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The objective: optimization of approaches to the choice of endoscopic ureterolithorpsy method in the presence of large stones of the proximal ureter. Materials and methods. For the period 2017–2020 y. the study included 136 patients with large stones of the proximal ureter, who were performed one of two methods of ureterolithotripsy: rULT (group I) or m-aULT (group II). In group I 73 (53,7%) patients were operated, in group II – 63 (46,3%) patients. The age of patients ranged from 18 to 81 years, the average age was 52,7 years (54±10,5). The age of patients in group II ranged from 25 to 77 (63±10,5) years; the size of a concrement from 10 to 20 (14±3,5 mm). In group I, the age of patients ranged from 18 to 91 (63,5±10 years); the size of a concrement from 7 to 20 (12±5,5 mm). Results. The average time of m-AULT was 58,5±15,4 min, while the status of stone free was achieved in all 100% of patients. The operation ended with the installation of nephrostomy drainage in 11 (17,5%) cases, nephrostomy drainage and internal ureteral JJ-stent – in 33 (52,4%), in 19 (30,2%) cases – tubeless drainage method with the installation of ureteral stent. And the total percentage of stenting in staghorn stones of the proximal ureter, after lithotripsy and litholapaxy was 82,6% (52 patients). RULT surgery in 92% (67 patients) of cases ended with drainage of the kidney by JJ-stent, in 6 (8%) patients the operation ended without drainage. Conclusions. Analyzing the results, it was noted that the antegrade approach is a safe and effective method of treatment for proximal ureterolithiasis in the group with large stones of the proximal ureter, where the effectiveness of RULT (SFR up to 86,3±3,9%) is significantly inferior to AULT, and minimizing the size of instruments m-aULT) reduces the number and degree of complications associated with the size of the coiled tract, while providing a high level of SFR (96,8±4,4%).

Reginald Harrison (1837 – 1908) was one of Liverpool’s most famous surgeons; in the late 19th Century he was well known to both the London and provincial medical world. Working at both the Royal Infirmary and Northern Hospital in Liverpool he developed an interest in genito-urinary surgery, becoming a notable expert. Hence, in 1899 he moved to London where he was appointed Surgeon to St Peter’s Hospital for the Stone, England’s first urology hospital. Harrison observed Bigelow’s early cases of litholapaxy in Boston, USA and championed the technique in England. He was an expert in urethral stricture disease, favouring gentle dilatation with filliform bougies, which became known as Harrison’s Whips. He was an energetic Dean of the Liverpool Medical School and was active in its eventual rise and transformation into the University of Liverpool. He also tirelessly campaigned for the introduction of ambulances to Britain’s towns and cities. His efforts led to Europe’s first civilian hospital ambulance being introduced in 1883 at the Northern Hospital in Liverpool. Reginald Harrison is a somewhat forgotten name in urology today, but his contributions to Liverpool’s University, the Ambulance Service and British urology should be celebrated and remembered.

Hydronephrosis (HN) is a disease characterized by progressive distention and dilation of the pyelocaliceal system, which are caused by pelvoureteral segment stenosis and urine outflow problems. Increased hydrostatic pressure in the pyelocaliceal system gives rise to parenchymal atrophy and diminished renal function. Prior to the end of puberty, HN is more common in boys than in girls. In 20-to-40-year-old adults, HN occurs in 1 % of cases; being 1.5 times greater in women than in men. Modern urology has achieved a notable advance in treating patients with HN. Highly informative diagnostic techniques allow the detection of this disease at early stages and the choice of the most effective approach to managing the patients. The first laparoscopic pyeloplasty was performed by W. Schuessler in 1993. Up to date, it is the gold standard for HN surgery. Pelvoureteral segment stenosis and HN are often complicated by secondary lithogenesis. The quest of novel effective procedures for pyelocaliceal litholapaxy is due to technical complexities and a large number of residual calculi. This paper describes the use of flexible pyelocaliceal lithoextraction in a patient with secondary renal calculi during laparoscopic pyeloplasty.

Urolithiasis has been described in all civilizations in the antiquity, including India, China, Egypt, Persia, Greece, and Rome. This disease along with the herbal treatment attempting to prevent or to cure it are as old as the mankind itself. Perineal lithotomy was reported in the ancient India, the Greco-Roman period, throughout the islamic medieval period, and in the european renaissance. Nonetheless this procedure was associated with a very high mortality rate. Lithotripsy and litholapaxy were developed in the 19th century resulting in a dramatic decrease of the related mortality. Further important surgical advances have been achieved throughout the 20th and the beginning 21th centuries.

