From June 1989 to October 1991. 52 patients with renal staghorn calculi (34 with incomplete staghorn renal calculi and I8 with complete staghorn calculi) underwent extracorporeal shock wave lithotripsy. monotherapy by Northgate SD-3 Iithotriptor. Of 52 patients, 27 were treated without preoperative double-J stenting. while 25 underwent double-J stenting before extracorporeal shock wave lithotripsy. The mean shock waves per patients were gradually increased in proportion to stone burdens rather than the insertion of double-J stent. The average duration of hospitalization was shorter for The group who received prophylactic double-J stenting. The incidence of postoperative complications such as ureteral obstruction, colic, fever decreased in double-J stenting group, but was not statistically significant (p>0.05). 62% (32 cases) of the patients were free of stones after 6 months but double-J stenting did not influence the rate free of stones.
Calculi* ; Colic ; Fever ; Hospitalization ; Humans ; Incidence ; Kidney Calculi ; Lithotripsy* ; Postoperative Complications ; Shock* ; Stents* ; Ureteral Obstruction

PURPOSE: The developments and advances in extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open surgery in the treatment of renal and ureteral stones. We reviewed our experience of open stone surgery to determine current indications and efficacy of this treatment modality. MATERIALS AND METHODS: We undertook a review of hospital and office charts, operative records, and pertinent radiographic studies of all patients that had undergone open stone surgery from May 1986 to June 2001 at a single tertiary university hospital. Of 5,533 procedures performed for stone removal, 355 were open surgical procedures (6.4%), these included ureterolithotomy in 215 (60.6%), pyelolithotomy in 50 (14.1%), anatrophic nephrolithotomy in 43 (12.1%), and nephrectomy in 47 (13.2%). RESULTS: The indications for open surgery were complex stone burden (61%), failure of extracorporeal shock wave lithotripsy or endourological treatment (9%), other co- operation (10.4%) and anatomical abnormalities, such as: ureteropelvic junction obstruction, infundibular stenosis and/or renal caliceal diverticulum (6.5%). Stone free rate, following surgery, was 90.7%. All patients had minor postoperative complications that were resolved with appropriate therapy. CONCLUSIONS: Open stone surgery continues to be a reasonable alternative modality for a small proportion of patients with urinary stones. Those patients with large urinary stone, failed less invasive method, anatomical abnormality and serious medical diseases would be recommended for open stone surgical correction.
Constriction, Pathologic ; Diverticulum ; Humans ; Lithotripsy ; Nephrectomy ; Postoperative Complications ; Shock ; Ureter* ; Ureteral Calculi* ; Urinary Calculi

OBJECTIVETo evaluate the feasibility of retroperitoneal laparoscopic surgery combined with ureteroscopic lithotomy through the pelvis for treatment of renal and ureteral calculi.

METHODSIn February 2010, 2 patients with renal and ureteral calculi underwent retroperitoneal laparoscopic surgery combined with ureteroscopic lithotomy through the pelvis.

RESULTSThe operation time in these two cases was 70 and 80 min, and the volume of intraoperative blood loss was about 20 ml. The exposure was excellent, and the patient recovered rapidly without complications or residual calculi.

CONCLUSIONRetroperitoneal laparoscopic surgery combined with ureteroscopic lithotomy through the pelvis is feasible for treatment of renal and ureteral calculi.

Aged ; Female ; Humans ; Kidney Calculi ; complications ; surgery ; Kidney Pelvis ; Laparoscopy ; Male ; Treatment Outcome ; Ureteral Calculi ; complications ; surgery

PURPOSE: This study aimed to determine the value of the NTrap(R) (Cook Urological INC, USA), which was designed to block the upward movement of stones during ureteroscopic lithotripsy. MATERIALS AND METHODS: We reviewed the data of 144 patients who underwent ureteroscopic lithotripsy for an upper ureteral stone from June 2006 to May 2010. Sixty-eight patients who underwent ureteroscopic lithotripsy without the use of the NTrap(R) were assigned to Group I and 76 patients who underwent ureteroscopic lithotripsy with the NTrap(R) were assigned to Group II. The size of the stones, operation time, success rate, and pre- and postoperative complications were compared retrospectively between the two groups. RESULTS: The mean age of the patients (Group I: 35.8 years; Group II: 32.6 years) and the sex ratios were not significantly different between the two groups. The mean size of the stones was 6.9 mm and 7.4 mm, which also was not significantly different between the two groups. The mean operation time was 82.7 minutes and 78.7 minutes. The operation time was shorter in Group II, but the difference was not significant. The success rate of stone removal was 89.7% and 98.7% in Groups I and II, respectively; Group II showed a significantly higher success rate. Two cases of ureteral perforation and one case of ureteral avulsion occurred in Group I, and one case of ureteral perforation occurred in Group II. CONCLUSIONS: NTrap(R), which is an instrument used to assist during ureteroscopic lithotripsy, can be considered to be an effective tool that blocks the upward movement of the stone and aids in safe stone removal.
Humans ; Lithotripsy ; Postoperative Complications ; Retrospective Studies ; Sex Ratio ; Ureter ; Ureteral Calculi ; Ureteroscopy

