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Query: UMLS:C0403608 (ureter)
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Between October 1989 and June 1991, 1,250 patients with urinary calculi were treated at our institution using the Siemens Lithostar. A total of 17 patients (1.37%) with radiolucent or slightly opaque calculi underwent lithotripsy with the Lithostar Plus, which has an overhead electromagnetic generator module and a localization system composed of a real-time on-line 3.5 mHz. ultrasound transducer. The stones were located in the calices in 52.9% of the cases, renal pelvis in 17.7%, ureter in 23.5% and bladder in 5.9%. Followup consisted of a nephrotomogram or ultrasound 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 76.4% of the cases after 3 months. Retreatment was necessary in 23.5% of the cases. All treatments were performed without anesthesia and hospitalization. Complications were present in 11.8%; perirenal hematoma was noted in 1 patient but this resolved spontaneously within a few days and the same occurred in 1 patient with renal pain. Extracorporeal shock wave lithotripsy using the Lithostar Plus proved to be an effective noninvasive procedure to treat radiolucent and slightly opaque urinary calculi. However, since the Lithostar Plus has a higher power setting, care must be taken to avoid damage with the use of high energy.
J Urol 1992 Sep
PMID:Extracorporeal shock wave lithotripsy of radiolucent urinary calculi using the Siemens Lithostar Plus. 150 46

Extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for the majority of urinary tract calculi. This form of treatment boasts excellent patient acceptance and has significantly reduced the need for surgical intervention. An evaluation of our first 646 patients undergoing 722 ESWL treatments at Walter Reed Army Medical Center revealed an overall stone-free rate at 1 and 3 months of 52% and 79%, respectively. The exact location of each stone within the kidney and ureter further determined the stone-free rates at 1 and 3 months. Stone-free rates at 3 months ranged from 89% for renal pelvic stones to 64% for lower pole caliceal stones. Upper third ureteral stones treated in situ without stenting resulted in a 74% stone-free rate at 3 months. This rate increased to 85% when these patients were stented and treated in situ. Although statistically insignificant, when the upper third ureteral stones were manipulated into and treated in the renal pelvis (31% of our patient population) the 3-month stone-free rate increased to 87%. Attempts were made to stent all ureteral stones before treatment. The stone-free rate at 3 months was 86% for mid third ureteral stones and 81% for lower third ureteral stones. The overall retreatment rate was 11.8% with a complication rate of 7.6% and a 6.3% post-ESWL intervention rate (open or percutaneous surgery, stent or percutaneous nephrostomy placement).
J Urol 1992 Sep
PMID:An evaluation of 646 stone patients treated on the HM4 extracorporeal shock wave lithotriptor. 150 47

Ureteroarterial fistulas are rare, with less than 20 well documented cases reported. We report a case of a fistula between the left external iliac artery and the left ureter in a patient who underwent a previous operation for bladder cancer. The diagnostic and therapeutic approaches in these rare but high risk patients are discussed.
J Urol 1992 Sep
PMID:Ureteroarterial fistula: a case report. 151 41

A 19-year-old man with crossed ectopia of the vas deferens was investigated with special reference to right hydronephrosis and renal dysfunction. There was no vesicoureteral reflux. The left kidney was hypoplastic or dysplastic and the left ureter emptied into the left seminal vesicle. The right malrotated hydronephrotic kidney was in the lumbar position. The right lower ureter communicated with either the right seminal vesicle or the ampullary portion of the left vas deferens and drained into the bladder at the normal site. The end of the right vas deferens was dilated. The left vas deferens crossed the midline and opened into the right seminal vesicle, leaving the ipsilateral seminal vesicle in the normal position. A search of the literature failed to reveal any similar anomalies.
J Urol 1992 Sep
PMID:Crossed ectopia of left vas deferens, leaving ipsilateral seminal vesicle in normal position. 151 48

