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Anthony G Timoney

Publications and source records attributed to Anthony G Timoney.

11 recordsLinked to original sources
PubMed2006

Does rate matter? The results of a randomized controlled trial of 60 versus 120 shocks per minute for shock wave lithotripsy of renal calculi.

PURPOSE: In this study we prospectively compared 2 rates of shock wave delivery, 60 and 120 shock waves per minute, to determine whether rate affects outcome with the Dornier Lithotripter S, a lithotriptor with an electromagnetic shock wave source, for renal calculi. MATERIALS AND METHODS: A total of 104 patients with uncomplicated single renal calculus were randomized and treated. Following a single treatment patients were reviewed at 3 months to determine outcome. A plain abdominal x-ray was performed and the size of any residual fragments was noted. Four patients were lost to followup, 1 in the 60 shock waves per minute group and 3 in the 120 shock waves per minute group. RESULTS: Of the 100 patients with complete followup 49 were treated at 60 shock waves per minute and 51 at 120 shock waves per minute. There was no statistically significant difference between mean stone area treated (p = 0.32) or additional analgesic use in the form of patient controlled alfentanil (p = 0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. At 60 shock waves per minute 59% of patients had a successful outcome compared with 61% at 120 shock waves per minute (p = 0.87) following a single treatment. Post-treatment complications were similar in both groups at 8% for 120 shock waves per minute and 10% for 60 shock waves per minute (p = 0.68). CONCLUSIONS: There was no significant difference in patient controlled analgesia use, complications or outcome between rates 60 and 120. Contrary to previous studies these results suggest that a slower rate of shock wave delivery during extracorporeal shock wave lithotripsy for renal calculi does not improve treatment efficacy with the Dornier Lithotripter S.

Adolescent↗
PubMed2006

A 3-year review of The British Association of Urological Surgeons Section of Endourology Laparoscopic Nephrectomy Audit.

OBJECTIVE: To report and compare the data obtained from the BAUS UK national laparoscopic nephrectomy audit over the past 3 years. METHODS: Each year, consultants performing laparoscopic nephrectomy are invited to submit prospectively collected data on all patients so treated at their centres. The data from each centre is entered into a nationally established database using a standard data-collection sheet. The indications for surgery, and data during and after surgery are collected. Since 2001, data were reported on 1294 laparoscopic nephrectomies. RESULTS: Over the 3 years, the number of centres returning data has increased from 25 to 48. In 2002, data on 263 nephrectomies were returned; by 2004, this had increased to 598. In all three audits, most cases were for nonfunctioning kidneys and renal cell carcinoma, with transitional cell carcinoma and stones forming a smaller proportion. Over the 3 years, the mean (range) operative duration has reduced from 173 (89-335) to 166 (42-395) min. The median postoperative stay remained at 4-5 days, with a wide range reflecting other than clinical reasons for delayed discharge. The mortality rate remained low, at 0.7% and 0.2%, respectively, for 2002 and 2004. The mean conversion rate remained at 6-8% and the mean complication rate at 17-2%, but the proportion of major complications reduced from 10% to 4%. The transfusion rate also reduced from 10% to 7%. The operative duration, transfusion and conversion rates were higher in those centres performing fewer than 12 cases/year than in those performing at least one case per month. CONCLUSION: The BAUS laparoscopic nephrectomy audit is an effective method for ensuring both the safe and widespread implementation of this relatively new technique to the UK, and compliance with internationally accepted standards. This audit has shown differences in clinical outcomes in favour of high-volume centres, which may help to inform decisions about the centralization of urological laparoscopy services.

Humans↗
PubMed2006

Is using ethanol-glycine irrigating fluid monitoring and 'good surgical practice' enough to prevent harmful absorption during transurethral resection of the prostate?

OBJECTIVE: To evaluate the utility of using a tracer of 1% ethanol in 1.5% glycine for the early detection of irrigation fluid absorption during transurethral resection of the prostate (TURP). PATIENTS AND METHODS: In all, 126 men undergoing TURP were irrigated with a solution of 1% ethanol and 1.5% glycine; their expired air was tested for ethanol every 20 min, and again at the end of the procedure. Maximum absorption by the breath-ethanol reading was compared with the serum concentration of absorbed glycine (analysed by anion-exchange chromatography). RESULTS: Complete data on 120 men were assessed; 75% of the men absorbed irrigation fluid, with glycine levels above the normal range. The sodium levels tended to decrease with increasing glycine levels (Spearman's rank correlation coefficient, - 0.57; 120 men) and five men (4%) developed clinical features of the TUR syndrome. There was a weak correlation between breath-ethanol levels and serum glycine levels (Spearman's rank correlation coefficient, 0.54). The experience of the surgeon, the weight of the resected chips, and the operative duration were not significantly predictive of irrigation fluid absorption. CONCLUSIONS: A rising breath-ethanol level indicates irrigation fluid absorption. However, irrigating fluid absorption is unpredictable, supporting the case for alternative, potentially safer irrigants.

