Biomedical subjects

G C Bellman

Publications and source records attributed to G C Bellman.

31 records · Page 2Linked to original sources

PubMed1997

Influence of technique of percutaneous tract creation on incidence of renal hemorrhage.

PURPOSE: Renal hemorrhage is one of the most common and worrisome complications of percutaneous renal surgery. We studied the incidence of renal hemorrhage and transfusion rates in patients undergoing balloon or Amplatz fascial dilation of the nephrostomy tract. MATERIALS AND METHODS: Medical records of 143 patients who underwent 150 percutaneous renal procedures, including percutaneous nephrolithotomy, antegrade endopyelotomy and percutaneous treatment of stones in caliceal diverticula, were reviewed. The nephrostomy tract was dilated with balloon (50 patients) or Amplatz sequential (100) dilators. Perioperative decreases in hemoglobin level and blood transfusion rates were compared between the 2 groups. RESULTS: Of the 100 patients undergoing percutaneous renal Amplatz dilation 25 (25%) required a blood transfusion, compared to only 5 of 50 (10%) undergoing balloon dilation. The difference in the transfusion rates between the 2 groups was statistically significant (p = 0.048). CONCLUSIONS: Improvements in the technique of percutaneous renal surgery have decreased the morbidity associated with these procedures. In our study use of balloon tract dilators led to less renal hemorrhage and lower transfusion rates compared to Amplatz dilation. Additionally, balloon dilation appears to be more rapid and avoids renal movement away from the surgeon, which occasionally occurs during Amplatz dilation.

Adolescent↗

PubMed1997

"Tubeless" percutaneous surgery: a new advance in the technique of percutaneous renal surgery.

We describe our modification of the technique of traditional percutaneous renal surgery called "tubeless" percutaneous renal surgery. Fifty patients have now undergone percutaneous renal procedures without the use of a postoperative nephrostomy tube consisting of percutaneous nephrolithotripsy, percutaneous endopyelotomy, and both percutaneous stone extraction and endopyelotomy in the same setting. Our current modification of standard percutaneous surgical technique includes the placement of an internal ureteral catheter with primary closure of the access site using hemostatic skin sutures. The study group was compared to a control group of 50 patients who were age, sex and procedure matched who had undergone standard percutaneous renal procedures previously with routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, time of return to normal activities, and cost of treatment were compared between the two groups. All tubeless percutaneous procedures were successfully performed without significant complications. The initial 15 patients had postoperative renal ultrasounds demonstrating no urinoma. Hospital stay, analgesia requirements, and the patient's ability to return to normal activities were statistically significantly decreased in the patient group studied. The cost of a "tubeless" procedure was $1,638 compared with $3,750 (129% greater) for traditional percutaneous surgery (cost saving of $2,112/case). Tubeless percutaneous renal surgery is a safe procedure and offers advantages over the routine placement of a nephrostomy tube. The hospitalization period, analgesia requirements, return to normal activities, and cost are significantly less with this new technique.

Activities of Daily Living↗

PubMed1996

Special considerations in endopyelotomy in a horseshoe kidney.

We report a patient with ureteropelvic junction obstruction in a horseshoe kidney who was successfully managed with an antegrade endopyelotomy. Follow-up at 1 year confirmed a good result. Special considerations are necessary for the successful performance of an endopyelotomy in a horseshoe kidney. Recommendations will be made regarding percutaneous access and orientation of the incision as well as a review of the literature.

Adult↗

PubMed1996

Complications of endopyelotomy.

Complications of endopyelotomy can be classified as major (vascular, ureteral, or pulmonary injury or lost wire), minor (stent-related problems, infection, urinoma, or unrecognized incision of infundibular narrowing or renal pelvis), or failure to obtain the desired results. Awareness of the potential problems enables the surgeon to take preventative steps.

Blood Vessels↗

PubMed1995

Laparoscopic evaluation of indeterminate renal cysts.

OBJECTIVES: To determine the efficacy and safety of laparoscopic evaluation of indeterminate renal cysts. METHODS: Ten patients with indeterminate renal cysts (5 Bosniak type II and 5 Bosniak type III) underwent transperitoneal laparoscopic aspiration of cyst fluid for cytologic analysis with examination, biopsy, and excision of the cyst wall and base. RESULTS: All procedures were successful and without complications. All the lesions were benign. CONCLUSIONS: Laparoscopic evaluation of indeterminate renal cysts is safe and effective. The procedure alleviates patient anxiety about the nature of the lesion and obviates years of radiologic surveillance, thus reducing costs.

Adult↗

PubMed1995

Special considerations in the endourologic management of stones in continent urinary reservoirs.

To various degrees, all continent pouch designs are subject to stones, which often are infected. We report on the endourologic management of large stone burdens in three types of continent reservoirs. Stone in a UCLA and a Kock pouch were managed endoscopically, and stones in an augmented pouch with a Mitrofanoff valve were managed percutaneously. Recommendations are made with regard to the optimal endourologic management of significant stone burdens in each of the common continent urinary reservoirs.

