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Demetrius H Bagley

Publications and source records attributed to Demetrius H Bagley.

13 recordsLinked to original sources
PubMed2006

The camera phone: a novel aid in urologic practice.

OBJECTIVES: To describe a novel use of the camera phone for efficient, reliable, and cost-effective collection and transmission of medical data in the urologic setting. METHODS: We used camera phones (Verizon VGA and Sanyo-Sprint PCS) with a resolution of 640 x 480 pixels to capture images in the operating room, as well as in the outpatient clinic. Images were obtained directly from the monitor or the x-ray viewing box. These were then immediately transmitted to the office computer through a secure Internet connection. The images were then incorporated into operative and office notes, as needed. RESULTS: The images obtained with this method were of adequate quality for demonstration purposes, with the added advantage of allowing secure transmission and storage. The best-quality images were those obtained directly from the x-ray viewing box or from a liquid crystal display monitor. In addition, the images could be edited and labels added with the aid of the software that came with the camera phone. CONCLUSIONS: This method allows the acquisition of fair-quality digital images of surgical procedures and radiographic studies with simultaneous data transmission and storage for clinical documentation. The technology reduced costs and increased the efficiency of our practice considerably.

Cell Phone↗
PubMed2005

Retrieval and releasing capabilities of stone-basket designs in vitro.

BACKGROUND AND PURPOSE: A serious problem during calculus retrieval is the inability to release a stone from the basket. We evaluated a variety of basket designs to address this issue in two in-vitro models. MATERIALS AND METHODS: Four baskets--a modified, flat-wire, a double-helical, and two tipless Nitinol models (a passive and an articulating type)--were evaluated. The ability to retrieve and release beads of 4, 6, 8, 10, 12, and 14 mm diameter was compared in both a ureteral and a caliceal model. RESULTS: In the ureteral model, all baskets were successful in retrieving all sizes of beads as long as the bead was smaller than the measured basket diameter. Only the articulating (all sizes) and larger non-articulating Nitinol models were able to release each of the bead sizes once engaged. The double-helical basket (larger size only) was able to release only the 4- and 6-mm beads after retrieval. For the 10- and 12-mm beads, the respective articulating Nitinol baskets could liberate the bead only when the articulating mechanism was used. In the caliceal model, the flat-wire and double-helical baskets were unsuccessful in all attempts at retrieval. The larger non-articulating Nitinol model was successful for beads >8 mm but had difficulty retrieving those smaller. Only the articulating Nitinol models were able to engage and release each of the beads. CONCLUSION: From these in-vitro studies, it is apparent that the Nitinol basket designs have the best retrieval capabilities. The ability to articulate the basket improves release of a stone once engaged.

Alloys↗
PubMed2005

Current practice patterns in urologic management of upper-tract transitional-cell carcinoma.

PURPOSE: To determine the current practice patterns in the management of upper-tract transitional-cell carcinoma (TCC) among a large group of urologists. MATERIALS AND METHODS: A survey was sent to 220 practicing members of the Society of Urologic Oncology (SUO) and the Endourological Society (ES) and members of the American Urological Association who did not belong to either society. The survey consisted of 16 focused questions pertaining to the surveillance and management of upper-tract TCC. The responses were used to create a database, which was then analyzed to determine practice trends. RESULTS: Eighty-four of the urologists responded, for a response rate of 38%. Fourteen responses were excluded because of multiple answers to a given question, so 70 were included in the final analysis. Eighty percent of the respondents were in academic practice. A CT urogram was the favored initial procedure for diagnosis of upper-tract TCC and an intravenous urogram was the next commonest choice (53% and 40%, respectively). Ureterorenoscopy was the surveillance tool of choice (70%) after conservative treatment of upper- tract TCC. Laparoscopic nephroureterectomy was the preferred procedure (73%) for a high-grade, large renal-pelvic TCC. Twenty-one percent of the endourologists recommended ureteroscopic ablation for a high-grade, large distal ureteral tumor. This was in sharp contrast to 77% of the respondents who favored a distal ureterectomy for the same clinical scenario. CONCLUSIONS: This study confirms that most urologists treating upper-tract TCC follow the principles reported in the published literature regarding the management of these patients. Further, most urologists, regardless of society affiliations or years in practice, favor minimally invasive techniques for the management of upper-tract TCC. This information may be useful in formulating clear guidelines for the management of this disease.

Adult↗
PubMed2005

Minimizing minimally invasive surgery: the 5-mm trocar laparoscopic pyeloplasty.

BACKGROUND AND PURPOSE: Laparoscopic pyeloplasty has evolved into the procedure of choice when definitive repair of the obstructed ureteropelvic junction is contemplated. Its main advantage over the gold standard of open pyeloplasty is decreased morbidity. We have utilized only three 5-mm ports in our last 15 pyeloplasties in an effort to further reduce morbidity and improve acceptance by an often-younger patient population. PATIENTS AND METHODS: Fifteen consecutive patients underwent laparoscopic transperitoneal pyeloplasty by the 5-mm port technique. Three trocars were utilized, two for the working instruments and one for a 5-mm telescope mounted on a voice-activated robotic arm (AESOP; Intuitive Surgical, Sunnyvale, CA). Three patients required an additional trocar for liver retraction. All patients underwent dismembered pyeloplasty and had indwelling double-pigtail stents placed for 4 to 6 weeks. RESULTS: The mean operative time was 195 minutes (range 120-240 minutes). The average blood loss was 30 mL. None of our patients required open conversion. With a median follow-up of 10 months (range 3-15 months), all 15 patients have shown both subjective (freedom from symptoms) and objective (renal scan) improvement. CONCLUSION: We believe our technique has further minimized the morbidity of laparoscopic pyeloplasty without compromising the outcome. The 5-mm trocars obviate fascial closure, decrease patient discomfort, and improve cosmesis. Furthermore, the use of the robotic arm eliminates the need for a surgical assistant and makes this an essentially "one-person" procedure.

Adolescent↗
PubMed2005

Ureteroscopic endoureterotomy.

OBJECTIVE: To highlight the current status of ureteroscopic endoureterotomy (UE) by reporting extensive experience with the endoscopic management of ureteric strictures, with special emphasis on factors determining success, and by reviewing publications on the minimally invasive management of ureteric strictures. PATIENTS AND METHODS: The study comprised 50 patients (mean age 53 years, range 18-85, equal sex distribution) with ureteric strictures of varying causes; all had their stricture treated endoscopically. The follow-up was 0.5-9 years; 10 patients with recurrent strictures had two ipsilateral stents placed to try to improve the outcome, and eight patients with completely obliterating strictures were treated by ureteroscopic re-canalization. RESULTS: The site of stricture had no bearing on the eventual outcome. Patients with uretero-enteric and malignant strictures did not fare so well. The most important predictor of failure was the length of the stricture, with failure in all seven patients with strictures of > 2 cm. In the 10 patients treated with two ipsilateral stents, eight were successful, which was very promising considering that these patients had recalcitrant strictures and placing one stent had previously failed. The overall success rate was 74%. CONCLUSION: UE has become the procedure of choice for the initial management of ureteric strictures. Simple balloon dilatation is also effective in certain situations. The characteristics of the stricture often govern the eventual outcome. In properly selected cases success rates of approximately 75% can be expected.

Adolescent↗
PubMed2005

Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope.

OBJECTIVE: To determine the optimum size of a flexible ureteroscope (FU) to minimize the need for ureteric dilatation. MATERIALS AND METHODS: FUs from several different manufacturers and with different shaft diameters were used for ureteroscopy in adults. An initial attempt was made to pass one of the larger diameter FUs; if this was unsuccessful, the smaller 7.5 F FU was used. The results were reviewed retrospectively. RESULTS: Flexible ureteroscopy was used in 115 consecutive patients at two different institutions. The ability to pass the FUs with no formal dilatation was directly related to the FU diameter. The rate of failing to pass with no formal dilatation was 37% for the 9.0 F, 8.5% for the 8.6 F, 5% for the 8.4 F and 0.9% for the 7.4 F ureteroscope. CONCLUSION: Although other factors influence the overall effectiveness of the FU, the ability to pass FUs is directly related to their outer diameter. When only the ease of introduction is considered, the ideal ureteroscope outer diameter is 7.4 F.

Adult↗
PubMed2004

Ureteroscopic surgery: changing times and perspectives.

Ureteroscopy developed as an extension of cystoscopic techniques into the upper urinary tract with smaller, rigid, and flexible endoscopes. Smaller working instruments have made therapeutic procedures possible. Ureteroscopy has become the technique of choice to diagnose and treat benign essential hematuria and has a major role in treating ureteropelvic junction obstruction, upper tract neoplasms, and calculi. Finally, there is a need for smaller and more effective endoscopes and working devices.

Female↗
PubMed2004

An update on ureteroscopic instrumentation for the treatment of urolithiasis.

PURPOSE OF REVIEW: Ureteroscopic instruments, both endoscopic and working devices, continue to evolve. Changes in instrumentation have necessitated concurrent modifications in ureteroscopic techniques over the years. The safety and efficacy of the ureteroscopic approach for the treatment of renal and ureteral calculi, however, have continued to improve. RECENT FINDINGS: This review emphasizes the recent advances in the major groups of instruments employed for ureteroscopy. Among the endoscopic instruments, the flexible ureteroscopes have undergone the most notable advances, benefiting from greatly improved deflection and durability. Progress has been made in adjunctive instruments as well. Current stone retrieval devices composed of nitinol-based wire technology are able to easily secure fragments from the most peripheral calices. The holmium laser is a versatile device with proven safety and effectiveness as an endoscopic lithotrite. SUMMARY: The availability and coordinated use of the latest ureteroscopic instruments have resulted in better treatment outcomes, thus expanding the use of ureteroscopy as a first-line option for the treatment of calculi in appropriate cases. Urologists should be familiar with currently available instrumentation in order to optimize their equipment.

Device Removal↗
PubMed2004

The incidence of crossing vessels in patients with normal ureteropelvic junction examined with endoluminal ultrasound.

PURPOSE: We estimated the incidence of a crossing vessel at the normal ureteropelvic junction (UPJ) in patients undergoing ureteroscopy and endoluminal ultrasonography for indications other than UPJ obstruction. MATERIALS AND METHODS: Endoluminal ultrasonography was performed in 141 patients undergoing upper tract endoscopy for various indications excluding UPJ obstruction. A detailed description of the anatomy of the UPJ as well as the location and size of crossing vessels was included in the operative note. Charts were reviewed to determine the precise anatomy of the UPJ. RESULTS: The overall incidence of crossing vessels at the unobstructed UPJ was 19.2%. Endoluminal ultrasonography demonstrated a crossing vessel in 13.2% of patients with ureteral narrowing or stricture, 31.3% of those with tumors or filling defects, 10.5% of those with submucosal calculi and 16.7% of patients with ureteral diverticula. In cases where the position of a crossing vessel was ascertained, 41% were anterior to the ureter, 28% anterolateral, 24% anteromedial and 7% posterior. There was a statistically significant difference in the frequency of vessels at the UPJ in patients with and without obstruction examined with endoluminal ultrasound (p <0.0001). CONCLUSIONS: A crossing vessel at the UPJ is seen with endoluminal ultrasound in 19.2% of patients with a normal UPJ. This incidence is lower than that seen in patients with obstructed UPJ. Many of these vessels are related to the lateral surface of the UPJ and there was no area that was always free of vessels.

Adolescent↗
PubMed2002

Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal ureteral and intrarenal calculi.

