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D A Tolley

Publications and source records attributed to D A Tolley.

At least 19 recordsLinked to original sources
PubMed1992

Mechanisms responsible for diminished fragmentation of ureteral calculi: an experimental and clinical study.

We molded 24 synthetic stones (mean weight 680 mg., range 641 to 715) from a commercial mixture of gypsum, silica, cellulose and polyvinyl acetate. Each stone was subjected to 400 shocks on a Wolf 2300 Piezolith and groups of 6 stones were treated in 4 different modes. Mean amounts fragmented were 243 +/- 18 mg. in a free environment, 62 +/- 18 mg. confined loosely in a latex tube, 22 +/- 8 mg. impacted in the tube and 30 +/- 8 mg. impacted alongside a 7F stent. During a 30-month period 118 patients received in situ extracorporeal shock wave lithotripsy for ureteral calculi using the same lithotriptor. The mean stone burden was 11.4 mm. (range 4 to 29). Success was greater for patients with calculi 10 mm. or less than for those with stones greater than 10 mm. (71% versus 51%, p less than 0.05), despite the former group receiving less shocks (5,404 versus 7,491). The influence of size was then excluded by studying the number of shocks delivered per mm. of calculus. Patients receiving 500 to 699 shocks per mm. showed a higher success rate than those receiving a smaller number of shocks per mm. Treatment with a greater number of shocks per mm. did not improve success rate. The experimental study demonstrated that confinement and impaction significantly diminish the rate of fragmentation of calculi. However, the clinical study suggested that there may be an optimum number of shocks per mm. that should be delivered. Treatment beyond this point fails to improve results. The 28% failure rate even in those receiving the highest number of shocks per mm. suggests that large, impacted calculi are unsuitable for treatment with in situ shock wave lithotripsy on this machine.

Adolescent↗
PubMed1992

J-wire facilitates retrograde manipulation of ureteric calculi prior to extracorporeal shock wave lithotripsy.

During a 13-month period, 55 patients underwent attempted retrograde manipulation for ureteric lying above the pelvic brim. The mean stone burden was 11 mm (range 5-21); 41 stones (75%) were primary ureteric calculi and 14 (25%) were fragments resulting from extracorporeal shock wave lithotripsy to renal calculi. The method of retrograde manipulation was recorded prospectively. Retrograde flushing through an 8F angiography catheter with a mixture of saline and lignocaine gel was successful in 27 patients (49%). The insertion of a J-wire through the angiocath allowed for successful manipulation in a further 17 patients (31%). Retrograde manipulation was impossible in 11 patients (20%). There were 4 complications (7%), none attributable to the use of a J-wire.

Adolescent↗
PubMed1991

The impact of extracorporeal piezoelectric lithotripsy on the management of ureteric calculi: an audit.

The presentation and management of 153 patients with ureteric calculi requiring active treatment over a 12-month period were reviewed; 74% of patients had primary ureteric calculi and 26% had ureteric calculi composed of fragments resulting from extracorporeal piezoelectric shockwave lithotripsy (EPL) to renal calculi; 32 patients (21%) had more than 1 calculus or a steinstrasse. The primary procedures included were in situ EPL (n = 54), push-bang (44), retrograde ureteroscopy (40), Dormia basket extraction (6), push-pull (1), antegrade ureteroscopy (1) and combinations of these (7). The success of the primary procedure could not be predicted from stone size, site or duration in the ureter, but upper tract dilatation was significantly less (p less than 0.01) in the successful group. The overall success rate for complete stone extraction was 97%, but 54 patients (35%) required more than 1 procedure to achieve this. In situ EPL and push-bang, as either primary or secondary procedures, were successful in treating 79 patients (52%); 2 patients required ureterolithotomy (1.3%). The overall complication rate was 18%. Since EPL is only successful in treating approximately half of ureteric calculi, a range of other treatments should be available to maintain a low rate of open surgery.

Adolescent↗
PubMed1991

Does further extracorporeal lithotripsy promote clearance of small residual fragments?

Small persistent fragments (less than or equal to 4 mm) following extracorporeal shock wave lithotripsy have been termed clinically insignificant residual fragments (CIRF), but their presence may be associated with an increased rate of development of recurrent symptomatic renal calculi. We have adopted a policy of further extracorporeal piezoelectric shock wave lithotripsy (EPL) for patients with CIRF in an attempt to promote complete clearance. A series of 22 patients with a mean initial stone burden of 16 mm (range 7-48) developed CIRF after a median of 2 EPL treatment sessions (range 1-9). CIRF were in the lower calices (n = 20), middle calices (n = 1) and upper calices (n = 1). These calices were normal (n = 6), slightly dilated (n = 9), moderately dilated (n = 2) or grossly dilated (n = 5). After 6 to 14 months, patients underwent a further session of EPL. One month later, 3 patients with normal calices showed a considerable reduction in CIRF, but all other patients showed no change. When CIRF form in normal calices a further session of EPL may promote clearance. However, when calices containing CIRF are significantly dilated, further EPL is of no value.

Adult↗
PubMed1990

Dermatitis due to intravesical mitomycin C: a delayed-type hypersensitivity reaction?

