RETROGRADE URETEROPYELOSCOPY FOR LOWER POLE CALICEAL CALCULI
1999; Lippincott Williams & Wilkins; Volume: 162; Issue: 6 Linguagem: Inglês
10.1016/s0022-5347(05)68065-2
ISSN1527-3792
AutoresMichael Grasso, Michael Ficazzola,
Tópico(s)Pediatric Urology and Nephrology Studies
ResumoNo AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 1999RETROGRADE URETEROPYELOSCOPY FOR LOWER POLE CALICEAL CALCULI MICHAEL GRASSO and MICHAEL FICAZZOLA MICHAEL GRASSOMICHAEL GRASSO More articles by this author and MICHAEL FICAZZOLAMICHAEL FICAZZOLA More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68065-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Contemporary treatment of lower pole renal calculi includes extracorporeal shock wave lithotripsy, percutaneous nephrostolithotomy and retrograde ureteropyeloscopy. Success rates for shock wave lithotripsy are reduced in this setting, especially for stones greater than 1 cm. and/or in patients with anatomical variants. Percutaneous treatment, although effective, subjects the patient to increased morbidity. We studied the safety and efficacy of retrograde ureteroscopic treatment of lower pole intrarenal calculi. Materials and Methods: We evaluated 90 stone burdens localized to the lower pole and treated with a small diameter, actively deflectable, flexible ureteropyeloscope and a 200 μ. holmium laser fiber. Stone burdens were classified as group 1—10 or less, group 2—11 to 20 and group 3—greater than 20 mm. in largest diameter. Patients with calculi less than 2.5 cm. were treated as outpatients unless concurrent medical conditions required hospitalization. Larger stones and partial staghorn calculi (group 3) frequently required 2-stage endoscopic procedures with retrograde intrarenal irrigation for 36 hours to clear debris. An acceptable immediate surgical outcome was defined as complete fragmentation reducing the stone burden to dust and 2 mm. or less fragments. Success was defined as clear imaging (that is stone-free) on renal sonography with minimum 3-month followup. Extreme anatomical variants, including a long infundibulum, acute infundibulopelvic angle and a dilated collecting system, were noted and correlated with surgical failures. Results: Endoscopic access and complete stone fragmentation were achieved in 94, 95 and 45% of groups 1, 2 and 3, respectively. After a second treatment the success rate increased to 82% in group 3, with an overall rate of 91%. Of the 19 surgical failures 8 were secondary to inability to access the lower pole and 11 were secondary to inability to render the patient stone-free. In 2 of the 19 cases infundibular strictures hindered ureteroscopic access. In addition, of the anatomical variants a long lower pole infundibulum was the most statistically significant predictor of failure. Mean operative time ranged from 38 minutes for small to 126 for the largest calculi. There were no major complications. Overall stone-free rates with minimum 3-month followup were 82, 71 and 65% in groups 1, 2 and 3, respectively, and 88, 77 and 81%, respectively, in patients with an acceptable initial surgical outcome (that is excluding those with access failures from analysis). Conclusions: Retrograde ureteropyeloscopy is a safe and effective surgical treatment for lower pole intrarenal calculi. References 1 : Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. J. Urol.1994; 151: 1648. Link, Google Scholar 2 : The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock wave lithotripsy failures. Urology1995; 45: 363. Google Scholar 3 : Retrograde intrarenal surgery for calculous disease: new minimally invasive treatment approach. J. Endourol.1990; 4: 337. Google Scholar 4 : Electrohydraulic lithotripsy of renal and ureteral calculi. J. Urol.1990; 143: 13. 