Second generation lithotripsy: an experience of 200 patients.
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Adolescent↗
Biomedical subjects
J E Wickham
Publications and source records attributed to J E Wickham.
Extracorporeal shockwave lithotripsy: first 1000 cases at the London Stone Clinic.
One thousand patients underwent extracorporeal shockwave lithotripsy for renal and ureteric calculi at this clinic. An overall success rate of 91.8% was achieved (stone free or less than 2 mm fragments at three months) and for stones measuring 1 cm 96.3%. Lithotripsy produced extremely low morbidity, and no deaths have occurred at the clinic. Patients who had lithotripsy alone had a mean hospital stay of three days and in most instances were able to perform their full range of activities on discharge. Planned combination of lithotripsy with minimally invasive endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy has allowed us to extend the range of treatable cases to include large stones. Prophylactic use of Double-J ureteric stents in selected cases has reduced the incidence of obstruction by stone fragments after lithotripsy, thereby decreasing morbidity and hospital stay.
Adolescent↗
The treatment of 100 consecutive patients with ureteral calculi in a British stone center.
Of all ureteral calculi 20 per cent will require removal. The use of extracorporeal shock wave lithotripsy has changed dramatically the treatment of ureteral stones requiring intervention. We reviewed 111 procedures for 108 stones in 100 consecutive patients. Primary techniques included extracorporeal shock wave lithotripsy after retrograde manipulation (63 cases), percutaneous nephrolithotomy alone (1) and after retrograde manipulation (3), ureteroscopic removal (29), cystoscopic removal (2) and open ureterolithotomy (2). These techniques and the results are discussed. Of the patients 11 required a secondary procedure, including extracorporeal shock wave lithotripsy in 3, ureterorenoscopy for failed extracorporeal shock wave lithotripsy in 2, an open operation for complications of ureterorenoscopy in 2 and correction of associated stricture in 2. All patients ultimately were free of stones. Our experience with in situ extracorporeal shock wave lithotripsy is described. An open operation was done only when less invasive forms of treatment failed or electively to correct an associated anatomical abnormality.
Adult↗
The integrated cystoscope: an alternative to conventional and fibreoptic cystoscopy.
This report describes a new integrated rigid cystoscope which has been designed for diagnostic and therapeutic cystoscopy under local anaesthesia. The small external diameter (17.5 F) and large instrument channel permit maximum irrigant flow and operating potential whilst causing minimum discomfort to the patient. We believe this instrument to be a practical alternative to conventional cystoscopes, including the fibreoptic cystoscope.
Cystoscopes↗
Idiopathic retroperitoneal fibrosis. A retrospective analysis of 60 cases.
Sixty patients with idiopathic retroperitoneal fibrosis presenting between 1965 and 1984 are reviewed. Their mean age at presentation was 56 years and the male:female ratio was 3:1. The commonest presenting symptoms were flank and abdominal pain, weight loss, nausea and polyuria. Physical examination was usually normal, expect for the presence of hypertension. Anaemia and elevation of erythrocyte sedimentation rate were usually present. Proteinuria was found in less than a third of patients at presentation and significant bacteriuria was uncommon. The correct diagnosis was made or suspected in very few patients before referral. The cumulative actuarial survival rate was 86% at 1 year and 78% at 2 years. Seventeen patients died; they were significantly older and more uraemic at the time of referral than those who survived. A few patients did well with either corticosteroid therapy or ureterolysis alone. In the majority, both operation and steroid treatment were necessary. In bilateral obstruction with residual function in both kidneys, bilateral ureterolysis proved superior to unilateral operation (each followed by steroid therapy) in conserving renal function. Operation alone or steroid therapy alone should be considered in cases where steroids or surgery respectively present particular hazards. The less traumatic unilateral operation should be considered in poor risk patients and in those whose renal function is absent on one side. In many survivors, disease activity has persisted for many years. Life-long follow-up is recommended.
Adrenal Cortex Hormones↗
Initial experience with a pulsed dye laser for ureteric calculi.
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Child↗
Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.
This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.
Adolescent↗
The effects of extracorporeal shock wave lithotripsy on urological prostheses and endoprostheses.
