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Biomedical subjects

K H Tung

Publications and source records attributed to K H Tung.

At least 37 records · Page 2Linked to original sources
PubMed1990

In situ extracorporeal shock wave lithotripsy for upper ureteral stones using the EDAP LT-01 lithotriptor.

We reviewed 64 cases of upper ureteral stones treated between December 1986 and June 1988. Upper ureteral stones were defined as stones in the ureter distal to the ureteropelvic junction and proximal to the S1 vertebra. All stones were treated in situ with no invasive procedures done before treatment. The over-all success rate in rendering patients free of stones by extracorporeal shock wave lithotripsy monotherapy was 75%. Of the patients 25% required auxiliary procedures, such as percutaneous ultrasonic lithotripsy. The average duration of treatment for each stone was 88 minutes and the average storage energy used was 208 units.

Adult↗
PubMed1990

Piezoelectric extracorporeal shock wave lithotripsy by EDAP LT-01: the Singapore experience.

One hundred and eighty patients with stones in the calyces, renal pelvis, upper, middle, and lower ureter were treated by piezoelectric extracorporeal shock wave lithotripsy using the EDAP LT-01 lithotripter. The size of the stones treated ranged from 0.5 cm to 6.5 cm with the vast majority (94%) measuring less than 3.0 cm. Forty-eight patients (27%) had multiple stones in the renal collecting system. Successful fragmentation occurred in 79%, partial fragmentation in an additional 17%, and no fragmentation in 4%. Forty percent of patients required repeated treatment with an average of 2.3 sessions. Of those patients treated, none required general anesthesia, however, analgesia was needed in 121 patients (67%). Urosepsis occurred in 4% and 0.5% developed intrarenal hematoma. There was no mortality or loss of renal units in this series. The auxiliary procedure rate was 15% (percutaneous nephrolithotripsy 5%, ureteroscopic manipulation 9%, and open surgery 1%). The 3-month stone-free rate was 64%.

Humans↗
PubMed1989

Percutaneous ultrasonic lithotripsy--its role in the management of renal and upper ureteric stones.

Percutaneous ultrasonic lithotripsy (PUL), a new technique used in the treatment of renal stones has been shown to be safe and effective with low morbidity. 54 of the 57 patients (95%) were successfully treated by this method and all were done as a single stage procedure. 39 patients (68%) in this series were either unsuitable or had failed extracorporeal shock wave lithotripsy (ESWL). No mortality occurred in this series and one patient with staghorn stone required a nephrectomy due to severe secondary haemorrhage. Though PUL is technically more difficult to perform, it is a better alternative than open renal surgery and is complementary to ESWL especially in the treatment of the more complicated renal stones.

Adult↗
PubMed1989

Antegrade ureteroscopy and ultrasonic lithotripsy in the treatment of difficult upper and middle ureteric stones.

34 patients with difficult upper and middle ureteric stones were treated by antegrade ureteroscopy with ultrasonic lithotripsy over a 2-year period. 14 patients (41 percent) had failed extracorporeal wave lithotripsy and another 20 patients (59 percent) were considered unsuitable for extracorporeal shock wave lithotripsy due either to obstruction associated with urosepsis or renal failure. Thirty patients (88 percent) had large stones with a transverse diameter from 10 to 20mm in size. Thirty-three of the 34 patients (97 percent) were successfully treated by this method with minimal morbidity. Of the 7 patients with residual stones, only one needed transurethral ureteroscopic removal and another by piezoelectric extracorporeal shock wave lithotripsy. This technique is a safe and effective method in removing impacted upper and middle ureteric stones for patients who have failed or are unsuitable for extra-corporeal shock wave lithotripsy treatment.

Endoscopy↗
PubMed1988

Carcinoma in situ of the urinary bladder--the Singapore experience.

Carcinoma in situ of the urinary bladder has been described since 1952. However, it was not well recognised as a clinical entity until recently when we are more aware of its clinical significance, that a large proportion progresses to muscle invasive cancer and becomes life threatening, and therefore more aggressive management is needed. From 1980 to 1984 over a period of 5 years, we studied the records of 130 patients with transitional cell carcinoma of the urinary bladder. Eighty-two (63%) were staged as superficial carcinoma while 48 (37%) were diagnosed as muscle invasive cancer (Tables II, III & IV). Out of the 82 cases of superficial carcinoma, 12 (11%) were found to have associated carcinoma in situ of the bladder. Diagnosis depends on a high index of suspicion, urinary cytology and biopsies of not only the obvious papillary or solid tumours but also any abnormal bladder mucosa and random bladder biopsy. Management is a problem and controversial. We have been using intensive intravesical chemotherapy with thiotepa and mitomycin, and if there is evidence of deep muscle invasion, then more aggressive therapy such as cystectomy would be advised. Management of these 12 cases and the problems we encountered are discussed.

Carcinoma in Situ↗
PubMed1987

Transurethral ultrasonic lithotripsy for ureteric stones under direct vision.

