RESUMO
This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients' demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.
Assuntos
Meios de Contraste , Complicações Intraoperatórias/epidemiologia , Cálculos Ureterais/diagnóstico , Ureteroscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Cintilografia/métodos , Estudos Retrospectivos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos , Urografia/métodos , Adulto JovemRESUMO
This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Meios de Contraste , Complicações Intraoperatórias/epidemiologia , Cálculos Ureterais/diagnóstico , Ureteroscopia/métodos , Incidência , Litotripsia/efeitos adversos , Litotripsia/métodos , Período Pré-Operatório , Estudos Retrospectivos , Cintilografia/métodos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos , Urografia/métodosRESUMO
PURPOSE: To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. METHODS: Fifty cases of unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n=25), and another group underwent laparoscopic ureterolithotomy under general anesthesia (n=25). Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. RESULTS: Operation was successfully performed in all 50 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 49.0±10.7 min and 41.8±8.0 min (t=2.68, P=0.00999), respectively, their hospitalization time was 2.8±1.3 days vs. 2.9±0.8 days (t =-0.40, P=0.69413), and stone clearance rate was 88.0 percent (22/25) vs. 100 percent (25/25). Stone moved to the renal pelvis in three cases in the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL). All patients were followed up for more than three months, and no serious complications such as ureterostenosis occurred. CONCLUSIONS: Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is one safe and effective treatment on unilateral upper ureteral stones.(AU)
OBJETIVO: Comparar os efeitos curativos da litotripsia ureteroscópica e a ureterolitotomia laparoscópica para cálculos unilaterais altos e pesquisar as indicações e resultados. MÉTODOS: Cinquenta casos de cálculos unilaterais altos foram distribuídos aleatoriamente em dois grupos: um grupo submetido a litotripsia ureteroscópica com laser holmium sob anestesia epidural ou lombar (n=25) e outro grupo submetido a ureterolitotomia laparoscópica sob anestesia geral (n=25). Duplo-J stent foi rotineiramente instalado em ambos os grupos. Comparou-se o tempo operatório, tempo de hospitalização pós-operatória, nível de desaparecimento dos cálculos e complicações pós-operatórias. RESULTADOS: Atos operatórios nos 50 casos sem ocorrências e nenhum ato convertido. Nos grupos por ureteroscopia e laparoscopia, o tempo operatório médio foi 49,0±10,7 minutos e 41,8±8,0 minutos (t=2,68, P=0,00999) respectivamente, tempo de hospitalização foi 2,8±1,3 dias vs. 2,9±0,8 dias (t=0,40, P=0,69413) e o nível de desaparecimento dos cálculos foi 88.0 por cento (22/25) vs. 100 por cento (25/25). Cálculo deslocado para pelve renal em três casos no grupo ureteroscópico e cálculos residuais foram removidos por litotripsia por onda de choque extracorpóreo (ESWL). Todos pacientes foram seguidos por mais de três meses e não ocorreram complicações sérias como estenoses ureterais. CONCLUSÕES: A ureterolitotomia laparoscópica teve maior nível desaparecimento dos cálculos e tempo operatório menor comparado à litotripsia ureteroscópica A ureterolitotomia laparoscópica é um tratamento seguro e efetivo para cálculos ureterais unilaterais altos.(AU)
Assuntos
Animais , Cálculos Ureterais/diagnóstico , Litotripsia , Ureteroscopia , Laparoscopia , Uretra/anatomia & histologiaRESUMO
Urinary lithiasis is one fo the most frequent disorder of the urinary tract, predominant in males and in their formation are involucrate many factors such as age, inheritance, diet, scant ingestion of fluids and sedentarity. Extracorporeal lithotripsy has become the method of choice for urinary lithiasis. The objective of this report is to present the authors experience with the treatment of urinary lithiasis using extracorporeal wave lithotripsy. From 1997 through 2005 we have treated 1456 patients suffering renouretheral lithiasis with our equipment Triper compac. Successful results were obtained in 96 por ciento in interior uretheral calculi, 94 por ciento for medial calculi and 96 por ciento for upper calculi. Several references related to this procedure are commented in the article(AU)
Assuntos
Humanos , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/terapia , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , LitotripsiaRESUMO
Urinary lithiasis is one fo the most frequent disorder of the urinary tract, predominant in males and in their formation are involucrate many factors such as age, inheritance, diet, scant ingestion of fluids and sedentarity. Extracorporeal lithotripsy has become the method of choice for urinary lithiasis. The objective of this report is to present the author's experience with the treatment of urinary lithiasis using extracorporeal wave lithotripsy. From 1997 through 2005 we have treated 1456 patients suffering renouretheral lithiasis with our equipment Triper compac. Successful results were obtained in 96 por ciento in interior uretheral calculi, 94 por ciento for medial calculi and 96 por ciento for upper calculi. Several references related to this procedure are commented in the article
Assuntos
Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/terapia , LitotripsiaRESUMO
Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy.
Assuntos
Técnicas de Sutura , Cálculos Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Jamaica , Tempo de Internação , Litotripsia a Laser/métodos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/diagnóstico , Ureteroscopia/métodosRESUMO
Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy