat treatments usually on an outpatient basis. Of the patients 82 per cent had transient hematuria, 6 per cent had fever and 28 per cent temporarily took some type of analgesics within the first 3 months after treatment. Nine per cent of the patients required postoperative ancillary interventions. After 3 months 92 per cent of the renoureteral units in group 1, 73 per cent in group 2, 74 per cent in group 3 and 50 per cent in group 4 were free of stones. Piezoelectric extracorporeal lithotripsy proved to be as efficient as spark-gap lithotripsy, yet it was essentially painless. Ultrasound localization permits treatment of all renal stones but it restricts lithotripsy of ureteral stones to the most proximal and distal fourths of the ureter.

Equipment Design↗