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Biomedical subjects

E Holman

Publications and source records attributed to E Holman.

At least 19 recordsLinked to original sources
PubMed2002

Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy.

OBJECTIVE: To compare simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) and unilateral PCNL in separate sessions in patients with bilateral renal stones for several variables before and after surgery. PATIENTS AND METHODS: The results from SBPCNL carried out at two centres in different countries on 198 patients (aged 1.25-70 years) were compared with those from 300 patients undergoing unilateral PCNL in separate sessions. At one centre where extracorporeal shockwave lithotripsy (ESWL) was available SBPCNL was used for stones where at least two sessions of ESWL would have been required on each side. Other associated procedures were also used wherever required. RESULTS: The stones were cleared bilaterally in one session of SBPCNL in 190 patients; in eight, fragments of < 3 mm remained but were not clinically significant. A second session was required in six patients on one side only. Variables assessed before and after treatment (e.g. hospital stay, analgesia requirements and complications) were not significantly different between SBPCNL and PCNL. The mean (range) total operative duration for SBPCNL was 46 (20-100) min and the hospital stay 4.3 (3-8) days. CONCLUSION: From this experience, SBPCNL is a cost-effective and beneficial solution for selected patients, with clear advantages over separate unilateral PCNL in patients with bilateral stones.

Adolescent↗
PubMed2001

Percutaneous suprapubic cystolithotripsy for pediatric bladder stones in a developing country.

OBJECTIVE: To evaluate our experience with percutaneous suprapubic cystolithotripsy (PCCL) in Yemeni children with endemic urinary bladder stones. PATIENTS AND METHODS: Between January 1993 and December 1998, 117 children underwent percutaneous suprapubic lithotripsy in Arabia Felix Modern Hospital, Sana'a Republic of Yemen. The patients' ages ranged from 8 months to 14 years (average 3.7 years). Ninety patients (77%) were under 5 years old; 20 patients (16%) were between 6 and 10 years old, and 7 patients (6%) were between 11 and 14 years old. There were 116 boys and 1 girl. The stone size ranged from 0.7 to 4 (average 2.3) cm. Five patients had coexisting urinary bilharziasis and another 5 patients had coexisting renal stone. In 10 patients, the stone was in the urethra. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was an adult 26-french nephroscope, the same as that used for percutaneous nephrolithotripsy. Ultrasound disintegration was needed for stones of > 1 cm. A suprapubic catheter was left for 24 h, and a urethral catheter was kept for 48 h. RESULTS: All patients became stone free. The average operating time was 15 (5-50) min. The average hospital stay was 2.7 (2-5) days. No severe intra- or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 109 patients (93%). CONCLUSION: Based on our experience we can conclude that percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. Our series proves the nutritional etiology of endemic pediatric bladder stones. To our knowledge, this is the largest series reported on percutaneous suprapubic management of endemic bladder stones in children.

Adolescent↗
PubMed2000

Percutaneous nephropexy.

OBJECTIVE: The authors present a 12-year (1986-98) study of a new procedure called percutaneous nephropexy (PCNP). This procedure was performed on 51 renal ptosis patients at two urological departments (in Pakistan and Hungary) with satisfactory results. The idea for PCNP was adapted from the observation that after drain insertion following nephrostomy a scar is quite sufficient to hold the kidney in place. That idea was used to fix the kidney at the required level. MATERIAL AND METHODS: Thirteen patients complained of a palpable mobile mass in the abdomen while others suffered from pain in their affected flank with recurrent attacks of urinary tract infection. On ultrasonic examination the kidney was found to be lower than the normal position. This observation was confirmed by a standing intravenous urography (IVU) examination that also showed a tortuous ureter. Nine patients also had a stone in the affected kidney. The operation involved puncture and dilatation of a channel through the lower calyx. RESULTS: Control IVU examination was performed after wound healing and was repeated 2 months after the operation, followed by consecutive ultrasonic examinations. Standing X-ray films obtained after contrast material injection showed the kidney to be at a higher level with a straight ureter. Forty-five patients (88.2%) recovered completely. CONCLUSION: In the authors' opinion PCNP is a good alternative to open nephropexy operations in renal ptosis cases, particularly when laparoscopic surgery facilities are not available. Although PCNP was developed in circumstances in which the availability of equipment was restricted, in terms of benefits it is comparable with laparoscopic nephropexy.

Adolescent↗
PubMed1998

Laparoscopic management of ureteral perforation during ureterolithotripsy.

The author presents a case of successful laparoscopic repair of a ureteral perforation happening during ureterolithotripsy (URS). The perforation of the mid-ureter was managed by a retroperitoneal approach: the stone from the retroperitoneum was removed, a double-J stent was inserted up to the kidney, the perforation opening was sutured, and the retroperitoneum was drained. The patient healed without any complication. Similar management of a ureteral perforation has not been found in the literature.

Drainage↗
PubMed1998

Laparoscopically assisted percutaneous transperitoneal nephrolithotomy in pelvic dystopic kidneys: experience in 15 successful cases.