In a period of twenty-seven months, 15 patients with ureteral trauma were encountered, leading us to believe that there is an increasing incidence of these injuries. The injuries were caused by blunt trauma in 3 patients and gunshot wounds in 12. All patients sustained injuries to other organs as well as the ureter. The diagnosis of ureteral injury was frequently delayed beyond the day of presentation (33%) primarily due to the number and severity of associated injuries. The most accurate methods of diagnosis were surgical exploration and retrograde pyelography. Intravenous pyelography and abdominal computerized tomography scanning were diagnostic in only 33 percent of cases. Hematuria was present in only 63 percent of patients who had no other genitourinary injuries, emphasizing the lack of reliability of this sign in ureteral trauma.
Urology 1992 Sep
PMID:Ureteral injury due to blunt and penetrating trauma. 152 43

We describe the eight case of idiopathic retroperitoneal fibrosis infiltrating the ureter to cause intrinsic obstruction. Discovery of this situation intraoperatively necessitates a change in treatment plan, as ureterolysis is not sufficient.
Urology 1992 Sep
PMID:Idiopathic retroperitoneal fibrosis infiltrating ureteral wall. 152 56

A thirty-two-year-old Samoan woman was referred for evaluation of "unstable bladder" and a history of continuous life-long urinary incontinence. A comprehensive radiographic and urodynamic evaluation demonstrated the unusual combination of a vaginal ectopic ureter draining a dysplastic kidney and genuine stress urinary incontinence. Appropriate treatment based on the recognition of both abnormalities resulted in restoration of continence.
Urology 1992 Sep
PMID:Ectopically draining dysplastic kidney associated with genuine stress urinary incontinence: unusual combined cause of incontinence. 152 58

ESWL does not remove the kidney stone, but pulverizes it into tiny particles so that it can be excreted with the urine. Drainage and percussion treatment after ESWL helps excrete particles from the kidney to the ureter much more rapidly and with less trauma, pain, and blood urine, and fewer medications for pain are needed as the particles pass through the urine. Teaching the principles behind this treatment will lead to greater patient compliance and success.
Urol Nurs 1992 Sep
PMID:Percussion after extracorporeal shock wave lithotripsy. 152 62

The in vitro evaluation of a pulsed Nd:YAG laser, showed an effective and fine fragmentation of urinary calculi and showed only minimal subepithelial bleeding in the directly irradiated canine ureter. Since 1989 we have treated ureteral calculi in 30 patients. The laser pulses of 15-20 mJ (at fiber tip), 20 ns, 20-25 cps are transmitted by a 300-microns quartz fiber with a specially formed tip focusing the light. The fiber is passed through an 11.5-F ureteroscope within a guide tube, or, without a guide tube, through one of the new minimized ureteroscopies and is placed in front of the calculus. In 27 patients the procedure was successful, without any residual concretions after 1 day. In our opinion the advantages of this method are the very fine-grained, complete fragmentation of all sorts of calculi, the highly atraumatic procedure, and the absence of either optical or acoustic irritation to the operator.
Urologe A 1991 Sep
PMID:[Laser lithotripsy of ureteral stones. Personal experiences]. 168 42

With the extended use of transurethral endoscopic surgery, we modified the conventional nephroureterectomy that usually requires either a very long incision or two separate shorter incisions. From August 1983 to October 1988, 13 cases of renal pelvic tumor in this hospital were treated single-incision nephroureterectomy combined with transurethral incision of the bladder cuff. The advantages of this technique were less surgical time and a decrease in postoperative wound pain. There were no significant complications or local recurrence noted in this series. The proposed indications were urothelial tumors in the renal pelvis and upper ureter without demonstrable metastases. Tumors of an uncertain cell type preoperatively are especially indicated. The details of this technique are described.
J Formos Med Assoc 1991 Sep
PMID:Single-incision nephroureterectomy combined with transurethral incision of bladder cuff for renal pelvic tumor. 168 83


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