Biomedical subjects

D Lenaghan

Publications and source records attributed to D Lenaghan.

16 recordsLinked to original sources

PubMed1994

Risk factors predisposing to repeated extracorporeal shockwave lithotripsy.

The Victorian Lithotripsy Service is geographically unique, representing the only Australian lithotripter for a 900-km radius and serving a patient population of over 3 million, and 26 accredited operator urologists. Because of distance and health service constraints few patients treated for renal calculi on this machine have the opportunity to seek additional treatment by extracorporeal shockwave lithotripsy (ESWL) elsewhere. The treatment histories of all patients who underwent ESWL at this center over a 4-year period were examined, with those patients who required ESWL on more than one occasion being identified and their treatment details reviewed. The retreatment rate was approximately 6%. In patients who required three or more ESWL treatments multiple calculi were present significantly more often than in the overall cohort (p < 0.05), and ESWL alone was ultimately successful in obtaining satisfactory stone fragmentation in only 62% of this group. In view of the high cost of repeated treatments by ESWL the applicability of this treatment method in cases of multiple calculi should be questioned. Initial undertreatment of calculi may also represent a significant factor in the retreatment of some radiopaque calculi.

Adult↗

PubMed1991

Comparative study of the role of endo-urological manipulation in the treatment of ureteric calculi using extracorporeal shock wave lithotripsy.

The results of treatment of 115 patients with upper and mid-ureteric calculi, using endo-urological manipulation and extracorporeal shock wave lithotripsy were reviewed. The number of shocks administered, the kilovoltage used, the radiation exposure time and the degree of fragmentation achieved were evaluated. Complications occurring in the course of this treatment were also reviewed. A significantly lower number of impulses was required for fragmentation to be apparent at 24 h post-treatment, when the ureteric calculus was able to be manipulated back into the renal pelvis. However, at 6 weeks post-extracorporeal shock wave lithotripsy (ESWL) satisfactory fragmentation was apparent in approximately equal percentages of patients who had undergone successful and unsuccessful manipulation. In addition, a significantly greater mean radiation exposure was used in the treatment of mid-ureteric calculi that could not be successfully manipulated and required treatment in situ within the ureter. These results suggest that treatment of a ureteric calculus in situ within the ureter provides a satisfactory method of fragmentation, although fragmentation takes longer to become apparent than when treatment is undertaken upon a calculus within the renal pelvis. The greater radiation exposure for patients in whom ureteric calculi were treated in in situ within the ureter may reflect the operators' attempts to visualize a change in configuration of the calculus similar to that seen when treatment is given to a stone that has been successfully manipulated. However, since the absence of fragmentation at 24 h post-surgery does not indicate a failed treatment in this group, prolonged screening of the calculus with fluoroscopy may be unnecessary. The complication rate of this method of treatment was low.

Adult↗

PubMed1980

Carcinoma of the bladder treated by partial or total cystectomy.

The results obtained in 37 patients treated by partial cystectomy and 51 patients treated by total cystectomy are presented. Partial cystectomy was usually performed for deeply invasive tumours. THere were no operative deaths, but 85% of the patients died in the first two years of follow-up and the five-year survival was 11%. Of the 51 patients having total cystectomy, 22 were operated upon after other treatments had failed. There were six (11.8%) operative deaths, only one following simple cystectomy, and the remainder following radical cystectomy with or without urethrectomy. Almost half the survivors died in the first two years, and the five-year survival was 31%. The better prognosis in total cystectomy is attributable to the presence of a number of patients with multicentric but relatively non-invasive tumours. Thirteen patients, all with invasive bladder tumours, had 4,000 R irradiation to the pelvis before operation. There was no benefit demonstrated in this combined treatment. The loss survival rate despite treatment in deeply invasive bladder tumours indicates the value of early diagnosis and the need for more effective forms of treatment.

Adult↗

PubMed1977

The surgical treatment of retrocaval ureter.

Ureteric obstruction resulting from retrocaval ureter may be due to either compression of the ureter by the vena cava or stenosis of the postcaval segment. If obstruction is due to stenosis, the commonly described operation of division and anastomosis through the proximal dilated ureter or pelvis, after repositioning of the ureter, is likely to fail, as is division of the vena cava itself. Excision of the postcaval segment with anastomosis of the spatulated ureter over a Silastic splint is therefore recommended. Three case histories of patients with retrocaval ureter treated surgically are presented and support this view.

Adult↗

PubMed1976

The natural history of reflux and long-term effects of reflux on the kidney.

Spontaneous cessation of vesicoureteral reflux occurred in 42 per cent of 102 patients. It ceased in 65 per cent of the patients with unilateral reflux, in 50 per cent of those with bilateral reflux in normal caliber ureters and in 9 per cent of those with bilateral dilated ureters. Renal parenchymal changes were seen most frequently in patients with urinary infection after diagnosis. The likelihood of such infections lessened if reflux ceased. Proportionately more male than female subjects were free of infection. Renal damage may follow even 1 episode of infection. Lesions appeared with equal frequency during the entire followup period, whereas urinary infection was more common in the 5-year period after diagnosis. Renal damage was more likely to occur in kidneys that were already abnormal. Reflux should be controlled surgically if urinary infections occur after diagnosis and during long-term chemotherapy and careful observation. In the absence of infection indications for operation are infrequent. Non-surgical management may apply to normal caliber ureters and in infancy, while antireflux operation may be considered at diagnosis in dilated ureters, bilateral reflux or in the presence of renal lesions.

Adolescent↗

PubMed1974