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Link, Google Scholar From the Department of Urology, The New York University School of Medicine, New York, New York© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byShields J, Bird V, Graves R and Gómez-Marín O (2018) Impact of Preoperative Ureteral Stenting on Outcome of Ureteroscopic Treatment for Urinary LithiasisJournal of Urology, VOL. 182, NO. 6, (2768-2774), Online publication date: 1-Dec-2009.Pearle M, Lingeman J, Leveillee R, Kuo R, Preminger G, Nadler R, Macaluso J, Monga M, Kumar U, Dushinski J, Albala D, Wolf J, Assimos D, Fabrizio M, Munch L, Nakada S, Auge B, Honey J, Ogan K, Pattaras J, McDougall E, Averch T, Turk T, Pietrow P and Watkins S (2018) Prospective Randomized Trial Comparing Shock Wave Lithotripsy and Ureteroscopy for Lower Pole Caliceal Calculi 1 cm or LessJournal of Urology, VOL. 179, NO. 5S, (S69-S73), Online publication date: 1-May-2008.Inci K, Sahin A, Islamoglu E, Eren M, Bakkaloglu M and Ozen H (2018) Prospective Long-Term Followup of Patients With Asymptomatic Lower Pole Caliceal StonesJournal of Urology, VOL. 177, NO. 6, (2189-2192), Online publication date: 1-Jun-2007.PEARLE M, LINGEMAN J, LEVEILLEE R, KUO R, PREMINGER G, NADLER R, MACALUSO J, MONGA M, KUMAR U, DUSHINSKI J, ALBALA D, WOLF J, ASSIMOS D, FABRIZIO M, MUNCH L, NAKADA S, AUGE B, HONEY J, OGAN K, PATTARAS J, McDOUGALL E, AVERCH T, TURK T, PIETROW P and WATKINS S (2018) PROSPECTIVE, RANDOMIZED TRIAL COMPARING SHOCK WAVE LITHOTRIPSY AND URETEROSCOPY FOR LOWER POLE CALICEAL CALCULI 1 CM OR LESSJournal of Urology, VOL. 173, NO. 6, (2005-2009), Online publication date: 1-Jun-2005.STAV K, COOPER A, ZISMAN A, LEIBOVICI D, LINDNER A and SIEGEL Y (2018) Retrograde Intrarenal Lithotripsy Outcome After Failure of Shock Wave LithotripsyJournal of Urology, VOL. 170, NO. 6, (2198-2201), Online publication date: 1-Dec-2003.Zheng W, Beiko D, Segura J, Preminger G, Albala D and Denstedt J (2018) Urinary Calculi in Aviation Pilots: What is the Best Therapeutic Approach?Journal of Urology, VOL. 168, NO. 4 Part 1, (1341-1343), Online publication date: 1-Oct-2002.Schuster T, Hollenbeck B, Faerber G and Wolf J (2018) Ureteroscopic Treatment of Lower Pole Calculi: Comparison of Lithotripsy In Situ and After DisplacementJournal of Urology, VOL. 168, NO. 1, (43-45), Online publication date: 1-Jul-2002.LANDMAN J, MONGA M, EL-GABRY E, REHMAN J, LEE D, BHAYANI S, SUNDARAM C and CLAYMAN R (2018) Bare Naked Baskets: Ureteroscope Deflection and Flow Characteristics With Intact and Disassembled Ureteroscopic Nitinol Stone BasketsJournal of Urology, VOL. 167, NO. 6, (2377-2379), Online publication date: 1-Jun-2002.Schuster T, Russell K, Bloom D, Koo H and Faerber G (2018) Ureteroscopy For The Treatment Of Urolithiasis In ChildrenJournal of Urology, VOL. 167, NO. 4, (1813-1816), Online publication date: 1-Apr-2002.ALBALA D, ASSIMOS D, CLAYMAN R, DENSTEDT J, GRASSO M, GUTIERREZ-ACEVES J, KAHN R, LEVEILLEE R, LINGEMAN J, MACALUSO J, MUNCH L, NAKADA S, NEWMAN R, PEARLE M, PREMINGER G, TEICHMAN J and WOODS J (2018) LOWER POLE I: A PROSPECTIVE RANDOMIZED TRIAL OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND PERCUTANEOUS NEPHROSTOLITHOTOMY FOR LOWER POLE NEPHROLITHIASIS—INITIAL RESULTSJournal of Urology, VOL. 166, NO. 6, (2072-2080), Online publication date: 1-Dec-2001.SCHUSTER T, HOLLENBECK B, FAERBER G and WOLF J (2018) COMPLICATIONS OF URETEROSCOPY: ANALYSIS OF PREDICTIVE FACTORSJournal of Urology, VOL. 166, NO. 2, (538-540), Online publication date: 1-Aug-2001. Volume 162Issue 6December 1999Page: 1904-1908 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.Keywordskidney calculiendoscopylithotripsy, laserMetricsAuthor Information MICHAEL GRASSO More articles by this author MICHAEL FICAZZOLA More articles by this author Expand All Advertisement PDF downloadLoading ...
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