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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.
Bile duct stones
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
In the vast majority of centres carrying out this type of work the only available technique for stone fragmentation is that of mechanical lithotripsy. Only this technique will be discussed from the practical standpoint, although laser and electrohydraulic lithotripsy are mentioned in general terms above. There are two types of lithotripter in common use. The most popular of these is the through-the-endoscope lithotripter; the second approach is using an outside-the-endoscope technique in which lithotripsy takes place after the endoscope has been withdrawn.
Questions
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
Primary treatment of this condition is? Extracorporeal shock wave lithotripsyUreteroscopy – electrohydraulic lithotripsyOpen ureterolithotomyLaparoscopic ureterolithotomyUreteroscopy with use of Darmia basket
Bouveret syndrome as a rare cause of gastric outlet obstruction
Published in Baylor University Medical Center Proceedings, 2020
Pujitha Kudaravalli, Sheikh A. Saleem, Alexandra Goodman, Venkata Satish Pendela, Muhammad Osman Arif
Management of Bouveret syndrome depends on patient comorbidities, the location of obstruction, the size of the stone, and the presence of a fistula.7 Endoscopy should be the first step in patients with advanced age and comorbidities. Cappell et al5 reported that endoscopy identified a gastroduodenal obstruction in all reported cases, but a stone was identified in only 69% of cases. Many endoscopic techniques, such as endoscopic removal, net extraction, mechanical lithotripsy, electrohydraulic lithotripsy, and intracorporeal laser lithotripsy, or combinations of these techniques, are used for extraction of the stone. Endoscopy is successful if the stone is small to medium sized and mobile but often fails in large, immobile stones.8 If endoscopic intervention fails, surgical interventions are sought.
Duodenal bulb obstruction caused by a gallstone (Bouveret syndrome) successfully treated with endoscopic measures
Published in Baylor University Medical Center Proceedings, 2020
Gilles Jadd Hoilat, Vanessa Sostre, Judie N. Hoilat, Ceren Durer, Seren Durer, Gowthami Kanagalingam, Divey Manocha
If the latter modality fails, other techniques of lithotripsy can be attempted but are not readily available. Electrohydraulic lithotripsy is more available and less expensive than laser lithotripsy. Its downside is the high dispersion of shock waves, which could damage the surrounding tissues and lead to possible bleeding or perforation.7 In comparison, laser lithotripsy has fewer damaging effects on the tissues, by precisely targeting the energy onto the gallstone and/or by having the capability of differentiating between the gallstone and the surrounding tissues.5,8
Robotic stone surgery – Current state and future prospects: A systematic review
Published in Arab Journal of Urology, 2018
Philippe F. Müller, Daniel Schlager, Simon Hein, Christian Bach, Arkadiusz Miernik, Dominik S. Schoeb
For most larger kidney calculi, PCNL remains the first-choice intervention [18]. There are only rare situations where laparoscopic or robot-assisted laparoscopic approaches should be considered. In most cases, robot-assisted pyelolithotomy is conducted in patients with pelvi-ureteric obstruction combined with pyeloplasty. Only a few groups have published their experiences and surgery outcomes with combined stone extraction and pyeloplasty using da Vinci robotic systems. Another indication for a robotic approach is staghorn calculi where SWL or PCNL fails. Badalato et al. [19] in 2009 reported a meta-analysis including four clinical trials with a total of 39 patients that underwent robot-assisted stone extraction from the kidney with or without pyeloplasty [20–24]. Mufarrij et al. [23] and Atug et al. [24] reported concomitant robotic pyelolithotomy and pyeloplasty in a total of 21 patients. In both studies, all patients were stone-free 3 months after surgery and showed durable radiographic resolution of the obstruction. The group in the study by Atug et al. [24] did not report intraoperative complications or conversion to open surgery. Mufarrij et al. [23] did not especially stratify for complications and conversion in patients with concomitant stone burden. Lee et al. [22] retrospectively reported a series of five adolescents undergoing robot-assisted pyelolithotomy. In one case, conversion to open surgery was required because the stone could not be removed by the robotic grasper or fragmented by electrohydraulic lithotripsy. Of the four patients with completed robotic pyelolithotomy, three were stone-free at the follow-up examination. Badani et al. [20] completed robot-assisted pyelolithotomy in 13 patients. In their series, no open conversion was necessary, and in all patients, except for one with a complete staghorn calculus, the stone could successfully be removed. The other 12 patients also showed no residual fragments on postoperative imaging. Interestingly, in both the Badani et al. [20] and Lee et al. [22] studies, the two patients with open conversion or incomplete stone extraction had complete staghorn calculi. As Badalato et al. [19] stated in their review, data presentation and follow-up were very inconsistent in the four articles included.