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At least 55 records · Page 3Linked to original sources
PubMed1994

[Role of laparoscopy in the current treatment of lithiasis of the common bile duct. Apropos of 63 cases of lithiasis].

The purpose of this study is to evaluate the operative technique, indications and results of laparoscopic management of common bile duct (CBP) stones. While laparoscopic cholecystectomy has become the procedure of choice for gallstones, the management of CBD stones remains controversial. From October 1989 to may 1993, we performed 634 cholecystectomies, 615 of them carried out by laparoscopy, (97%). We found 63 cases of CBD stones (9.9%). At the beginning, CBD stones were managed either by endoscopic sphincterotomy (12 cas) or by laparotomy (6 cas). We subsequently performed laparoscopic treatment of CBD stones. Forty-six patients have been treated in this way: 17 via a transcystic approach successfully in 14 cases (82.3%) and 29 by choledochotomy with 27 successful extractions (93.1%). There was no mortality and a morbidity of 4.3% (1 retained stone and 1 wound infection). Endoscopic sphincterotomy is indicated in high risk elderly patients and in complicated stones. (pancreatitis cholangitis), while the whereas incidence of open surgery is greatly reduced; the advantages of laparoscopic management of CD stones are its noninvasive aspect and the complete clearance of the stones in one operation.

Adult↗
PubMed2003

Therapeutic options in lithiasis of the lumbar ureter.

INTRODUCTION: In the past 25 years, the treatment of lithiasis of the lumbar ureter has evolved from ureterolithotomy to extracorporeal shockwave lithotripsy and/or endoscopic lithotripsy. Our objective has been to analyse the results of extracorporeal lithotripsy and endoscopic surgery in lithiasis of the lumbar ureter. MATERIALS AND METHODS: We have analysed 734 single calculi of the lumbar ureter treated during the decade 1990-2000, excluding patients with lithiasis in other locations in order to avoid bias in the assessment of the results. Extracorporeal shockwave lithotripsy (ESWL) was carried out using a Siemens Lithostar, urinary diversion with a double pigtail ureteric catheter or percutaneous nephrostomy, semi-rigid ureteroscopy and electrokinetic contact lithotripsy. The patient were divided into six groups. We assessed complete and partial success, the fragmentation index, and complications, analysing the results using a test for the comparison of proportions. RESULTS: In group A, non-obstructive lithiasis treated by in situ ESWL, complete success was achieved in 95.5%. In group B, obstructed lithiasis treated by in situ ESWL, 93.15%. In group C, obstructive lithiasis treated with a double pigtail catheter and ESWL, 81.11%. In group D, obstructive lithiasis treated with percutaneous nephrostomy and ESWL, 93.75%. In group E, ureteric lithiasis <1cm, treated by retrograde displacement to the renal cavities and ESWL, 82.3%. In group F, lithiasis of the lumbar ureter treated by ureteroscopy, 91%. CONCLUSIONS: The primary therapeutic option for the treatment lithiasis of the lumbar ureter, in the absence of criteria for urinary diversion, is in situ ESWL. We consider the criteria for urinary diversion prior to ESWL to be severe obstruction, obstruction associated with urinary tract infection, and obstruction caused by a proximal ureteric calculus adjacent to the inferior renal pole. Ureteroscopy and/or contact lithotripsy is the technique of choice in lithiasis of the lumbar ureter resistant to ESWL due to non-fragmentation or to the persistence of impacted fragments. Ureteroscopy may be the first choice of therapy in obstructive lithiasis, substituting urinary diversion plus ESWL.

Humans↗
PubMed1998

[Ambulatory treatment of ureteral lithiasis using shock wave extracorporeal lithotripsy].

Presentation of the results obtained with extracorporeal shock wave lithotripsy (ESWL) applied to 3173 ureteral lithiasis with a Dornier HM-4 equipment. Location of lithiasis was pyeloureteral junction (329), lumbar ureter (1068), sacral ureter (238), iliopelvic ureter (1474) and "lithiasic path" (64). All lithiasis were treated in situ. Treatments were carried out ambulatory with no anaesthesia. Treatment/lithiasis rate was 1.3. Percentage of stone-free patients with ESWL alone was 79.2% after the first session, and reached 86.14% with retreatment. Percentage of success for lithiasis in pyeloureteral junction was 81.8%, 79.7% for lumbar ureter lithiasis, 80.09% sacral lithiasis, 90.10% iliopelvic ureter lithiasis and 79.9% for those in the "lithiasic path". 12.6% lithiasis required post-ESWL auxiliary manoeuvres. Post-ESWL minor complications (pain, vegetations) occurred in 5.6% cases and major complications (obstruction, fever, sepsis) in 2.9%. The factors influencing lithiasis fragmentation were the number of shock waves and the lithiasis duration. Size of lithiasis and presence or absence of ureteral catheter had no influence. These results suggest that ESWL is an effective method for managing ureteral lithiasis.

Ambulatory Care↗
PubMed1980

[Urinary lithiasis in the child (author's transl)].

The authors report a series of 130 children suffering from urinary lithiasis (essentially between the age of 4 to 6 years) and particularly in boys (2.5 to 1). There were 108 cases of reno-ureteric lithiasis as against 23 vesico-urethral. In 69 cases, pyelocalyceal lithiasis predominated. Thirty per cent of the children had bilateral lithiasis, and 19% of all cases of lithiasis were staghorn calculi. Presenting symptoms : haematuria, diffuse abdominal pain, anuria (6 cases), complete urinary retention (5 cases). Study of these cases failed to indicate whether obstruction of the upper urinary tract (14%) or infection (27%) was the cause or the effect of the lithiasis. Particularly notable were 8 cases of cystinuria (6%), 1 of glycinuria, 1 of hyperoxaluria and 7 of hypercalciuria. At least in Spain, lithiasis in children would appear to be essentially idiopathic. However, 40% of these cases of lithiasis were secondary to obstruction of the excretory tract and/or urinary infection. All types of entero-uroplasty were lithogenic (6 cases). 32% of the children had a proteus infection. Treatment : 14 children were treated medically as against 125 surgically. 70% are free of any recurrence. 7% have a residual lithiasis. The rarity of recurrences and the quality of the results obtained indicate that complete surgical treatment represents the essential feature of the treatment of urinary lithiasis in children.

Adolescent↗
PubMed2001

[Epidemiology of urinary lithiasis].

An epidemiological study of urinary stone disease has been carried out in the districts of La Sierra and Hellín (Albacete, Spain). Between January 1992 and December 1999 a total of 887 patients with urinary lithiasis have been studied, analysing the number of patients discharged from hospital with the primary diagnosis of lithiasis, the distribution of lithiasis by area, age, gender, family history of lithiasis, diet, occupation and concurrent pathology. The geographical, geological, and climatic conditions, the composition of the water supply and the clinical characteristics are described. The incidence of urinary lithiasis in the whole area in 2.66 per thousand inhabitants/year, showing a male predominance with a male:female ratio of 1.26:1. The mean age was 51.34 years (bimodal distribution with peaks in the 4th and 7th decades). 20.41% of the patients had a family history, with the father being the most frequently affected relation. Those occupations associated with a sedentary life style or with a hot, dry workplace show a higher incidence of lithiasis. A hot, dry climate favours the formation of urinary lithiasis and the highest incidence of lithiasis is in the summer, during the months of July and August. No statistically significant influence was shown between at the hardness of the water and the incidence of urinary lithiasis in the study population.

Adolescent↗