Combined retrograde and antegrade manipulations for percutaneous nephrolithotomy of ureteric calculi: "push-pull" technique.
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Cystoscopy↗
Biomedical subjects
J E Wickham
Publications and source records attributed to J E Wickham.
A preliminary in vivo assessment of acrylic acid graft-copolymers in the urinary tract.
Polymers such as polyethylene, polytetrafluorethylene and polypropylene may be copolymerized with acrylic acid by radiation initiation to produce copolymers which are cationic hydrogels and thus possess physical properties different to the base polymers from which they are derived. The present preliminary study was undertaken to determine whether this class of material may have potential application for use within the urinary tract. Inserts of such copolymers in sheet form (5 mm. square) and their corresponding base polymers were placed in the bladders of male Wistar rats as free floating grafts and left in situ for 3 months. Stone formation and/or encrustation occurred on 12 of the 16 radiation graft copolymers and on 9 of 11 of the corresponding base polymers. The altered physical properties of the tested acrylic acid graft copolymers appear to offer no additional resistance to encrustation although their plasticity and ability to swell in water may provide some advantages over more conventional polymeric materials.
Acrylates↗
Frusemide intravenous urography in the diagnosis of pelviureteric junction obstruction.
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Constriction, Pathologic↗
A strategy for management of upper tract calculus disease.
Extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and ureterorenoscopy now mean that approximately 98% of all renal and 85% of all ureteric calculi can be treated effectively, without recourse to open operative intervention, in centres possessing the necessary equipment and expertise. Experience with these techniques allows us to propose a strategy for the surgical treatment of upper tract stone disease.
Humans↗
The effects of double J stenting on unobstructed ureters. An experimental and clinical study.
Upper tract pressure flow studies in four clinically unobstructed ureters with double J stents in situ indicated that urinary flow occurred mainly around the stent and that there was significant vesicorenal pressure transmission. This study examined the dynamics of ureteric urinary flow and morphological effects consequent upon stenting a ureter in vivo. In a porcine model, ureteric intubation caused a rise in intrapelvic pressures, hydroureter, vesicorenal reflux and generalised thickening of the ureteric wall with characteristic histological changes in the urothelium. These findings suggest that double J stents may compromise urinary drainage when ureteric obstruction is not present, urging caution in their use in the damaged, unobstructed upper urinary tract.
Animals↗
Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.
The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones.
Adolescent↗
Transurethral ureteroscopic stone extraction.
Transurethral ureteroscopy has now been used for stone retrieval in 31 patients with ureteric calculi. Four stones were located in the upper third, nine in the middle third and eighteen in the lower third of the ureter. The stones varied in size from 4 to 10 mm in diameter. Successful retrieval of the stones was achieved at the first attempt in 17 and at a second attempt in 3. Of the 11 failures (due to impaction, dislodgement into the pelvis or failed instrumentation), 4 have required open ureterolithotomy, 2 percutaneous nephroscopy and 2 ureteric meatotomies; 3 have been successfully disintegrated in situ. There have been no significant complications to date. Transurethral ureteroscopy appears to offer an alternative to existing therapeutic options.
Adult↗
Percutaneous nephrolithotomy: advances in equipment and endoscopic techniques.
Over the last two years there has been a 30-per cent increase in our success rate for percutaneous nephrolithotomy. A significant reason for this has been advances in endoscopic equipment. We describe our new lightweight nephroscopes and how they may be used in combination with the Amplatz sheath. Seventeen patients who were successfully treated by electrohydraulic disintegration are reported. We believe this method to be preferable to ultrasonic stone destruction in most cases. The first report of the clinical use of bipolar diathermy for intrarenal endoscopy is described.
Data Display↗
Optical triradiate nephroscope: new concept in percutaneous renal surgery.
We have been disappointed by the high residual fragment rate following electrohydraulic and ultrasonic stone disintegration during percutaneous renal surgery. As a result the optical triradiate nephroscope (Wickham/Miller, Karl Storz GmbH) has been developed to allow the extraction of calculi in the range of 0.8 mm to 1.5 cm intact. The grasping jaws of the instrument provide a vice-like grip from which the stone will not dislodge during extraction. This endoscope should be included in any basic kit for percutaneous renal surgery. It has proved invaluable both for one-stage and two-stage cases. Techniques and principles of triradiate grasping are reported.
Endoscopes↗
Explosive nephrolithopaxy: reality or fiction?
The use of silver and lead azide explosive charges for the percutaneous distintegration of renal calculi has been investigated. Charges of 10 mg or more reliably reduced calculi to fragments of extractable size; however, the concomitant tissue effects would preclude the use of such charges clinically. Smaller charges require multiple applications. High-speed flash photography demonstrated the unfocussed nature of these discharges. Considerable improvements are anticipated when the shock waves are focused. The use of Nonel tubing is described, and future developments are discussed.
