Search

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%).

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.

n/a

n/a

n/a

n/a

n/a

I am indebted to my friend, Dr. C. C. Moyer of Hartleton, Pa., for this patient, a girl 16 years old, short in stature, light in weight and delicate-looking. She had been suffering from severe vesical trouble for fourteen months. Dr. Moyer said he had sounded her bladder and discovered a large vesical calculus. On the 30th of March last, I placed her in the Jefferson College Hospital. On examination there was no difficulty in confirming Dr. Moyer's statement. Recalling that the relative frequency of stone in the bladder of men to women is as four to one, a fact due, no doubt, to the ease with which an ordinary nucleus can escape from the short and easily dilated urethra of the female, I expressed my surprise at finding so large a calculus in so young a girl. Dr. Moyer had asked her if at some time something could not

n/a

n/a

In our department for paraplegics a total of 554 patients have received treatment during the past i\ years. On 65 of these patients—that is 12 per cent.—84 urological operations were performed: Litholapaxy in 13 cases, T.U.R. of the prostate gland in 23, meatotomy in 7, plastic surgery on the urethra in 4, bladder neck resection in female in 12, in male in 17, and external sphincterotomy in 8 cases. Techniques and results of these operations are discussed. Litholapaxy is indicated for whenever bladder stones are present. T.U.R. of the prostate gland, bladder neck resection and transurethral external sphincterotomy yield good results, when the special indications for these operations are observed.

The new instruments and modified methods introduced by Bigelow, of Boston, for crushing and evacuating vesical calculi seemed at first dangerously severe. In litholapaxy one must often work with his instruments in the bladder for more than an hour, and it naturally impressed surgeons as a rash and perilous procedure. I confess to having felt strong fears in this direction, and many other surgeons were even more timid in the matter than myself. Prof. Paul F. Eve seems to have avoided the new plan almost entirely, and Prof. James R. Wood, of New York, shortly before his death, showed me his collection of vesical calculi, and informed me that he had just cut for stone the ninetieth time, and had never crushed in a single instance. However, experience soon showed that the bladder is far more tolerant of even a whole hour or more of Careful instrumentation, which thoroughly clears

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

Lithotrity at one sitting, as planned and developed by Prof. Bigelow, has revolutionized the treatment of vesical calculus. Those most familiar with this method will agree with me that it is destined not only to supersede the slow lithotrity, but to abolish lithotomy itself in forty-nine fiftieths of the adult cases. I have now performed this operation eighteen times with only one death, though the patients averaged nearly sixty years of age, and the stones were mostly very large. In one of the successful cases the crushed fragments weighed two ounces and five drams, and the patient was about 70 years of age. No such success could have been obtained by cutting on such unpromising cases. Passing by as irrelevant the unpleasant personal controversy between Prof. Bigelow and Sir Henry Thompson, a few words are proper respecting the newly coined word, litholapaxy. By the laws of literature, Prof. Bigelow is

To our knowledge of the very perfect operation of litholapaxy I can contribute nothing important. Indeed, I can add but little to what I said about it in 1899 before the Section on Surgery and Anatomy of the American Medical Association 1 at Newport. At that time I stated my opinion that litholapaxy was the operation of choice for the removal of most stones in the bladder. After a much enlarged experience I wish to express the belief that litholopaxy is the operation of choice in all uncomplicated cases of stone, and having seen this opinion constantly supported and confirmed by such masters of genito-urinary surgery as M. Guyon, Freyer, Keyes, Keegan, Chismore and others, it has been a source of surprise to me to find the operation imperfectly understood and little practiced among the younger generation of surgeons. So great has seemed to me the indifference toward this operation even

The operation of litholapaxy, or lithotrity at one sitting, derived much of its marvelous success from the improved rubber bulbs and metallic tubes devised by Bigelow for the evacuation of the fragments of stone. Yet Bigelow's evacuators, and also those of Sir Henry Thompson, have this serious defect: the rubber bulb makes suction only for an instant. When it reaches the limit of its expansion, it suddenly stops the outward current from the bladder, and arrests in transitu a row of fragments of stone lying along the whole length of the tube, which at the next compression of the bulb are all thrown back into the bladder. Thus a large part of the fragments are pumped out and in many scores of times before they finally escape, and the evacuating stage of the operation is tediously prolonged, often lasting thirty or forty minutes. At the same time the inflamed bladder

In order to make the drift of this paper at once clear, I wish to state at the outset the conclusions I have reached by a study of the results of others in stone operations, and from the moderate experience I have had in these cases myself. Unfortunately, residence in a region where stone in the bladder is rather rare has made the accumulation of personal observations slow, but, on the other hand, my association with Dr. Bigelow has given me unusual advantages in getting an understanding of the operation which he devised and christened "litholapaxy," and of which I shall especially speak to-day. In my opinion, we have in litholapaxy the operation of choice for the removal of most stones. While this is the rule, there are exceptions to it, and the varying conditions surrounding stone in the bladder, will now and then lead us to choose some other

n/a

The apparatus as shown in the accompanying cut consists of an evacuating tube, a glass receptacle, a wire sieve and a syringe. These are connected by means of two pieces of rubber tubing, two glass tubes and one rubber stopper. The evacuating tube, straight or curved, is made after the ordinary pattern. The glass receptacle is five inches in length and one and three-eighths inches in diameter. It is constricted in the lower portion, at which place the lumen is slightly larger than that of the evacuating tube. During the operation the stone fragments fall through this aperture and into the lower portion of the receptacle, where they remain undisturbed by the motion of the fluid in the upper part. The wire sieve is a closed cylinder; it is connected to the rubber stopper by means of a piece of brass tubing; this device serves to prevent any particles from

In the month of September, 1895, I was called in consultation in Johnstown by Dr. A. N. Wakefield and Dr. F. Shill, to see a man about 30 years of age, who stated that he had gravel. The man showed us a small piece of willow twig, half an inch long and about the thickness of an ordinary match, incrusted for half its length with phosphate of lime making the mass one-quarter of an inch in diameter. He had passed this piece of twig from his bladder within a week, also two smaller pieces during the month of January last. He said that in November, 1895, he had shoved up in his urethra a long piece of willow twig and that it had accidently broken off at the head of his penis. As is usually the case with foreign bodies in the urethra, this willow twig had been carried by