The combination of ESWL and Endourology (EU) enables a wider range of stones to be treated without open surgery than either modality alone. EU frequently involves the maintenance of a plastic prosthesis in or near the area of maximal shock wave concentration during ESWL. Prostheses subjected to a standard test treatment by ESWL and others removed from patients after ESWL were examined visually, microscopically and biochemically by electron microscopy (SEM) and X-ray emission spectroscopy (XES) to investigate the effects of ESWL on the prosthesis itself. Foley catheter balloons leaked. Previously smooth surfaces were disrupted and possibly toxic additives may be released. Care should be taken in selecting indwelling EU prostheses if ESWL treatment is likely to follow.
Bismuth↗
Re: Percutaneous ureterolithotomy.
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Humans↗
Extracorporeal shockwave lithotripsy and percutaneous renal surgery. Comparisons, combinations and conclusions.
Although percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) were introduced clinically at approximately the same time (1980-1981), their clinical progress appeared to progress along separate paths and to compete with each other. After 5 years it has become apparent that for optimal removal of nearly all renal stones by minimal or noninvasive techniques, PCNL and ESWL are required either separately or as combined procedures. This review traces the development, introduction and progress of these procedures and defines the current indications for extracorporeal, percutaneous and open renal stone surgery.
Combined Modality Therapy↗
An experimental study of hydrophilic plastics for urological use.
Hydrophilic graft copolymers of polyethylene vinyl acetate (PEVA) were extruded into tubular form. These materials increase both external and internal diameters by 60% on contact with water. The tubes were used as ureteric stents in an experimental study and were superior to silicone stents of the same calibre in the limitation of urinary extravasation. Histological, cytotoxic and electron microscopic studies showed that PEVA is a biocompatible material suitable for clinical use in urology.
Animals↗
The complications of extracorporeal shockwave lithotripsy: management and prevention.
Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.
Adolescent↗
Combination of percutaneous surgery and extracorporeal shockwave lithotripsy for the treatment of large renal calculi.
Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCNL and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.
Combined Modality Therapy↗
Ureterorenal endoscopy: which instrument, what cost?
This report describes the design, availability, repair facilities and costs of rigid ureteroscopes. Clinical factors affecting design are detailed. A classification is given. A new test of flow dynamics is described. Short operating ureteroscopes with a stable or integral telescope system appear to be superior to other types, especially as they may be used for antegrade ureteroscopy.
Endoscopes↗
Complications associated with ureteroscopy.
A review of 125 ureteroscopies in 111 patients is reported. Eight per cent suffered major complications of perforation or stricture formation and 3% required ureteric reimplantation. Clinical follow-up and imaging studies performed more than a year after ureteroscopy produced no evidence that late complications arise.
Adult↗
Extracorporeal shock wave lithotripsy: the first 50 patients treated in Britain.
Fifty patients have been treated for upper tract urinary calculi by extracorporeal shock wave lithotripsy (ESWL) at the Devonshire Hospital lithotripter centre since November 1984. The average stay for an inpatient was 3 X 7 days. All patients suffered minimal postoperative discomfort and nearly all resumed normal activity within one day after discharge. Complications requiring auxiliary procedures were few. The procedure was found to be safe, cost effective, extremely well received by patients, and superior to all other methods of removing renal stones. This study confirms that treatment by ESWL is a specialised urological procedure that requires operators who are also trained in open, percutaneous, and ureteroscopic surgery and with a back up of a radiological team skilled in percutaneous renal puncture.
Adult↗
Endoscopic management of upper urinary tract stones.
Since 1981, 525 renal and ureteric calculi have been removed with percutaneous nephrolithotomy (PCN) or transurethral ureteroscopy as the primary modalities of therapy. Successful extraction of the stone at the first attempt was achieved in 92 per cent of cases by PCN and 70 per cent of cases by ureteroscopy, whilst further endoscopic surgery improved the overall success rates to 98 per cent and to 80 per cent respectively. Complication rates from these procedures have both been low as has the morbidity, with most patients leaving hospital within 4 days and returning to work within 2 weeks. The successful development of endoscopic lithotomy and the use of in situ destruction techniques has meant that we now reserve open surgery for difficult multibranched staghorn calculi and ureteric stones embedded in the urothelium. With the advent of extracorporeally generated shockwave lithotripsy it is likely that even these types of stone will be amenable to minimally invasive procedures.
Adolescent↗