Azides↗
Does calcium contribute to the effectiveness of a coagulum for pyelolithotomy?
Adding calcium to a mixture of thrombin and fibrinogen increased the breaking strain of the resultant coagulum by 10-fold, but did not significantly reduce the length to which it could be stretched. There was no detectable change in the time taken for the coagulum to dissolve in urine. Simulation pyelolithotomies were performed on pig kidneys containing ball-bearings which represented calculi. Coagula formed with calcium were significantly more effective at retrieving the ball-bearings than coagula without calcium. It is concluded that the ideal coagulum formula should include 1 mmol of calcium.
Animals↗
Review of accessories for percutaneous renal surgery.
Adequate accessory equipment is a prerequisite for successful percutaneous nephrolithotomy. The advantages of the Amplatz tube used in combination with the new sheathless nephroscopes are described. The design, action and efficiency of forceps are detailed. Triradiate rigid forceps have been shown to be superior to other types of forceps. All accessories are liable to be damaged and therefore must be regarded as semi-disposable.
Endoscopes↗
Percutaneous nephrolithotomy: one stage or two?
Two hundred and fifty cases of percutaneous nephrolithotomy (PNL) are described. One hundred and fifty cases were treated in two stages, 100 in a single stage. The one-stage method has been shown to be as safe as the two-stage method but should be reserved for those with experience of the technique and who possess adequate instrumentation. PNL has proved to be a preferable option to open stone surgery and a useful alternative to extracorporeal shock wave lithotripsy (ESWL).
Endoscopy↗
Percutaneous pyelolysis: indications, complications and results.
The results of percutaneous pyelolysis in 28 patients are presented. There were 18 successful and 10 unsuccessful cases. The indications for the procedure are defined in the light of this analysis.
Adolescent↗
Electrohydraulic nephrolithotripsy: a preferable alternative to ultrasound.
Three hundred patients have undergone percutaneous nephrolithotomy in our unit; 66 required disintegration of their renal calculi, 24 by electrohydraulic lithotresis (EHL) and 42 by ultrasonic lithotresis (USL). EHL has been associated with a lower residual stone rate, a reduced number of repeat endoscopic sessions and no additional complications. EHL has been shown to be efficient, safe and preferable to USL. The occurrence of residual stone fragments following disintegration suggests that mechanical extraction should be used whenever possible and that disintegration, whether by electrohydraulic or ultrasonic lithotresis, should be reserved for stones which are either impacted or too large for mechanical extraction.
Adult↗
The impact of transurethral ureteroscopy on the management of ureteric calculi.
Transurethral ureteroscopy has now been used in an attempt to retrieve ureteric calculi in 48 patients. Six stones were located in the upper ureter, 11 in the middle and 31 in the lower third of the ureter. Successful retrieval was achieved in 27 patients at the first attempt and in 4 at a second ureteroscopy. Of the 17 failures, 7 patients have required open ureterolithotomy, 3 percutaneous nephrolithotomy and the remainder passed their stones either after in situ disintegration or ureteric meatotomy. There have been no serious complications to date. Transurethral ureteroscopy should now be regarded as the procedure of first choice in the management of ureteric calculi.
Adult↗
Air embolism, a new complication of percutaneous nephrolithotomy. What are the implications?
We report a single case of air embolism following air pyelography in a patient undergoing percutaneous nephrolithotomy. The significance of this finding and the implications for gas nephroscopy and the use of irrigants, stone solvents, coagulants and local anaesthetics are discussed.
Embolism, Air↗
Clinical and experimental evaluation of ureteric dilatation.
The present study was designed to evaluate the effect of ureteric dilatation (performed as a prelude to rigid ureteroscopy) on the vesicoureteric mechanism in experimental animals and man. Through a vesicotomy the left ureteric orifices of 10 anaesthetised male New Zealand White rabbits were dilated approximately 3-fold (to 4-5F) using Seldinger wires and gradated cannulae. Serial intravenous urograms and histological examination of the excised vesicoureteric junctions were performed at intervals of 2 weeks. Histologically, acute inflammatory changes were noted at 24 h, but at 2 to 8 weeks the histological appearances were normal. Radiologically, transient upper tract dilatation was noted in three animals. In 10 patients, intravenous urograms and micturating cystograms were performed 3 months after ureteric dilatation to 14F (prior to ureteroscopy). One asymptomatic patient had grade 1 vesicoureteric reflux but no other radiological abnormalities were found. It is concluded that ureteric dilatation is a safe procedure which merits reassessment as a urological technique.
Animals↗