The infected arterial aneurysm has a fulminent infectious process frequently resulting in death if not properly treated. We reviewed 10 patients to identify the aneurysm location, etiology, bacteriology, and the mortality of surgical treatment. The abdominal and thoracic aorta was the most common site (6 cases). The primary causes were infected endocarditis, acute cholecystitis, abscess in the psoas muscle and depressed immunocompetence, but there was no case of iatrogenic trauma. Eight patients had positive blood or aneurysmal wall culture, Staphylococcus aureus, Staphylococcus epidermidis and salmonella being the most frequent bacteria identified. The proper treatment of infected arterial aneurysm remains controversial. Three methods of surgical treatment were performed; one, en bloc aneurysmal excision with in situ prosthetic graft replacement, two, open aneurysmal resection and irrigation with large amount of diluted popdon iodine solution followed by in situ prosthetic graft replacement with wrapping by an omental pedicle. Three, extraanatomical bypass grafting. Six of 7 patients in whom the infection subsided with antibiotic therapy showed good long term results. However, 3 patients with uncontrollable infection died 1 to 3 months after operation.

Long-term results of surgery for abdominal aortic aneurysms in the over-80 age group were studied. Among nine survivors we found four of them to have had a late death. Their survivals ranged from 17 to 96 months. The ratio of life expectancy was poor (29-51%) in men but good (159%) in women. Long-term survival was not significantly influenced by any preoperative complication but by unexpected disease, such as pancreatic cancer and pneumonia. In postoperative general care, it is important to pay attention not only to preoperative complication but also to the unexpected disease in other organs for octogenarians to achieve a goal of normal Japanese postoperatial survival.

Purpose: Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. Materials and Methods: This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. Results: The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator’s hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). Conclusions The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side.

Purpose: Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. Materials and Methods: This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. Results: The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator’s hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). Conclusions The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side.

Purpose: Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. Materials and Methods: This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. Results: The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator’s hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). Conclusions The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side.

Purpose: Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. Materials and Methods: This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. Results: The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator’s hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). Conclusions The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side.