Mitomycin C is an alkylating agent, used by intravesical instillation to treat carcinoma of the bladder. Repeated instillations can induce cystitis and an eczematous eruption affecting the palms, soles and face. If these effects are due to delayed hypersensitivity with sensitization to mitomycin C occurring in the bladder wall, it should be possible to demonstrate antigen-presenting cells in the bladder wall and positive patch tests to the drug. Using an immuno-alkaline phosphatase method we have identified CDI+ cells in bladder epithelium and submucosa and have demonstrated Birbeck granules in a few cells. In further support of our hypothesis it was also possible to demonstrate delayed type hypersensitivity in 13 out of 26 patients who had received mitomycin instillations by applying the allergen as a patch test. These results indicate that the eczematous eruption in this group of patients is most likely a hypersensitivity reaction and that it may be mediated transvesically.

Administration, Intravesical↗
PubMed1990

Lithotripsy for calculi in caliceal diverticula?

There is continuing debate about the optimum management of patients with calculi in caliceal diverticula. Extracorporeal piezoelectric lithotripsy (EPL) has the advantage of being non-invasive, whereas endourological management can treat the underlying anatomical problem. A total of 20 patients with calculi in caliceal diverticula were treated with EPL. Twelve of 16 patients with symptoms (75%) were rendered symptom-free but only 5 (25%) became stone-free. This information should be of value in counselling patients before selecting the appropriate treatment.

Adult↗
PubMed1990

Is long distance lithotripsy effective?

The outcome and morbidity of a group of 132 patients living near a lithotriptor was compared with that for a group of 251 patients living at a distance. The two groups were similar in age, stone burden and the need for preliminary procedures. With short follow-up, the main difference between the groups was the overall stone-free rate (20% difference, X2 = 13.5, d.f. = 1, P less than 0.001). This difference was not apparent when patients with residual fragments of 3 mm or less were included and is explained by shorter follow-up in the 'distant' group. After a minimum period of 10 days follow-up there was no significant difference in the stone-free rates. There was no significant difference between the groups in the incidence of complications (18% for the 'local' group versus 19% for the 'distant' group). The stone-free rates and incidence of complications were similarly related to stone burden in both groups. It is concluded that, within certain limitations such as inconvenience of travel, 'long distance, second generation lithotripsy' offers no disadvantage.

Adolescent↗
PubMed1989

Prognostic factors for recurrence and followup policies in the treatment of superficial bladder cancer: report from the British Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party).

With data from 2 large randomized British Medical Research Council studies we identified several factors influencing the recurrence of newly diagnosed superficial bladder cancer. Using multivariate methods to assess the relative importance of these factors we found the most important to be the result of cystoscopy performed 3 months after initial transurethral resection and the number of tumors (single or multiple) at presentation. With these 2 factors we divided the patient population into 3 groups with varying degrees of prognosis. Different followup procedures are proposed for each of these 3 groups.

Administration, Intravesical↗
PubMed1989

Extracorporeal piezoelectric lithotripsy for all renal stones: effectiveness and limitations.

An unselected group of patients with renal stones was treated with extracorporeal piezoelectric lithotripsy (EPL) monotherapy. The results showed that this minimally invasive treatment was very effective for patients with stones smaller than 20 mm. After a minimum follow-up of 1 month, 65% of these patients were stone-free and 22% of the remainder had only small fragments. Patients with larger stones (20 mm or larger) required multiple treatment sessions (mean 5.8) and had less favourable results. One month or more after treatment, only 46% of these patients were free of stone and 21% required secondary operative procedures for obstructing ureteric fragments. Most of these patients are better treated initially by percutaneous nephrolithotomy.

Adolescent↗
PubMed1989

Primary endoscopic surgery for ureteric stones.

A group of 184 consecutive patients requiring surgery for ureteric stones was studied over a 4-year period. The success rate for primary endoscopic management was 90.3%; 12 patients required ureterolithotomy for failed endoscopic manoeuvres and complications occurred in 5.5%. Optimum methods of treatment for ureteric stones according to size and location are suggested.

Endoscopy↗
PubMed1988

Effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: interim report from the Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party).

A randomised control trial of intravesical instillation of mitomycin C was conducted in 457 patients with cancer of the bladder that was confined to the submucosa on histological examination. The events studied were the recurrence free rate, the recurrence rate/year, and the number of new tumours developing/year. At the initial cystoscopy the tumours were completely resected and the patients randomised to have no instillation of mitomycin C, a single instillation of 40 mg in 40 ml of water at that cystoscopy, or a single instillation and then four further instillations. All patients had follow up cystoscopies every three months for the first year, twice in the second year, and yearly thereafter. After a median of 12 months, follow up information was available for 397 patients. Patients receiving both the single instillation of mitomycin C and the instillations at five cystoscopic examinations had significantly lower yearly recurrence rates and tumour rates than those in the control group, and the group receiving multiple instillations fared significantly better than those receiving a single instillation. The figures on progression to invasive cancer were too small to allow conclusions to be drawn.

Administration, Intravesical↗