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Biomedical subjects

G C Lemos

Publications and source records attributed to G C Lemos.

At least 19 recordsLinked to original sources
PubMed1992

Extracorporeal shock-wave lithotripsy with Lithostar lithotriptor.

Initial experience of extracorporeal shock-wave lithotripsy (ESWL) using the Lithostar lithotriptor is reported; 193 patients underwent 248 treatments for 210 stones. A total of 139 renal calculi (126 patients) and 71 ureteral stones (67 patients) were analyzed. Treatments were performed without anesthesia in 65 calculi (27.6%), with intravenous sedation in 91 (42.5%), and under epidural anesthesia in 34 calculi (29.9%). A three-month follow-up showed a success rate of 88.0 percent for renal calculi and 95.5 percent for ureteral calculi treated in situ. Renal stone fragmentation was achieved with a mean of 4,890 shocks at 17.4 kV and ureteral calculi were fragmented with a mean number of 4,798 shocks at a mean of 18.3 kV. Auxiliary procedures after ESWL were required in 2 patients with renal stones and in 1 with ureteral calculi. A comparison between stone size and number of shock waves required to achieve stone fragmentation revealed a linear relationship. Hospitalization was not necessary in 84.4 percent of renal calculi and 89.6 percent of ureteral calculi. Retreatments were necessary in 22 (15.8%) of the renal calculi (18 had 2 sessions, 3 had 3 sessions, and 1 had 4 sessions). Of the ureteral calculi, 8 (11.3%) underwent retreatment (6 had 2 sessions, 1 had 3 sessions, and 1 had 4 sessions). The low morbidity with a large number of patients treated on an outpatient basis, minimizing the need for anesthesia, demonstrated a favorable initial successful experience with the Lithostar.

Brazil↗
PubMed1991

Lumbar ureteric stones: which is the best treatment?

We reviewed retrospectively 145 patients presenting ureteral calculi above the iliac crest. According to the treatment three groups were established. Group 1 was represented by 24 patients submitted to posterior ureterolithotomy; group 2, 100 patients treated by endourologic procedures; and group 3, 21 patients treated by extracorporeal shock-wave lithotripsy (ESWL). Success rate considered as complete removal of all calculous material was 100 percent in the posterior ureterolithotomy group, 92 percent in the endourologic group, and 94.7 percent in the ESWL group. Hospitalization, anesthesia, and complication rates were minimal in patients submitted to ESWL. One may conclude that ESWL is the treatment of choice for lumbar ureteric calculi.

Adolescent↗
PubMed1991

Treatment options for ureteral calculi: endourology or extracorporeal shock wave lithotripsy.

Two therapeutic methods, endourology and extracorporeal shock wave lithotripsy (ESWL), can be used in the treatment of ureteral calculi. In a retrospective analysis during a 2-year period 236 patients treated with endourological procedures and 71 who underwent ESWL with a Siemens Lithostar were analyzed as to the success rate, effectiveness quotient, complication rate and hospitalization. The mean stone size was 1.12 cm. in the endourology group and 1.03 cm. in the ESWL group. Complete removal of all stone fragments was achieved in 93.6% of the patients treated endourologically and without retreatment. In the ESWL group success was obtained in 90.1%, with an 11.2% retreatment rate. The retreatment rate was higher (25.0%) for calculi in the mid ureter. The group treated endourologically had a better success rate and no retreatment was necessary. On the other hand, the group treated with ESWL had a shorter hospitalization and a lower complication rate. Followup ranged from 11 to 60 months (mean 48 months) in the endourology group and 7 to 29 months (mean 11 months) in the ESWL group. These observations showed that in situ ESWL therapy with the Siemens Lithostar device is the method of choice for upper ureteral stones. Lower ureteral calculi should be treated endoscopically. Mid ureteral stones larger than 1 cm. had better results with endoscopic procedures and those smaller than 1 cm. had better results with ESWL.

Adolescent↗
PubMed1991

Renal calculi in lower pole calices: what is the best method of treatment?

Percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy (ESWL*) can be used in the treatment of lower pole caliceal calculi. In a retrospective analysis these 2 therapies were compared for treatment of solitary lower pole caliceal calculi to evaluate morbidity. During a 2-year period 23 patients treated with percutaneous nephrolithotomy and 24 who underwent ESWL with the Siemens Lithostar were analyzed in regard to the success rate, effectiveness quotient, complication rate, length of hospitalization and disability period. Followup consisted of ultrasound and/or a plain film of the kidneys, ureters and bladder 1 day and 1 to 3 months postoperatively. A nephrotomogram was included in the ESWL group. Complete removal of all stone fragments was achieved in 93.6% of the patients treated percutaneously without retreatment. In the ESWL group the success rate was 79.2% with a 41.6% retreatment rate. On the other hand, the ESWL group had a shorter hospitalization and an earlier return to normal physical activities. Among the patients who underwent a percutaneous operation 13% had complications compared to 4.1% in the ESWL group. The recurrence rate was higher in the former group (13% within a median of 18 months, compared to 8.3% within a median of 11 months in the ESWL group). The mean stone diameter was 1.42 cm. in the percutaneous group and 1.22 cm. in the ESWL group. Stone composition was similar in both groups. Since ESWL is an effective noninvasive procedure without the need for routine anesthesia and hospitalization, and with prompt return of the patient to a normal life it must be considered the method of choice for lower caliceal stones less than 2 cm. in diameter. However, percutaneous nephrolithotomy will continue to have a primary role in the management of larger stones.

Adolescent↗
PubMed1991

Adjunct controlled inversion therapy following extracorporeal shock wave lithotripsy for lower pole caliceal stones.

The lower calix is responsible for a significant number of kidneys with residual stone fragments after extracorporeal shock wave lithotripsy (ESWL*). To compare the effectiveness of controlled inversion therapy as an adjunctive method to the elimination of calculous fragments, 42 patients who had undergone treatment for lower caliceal stones with a Siemens Lithostar lithotriptor were reviewed. Of the patients 25 had no adjunctive therapy and 17 underwent controlled inversion therapy. The success rate, effectiveness quotient and complication rate were analyzed. Followup consisted of ultrasound and a nephrotomogram 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 84% of the patients without an adjunctive maneuver and in 64.7% of those treated with controlled inversion therapy. The effectiveness quotient was 72.4% and 35.5%, respectively. The group treated without adjunctive therapy had fewer retreatment sessions and a lower complication rate. There were no complications related to the controlled inversion therapy and patient acceptance was generally enthusiastic. We conclude that controlled inversion therapy did not improve the results of ESWL for lower pole caliceal calculi.

Adolescent↗
PubMed1990

In situ extracorporeal shock wave lithotripsy for ureteral calculi.

We reviewed our experience with in situ extracorporeal shock wave lithotripsy for ureteral stones in 30 patients. The Siemens Lithostar unit was used for stone disintegration and no attempts were made to manipulate the calculi back into the kidney. During the study period 15 patients presented with upper, 9 with mid and 6 with lower ureteral calculi. The mean stone size was 5 x 12 mm. The success rates in stone removal, hospitalization, anesthesia, average number of shocks and kilovolts used were analyzed. Complete removal of all calculous material was obtained in 86.6% of the patients after 3 months. Followup consisted of a plain film of the kidneys, ureters and bladder, and eventually renal ultrasound 1 day and 1 to 3 months postoperatively. Routinely, patients were treated without hospitalization, while 3 had persistent stone fragments and required hospitalization for auxiliary endourological procedures. The average hospital stay for these patients was 1.6 days. Of the 30 patients 13 (43.4%) were treated without anesthesia, 9 (30.0%) received intravenous sedation and 8 (26.6%) had epidural anesthesia. Patients received 3,000 to 6,000 shock waves per session (median 4,000) at 14.0 to 19.0 kv. (median 18.1 kv.), and in 76.9% the treatment was completed after 1 session. Patients who needed more than 1 session received 3,000 to 4,000 shock waves (median 3,000) at 15.0 to 19.0 kv. (median 17.8 kv.) per additional session. Minor complications, such as hematuria, were observed in 33.3% of the patients for less than 24 hours. A small erythematous area usually was present on the abdominal wall at the shock wave entrance site and temporary ileus was noted in 2 patients. In situ extracorporeal shock wave lithotripsy with the Siemens Lithostar device is an effective method for treatment of ureteral stones in all parts of the ureter due to the ease of patient positioning.

Anesthesia, Epidural↗
PubMed1990

Endourological management of ureteral strictures.

We reviewed the records of 20 patients (21 ureters) treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureterolithotripsy in 47.7% of the patients, open ureterolithotomy in 9.5%, other urological procedures in 23.8%, general surgical and gynecological procedures in 9.5% and miscellaneous factors in 9.5%. A total of 20 patients (21 ureters) underwent endourological treatment with balloon dilation (19) or balloon dilation and internal ureterotomy (2), with good results in 57.1% and a mean followup of 24 months. Of the 9 patients who failed endourological management 3 underwent successful open repair, 3 underwent nephrectomy, and 3 had a relatively large ureteral lumen and became asymptomatic, receiving no further treatment. The interval between injury and treatment was not a decisive factor. The length of ureteral stricture assumes the most significant parameter to predict success in the treatment of ureteral stricture. There were no intraoperative or postoperative complications. The association of balloon dilation and incision by special endoureterotomy scissors is a potentially useful technique.