PURPOSE OF REVIEW: Ureteroscopy has assumed an expanded and important role in the treatment of proximal ureteral and intrarenal calculi with the development of new endoscopes, more effective grasping devices, and the holmium laser lithotriptor. RECENT FINDINGS: The success rate for treating proximal ureteral stones with small rigid and flexible ureteroscopes and the holmium laser is well over 90%. Lower pole renal calculi can also be treated with a success rate of approximately 80%, which surpasses that of shock wave lithotripsy. Selected stones that are over 2 cm in diameter, along with branched stones, can also be treated successfully with ureteroscopy. SUMMARY: Ureteroscopy is the most successful technique for the treatment of ureteral calculi (success rates >90%) and is an optional treatment for many renal calculi.

Humans↗
PubMed2002

Endoluminal sonography of the genitourinary and gastrointestinal tracts.

OBJECTIVE: Endoluminal sonography with high-frequency catheter-based transducers is a technique well suited to imaging structures beyond the lumen of the hollow viscus. The purpose of this article was to review some aspects of endoluminal sonography, including instrumentation, clinical applications in the gastrointestinal and genitourinary tracts, and its three-dimensional reconstruction. METHODS: The development of 6F to 10F catheter-based ultrasonic probes has made this technique available for use within a variety of lumina. Endoluminal sonography with frequencies of 9 to 20 MHz has been used for evaluation of a wide range of abnormalities in both the genitourinary and gastrointestinal tracts. RESULTS: Uses in the gastrointestinal tract include quantification of esophageal varices, distinguishing between various submucosal lesions, and measuring the degree of fibrosis in scleroderma. In the genitourinary system, endoluminal sonography has been used to guide collagen injection, to diagnose urethral diverticula and upper tract neoplasms, to locate crossing vessels and septa for guiding endopyelotomy, and to identify submucosal calculi. CONCLUSIONS: High-resolution endoluminal sonography is a new sonographic approach for evaluation of the genitourinary and gastrointestinal tracts. This should lead to the expansion of the diagnostic capabilities of sonography, providing important information for decision making relative to patient care and minimally invasive interventional procedures. Reconstructed three-dimensional endoluminal sonography has the potential to become a valuable tool in both the research and clinical areas.

Digestive System↗
PubMedDate not supplied

Endoscopic treatment of upper tract transitional cell carcinoma.

PURPOSE: To review the current literature and data describing primary endoscopic treatment of upper tract transitional cell carcinoma (TCC). MATERIALS AND METHODS: Published, peer-reviewed articles on ureteroscopic, percutaneous, and laparoscopic treatment of upper tract TCC were identified using the MEDLINE database. RESULTS: Nephroureterectomy has been considered the "gold standard" for upper tract TCC. Minimally invasive approaches, initially advocated for patients requiring a nephron sparing approach (i.e., solitary kidney or renal insufficiency) or those with significant comorbidities precluding definitive surgery, have been increasingly used with the further refinement of ureteroscopy, percutaneous renal surgery, and laparoscopy. Ureteroscopy has been used successfully, resulting in recurrence rates ranging from 31% to 65% and disease-free rates of 35% to 86%. Progression and metastatic rates are low and correlate with tumor grade. Likewise, percutaneous approaches show disease specific survival and recurrence rates correlating with tumor grade. Patients with low-grade tumors (Grades 1-2) do well with this approach with recurrence rates and disease specific survival rates of 26% to 28% and 96% to 100%, respectively. For those patients requiring complete extirpation of the kidney and ureter, laparoscopic nephroureterectomy results in decreased postoperative pain, shorter hospital stay, and more rapid convalescence without compromising cancer control. CONCLUSIONS: Nephron sparing approaches in well-selected patients with low stage and low-grade disease can be treated endoscopically with ureteroscopy and percutaneous renal surgery. Laparoscopic nephroureterectomy offers a safe, minimally invasive alternative to traditional open surgical techniques for patients with TCC of the upper urinary tract.

Carcinoma, Transitional Cell↗