The stone-holding pelvic dystopic kidneys of 15 patients were treated with laparoscopically assisted percutaneous transperitoneal nephrolithotomy. With patients in the Trendelenburg position under laparoscopic control, the bowels were dislodged with forceps until the kidney became visible. Under simultaneous laparoscopic and fluoroscopic control, the nephrostomy track was created on the antegrade route using telescopic metal dilators and a rigid nephroscope. Percutaneous nephrolithotomy was carried out in the usual manner. All the stones could be removed successfully. The only minor complication was a delayed urine leakage through the abdominal drain in a patient with a double J stent. Severe complications did not occur. The average operating time was 55 (40-85) minutes; the average hospital stay was 4.8 (4-11) days. On the basis of the authors' experience and a literature review of cases of failed shock wave lithotripsy-which is quite frequently unsuccessful in these cases-and cases of large, dense stones, this method appears to be the simplest and most suitable minimally invasive treatment of the stone-holding pelvic dystopic kidney.

Adolescent↗
PubMed1997

Endopyelotomy: experience with 320 cases.

We were the first to initiate endopyelotomy in Hungary (in 1986) and in Yemen and Pakistan (in 1993). Through the end of 1995, 320 cases of ureteropelvic junction (UPJ) stenosis have been operated upon. The procedure was performed under local anesthesia in adult patients and general anesthesia in children. The minimum age of the patient was 4 years, while the oldest patient was 80 years of age. The UPJ was incised longitudinally at the posterolateral aspect until the perinephric fat was seen, and a drain of 8F to 12F was inserted transrenally into the ureter through a nephroscope. Patients soon left the hospital and were able to start working in 5 days (average). The drain was removed after 6 weeks. During the follow-up period, ultrasonic examination was performed each 3 months. The success rate (mean of three centers) came out to be 87%. Open pyeloplasty was performed in cases where the symptoms of pyelectasia were persisting and caused complaints and stenosis was present even after 6 months. In our opinion, endopyelotomy should be the procedure of first choice for UPJ stenosis, because it is less troublesome for the patient than open pyeloplasty, and the results are real encouraging.

Adolescent↗
PubMed1995

Endoscopic clip-knot suturing technique: preliminary report of application in retroperitoneal ureterolithotomies.

A newly developed laparoscopic knot-substituting technique is presented and applied in cases of retroperitoneal laparoscopic ureterolithotomies. The authors substituted the difficult laparoscopic knotting techniques with the technique of using one or two clips to hold the sutures tight, which shortens and simplifies the endoscopic suturing. This technique is a great advantage, mainly in cases of major reconstructive laparoscopic operations. The technique and advantages of retroperitoneoscopy are discussed as well.

Humans↗
PubMed1993

[Percutaneous nephropexy].

We present a new, minimally invasive method for the treatment of nephroptosis. We are suggesting the more spreaded use of this method after the good results we found during the long term observation of our 40 patients with percutaneous nephropexy.

Adult↗
PubMed1993

Laparoscopically controlled and assisted percutaneous transperitoneal nephrolithotomy in a pelvic dystopic kidney.

Two renal pelvic stones were removed percutaneously from a pelvic dystopic kidney using a transabdominal, transperitoneal approach. The puncture was made antegrade and controlled partly fluoroscopically and partly laparoscopically. Where the kidney was covered by bowels, these were displaced with forceps inserted through another laparoscopic trocar. The dilation and stone removal were performed traditionally. As the kidney was just behind the uterus, the authors considered extracorporeal lithotripsy contraindicated in this case, so the only minimally invasive resolution was percutaneous nephrolithotomy, which could be performed only with the aid of laparoscopy.

Adult↗
PubMed1990

[Endoscopic removal of urinary calculi in children].

In 55 children less than 14 years old urinary calculi have been removed endoscopically. In larger stones the ultrasonic lithotripsy has been used. Due to our experience and a review of the literature it was found that the majority of urinary calculi in children could be removed endoscopically. The open operation should be used in exceptional cases. Problems, results and complications of the endoscopic approach are described in detail.

Child↗
PubMed1989

[Endoscopic removal of urinary calculi in children].

The authors present their experience with the endoscopic kidney stone removal in pediatric patients. They treated 55 children under 14 with this method. If the stone was large they used ultrasonic disintegration. On the basis of their own experience and the technical literature they assert that most of the pediatric kidney stones are removable in this way and there is no reason for the existence of open surgery only in exceptional cases. They detail the difficulties of the performance, their results and complications. On the basis of these they emphasize that the aversion from the endoscopic kidney stone removal in pediatric patients--if someone has the necessary skill--is causeless.

Child↗
PubMed1988

Ultrasonic destruction and endoscopic removal of kidney, ureteral, bladder and urethral stones.

Endoscopic removal of renal calculi was introduced at our department in 1984, first in Hungary and East-Europe. Renal, ureteral, bladder and urethral calculi are all endoscopically removed partially following ultrasonic destruction. The procedure is similarly used in cases of solitary kidney or of kidneys with staghorn calculi. Several hundreds of successful cases have proved the necessity and importance of the procedure.

Adolescent↗