Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0451641 (urolithiasis)
 3,973 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Extracorporeal shock wave lithotripsy (ESWL*) has revolutionized management of most patients with urolithiasis. The effect of ESWL on patients with an aortic aneurysm is unknown and its safety is questioned by the absence of any case reports in the urological literature. A 68-year-old man with an abdominal aortic aneurysm underwent successful ESWL using the Medstone STS 1050 lithotriptor for right renal calculi. Continuous monitoring of the aneurysm was done using real-time ultrasound during the ESWL treatment. Careful preoperative evaluation in conjunction with appropriate intraoperative and postoperative monitoring makes ESWL management of patients with associated aortic aneurysm possible.
 ...
PMID:The use of extracorporeal shock wave lithotripsy in patients with aortic aneurysms. 185 43

Spinal cord injury patients are at increased risk for urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy. New, second generation lithotripsy devices allow treatment without tub immersion, and without general or regional anesthesia for most patients. Spinal cord injury patients, with loss of sensation below the level of injury, would seem to be ideal candidates for such treatment. We present our experience with 20 consecutive spinal cord injury patients treated without anesthesia on the Medstone STS second generation lithotriptor. All patients were awake and experienced no direct sensation from the shock waves. All but 1 patient (T12 level), however, experienced autonomic dysreflexia, with significant elevations in systolic blood pressure (mean increase 44 mm. Hg, maximum 74) and diastolic blood pressure (mean increase 24 mm. Hg, maximum 61), with reflex bradycardia (mean decrease -22 beats per minute). Autonomic dysreflexia was successfully treated in this setting with short-acting sublingual nifedipine. Associated bradycardia was treated with atropine in 6 patients. Preoperative bowel preparation proved to be useful in spinal cord injury patients to maximize stone imaging and may decrease autonomic dysreflexia if this is caused by shock waves impacting on the distended bowel. Other problems included uncontrolled skeletal muscle spasms elicited by shock waves, which proved to be troublesome in maintaining patient position and stone localization. Muscle spasms were decreased with benzodiazepines. Care was also observed in spinal cord injury patients to pad all pressure points on the hard, dry treatment surfaces associated with second generation lithotriptors and, thus, prevent skin breakdown.
 ...
PMID:Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor. 848 11

Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to nonobese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to nonobese patients), difficulty may be encountered in positioning the patient so that the stone is situated at the F2 focal point of the lithotriptor. Using various aids, such as the extended shock pathway and abdominal compression, we treated 81 patients weighing more than 300 pounds using the Medstone STS tubless second generation lithotriptor. The stone-free rate at 3 months or longer was 68%, with another 10% having asymptomatic fragments of 4 mm. or less in diameter. Thus, a clinical stone-free rate of 78% was achieved. The retreatment rate was 11% and the post-lithotripsy secondary procedures rate was 3%. Since these results are comparable to those obtained when treating patients less than 300 pounds, extracorporeal shock wave lithotripsy can be used successfully to treat urolithiasis in morbidly obese patients.
 ...
PMID:Extracorporeal shock wave lithotripsy in morbidly obese patients. 851 Feb 69