Although ultrasonography is regarded as the gold standard in the diagnosis of obstructive nephropathy, dilatation is sometimes not observed by ultrasonography. We report upon a case of minimally dilated obstructive nephropathy due to an ureter stone in a kidney donor with volume depletion. A 54-year-old man was admitted due to anuria and abdominal pain of 2 days duration. Ten years previously, his right kidney was donated for transplantation, and one month before admission, he abstained from all food except water and salt, for 30 days for religious reasons. He had lost 8 kg of body weight. On admission, he had clinical signs of volume depletion, i.e., a dehydrated tongue and decreased skin turgor. Laboratory data confirmed severe renal failure, his blood urea nitrogen level was 107.3 mg/dL, and his serum creatinine 16.5 mg/dL. The plain X-ray was unremarkable and ultrasonography showed only minimal dilatation of the renal collecting system. On follow-up ultrasonography, performed on the 5th hospital day, the dilatation of the collecting system had slightly progressed and a small stone was found at ureter orifice by cystoscopy. Removal of stone initiated dramatic diuresis with a rapid return of renal function to normal by the third day.
Anuria/*etiology ; Diagnosis, Differential ; Human ; Male ; Middle Aged ; Nephrosis, Lipoid/complications/*ultrasonography ; *Tissue Donors ; Uremia/*diagnosis ; Ureteral Calculi/*complications

Aged ; Female ; Humans ; Kidney Pelvis ; pathology ; surgery ; Rupture, Spontaneous ; diagnosis ; etiology ; surgery ; Ureteral Calculi ; complications ; diagnosis ; surgery ; Ureteral Obstruction ; complications ; diagnosis ; surgery

Ureteroscopic lithotripsy using Swiss Lithoclast was performed in 411 cases from January 1996 to September 2007 in a single hospital. Medical records of 341 cases, in which Swiss Lithoclast was successfully applied, were available for this retrospective study. We used 9.5Fr and 10Fr Storz rigid ureteroscopes. A success was defined as being free of stone-related symptoms and residual stones larger than 2 mm. Sixty one stones were located in the upper ureter, 49 stones were in the mid ureter, and 231 stones were in the lower ureter. The overall success rate was 93.5%. The success rate of upper ureter stone (80.3%) was significantly lower compared with those of mid (93.8%) and lower (96.9%) ureter stones (P=0.001). The higher the calculi was located within the ureter, the more chance of upward migration there was (P<0.001). The success rate in male patients was lower than in female patients without a statistical significance (P=0.068). The success rate decreased as the size of the stone increased (P<0.001), and as the degree of hydronephrosis increased (P=0.03). Perforation rates were 4.9%, 4.1%, and 2.6% from upper to lower ureter stone group. Ureteroscopic lithotripsy using Swiss Lithoclast is a safe and useful treatment modality for ureteral calculi.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; *Lithotripsy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Ureteral Calculi/complications/*therapy ; Ureteroscopy

OBJECTIVE: To evaluate the therapeutic effect and safety of holmium:YAG laser lithotripsy for treating ureteral calculi combined with acute renal failure. METHODS: Ureteroscopic holmium: YAG laser lithotripsy was used in 13 cases of ureteral calculi. RESULTS: After the operation the serum Bun and Cr levels in the patients decreased to different degrees or returned to normal and the stone free rate was up to 92.3% (12/13). CONCLUSION The ureteroscopic holmium:YAG laser lithotripsy can be the first choice for the upper urinary tract obstruction associated with acute renal failure,due to its safety and efficiency. It can also deal with the double sites of ureteral diseases.
Acute Kidney Injury ; etiology ; therapy ; Adult ; Aged ; Female ; Holmium ; Humans ; Lithotripsy, Laser ; methods ; Male ; Middle Aged ; Ureteral Calculi ; complications ; Ureteroscopy

OBJECTIVETo evaluate the clinical efficacy of extracorporeal shockwave lithotripsy (ESWL) for bilateral ureteral stones with renal colic in emergency.

METHODSWe retrospectively analyzed the clinical data of 86 patients suffered with sudden renal colic due to bilateral ureteral stones and treated with ESWL between January 2005 and January 2009.

RESULTSThe success rate was 74.4% after a single ESWL session, and the overall success rate was 82.6%. Significant difference in stone length was observed between successful group and failed group (P<0.01). The stone position did not produce significant impact on the outcome of the treatment (P>0.05).

CONCLUSIONESWL is an effective treatment modality in emergency for small-length and short-term obstruction bilateral ureteral stones with remal colic.

Adolescent ; Adult ; Emergencies ; Female ; Humans ; Lithotripsy ; Male ; Middle Aged ; Renal Colic ; etiology ; therapy ; Ureteral Calculi ; complications ; therapy ; Young Adult

PURPOSE: The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (alpha-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). MATERIALS AND METHODS: A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. RESULTS: Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95+/-2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage. CONCLUSIONS: Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.
Adult ; Aged ; Diabetes Complications/*therapy ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Remission, Spontaneous ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Ureteral Calculi/pathology/radiography/*therapy ; *Watchful Waiting