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Biomedical subjects

D Bagley

Publications and source records attributed to D Bagley.

At least 19 recordsLinked to original sources
PubMed1998

Utility of the Bard BTA test in detecting upper urinary tract transitional cell carcinoma.

OBJECTIVES: The Bard BTA test has been shown in early studies to be useful in diagnosing transitional cell carcinoma (TCC) of the bladder. However, the utility of this test has not been evaluated for TCC of the upper urinary tract. We therefore evaluated the clinical utility of the BTA test for upper urinary TCC. METHODS: We tested 71 specimens from the ureter and/or renal pelvis in 22 patients with a history or clinical suspicion for TCC and 9 patients with benign disorders. RESULTS: When compared to cytologic diagnoses, BTA had a sensitivity of 65%, a specificity of 40% (when correlated with clinical history), a false-positive rate of 33%, and a false-negative rate of 62%. The test had a positive predictive value of 83% and a negative predictive value of 32%. CONCLUSIONS: The BTA does not have any clinical value in detecting upper urinary tract TCC.

Carcinoma, Transitional Cell↗
PubMed1998

Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi.

PURPOSE: Upper urinary tract calculi that are too large to treat with extracorporeal shock wave lithotripsy are most commonly cleared with percutaneous endoscopic techniques. In a select group of patients who were poor candidates for percutaneous nephrostolithotomy we used retrograde endoscopic lithotripsy, and define the safety and efficacy of this modality in treating large, noninfectious stone burdens (2 cm. or greater). MATERIALS AND METHODS: A total of 51 patients with 66 large (2 cm. or greater) upper urinary tract stones were chosen for retrograde ureteroscopic surgery. Many of these patients had co-morbid conditions that precluded or complicated standard percutaneous treatment. Lithotripsy was based on the application of small diameter fiberoptic ureteroscopes and the holmium laser lithotriptor. Specifically, the 200 micro. laser fiber was used when lower pole renal access was required. Successful therapy was defined as total fragmentation of a stone burden with creation of fine sand and 2 mm. or smaller debris. Second look endoscopy was commonly performed in select patients with large branched calculi or stone burdens in excess of 3 cm. to rule out and treat large residual fragments. RESULTS: Of 51 patients 48 were treated solely in a retrograde ureteroscopic manner and in 3 either failure of lower pole access or infectious material encountered on initial endoscopy led to conversion to more standard percutaneous techniques. In 34 of 45 renal (76%), and 20 of 21 ureteral (95%) complete ureteroscopic fragmentation of the respective stone burden was accomplished after a single session. Second look endoscopy defined significant residual fragments requiring additional endoscopic lithotripsy in 8 of 15 large renal (53%) and 1 of 3 complex ureteral stone burdens. Success, that is complete pulverization of the stone burden to fine dust and small 2 mm. fragments, increased to 41 of 45 renal (91%) and all 21 ureteral calculi after these second look procedures. One patient required a third session to treat completely an exceptionally large (6 cm.) renal stone burden composed of pure cystine, thus increasing the overall success rate for renal calculi to 93%. Six-month followup data were available for 25 patients with large calculi treated ureteroscopically, of whom 15 (60%) had completely clear imaging, 6 (24%) had small lower pole debris that was decreasing on serial imaging and 4 (16%) had new stone growth which was, in part, related either to uncorrectable metabolic disorders or chronic renal scarring and urinary stasis. There were no intraoperative complications. Three postoperative complications included pyelonephritis in 1 patient, prostatic bleeding in 1 on anticoagulant therapy and a cerebral vascular accident 24 hours after the procedure in 1 with severe vascular disease. CONCLUSIONS: Large and complex upper urinary tract calculi can be addressed safely and efficiently with retrograde endoscopic techniques.

Adolescent↗
PubMed1998

Small diameter, actively deflectable, flexible ureteropyeloscopy.