With the development of the operating uretero-renoscope, and high frequency ultrasound generator, ureteric stones which otherwise would require open operative procedure can now be removed transurethrally with minimum morbidity and rapid recovery of patient. After preliminary cystoscopy, the ureteric orifice is dilated with flexible metal dilator or ureteric balloon dilator to size 15F. The rigid operating uretero-renoscope of 11F is then introduced and passed up to the stone. A 5F ultrasound probe is then passed through the uretero-renoscope to make contact with the stone. Stone disintegration with ultrasound is done under direct vision, and the fragments aspirated or removed with the help of forceps or Dormia basket. Of the first 70 patients done within 2 years from July 1984 to August 1986, 66 (94%) had their stones successfully removed by this procedure. It can be performed without radiological control and routine stenting of the ureter is not necessary. Serious complications included two perforation of the ureter and late development of ureteric strictures in another two patients. One patient had occlusion of the lower ureter requiring reimplantation.

Adult↗
PubMed1984

Endoscopic surgery of the lower urinary tract.

Endoscopic Surgery of the lower urinary tract was popularised in Singapore about a decade ago. Since then it has been established as the treatment of choice not only for obstructing prostates, but also for stones, carcinoma of the urinary bladder and management of neurogenic bladder, haemorrhagic chronic radiation cystitis, ureteric obstruction and urethral strictures. The main advantages of endoscopic surgery are lack of post-operative pain and minimum morbidity and mortality. Patients' recovery is rapid thus saving much needed hospital beds. However, endoscopic surgery requires special training and special equipment to get good results. If not properly done serious complications including the death of patients can occur. A plea is made for the setting up of a special division or department of Urology in Singapore to carry out this work and to train our young surgeons in this field.

Cystitis↗
PubMed1984

Transurethral resection of large obstructing prostates above the weight of 40 grams.

A series of 62 cases of transurethral resection of large obstructing prostates above 40 grams is presented. The weight of resected prostates ranged from 41 to 84 grams with an average of 54.5 grams. The average rate of resection was 0.7 gm/min. Though 74.2% of patients were in clinical grade II and III categories, no mortality occurred and serious complications were minimum. 71% of patients were discharged within a week. On the whole, the results were satisfactory although clot retention (11.3%) was a more common complication following transurethral resection of large prostate. Transurethral resection is a safe and acceptable alternative to open prostatectomy even for large prostates.

Aged↗
PubMed1984

Chemolysis of uric acid stones.

This paper illustrates one of the more satisfying aspects of the treatment of urinary calculous disease. A small series of 8 patients is presented to emphasize the possibility of dissolving uric acid stones by conservative measures thereby saving the patients extensive and often destructive surgical procedures. Patient selection is important for successful therapy. The stone must not be calcified and there must be sufficient function in the kidney. The regime consists of allopurinol 100 mg and sodium bicarbonate 2 to 4 grams given orally three times a day. Treatment period lasted up to six months, with dissolution of stones.

Adult↗
PubMed1984

Stone composition and metabolic study in urinary calculous disease.

A series of 178 urinary stones is analysed qualitatively during a three year period from 1980 to 1982. The majority (96%) of stones orginate from the upper tract. Calcium oxalate stones are the commonest entity seen in the western countries but less than 20% of such stones occur locally. A large proportion consists of mixed stones and one third are infective as triple phosphate is present. 20% contain urate as a constituent whereas relatively pure urate stones constitute 4%. The true incidence of pure urate stones is higher (about 10%) as we have been dissolving them with alkalinisation of urine without surgery. Idiopathic hypercalciura occurs in 11.8% and none has persistent hypercalcaemia. Hyperuricosuria which is commoner, occurs in 24% of patients. It is important to identify this group as it results in the formation of metabolically active stones, and they can be treated with allopurinol to prevent recurrence of stones.

Adult↗
PubMed1984

Haemorrhagic chronic radiation cystitis--following treatment of pelvic malignancies.

Haemorrhagic chronic radiation cystitis is not an uncommon clinical entity, and should be suspected in patients with painless gross haematuria who have a past history of radiotherapy to the pelvic region. A series of 29 patients with haemorrhagic chronic radiation cystitis were managed in the University Department of Surgery, Singapore General Hospital over a 5 years period from 1979 to 1983. Cystodiathermy was the mainstay of treatment and was successful in controlling haematuria in 27 patients. Two patients developed uncontrolled haematuria, urinary tract infection, septicaemia and died giving mortality of 6.9%. Excellent control of haemorrhage can be obtained with cystodiathermy in the majority of patients. Intravesical instillation of steroid or silver nitrate is used for the more intractable cases, after cystodiathermy. Urinary diversion with or without cystectomy are desperate measures to salvage the severe case and mortality is high.

Adult↗
PubMed1984

Optical urethrotomy for urethral strictures--a preliminary report.

24 patients with urethral strictures which were managed with the optical urethrotome are studied. These patients had developed strictures due to previous transurethral reaction of the prostate, and trauma or inflammation of the urethra. In some cases we have not been able to determine the aetiology of the problem. 58% of the patients responded satisfactorily to this mode of therapy. Although a high percentage develop recurrent stenosis, these can be treated by repeated urethrotomy under vision without much morbidity. Resistant cases would need urethroplasty.

Adult↗