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Query: UMLS:C0403608 (ureter)
 9,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal and ureteral calculi are treated primarily using extracorporeal lithotripsy, with percutaneous nephrostolithotomy retaining an important role for the treatment of large stones and complex situations. Aspects of pretherapy evaluation are reviewed. The vast majority of calculi 5 mm or less in diameter in the mid and lower ureter will pass spontaneously; in patients with acute ureteral obstruction, lower-osmolar nonionic contrast for urography caused as much discomfort as conventional high-osmolar contrast. Treatment planning for extracorporeal lithotripsy has changed in that internal stenting is no longer routinely recommended. Milk-of-calcium and calyceal diverticular stones respond poorly to extracorporeal lithotripsy. The access route used for percutaneous stone removal varies among investigators. Some advocate an intercostal approach for up to one third of patients; substantial complications occur with placement of a track above the 11th rib. Sepsis develops after percutaneous nephrostomy in up to 21% of patients, but the risk of sepsis can be decreased significantly by the administration of antibiotics during and after the procedure. Complications of extracorporeal lithotripsy include renal hematoma (especially if the patient is hypertensive or is taking aspirin), regional organ injury, and bacteremia. Although originally feared to occur frequently, hypertension occurring after or caused by extracorporeal lithotripsy was not confirmed to be a major problem. The incidence in a 2-year postlithotripsy follow-up was no greater than that for control subjects.
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PMID:Radiology and treatment of urinary tract stone disease. 155 85

Between March 1988 and March 1990, 751 patients were treated with shock wave lithotripsy using EDAP LT-01. Six hundred and eight patients had renal stones while 143 patients had stones located in the ureter. Because of difficulties in locating ureteric stones with ultrasound 92% of them were pushed back to the kidney before treatment. The mean stone size was 10 mm, range 4-30 mm. Patients with stones bigger than 15 mm had a double J-stent placed before treatment. The mean number of treatments per patient was 1.7 (range 1-8). Sixty-six per cent of the patients with renal stones were completely stone-free after ESWL monotherapy. Another 5% became stone-free after auxiliary procedures in the ureter, because of retained fragments. Fragments equal to or less than 4 mm were retained in 14% of the patients with the renal stones. Of the patients with ureteric stones mobilised back to the kidney 95% were rendered stone-free after ESWL. Most patients experienced no or very little discomfort during the treatment and only 29% of them received analgesics. General of epidural anaesthesia was given to 1% of the patients. Because of the low demand for analgesia or anaesthesia, 99% of the patients with renal stones were treated on an outpatient basis. During the second year, 74% of the patients with ureteric stones were treated on an outpatient basis.
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PMID:Outpatient-based extracorporeal shock wave lithotripsy using EDAP LT-01. 178 16

Anesthesia for radiologic procedures is usually provided in locations remote from the operating theater. The anesthesiologist is removed from the environment in which experienced support is available for the care of anesthetized patients. Therefore, reliable anesthetic techniques that cause the least perturbation in the patient's physiology are often preferred. This is a report of the application of a paravertebral and lumbar sympathetic block to provide anesthesia for the renal pelvis and ureter so that percutaneous radiologic procedures that involve the manipulation and dilation of those areas can be performed with minimal patient discomfort.
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PMID:Anesthesia for percutaneous renal procedures. 195 12

In recent years, there has been a complete change in the treatment of reno-ureteral lithiasis due to the availability of new endourological techniques (percutaneous nephrolithotomy, ureteroscopy) and particularly due to the development of extracorporeal shock wave lithotripsy (ESWL). The present study assessed the combination of endourological procedures and ESWL in the treatment of calculi localized in the kidney and lumbar ureter. A prospective study was undertaken to assess 1,500 renal units with calculi in the renal cavity and lumbar ureter that had been submitted to treatment by ESWL and endourological techniques. The results demonstrate that ESWL combined with percutaneous and endoscopic techniques affords effective treatment without major complications in 85.4% of calculi in the renal cavity and lumbar ureter. Treatment with ESWL as monotherapy was successful in 45.6% of the cases and endourological management prior to ESWL was successful in 39.8% of the cases. The most common complication of ESWL was colic and/or kidney referred discomfort (28.6%) and the most important complication was urinary tract obstruction following ESWL (9.67%). These required maneuvers to remove post-ESWL obstruction in 6.1% of the renal units treated. The number of shock waves employed and the kV utilized were associated to intense hematuria and perirenal hematoma. The combination of endourological techniques with extracorporeal shock wave lithotripsy completely eliminated calculi in 80.5% of the renal units at 3 months. 10.5% had remaining stone fragments that could be spontaneously passed, and 7.6% had larger residual fragments that could not be passed.
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PMID:[Treatment of reno-ureteral calculi using ESWL and endourologic technics]. 263 40

