Portal de Periódicos da CAPES

UPDATE ON INTERVENTIONAL URORADIOLOGY

1997; Elsevier BV; Volume: 24; Issue: 3 Linguagem: Inglês

10.1016/s0094-0143(05)70405-5

1558-318X

Ray Dyer, Dean G. Assimos, John D. Regan,

Pediatric Urology and Nephrology Studies

More than 40 years have passed since Goodwin et al44 reported on "percutaneous trocar (needle) nephrostomy in hydronephrosis." After a period of relative neglect, interest in the technique was rekindled with reports of the successful creation of large-bore nephrostomy tracts for percutaneous stone extraction.82, 84, 110 As the team of urologist and interventional radiologist gained experience, percutaneous nephrostolithotomy (PNL) became the primary method of treatment for stones of the upper urinary tract, and the performance of percutaneous renal entry became an almost daily occurrence in most large medical centers. The field of interventional uroradiology was born.Approval by the Food and Drug Administration of the first device for the performance of extracorporeal shock wave lithotripsy (ESWL) in 1984 led to rapid substitution of ESWL for PNL as the primary mode of treatment for most upper urinary tract stones. As experience was gained with ESWL, limitations of the technique were defined. It was recognized that percutaneous techniques were still necessary as primary or supplemental therapy in some patients. The experience previously gained with percutaneous techniques, coupled with technologic advances in instrumentation, continued to broaden the indications for performance of percutaneous renal entry12, 35, 105: Indications for Percutaneous Renal EntryUrinary diversion Supravesical obstructionFistula managementAdjunct therapy for complex infectionsCalculus disease Primary therapyCombined with ESWLNephroscopy and ureteroscopy DiagnosticTherapeuticUreteral interventionAt the authors' institution, which is a center for treatment of stone disease, the authors average four to six new renal entries per week, about half of which are performed for complex urinary tract stones. Urinary diversion for obstruction not related to stones accounts for about one third of the entries. Also included are many unique problems that can be managed with percutaneous techniques but in the past frequently required major surgical intervention. Familiarity with basic entry techniques allows the application of interventional uroradiologic procedures to the transplant kidney and to the bladder. Applying new technologies, such as metallic stents, to difficult management problems also appears promising.