Adult↗

PubMed1995

Management of hemorrhage after percutaneous renal surgery.

Renal hemorrhage is the most worrisome complication of percutaneous renal surgery. Between August 1983 and August 1992 we performed 2,200 percutaneous renal operations, with 17 patients (0.8%) requiring angiography and embolization for significant bleeding uncontrolled by the usual measures. The angiographic diagnoses were arteriovenous fistula in 7 patients, pseudoaneurysm in 4, fistula and pseudoaneurysm in 2, and lacerated renal vessels in 2. A total of 15 patients required no further treatment after embolization, while 2 underwent either partial nephrectomy or open exploration. No risk factors for hemorrhage could be identified. We recommend angiography and embolization under 3 conditions; 1) in the immediate postoperative period when clamping of the nephrostomy tube and a tamponade balloon catheter fail to control hemorrhage (24% of our series), 2) in the early postoperative period (2 to 7 days) when the patient requires 3 or 4 units of blood after replacement of the initial blood loss (41% of our series) and 3) for sudden hemorrhage more than 7 days postoperatively (35% of our series).

Adult↗

PubMed1994

Endourologic management of obstructed hydrocalyx after blunt renal trauma.

Significant renal injuries caused by blunt trauma can produce early and delayed complications. We report a case of blunt trauma that resulted in what appeared to be a persistent encapsulated hematoma, but was in reality an obstructed hydrocalyx. Communication with the collecting system was re-established percutaneously by a method similar to that used in the management of caliceal diverticula.

Adolescent↗

PubMed1994

Complications of intracavitary bacillus Calmette-Guerin after percutaneous resection of upper tract transitional cell carcinoma.

Percutaneous resection and intracavitary instillation of bacillus Calmette-Guerin (BCG) is currently being used in treatment protocols in select patients in whom the standard nephroureterectomy for upper tract transitional cell carcinoma is undesirable. However, the complications of BCG in these patients are not well defined. Among 16 patients treated in this manner 4 (25%) had asymptomatic granulomatous involvement of the renal pelvis discovered during regular followup nephroscopy and biopsy: 2 had recurrent carcinoma at discovery, whereas the other 2 remain free of disease. The significance and therapeutic consequences of BCG granulomatosis are unknown. Continued followup is necessary to identify any complications of BCG therapy.

BCG Vaccine↗

PubMed1994

Special considerations in the technique of laparoscopic ureterolithotomy.

Laparoscopic ureterolithotomy was performed in 2 men, accompanied in 1 by unroofing of a complex renal cyst. This new technique is indicated as an alternative to open lithotomy when more conventional minimally invasive measures have failed and in patients in whom laparoscopy is being performed for another indication. Modifications in technique are necessary depending on the location of the stone. Laparoscopic ureterolithotomy should not be performed unless a guide wire or catheter can be placed past the stone preoperatively. The technique is described in detail.

Aged↗

PubMed1994

Percutaneous approach to indeterminate caliceal filling defects.

Although the radiologic characteristics and endoscopic appearance of aberrant renal papillae have been described, a tissue diagnosis is the only way to exclude a low-grade urothelial malignancy. We report on three caliceal filling defects managed percutaneously in which biopsy findings confirmed aberrant papillae.

Adult↗

PubMed1994

Endourologic management of retained surgical drains and nephrostomy tubes.

A retained surgical drain or nephrostomy tube is a troublesome predicament that often has necessitated open surgical extraction. To assess the efficacy of endoscopic techniques in the management of this problem, several types of drains and tubes were placed intraperitoneally in a female pig and left for 3 weeks. Flat drains could be removed by traction. Jackson-Pratt drains could be removed by clearing the lumen of amorphous material with a guidewire and releasing the external adhesions with a 9.5Fr rigid ureteroscope passed beside the tube. The retained re-entry nephrostomy tubes could be removed under fluoroscopic control by using stone-grasping forceps and electrocautery inside the tube to incise the tissue holding the Malecot flanges. This latter method also was successful in a patient who had received intracavitary BCG after percutaneous tumor resection. Endourologic techniques can reduce the number of open operations that need to be performed to remove retained drains and tubes.

Aged↗

PubMed1993

Technique and follow-up of percutaneous management of caliceal diverticula.

Between June 1985 and July 1992 we treated 20 patients who had symptomatic caliceal diverticula (13 in upper calix, 6 in middle calix, and 1 in lower calix) in whom long-term (3 months to 3 years) evaluation of persistent symptoms, physical condition, and radiologic findings was possible. Of the 20 patients, 19 had had stones in the diverticulum preoperatively, and the other had a huge diverticulum but no stones. Eighteen patients (95%) with stones preoperatively had been rendered stone free, and the other patient demonstrated only small residual stones in the area of the obliterated diverticulum. Sixteen patients (80%) had obtained complete resolution of their diverticula, and the remaining 4 had at least a 50 percent diminution of the original size of the lesion. All patients had been rendered free of infection and symptoms. Percutaneous management of caliceal diverticula is the most effective approach to rendering patients with caliceal diverticula stone free and achieving diverticular ablation.

Adolescent↗