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Cystourethroscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The cystoscopic removal of bladder calculi is limited by the small caliber of the urethra in young children, especially boys. Various forms of intracorporeal lithotripsy have proven to be effective in fragmenting stones. The electrohydraulic lithotripsy (EHL) involves generation of an electric spark that produces a shock wave and a cavitation bubble for stone fragmentation. Other lithotripsy devices include ultrasonic, ballistic, and various forms of laser. It is important to take extreme caution and avoid direct contact with the bladder wall, as these techniques can lead to iatrogenic bladder perforation. For large or multiple bladder stones, retrieval of numerous stone fragments after lithotripsy can be quite difficult, and thus open cystolithotomy may be preferred. Percutaneous removal of bladder stones has also been described, especially in reconstructed bladders where the urethra has been closed.
Urolithiasis
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Thomas Johnston, James Armitage, Oliver Wiseman
Extracorporeal shockwave lithotripsy is recommended as treatment for stones up to 2 cm in all positions within the kidney other than in the lower pole [24]. A meta-analysis undertaken on behalf of the EAU and AUA in 2007 suggested that for proximal ureteric stones smaller than 1 cm, ESWL is more effective than ureteroscopic treatment [11]. However, for proximal ureteric stones larger than 1 cm clearance rates appeared better for ureteroscopy than lithotripsy. This may be explained in that the effectiveness of lithotripsy is dependent on stone size, whereas the effectiveness of ureteroscopic stone management is less influenced by stone size [11].
Management of stones and strictures and interventional sialography
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Michael P Escudier, Jacqui E Brown
All of these techniques required a papillotomy to enable the endoscopically controlled equipment to access the ductal system. In addition to this, the techniques often require expensive equipment and are relatively time-consuming for the success rates achieved. As a result, intracorporeal shock wave lithotripsy is currently of limited clinical importance.
Newly approved devices for endovascular treatment of femoropopliteal disease: a review of clinical evidence
Published in Expert Review of Cardiovascular Therapy, 2019
Stefanos Giannopoulos, Ehrin J. Armstrong
The Shockwave® peripheral IVL system consists of three components: a generator, a connector cable, and a proprietary balloon catheter. The Shockwave® balloon is compatible with 0.014” guidewire. The catheter is manufactured in 6 cm length and in diameters ranging from 2.5 mm to 7.0 mm. In general, the Shockwave® peripheral IVL system has integrated lithotripsy emitters and is designed to enhance PTA at low balloon pressures. After a low-pressure balloon dilation up to 4 atm, mechanical pulse waves are produced that alter the structure of the stenosed vessel. The lithotripsy is performed with 30 pulses delivered in each cycle at 1 cycle per second and is followed by balloon dilation to nominal diameter, usually for at least 2 min. If necessary, repeated lithotripsy can be performed. A single femoropopliteal catheter is capable of 10 cycles [70,71].
Comparing tamsulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomised trial
Published in Arab Journal of Urology, 2018
Md Jawaid Rahman, M. Shazib Faridi, Naloh Mibang, Rajendra Sinam Singh
In all, 135 patients were enrolled in the study, of which 120 patients met the inclusion criteria. After providing written and informed consent, patients were randomised into three equal groups based on computer generated random number table. Group A was given tamsulosin 0.4 mg once daily, those in Group B were given silodosin 8 mg once daily, and those in Group C were given a combination of silodosin 8 mg with tadalafil 5 mg once daily (Fig. 1). In all the groups, drugs were continued until stone expulsion or for a maximum period of 4 weeks. All patients were assessed by physical examination, serum creatinine levels, urine culture, and USG KUB or X-ray KUB when required. Along with the allocated drug, patients were advised to take plenty of fluids and tablet diclofenac 50 mg orally during pain episodes. Patients were followed-up for 4 weeks, after which ureteroscopic lithotripsy was used to remove any stones that had not been expelled. The primary endpoint was the stone expulsion rate and secondary endpoints were stone expulsion time, rates of interventions such as ureterorenoscopy, number of pain episodes, and side-effects associated with MET. The stone expulsion time was defined as the number of days from the random allocation to the expulsion of stone and expulsion of stone was confirmed by USG KUB or X-ray KUB.
Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques
Published in Arab Journal of Urology, 2020
Tarek K. Fathelbab, Amr M. Abdelhamid, Ahmed Z.M. Anwar, Ehab M. Galal, Mamdouh M. El-Hawy, Ahmed H. Abdelgawad, Ehab R. Tawfiek
Ureteroscopic lithotripsy is considered the first-line treatment for ureteric stones that fail to respond to medical expulsive therapy (MET) or shockwave lithotripsy (SWL) [1]. Advances in ureteroscope design and manufacture, as well as stone retrieval devices contribute, to a great extent, in the reported high success rate of ureteroscopic stone extraction [1]. During ureteroscopic lithotripsy, the possibility of stone retropulsion or upward migration limits the success rate. There is a wide variation in the retropulsion rate depending upon the kinetic energy of the lithotripter and ureteric stone level, as proximal stones have a higher rate of stone migration than those that are distally located [1,2].