The established treatment for ureterointestinal anastomotic strictures is open surgical revision. In an effort to evaluate the efficacy of endourological surgery for this problem, we compared 7 patients (9 strictures) who underwent open revision to 6 patients (7 strictures) who underwent endoscopic incision and balloon dilation of the stricture. The success rate (that is patent ureter and no stent) was 89 per cent for the open revision group and 71 per cent (5 of 7) for the endoscopic group. All open revisions required use of general anesthesia, while 3 of the endoscopic procedures were performed with the patient under assisted local anesthesia. The endoscopic group had markedly shorter hospitalization, decreased blood loss, diminished patient discomfort and no postoperative complications. While the endoscopic procedure for ureteroileal anastomotic strictures is less successful than open revision, the lower morbidity, decreased cost and shorter hospital stay associated with the endourological approach favor its use over open revision. For elderly patients who fail initial endoscopic revision and for patients with metastatic transitional cell cancer, placement of an indwelling stent is a reasonable alternative. Given these guidelines, less than 30 per cent of the patients who suffer a ureteroileal anastomotic stricture will require open surgical revision.
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PMID:Management of ureterointestinal anastomotic strictures: comparison of open surgical and endourological repair. 337 85

In ten patients, who underwent ESWL of renal calculi and had severe ureteral colic due to acute obturation of the ureteral lumen by larger stone fragments, i.v. glucagon injections combined with laevulose infusion were applied. All patients reported relief of pain and discomfort within 15-20 minutes after glucagon injection. Position of the stones in the ureter was regularly checked. No particular adverse effects of glucagon were noted. Glucagon increases GFR and diuresis and exhibits spasmolytic effect on the smooth muscle of the ureteral wall, thus facilitating the passage of stone fragments after ESWL. In certain cases and with certain indications we recommend the method as highly effective.
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PMID:A new method for the management of ureteral colic after extracorporeal shock wave lithotripsy. 340 92

Diagnostic puncture of the renal pelvis with a fine-gauge needle inserted under radiological and ultrasound control, has been performed in more than 100 cases. The method is safe, easy to perform for those trained in imaging modalities, and causes little discomfort. Pyelography and pressure flow studies can be made and urine specimens obtained from the upper urinary tract. Skinny needle pyelography is indicated in unilateral non-visualization of the ureter on intravenous pyelography, in acute oliguric renal failure when ultrasound reveals dilated ureters, and when retrograde pyelography is not feasible. The method is cost-effective, as it can be performed on outpatients as a follow-on procedure after intravenous pyelography or renal ultrasound scanning.
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PMID:Skinny needle pyelography. An advance in uroradiology. 702 95

The authors describe a percutaneous method of establishing a channel betweeen the ureter and bladder across an obstruction. This technique, which involves a balloon catheter and placement of pelvivesical stents to provide internal drainage, is useful when the underlying disease contraindicates surgery and when retrograde catheterization from the bladder has failed. Palliation is achieved with little discomfort or risk to the patient.
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PMID:Percutaneous antegrade bilateral dilation and stent placement for internal drainage. 735 34

In this manuscript we describe our initial experience with 22 patients who underwent laparoscopic nephrectomy at our institution. Of the 22 patients, 16 patients had benign disease, and 6 patients had malignant disease. Of the 6 patients with malignancy, 3 patients underwent laparoscopic nephroureterectomy for transitional cell cancer of the upper urinary tract. In 21 patients, a transabdominal approach was utilized, whereas 1 patient underwent laparoscopic nephrectomy using an entirely retroperitoneal approach. Laparoscopic nephrectomy showed lengthy operative times, but resulted in reduced postoperative discomfort, shortened hospital stay, and rapid convalescence. As laparoscopic nephrectomy has been performed with reproducible success by various other groups worldwide, further refinements in surgical technique, paired with advances in laparoscopic instruments designed for stapling and suturing, will most likely result in an increasing application of the principles of laparoscopy to diseases of the kidney, renal pelvis and ureter.
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PMID:Laparoscopic nephrectomy: current status. 823 35

A vaginal or a laparoscopic approach in radical surgery for cervical carcinoma has been proposed. A pilot study of eight cases shows that an oncologic surgeon familiarized with these techniques is able to take advantage of the benefits of both routes in the same patient: laparoscopic surgery is adapted to lymph node dissection, section of the origin of the uterine artery, and dissection of the ureter under direct vision; vaginal surgery allows a precise incision of the vaginal cuff. Both routes may be used for the section of parameters, but we propose the use of the vaginal route. The combination of vaginal and laparoscopic surgery spares the pain and discomfort of both laparotomy and perineotomy.
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PMID:Laparoscopically assisted radical vaginal hysterectomy. 827 2


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