PURPOSE: We studied and developed ureteroscopic technique and instrumentation beyond our initial experience with small diameter, actively deflectable, flexible ureteropyeloscopy. MATERIALS AND METHODS: Flexible ureteropyeloscopy was performed at 2 university centers in 492 consecutive patients. Endoscope designs and development were based on strict specifications, including 8F or less tip diameter, 3.6F or greater working channel, 2-way active tip deflection and secondary deflection for lower pole intrarenal access. Flexible ureteroscopes manufactured by 5 companies were studied through various prototypic steps and surgical technique. Complementary accessories were developed for specific treatments, including endoscopic lithotripsy, management of urothelial lesions, treatment of upper urinary tract obstruction (that is strictures) and percutaneous access with ureteroscopic assistance in select complex cases. RESULTS: A total of 584 procedures were performed with the small diameter, actively deflectable, flexible ureteroscopes. Flexible ureteropyeloscopic access was always preformed over a working guide wire without an operative sheath. In addition, the 10F dual lumen catheter was the primary device used to obtain 2 guide wires (working and safety), and gently and minimally dilate the intramural segment. Larger dilators were required in only 12% of procedures. The entire intrarenal collecting system was accessed in 94% of cases with lower pole access requiring secondary or passive deflection in 60% of procedures. Endoscopic lithotripsy was the most common procedure performed in this series (303, 52%). Small diameter, flexible ureteroscopy and holmium laser lithotripsy were successful in 97% of patients with ureteral and 79% with intrarenal calculi. When a 2-stage ureteropyeloscopy procedure was used for large upper urinary tract calculi, the success rate for intrarenal calculi increased to 91%. Endoscopic biopsy and treatment of upper urinary tract transitional cell carcinoma were performed in 101 procedures (17%), while retrograde ureteroscopic incision for stricture disease was performed in 36 (6%). The overall major complication rate was less than 1% and there were no ureteral perforations, avulsions, sepsis or deaths. These new endoscopes were more fragile than larger predecessors but a maximum of 30 procedures were performed between interval repair. CONCLUSIONS: Small diameter, actively deflectable, flexible ureteropyeloscopy facilitates various minimally invasive endoscopic therapies. Although this class of endoscope has greater fragility, it is easy to use and has broadened the therapeutic range of ureteroscopic treatment to include intrarenal lesions.

Adolescent↗
PubMed1995

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. Other important variables include the type of extracorporeal lithotriptor used, number of treatment sittings before referral, calculus location, calculus composition, patient body habitus, and the imaging leading to and associated with extracorporeal therapy. RESULTS: Large renal calculi (mean, 22.2 mm) and those within dependent or obstructed portions of the collecting system were frequently referred for endoscopic management after failed ESWL. Steinstrasse can be an extremely morbid complication from ESWL and in this series was associated with irreversible loss of renal function and ureteral stricture disease. Extracorporeal lithotripsy of infectious calculi can be associated with severe septic complication. Inadequate preoperative and intraoperative imaging and morbid obesity were also associated with failure. Second- and third-generation lithotriptors were represented in greater numbers than the Dornier HM-3 in this group of ESWL failures. CONCLUSIONS: ESWL remains the treatment of choice for moderately sized, uncomplicated renal calculi. Large calculi, those within obstructed or dependent portions of the collecting system, and those composed of calcium oxalate monohydrate, frequently fail ESWL. Training in the more technically challenging aspects of endoscopic lithotripsy must be encouraged.

Adolescent↗
PubMed1995

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. Percutaneous techniques are frequently used to address the diverticular stone burden and to dilate the diverticular neck, improving drainage. Small volume caliceal diverticular calculi and those in the anterior portion of the collecting system represent a greater technical challenge to the endoscopist. We describe a purely retrograde endoscopic technique for treating small stone burdens trapped in caliceal diverticula. Flexible ureteroscopy combined with 3F dilating balloons passed through the endoscopic working channel facilitated treatment. This retrograde technique was combined with a simultaneous primary percutaneous puncture into the diverticulum to treat larger stone burdens and calculi within long-necked diverticula. This combination facilitated prompt, through and through access of a percutaneously placed guide wire, increasing the overall efficiency of treatment. In conclusion, a retrograde endoscopic technique using the actively deflectable, flexible ureteroscope can successfully treat certain caliceal diverticular calculi. By combining this technique with a simultaneous percutaneous puncture, caliceal diverticular calculi throughout the collecting system may be cleared expeditiously.

Diverticulum↗
PubMed1995

Use of the holmium laser in the upper urinary tract.

The holmium (Ho:YAG) laser can effectively fragment ureteral calculi of all compositions. It can also ablate tissue including neoplasms. Because the laser light can be carried through small flexible quartz fibers, it is ideally suited for use through small-diameter rigid and flexible ureteroscopes in the upper urinary tract. Although care must be used in application of the laser, the combination of fine control and limited tissue penetration allow it to be used safely in the ureter. Techniques for stone fragmentation, tumor ablation and stricture incision are described in detail.