Aged↗
PubMed2006

A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha(1)-adrenoceptor antagonism on human ureteric activity.

OBJECTIVE: To compare the in vitro human ureteric muscle response to calcium-channel and alpha-adrenoceptor antagonists, to determine the promoting factor for stone passage. Clinical trials suggest that stone passage in renal colic can be promoted by ureteric relaxation using these agents, however nonsteroidal anti-inflammatory drugs appear to reduce ureteric activity in vitro but do not promote stone passage when used in clinical trials. MATERIALS AND METHODS: Human ureteric muscle strips were used to record the effect that each drug had on muscle tone in vitro. The ureter was obtained at open nephrectomy or cystectomy. Potassium-enriched Krebs' solution was used to evoke maximal muscle tone, followed by adding each drug in increasing concentrations to determine the percentage reduction in tone. The drugs used to represent each group were nifedipine, 5-methylurapidil (5-MU) and diclofenac. In all, 201 ureteric strips were obtained from 39 patients. RESULTS: At all drug concentrations, the in vitro relaxant effect of nifedipine and 5-MU was greater than that of diclofenac. At 10(-5) M the median reduction in proximal and distal ureteric tone to diclofenac, nifedipine and 5-MU were 18%, 5% and 47%, vs 57%, 33% and 65%, respectively. CONCLUSION: Nifedipine and 5-MU produced greater ureteric relaxation in vitro than diclofenac; they predominantly relax distal ureter. This suggests that a reduction in ureteric muscle tone, as opposed to complete ablation of activity, might be the promoting factor for stone passage.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed2005

Antegrade versus retrograde endopyelotomy for pelvi-ureteric junction (PUJ) obstruction.

OBJECTIVES: To compare complication and success rates of antegrade and retrograde endopyelotomy performed over 10 years and to define possible risk factors associated with treatment failure. METHODS: From 1994 to 2004, 61 patients underwent a total of 68 endoscopic treatments: 19 antegrade and 49 retrograde endopyelotomy procedures. Antegrade endopyelotomy was always performed using diathermy. In the first 18 procedures retrograde endopyelotomy was performed using diathermy. In the most recent 30 procedures the incision was made using holmium laser. Endoluminal ultrasound was used in 78% of retrograde endopyelotomy and in 5% of antegrade endopyelotomy. RESULTS: The retrograde endopyelotomy patients demonstrated significantly lower complication rates (12.5% vs. 42%) and shorter hospital stay (1.5 vs. 7 days) than the antegrade endopyelotomy patients. The mean follow up of the patients who remained free from disease recurrence during the study period was 46 and 24 months for the antegrade and retrograde endopyelotomy group, respectively. The overall success rate (mean time to failure) of antegrade and retrograde endopyelotomy was 56% (31 months) and 70% (17 months), respectively. There was no statistically significant increase in the overall success rate of retrograde endopyelotomy using endoluminal ultrasound per se. Stratifying retrograde endopyelotomy by the type of energy used for the incision, the overall success rate (mean time to failure) was 80% (10 months) and 53% (21 months) for Holmium laser and diathermy, respectively (p = 0.0626). CONCLUSIONS: The overall success of antegrade and retrograde endopyelotomy in this series appears to be largely a factor of lead-time bias and is similar enough to recommend retrograde endopyelotomy with holmium laser on the basis of its relative safety and shorter hospital stay.

Adolescent↗
PubMed2005

A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection.

OBJECTIVE: To examine changes in the pathophysiology and frequency of the transurethral resection (TUR) syndrome with two irrigation fluids, as variable amounts of irrigation fluid are absorbed during TUR of the prostate (TURP), and although polar solutes are required to prevent an effect on diathermy, the solutes may have effects when absorbed. PATIENTS AND METHODS: Between December 2001 and March 2003, 250 patients were included in a prospective randomized trial comparing glycine 1.5% with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, temperature change, biochemistry including a glycine assay, and peri-operative symptoms. Blood samples were taken immediately before and immediately, 5 and 24 h after TURP. Irrigating fluid absorption during TURP was measured with 1% ethanol as a marker and breath ethanol measurements. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of < or = 125 mmol/L with two or more associated symptoms or signs of TUR syndrome. RESULTS: Five (2%) patients had TUR syndrome; all five were irrigated with glycine, although this difference was not statistically significant (P = 0.06). Of the five men, three had hypotension, four were tired, one was nauseous, two had parasthesia, two had 'uneasiness', one had blurred vision and two were confused; none had chest pain. There was a large variation between the groups in the level of glycine assayed immediately after TURP; a high glycine level was associated with the TUR syndrome (P = 0.01). There was no difference between the groups in levels of sodium, potassium, urea, creatinine, osmolality, calcium, haematocrit, albumin serum levels or peri-operative blood loss (defined as a change from before to after TURP in haemoglobin level, accounting for transfusions). CONCLUSIONS: An increase in serum glycine was associated with TUR syndrome; there were large variations in the amounts of glycine absorbed, reaching levels many times the upper limit of normal. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long-term effects.

