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Palliative care in itself has many challenges; these challenges are compounded exponentially when placed in the setting of a mass casualty event, such as the 2010 Haiti earthquake. Haiti itself was an austere environment with very little infrastructure before the disaster. US surgeons, intensivists, and nurses worked hand in hand with other international providers and Haitian volunteers to provide the best care for the many. Improvisation and teamwork as well as respect for the Haitian caregivers were crucial to their successes. Sisyphean trials lie ahead. Haiti and its people must not be forgotten., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Children have been slow to benefit from the improvements in stone therapy. Despite the success of less invasive techniques, open surgery for pediatric urolithiasis is still commonly practiced. The authors' goal was to evaluate the indications, efficacy, and complications of endourologic surgery in the treatment of pediatric urolithiasis. They reviewed the treatment of 53 children who had upper tract calculi. Open nephro- and ureterolithotomy were avoided in all cases. The management of 25 children whose stones were not amenable to extracorporeal shock wave lithotriopsy is presented. Seventeen children (19 stones) were treated with miniature ureteroscopes and lasertripsy. Only one (6%) of the patients required ureteral dilation, and only five (29%) needed a postoperative internal stent. Eight children with large renal calculi were treated percutaneously, without transfusion, complication, or evidence of persistent renal damage. All 25 patients were rendered stone-free. The hospital stay was shorter and secondary procedures were less common in comparison to other series of endoscopic lithotripsy. With significant experience in adult endourology and proper instrumentation, one can apply the same techniques to children and achieve equal if not greater benefit. Nephrolithiasis in children is uncommon and should be managed in an institution where endourologists and multiple treatment modalities are available.

Kaufman reported a severe ureteral injury following ureteroscopy in 1984. His commentary summarizes the important messages in this article well: The intent of this report is not to denegrate the splendid advances in nephroscopy and ureteroscopy, but rather to introduce a sobering message that the patient must be informed of the inherent risk of such procedures and that the urologist must be wary of the problems that might occur. Problems have been known ever since endoscopic instrumentation was first introduced, and every experienced urologist has had his share of problems associated with stone extraction and other endoscopic procedures. Traditional teaching in urology has been to eschew manipulation of stones in the upper two thirds of the ureter because the lumbar ureter is mobile and more easily damaged by instrumentation than the pelvic segment. Endoscopic visualization of stones in the upper ureter allowing accurate grasping of calculi would appear at first to provide an element of security heretofore unachievable, but urologists nonetheless should be mindful of the hazards of any type of stone extraction from the upper ureter. Urologists must be ready and equipped to handle emergencies associated with new instruments and techniques, and the patients must be apprised of the exigencies. "Caveat emptor" (buyer beware) could not be a more apt or timely maxim in our specialty. Ureteroscopy has greatly aided many patients, and a large number of urologists have integrated this procedure into their daily practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Upper tract tumors may be diagnostic problems, and the importance of obtaining tissue in a closed fashion has been illustrated. This is probably the most important advantage of the ureteroscopic approach to these tumors. Ureteroscopy is safe and reliable and allows examination of about 95 per cent of all patients evaluated. Success rates will continue to improve with the expanded use of flexible instruments. Ureteroscopy may also be used for treatment. However, before this mode of therapy can be accepted, further work must be done comparing the findings of the endoscopic biopsy with the pathologic stage of the cancer. Nevertheless, it does appear that low-grade localized distal ureteral tumors can be managed effectively by ureteroscopic means. Possibly low-grade tumors in the renal pelvis can also be managed by this method (see also following article). Again, methods of surveillance such as radiographic studies and urinary cytology must be used in addition to endoscopic examination for follow-up (Table 2). Extensive pyelocaliceal tumors, high-grade pelvic tumors, and high-grade ureteral tumors probably cannot be managed effectively by ureteroscopic means. Either polychronotropism or failure to control a primary tumor may prove an indication for adjuvant topical therapy. Potential side effects such as systemic absorption resulting in myelosuppression need to be considered. However, if standard dosages known to be relatively safe intravesically are employed, there should be no significant problems.