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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.

Urolithiasis can result as a complication of urinary diversión, favored by urinary stasis, intestinal mucus, urinary tract bacteriuria, the metabolic derangements and the presence of foreign bodies. We present a 52- year-old male who underwent radical cystectomy with construction of a Bricker uretero-ileostomy. 5 years later he was found with a forgotten ureteral stent, a 6 cm calculi occupying the whole ileal conduit and a 13 mm calculi in the left renal pelvis. We present our experience in the successful endourological management of an encrusted neglected ureteral stent in an ileal conduit, achieving a stone-free status without complications. © 2017 The Authors

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.

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.

1. 1. Because of similarity of technique employed in their removal, urethral and bladder stones are included along with the other types of foreign bodies. 2. 2. Methods usually employed for the removal of urethral foreign bodies are meatotomy, urethroscopy, internal urethrotomy, dilation of urethra, external urethrotomy. Concerning external urethrotomy, the impropriety of opening the pendulous urethra directly over a foreign body is stressed. 3. 3. Methods usually employed for the removal of foreign bodies in the bladder are cystoscopy, injection of solvents, litholapaxy, suprapubic cystotomy, external urethrotomy. 4. 4. Attention is called to several cases of foreign bodies whose removal was accomplished by means of special techniques. 5. 5. The importance of a knowledge of renal function before resorting to operative procedures is stressed.

A new ultrasound lithotriptor in the treatment of bladder calculi is presented. This apparatus simultaneously allows the litholapaxyof the stones under direct observation and suctioning out of the fra

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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.

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

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

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Summary— Despite the availability of lithotripsy and endourology, clear guidelines on the management of impacted upper ureteric calculi are lacking. In this study, 51 upper ureteric calculi treated with in situ extracorporeal shock wave lithotripsy (ESWL) were classified according to the degree of impaction as indicated by proximal back pressure changes. Patients with mild proximal hydronephrosis (or none at all) had a success rate of 93% but only 35% of those in the impacted group (moderate to severe hydronephrosis) had a successful outcome. A percutaneous antegrade approach to 29 impacted upper ureteric calculi resulted in total clearance in 23 cases; 4 other patients were rendered stone-free following additional procedures, an overall success rate of 93%. The only complication was a ureteric stricture in 1 patient. We recommend the percutaneous approach in the management of impacted upper ureteric calculi.

Although many vesical and prostatic lesions are best treated by transurethral technics, procedures of this type are plagued by inherent difficulties and complications not encountered in open surgical interventions. Those seen most frequently are separation of the trigone and perforations through the bladder wall, prostatic capsule or urethra. Since the number of transurethral operations is increasing, we must anticipate a corresponding incidence of operative accidents. Urologic surgeons are well aware of these misfortunes and make every effort to avoid them. However, the possibility that perforation has occurred may either be overlooked or discounted on the basis of wishful thinking. As a result, the most favorable opportunity to correct damage and obviate sequelae may be lost. Injuries of this character usually develop during difficult transurethral resections but may complicate litholapaxy, resection of neoplasms or removal of foreign bodies. A few have resulted from sudden overdistention of the bladder by clot evacuators

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

During the last ten years, lithotomy has been written on extensively. Does this indicate that, in the advancement of surgical technic, lithotomy has become the operation of choice, or that litholapaxy is too dangerous a procedure? The advancement in prostatic surgery no doubt eliminates the stone cases that are complicated with a prostatic hypertrophy as these are today handled at the time of prostatectomy. We have always been of the opinion that in an uncomplicated case of vesical calculus lithotrity or litholapaxy is the operation of choice. OBJECTIONS TO THE PRESENT METHOD Objections to the present method may be divided into two groups: (1) when the plain lithotrite is used, and (2) when the cystoscopic lithotrite is employed. Under Group 1, the objections are that: ( a ) The operation is performed blindly. Everything depends on the sense of touch and good fortune. Neither the instrument nor the calculus is under the

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Believing that perhaps more light could be thrown on the interesting subject of recurrent calculi by an exhaustive study of cases in a clinic as yet unheard from on this problem, I undertook this investigation. Surgical procedure for vesical calculi greatly antedates that for kidney and ureteral calculi. Ultzman1quotes Olympios of Athens as having shown that lithotrity was done in the ninth century. About 1560, Pierre France first removed a vesical stone by suprapubic lithotomy in a child 10 years of age, and the patient recovered. Civiale, Jan. 13, 1824, actually first crushed a vesical calculus by an instrument passed through the urethra. In 1878, litholapaxy was introduced by Henry J. Bigelow of Boston. In 1871, Simon2first performed nephrectomy for renal calculus. In 1880, Czerny first performed pyelolithotomy, and in the same year, Morris first performed nephrolithotomy. In 1901, Israel3reported a case of bilateral