Evaluation of the utility and reliability of COSHH Essentials.
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Hazardous Substances↗
Biomedical subjects
David Tolley
Publications and source records attributed to David Tolley.
Ureteroscopy in the management of pediatric urinary tract calculi.
PURPOSE: To report our experience with ureteroscopy in the treatment of pediatric urinary tract calculi and present a review of the literature. PATIENTS AND METHODS: Between 1988 and 2003, 52 ureteroscopic procedures were performed in 25 male and 10 female children aged 11 months to 15 years (mean 5.9 years). Using a semirigid 6.8F 43-cm ureteroscope and routine antibiotic prophylaxis, stones were fragmented with a pulsed-dye laser (N = 14; stone size 6-15 mm with a mean of 9.6 mm), electrohydraulic lithotripsy (EHL) (N = 26; stone size 3-20 mm with a mean of 8.4 mm), or a holmium laser (N = 7; stone size 5-15 mm with a mean of 10 mm); removed by basket extraction (N = 5; stone size 5-8 mm with a mean of 7 mm); or both. Stenting or ureteral dilatation was not performed routinely. RESULTS: With the pulsed-dye laser, there was an overall stone-free rate of 72%. Complications consisted of one ureteral perforation and one stenosis of the intramural portion of a megaureter (14% complication rate). With EHL, the overall stone-free rate was 92%. Complications consisted of one case each of ureteral perforation and incipient urinary retention and five of mild fever (27%). With the holmium laser, the overall stone-free rate was 100%, and there were no complications. Basketing likewise produced a 100% stone-free rate, and there was one complication, a mucosal tear in a patient who also underwent pulsed-dye laser lithotripsy. CONCLUSION: Ureteroscopy is a safe and effective means of treating the majority of pediatric ureteral calculi, although retreatment rates are higher with multiple stones and in younger children. Dilatation of the vesicoureteral junction is usually not necessary with ureteroscopes <8F, nor is ureteral drainage required after uncomplicated ureteroscopy. The holmium laser is the most effective and safest method of fragmentation regardless of stone composition. Ureteroscopy for this indication should be performed only by an experienced endoscopist.
Adolescent↗
Management of ureteric stones.
The contemporary management of ureteric stones is reviewed and evidence based recommendations about treatment are made. Stones measuring less than 4mm in diameter have a high chance of spontaneous passage and the main debate for optimum treatment of larger stones centres around the choice of shock wave lithotripsy or endoscopic management combined with laser fragmentation. Treatment recommendations should be based on patient preference, published evidence, local audit (surgeon expertise and availability of equipment) and cost. Artificial Neural Networks could become a useful tool for prediction of treatment outcome for ureteric stones, and further research is needed to clarify this potential. ESWL is less effective than ureteroscopy but it may prevent the need for more invasive treatment in a substantial proportion of patients. It should only be considered as initial treatment in patients with stones less than 10mm in size. The routine use of stents should be avoided as both fragmentation and stone free rates are noticeably lower. For larger stones, initial laser ureteroscopy serves better both for proximal or distal calculi and is more cost-efficient. Provided that no contraindications for general anaesthesia exist, laser ureterolithotripsy should be regarded as an excellent first line treatment modality for ureteric stone especially in greater stone burden. In the best hands, the outcome for endoscopic management of ureteric stone in all sites is better than ESWL and is cheaper, although equipment, expertise and experience are all required to achieve this superior outcome.
Humans↗
Renal parenchymal hemostatic aids: glues and things.
PURPOSE OF REVIEW: Open partial nephrectomy is now recognized as the standard of care for small renal parenchymal tumors. Significant technical problems remain with regard to performing this procedure laparoscopically, namely warm renal ischemia during occlusion of the renal vascular pedicle and renal parenchymal bleeding following tumor excision and release of pedicle control. This article reviews the recent literature in the field of renal parenchymal hemostasis and its role in improving outcomes and increasing applicability for laparoscopic nephron-sparing surgery. RECENT FINDINGS: Two themes emerge in reviewing the recent literature on renal hemostasis: the use of increasingly advanced tissue sealants and the use of physical methods. Advances in both areas are covered in this article. SUMMARY: Laparoscopic partial nephrectomy has been developed in an attempt to reduce the morbidity of the open technique. We believe that advances in secure renal parenchymal hemostasis will increase the applicability of the laparoscopic procedure and bring it within the grasp of ordinary urologists.
Absorbable Implants↗
Re: Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications.
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Abdomen↗
Validation of a bench model for endoscopic surgery in the upper urinary tract.
OBJECTIVE: Open surgery is increasingly replaced by endoscopic techniques. In urology, endoscopic procedures of the upper urinary tract are still evolving. The surgical techniques imply high accuracy and are difficult to teach since they are "one man" procedures. Training on bench models has essentially given promising results in general surgery but has never been validated for advanced endourology. In this study, ureteroscopy on a bench model was compared to the same procedure on patients. MATERIAL AND METHOD: Fourteen urologists, trainees and consultants, were scored using a task-specific check list and a global score when performing rigid ureteroscopy on patients and on a bench model from Mediskills. The participants had not seen the check lists before the performance and the scoring was carried out by the same person in all cases. RESULTS: The urologists performed equally on patients and the model and they all considered the procedure on the model similar to real surgery. There was no statistical difference in the score between consultants and trainees but those urologists (five consultants and three senior registrars) who were sub-specialised in endourology scored significantly higher than the others on both patients and the model. CONCLUSIONS: Bench models are comparable to real surgery for, at least basic, endoscopic procedures in the upper urinary tract. The models are also useful for making the trainees familiar with the operating instruments.
Clinical Competence↗
Imaging: new diagnostic techniques.
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Diagnostic Imaging↗
Endoscopic data acquisition and storage.
Recent developments in the field of digital image acquisition and storage provide new opportunities for recording endoscopic procedures for use in the medical record and remote access for education and consultation. This article reviews the recent literature in the field of endoscopy.
Endoscopy↗