Purpose The optimal treatment options for lower pole stones with a diameter below 15 mm are controversially discussed. Extracorporeal shock wave lithotripsy (ESWL) is non-invasive but is hampered by low stone-free rates and a significant retreatment rate. Flexible ureterorenoscopy (URS) has been demonstrated to have high stone-free rates but the treatment costs - consisting of OR time, repair costs and expenditure for laser fibers, guide wires and stone baskets - as well as low stone-free rates with increasing stone size render this procedure highly expensive. Minimally invasive percutaneous litholapaxy (MIP) has shown low morbidity and high efficacy in the treatment of nephrolithiasis. The goal of this study was to investigate the efficacy and -safety of MIP for the treatment of small lower pole stones. Patients and method The charts of 29 patients who were treated with MIP were reviewed and clinical data like OR time, drop in haemoglobin, complication rate, stone-free rate and duration of hospital stay were collected. Results 28 of 29 patients were primarily stone-free; one had to undergo additional flexible URS to become stone-free. All procedures were undertaken with only one access, no severe complications occurred; none of the patients had to be transfused. Conclusions The MIP concept has a low complication rate and has been shown to be safe and effective in previous studies. We demonstrate that the feasibility and efficacy justify the percutaneous approach also for small lower pole stones.

Objective To assess a new lithotripter for intracorporal lithotripsy, which combines the mechanically driven pneumatic LithoClast™ (Electro-Medical Systems, Nyon, Switzerland) and a new ultrasonic device (Electro-Medical Systems), for use in percutaneous nephrolitholapaxy (PNL). Patients and methods The new lithotripter consists of a LithoClast Master with 12 Hz repetition rate and a new ultrasonic device. The 1.0 mm LithoClast probe is advanced off-centre through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. A new irrigation system with a pinch valve compressing the irrigation tube, a foot-switch for activating the ultrasound, the LithoClast and both together, and a stone bucket at the outlet tube are new features. Between February 1999 and August 2001, 68 patients were treated by PNL with the new device; 35 had complete and 33 had partial staghorn calculi. PNL was administered under fluoroscopic control and with the patient prone. Results The mean (range) duration of surgery was 61 (42–119) min. The complete stone-free rate was 66% after the first PNL; of the 68 patients, 16 received a second PNL, giving a final stone-free rate of 76% and 80%. The stone was composed of calcium oxalate monohydrate (COM) in 13%, COM with uric acid in 35%, apatite in 20% and cystine in 11%. Clinically the new lithotripter was very effective, producing smaller stone particles and thus fewer residual stone fragments after PNL than with the LithoClast or ultrasonic fragmentation alone. Conclusion The new lithotripter provides easily managed and highly effective stone fragmentation of all stones, regardless of their composition.

To evaluate the safety and efficacy of endoscopically guided percutaneous suprapubic artery forceps litholapaxy for pediatric vesical and posterior urethral stone1 cm in diameter.A retrospective series study of 73 children (68 boys and 5 girls) with vesical and urethral stones less than 1 cm in diameter with an average age of 3.5 years (range 1-9 years) were included in this study. Cases with previous suprapubic surgery, stones of more than 1 cm in diameter, multiple bladder or urethral stone, anterior urethral stones and cases with neurological or anatomical abnormalities were excluded from our study. The bladder was filled and punctured suprapubically by an artery forceps under the vision of the pediatric cystoscopy then the stone is completely crushed. All intraoperative and postoperative complications were recorded. The stone-free rate status was evaluated 2 weeks postoperatively using plain X-ray/ultrasonography.All cases were successful, and the stones were completely crushed to smaller insignificant fragments in a single session. No intraoperative bladder perforation or bleeding was recorded. The mean operative time was 12.5 min (ranging from 9 to 17 min). There were no postoperative complications apart from 2 cases of persistent suprapubic leakage postoperatively for 24 h and the leakage stopped after 48 h with the insertion of 8 Fr Foley catheter. In all cases, no significant stone fragments were found 2 weeks postoperatively.Our technique for management of pediatric vesical and posterior urethral stone less than 1 cm is an easy and safe with no intraoperative or postoperative significant complications.

Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.

Ureterorenoscopy rendered the endoscopic removal of ureteroliths possible. Big distal ureteroliths which do not pass spontaneously and for which ureterolithotomy is unavoidable, are treated by means of ureterorenoscopy which makes ultrasonic disintegration or stone extraction with a Dormia loop possible, and this under optical control too. The different techniques and strategies are presented. In animal experiments alterations of the urothelium after exposure to ultrasound were examined. There is the possibility to combine ureterorenoscopy with the percutaneous method of litholapaxy or ESWL when treating ureteroliths in the upper part of the ureter which do not pass spontaneously.