Aluminum Silicates↗
PubMed1994

A 7.5/8.2 F actively deflectable, flexible ureteroscope: a new device for both diagnostic and therapeutic upper urinary tract endoscopy.

OBJECTIVE: To develop and employ in a prospective fashion a small-diameter, actively deflectable, flexible ureteroscope that could be easily placed into the upper urinary tract and would increase the overall therapeutic potential for this class of endoscope. METHODS: A small-diameter, actively deflectable flexible ureteroscope was recently employed in clinical trials at two university centers. Improvements in fiberoptic engineering allowed endoscope miniaturization (7.5 F tip and 8.2 F shaft) while maintaining a relatively large (3.6 F) centrally located working channel. A variety of design modifications were employed through various prototype stages. Mechanical parameters included maximizing two-way active deflection, adequate secondary deflection allowing access to the lower pole caliceal system, and maintaining a sturdy (nonbuckling) durometer. RESULTS: The 7.5 F flexible ureteroscope was employed in sixty-seven procedures (64 patients). Therapeutic rather than purely diagnostic maneuvers made up the majority of procedures. Thirty-one upper ureteral, renal pelvic, or caliceal calculi were treated with a variety of endoscopic lithotriptors placed through the ureteroscope. Six patients underwent both biopsy and endoscopic treatment of superficial papillary transitional cell malignancies. Retrograde endopyelotomy, incision or dilation of ureteral strictures, extraction of renal pelvic foreign bodies, and endoscopic access and treatment of obstructed caliceal diverticula were other applications. Endoscopic access to the upper urinary tract rarely required active intramural ureteral dilation (14%). Excluding patients with prior ureteral stents or those who underwent rigid distal third ureteral endoscopy prior to flexible proximal ureteroscopy, 31 patients (48%) required no intramural ureteral dilation prior to placing the endoscope. CONCLUSIONS: The increased therapeutic potential observed with the 7.5 F actively deflectable, flexible ureteroscope opens a variety of upper urinary tract pathologic states to minimally invasive (endoscopic) treatments.

Adolescent↗
PubMed1994

Treatment of urinary calculi in a porcine and canine model using the Browne Pneumatic Impactor.

OBJECTIVES: To define the safety and efficacy of a pneumatically driven, mechanical lithotriptor using nitinol probes through semirigid and actively deflectable, flexible fiberoptic endoscopes. METHODS: The Browne Pneumatic Impactor (BPI) uses standard compressed air to drive a nitinol wire along its long axis onto a calculus, fragmenting it. Bench top and in vivo experiments were designed to explore variables, including the effects of various nitinol probe tip designs, outer diameters, excursion distances, and sheathing materials as well as the efficiency of fragmentation with active endoscope deflection. In vivo experiments in two animal models (porcine and canine) were performed using small diameter, fiberoptic semirigid, and actively deflectable, flexible ureteroscopes. Surgically placed calculi were fragmented with the BPI and representative tissue was obtained immediately and up to 2 weeks postoperatively to define histologic changes. A panel of human urinary calculi was chosen for their relative difficulty in fragmentation with other modalities. RESULTS: Calculi, including pure calcium oxalate monohydrate, brushite, cystine, and triamterene, were fragmented with the BPI used through both semirigid and actively deflectable, flexible endoscopes. A rounded tip design and excursions of 1 mm fragmented calculi most efficiently with minimal histologic reaction. Retrograde stone migration before fragmentation was noted in dilated upper urinary tracts. This was prevented by first entrapping the calculus within a standard basket. Ureteral calculi were fragmented with the nitinol probes deflected up to 45 degrees by the flexible endoscope. With increased active deflection, the efficiency of fragmentation decreased. CONCLUSIONS: The BPI represents a safe, thermal-free endoscopic lithotrite able to fragment the hardest calculi through semirigid and flexible ureteroscopes.

Alloys↗
PubMed1994

Prospective comparison of external sphincter prosthesis placement and external sphincterotomy in men with spinal cord injury.