Absorption↗
PubMed2004

The British Association of Urological Surgeons Section of Endourology audit of laparoscopic nephrectomy.

OBJECTIVE: To report the first UK national audit of laparoscopic nephroureterectomy, radical and simple nephrectomy. METHODS: All members of the British Association of Urological Surgeons (BAUS) undertaking laparoscopic nephrectomy were invited to submit prospectively collected data from their centres to a nationally established database, using a standard proforma. The period covered by the audit was 1 July 2001 to 30 June 2002. The indications for surgery, peri- and postoperative data, and some demographic details were collected. RESULTS: Data were received from 25 centres; 13 had undertaken five or fewer cases per year; 263 procedures were reported, including 20 of hand-assisted nephrectomy. Most cases were for nonfunctioning kidneys, or renal cell carcinoma, with transitional cell cancer and stones forming a smaller proportion. The mean (range) operative duration was 173 (89-335) min. The median postoperative stay was 4 days, with a wide range reflecting clinical and other reasons for delayed discharge. Two deaths were reported, giving a mortality of 0.7%. The mean conversion rate was 5.7% and the mean complication rate 16.8%; these rates were no higher in centres undertaking fewer than five cases per year than in the centres with a greater volume. CONCLUSION: Encouragingly, this first UK audit of laparoscopic nephrectomy shows similar results to those published worldwide. The lack of any difference in outcome between smaller and larger centres may be explained by case selection and the use of mentors, as recommended by the BAUS Section of Endourology.

Humans↗
PubMed2002

Endoluminal ultrasonography with reusable probe: preliminary results.

BACKGROUND AND PURPOSE: Endoluminal ultrasound probes have been disposable, making their regular use costly. We describe the technique and preliminary results of a reusable endoluminal ultrasound probe for examining ureteral anatomy. PATIENTS AND METHODS: The 2.4-mm (7.2F) or 3-mm (9F) probe (Olympus, Tokyo) is passed up the ureter after a retrograde ureteropyelogram has been obtained. No intraoperative preparation of the probe is needed. An axial image as little as 1 cm or as much as 10 cm around the ureter can be obtained. Over the last 20 months, 50 procedures using endoluminal ultrasonography were performed in our unit: 36 (72%) for uretero-pelvic junction (UPJ) obstruction, 10 (20%) for upper-tract filling defects, and the remaining 4 (8%) for ureteral strictures. RESULTS: Endoluminal ultrasonography detected crossing vessels at the UPJ in 19 (53%) and a septum in 9 (25%) of the 36 renal units with UPJ obstruction. In eight of the 36 renal units with UPJ obstruction (22%), endopyelotomy was not done because of the presence of crossing vessels. A further 4 renal units (11%) had the direction of the incision modified because of the ultrasound findings. In the cases with upper-tract transitional-cell carcinoma, images correlated well with the nephroureterectomy specimen. The probe had to be replaced twice. CONCLUSIONS: This endoluminal ultrasound system produces clear images of the ureteral and periureteral anatomy. The reusable aspect of the probe removes an important obstacle to its common use for evaluating a variety of upper urinary tract abnormalities.

Adolescent↗
PubMed2002

Analgesia for shock wave lithotripsy.

PURPOSE: We evaluated the effectiveness of and patient preference for analgesia used during shock wave lithotripsy by comparing diclofenac alone with a combination of diclofenac and patient controlled analgesia, that is alfentanil. MATERIALS AND METHODS: A total of 64 patients were treated using a Lithotriptor S (Dornier Medical Systems, Marietta, Georgia) and randomized to receive diclofenac alone or combined with an alfentanil patient controlled analgesia pump. If treated twice, they crossed over to the alternative form of analgesia. A record was maintained of the site and size of the stone, maximum power achieved, number of shocks, amount of alfentanil used and need for additional analgesia. After treatment patients scored on a visual analog scale the maximum level of pain and satisfaction with analgesia. RESULTS: There was no difference in the mean size of the stone treated (8.6 and 7.5 mm.), energy level (71% and 71% or approximately 17 kV.) or number of shocks (3,000 and 2,900, respectively) in the groups. Only 2 patients in the diclofenac group required additional analgesia and there were no significant side effects from either treatment. The mean pain scores were not significantly different in the diclofenac and patient controlled analgesia groups (3.54 and 2.93, respectively, (p = 0.34), although those on patient controlled analgesia were more satisfied (7.72 versus 9.14, p = 0.04). Of the 38 patients who presented twice 58% preferred diclofenac alone. CONCLUSIONS: This study suggests that there is no significant difference in the level of pain experienced with diclofenac alone or when combined with an alfentanil patient controlled analgesia pump during shock wave lithotripsy. However, patients are more satisfied with treatment when a patient controlled analgesia pump is available.

Alfentanil↗