The surgical treatment of renal calculi has been markedly changed by percutaneous manipulation and ultrasonic dissolution. The low morbidity and decreased cost of this procedure make it an obvious choice over classic surgical operations. We report our experience with percutaneous ultrasonic stone dissolution in 23 patients.

Tactile litholapaxy is a safe procedure and is not difficult to learn. It can be used for stones up to 5 cm. in diameter unless the stone is very hard. The bladder is distended with irrigating fluid, the lithotrite passed, the jaws opened, and the lower jaw depressed against the floor of the bladder and vibrated to allow the stone to roll on to it. The upper jaw is depressed against the stone, the threads at the handle are meshed, and the stone is crushed. Fragments are crushed in like manner and are then washed out through a resectoscope sheath. It is easier to do and more efficient in both length of operating time, absence of complications, and shorter hospital stay when compared with visual litholapaxy and cystolithotomy.

Pelvic urethrotomies were attempted on 32 bulls (12 cattle and 20 buffaloes). Infra-anal urethrotomy was carried out under a tranquilliser, posterior epidural and supra-ischial blocks. Prebulbomuscular urethrotomy was performed under a tranquilliser, posterior epidural and pelvic plexus blocks. Cystoscopy and litholapaxy were attempted to make comparisons. The animals which had been operated on were maintained for one month during which postoperative signs were noted, and after they were killed post mortem, radiographic, macro- and microscopic findings were recorded. From the results it is concluded that infra-anal urethrotomy presents difficulties whereas prebulbomuscular urethrotomy, especially the closed technique, is suitable for cystoscopy, pelvic lithotomy and litholapaxy.

A method for removal of a staghorn calculus from the kidney through 1 channel of a U-tube nephrostomy is presented. An ultrasound lithotriptor provided a safe and quick alternative to surgical treatment

The surgical management of 652 cases of bladder stone, with particular reference to the value of litholapaxy, is discussed. The majority of cases can be treated by closed methods--litholapaxy and transurethral removal. Those cases treated by closed methods have a reduced postoperative complication and morbidity rate, a shorter operating time, and a reduced period of hospitalisation. Provided the necessary skill is acquired, it is concluded that litholapaxy is a safe and efficient method of dealing with bladder stones.

Operative treatment of urinary calculous disease has been the method of choice for many years, although the possibility of percutaneous manipulation was first demonstrated more than 40 years ago. On the path to modern endourology, Rupel and Brown (1941) set a milestone by endoscopic removal of a stone via the operative nephrostomy track. Only in the past 10 years, however, have technical innovations led to a breakthrough in the form of new nonoperative therapeutic modalities, including percutaneous stone manipulation and extracorporeal shock wave therapy.

Percutaneous nephrolitholapaxy (PCNL) can be used independently or in combination with extracorporal shock-wave lithotripsy (ESWL). The major complication of PCNL is the possibility of leaving rest stones in the renal cavity or in the surrounding tissues. Especially frequent rest stones are found after surgery by less trained surgeons (1–3, 5–6). The term ‘rest stone’ means a smaller or larger calculus remaining after PCNL, for different reasons. Sometimes it is not convenient to reach calyceal stones or fragments by the rigid nephroscope (4).

Percutaneous stone manipulation has gained increasing popularity in the past 5 years. Following initial experience with stone dissolution as the least invasive form of percutaneous stone manipulation, litholapaxy and extraction emerged as a more efficient method of treatment which is independent of the composition of the calculi. With an average of 4–6 days of hospital stay and a low complication rate, percutaneous litholapaxy has now become an attractive alternative to operation.

Ten patients with slightly radiopaque urinary calculi were treated by percutaneous litholapaxy or even open surgery. The stone analysis revealed uric acid as the main stone composite suggesting that these patients should have been treated by oral litholysis alone alkalinizing the urine and decreasing uric acid levels with allopurinol. CT density measurements proved that concrements with HE less than 600 can be successfully dissolved by oral medication alone. Twenty-four patients were subsequently treated by oral citrate alkalinizing the spontaneous urine to pH 6.8-7.2 dissolving even large staghorns within 6-8 weeks. CT density measurements have become a routine diagnostic procedure when poorly radiopaque calculi are found on the standard plain film. The patient can thus be spared invasive treatment which is unnecessary in most cases.