The effectiveness and complications of the treatment of detrusor-external sphincter dyssynergia (DESD) and voiding pressure > 60 mm H2O using an endoluminal urethral sphincter prosthesis (Urolume) were compared with those of conventional external sphincterotomy in 46 men with spinal cord injury (SCI) (mean age 34 years; range 18-58 years). Twenty-six patients elected the Urolume, and 20 chose sphincterotomy. The age and level and duration of SCI were similar in the two groups. Follow-up ranged from 6 to 20 months. After prosthesis placement, voiding pressure dropped from 88 +/- 29 cm H2O to 38 +/- 22 cm H2O at 6 months (n = 23) and 35 +/- 16 cm H2O at 12 months (n = 18) (P < 0.001). The residual urine volume fell from 180 +/- 145 mL preoperatively to 85 +/- 125 mL at 12 months (P < 0.001), while the maximum cystometric capacity remained constant (P = 0.75). External sphincterotomy achieved similar statistically significant decreases in voiding pressure and residual urine volume, and bladder capacity was maintained. The preoperative and follow-up urodynamic measures were similar in the two groups. Prosthesis placement was associated with a significantly shorter operation (P = 0.001) and length of hospitalization (P = 0.01), a lower hospitalization cost (P = 0.01), and less bleeding (change in hemoglobin concentration) (P = 0.01) than external sphincterotomy. The complications of stent insertion were device migration (n = 4) and secondary bladder neck obstruction (n = 2). One patient with continuing reflux required bilateral ureteral implantation. The complications of sphincterotomy were bleeding necessitating transfusion (n = 2), recurrent obstruction (n = 2), and erectile dysfunction (n = 1). The sphincter prosthesis is as effective as sphincterotomy in the treatment of DESD, while being technically easier, less morbid, and less expensive.

Adult↗
PubMed1993

Versatile uses for plunger attachments.

Plunger attachments are among the simplest of all attachments, yet they are extremely versatile. When basic design principles are followed, plunger attachments can be employed to solve diverse restorative situations.

Denture Design↗
PubMed1991

Pulsed dye laser lithotripsy--currently applied to urologic and biliary calculi.

The flash lamp excitation of coumarin dye to produce light energy of the specific wavelength of 504 nm is the basis for the new wave of pulsed dye lasers. Numerous urological applications have been developed. Treatment of ureteral and renal calculi has proven to be an atraumatic and effective treatment modality. Most recently, this technology has been applied to the endoscopic treatment of biliary calculi. The authors review the most recent treatment techniques in both biliary and urinary stone disease.

Cholelithiasis↗
PubMed1991

Endoluminal sonography of the urinary tract: preliminary observations.

Endoluminal sonography of the urinary tract was performed by using endoluminal ultrasound transducers contained within 2-mm-diameter catheters. The catheters were inserted into the urinary bladder via the urethra and advanced into the ureters and renal pelvis under cystoscopic control; then, cross-sectional images of the bladder, ureters, and renal pelvis were obtained. Two dogs and seven human patients were studied. In one dog, a 4.5-mm pseudopolyp, which was surgically created in the bladder wall, was successfully imaged; in the other, stones 2 mm or larger inserted into the bladder were identified. Of the seven patients, sonography showed stones embedded in the renal parenchyma (one patient) and the mucosa of the distal ureter (one patient). These were ultimately confirmed by their eventual removal. In a third, sonography showed a tumor of the distal ureter and identified the depth of the tumor. This was confirmed by biopsy. In a fourth, sonography clearly showed a crossing vessel as the cause for narrowing of the proximal ureter. In a fifth, sonography showed that the cause of a ureteral stricture was idiopathic. In the last two cases, sonography did not reveal a cause for hematuria. In these last three cases, negative sonographic results were confirmed by direct ureteroscopic examinations and follow-up studies. Our observations based on this limited study suggest that endoluminal sonography is a useful procedure for diagnosing diseases of the urinary tract. Further study is warranted.

Adult↗
PubMed1982

Appearance of a partial nephrogram with an absent kidney.

A case is reported of a 16-year-old female who sustained a gunshot wound to the left upper abdomen. Early opacification of a structure in the left upper quadrant on an excretory urogram was suggestive of a nephrogram. The left kidney was absent at operation. The diagnostic limitations of excretory urography in the trauma patient and the alternative diagnostic techniques, radionuclide scanning, arteriography, or tomography, or possibly operative intervention, are recommended. Although not found in our patients, a thorough search for an ectopic kidney should be made.

Abdominal Injuries↗
PubMed1980

Renal angiomyolipoma: diagnosis and management.

Renal angiomyolipoma is a benign tumor. Use of excretory urography, plain tomography, arteriography, ultrasound, and computerized tomography can usually provide the diagnosis. Appropriate operative or nonoperative management can then be determined for the individual patient.

Adult↗