Catheterization↗
PubMed1989

Small caliceal stones: what is the best method of treatment?

In a retrospective analysis classical radial nephrolithotomy, percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy for symptomatic small nonobstructive caliceal stones were compared to evaluate morbidity. Size (less than 1 cm.) and location of the stone (caliceal and nonobstructive) did not explain the severity of the symptoms nor would they have been an indication for an operation. In 8 patients treated by an open operation, 16 treated percutaneously and 6 who underwent extracorporeal shock wave lithotripsy the procedure time, success rate, complication rate and length of hospitalization were analyzed. Followup consisted of ultrasound and/or a plain film of the kidneys, ureters and bladder 1 day and 3 months postoperatively. A nephrotomogram was included in group 3 patients. Of 30 patients 3 had persistent stone fragments for more than 3 months: 2 underwent percutaneous nephrolithotomy and 1 was treated by extracorporeal shock wave lithotripsy. A total of 28 patients (93.3 per cent) achieved complete or significant relief of pain. In the percutaneous group both patients with persistent fragments were symptomatic in contrast with the extracorporeal shock wave lithotripsy group, in which 1 patient presented with stone fragments but was free of pain. The group treated percutaneously had a shorter procedure time (60 minutes) and the shock wave group had a shorter hospitalization. On the other hand, the open operation group had a better success rate as well as relief of pain. These observations showed that small, nonobstructive caliceal stones can be responsible for persistent, severe flank pain. Since extracorporeal shock wave lithotripsy is an effective noninvasive procedure that does not require routine anesthesia and hospitalization, with prompt return of the patient to normal life, it must be considered the method of choice in these particular patients.

Adolescent↗
PubMed1989

Internal urethrotomy as a complementary method after urethroplasties for posterior urethral stenosis.

Failure of the treatment of posterior urethral stenosis ranges from 10 to 30 per cent. Strictures secondary to pull-through or transpubic urethroplasty are difficult to manage. The management of these strictures is reviewed in 21 children and 84 adults. Of the 105 patients 69 had been treated previously by a perineal pull-through technique and 36 by transpubic urethroplasty. A total of 18 patients (10 in the transpubic and 8 in the pull-through groups) whose results were fair or poor underwent internal urethrotomy with the Sachse knife as a complementary treatment after posterior urethroplasty. Internal urethrotomy provided good results in 8 patients (80 per cent) in the transpubic group and 5 (62.5 per cent) in the pull-through group. None of the patients was incontinent and there was no symptomatic urinary infection postoperatively.

Adult↗
PubMed1988

Comparison between percutaneous nephrolithotomy and open stone procedures.

A total of 205 patients have undergone stone extraction surgery. Three groups were studied: in 70 patients the stones were removed by flank incision, in 20 patients by posterior incision and 80 patients were treated by percutaneous nephrolithotomy. Patients submitted to percutaneous nephrolithotomy had a shorter hospitalization, operative time and a significantly reduced period of recuperation, allowing earlier return to work and decreased disability. Narcotic drugs were demanded in a lower amount in the percutaneous nephrolithotomy group.

Adolescent↗
PubMed1988

Colon perforation following percutaneous nephrolithotomy.

Between February 1984 and 1986, 285 patients underwent percutaneous nephrostomy placement followed by track dilation and calculi removal. Although percutaneous colonic perforation is rare, we report a case consequent to this procedure. The patient had a good outcome after surgical management of the damaged colon. This report considers the anatomic aspects for percutaneous nephrostomy placement as well as the auxiliary methods used in diagnosis of lesions of the colon.

Adult↗
PubMed1988

Percutaneous nephrolithotomy in patients with previous renal surgery.

Although safe and effective, nephrolithotomy sometimes is difficult. 224 patients have undergone percutaneous stone extraction surgery. Two groups were established according to previous open renal surgery. 79 patients had had previous surgery and 145 patients were initially treated by percutaneous nephrolithotomy. Bleeding and operative time, i.e. puncture of the kidney, dilation of the tract and lithotripsy were greater in the group with previous renal surgery. However, no statistical difference was verified. In conclusion, percutaneous lithotripsy is a safe and effective method with minimal morbidity even in patients with previous renal surgery.

Female↗
PubMed1988

Staghorn calculi: percutaneous versus anatrophic nephrolithotomy.

In a retrospective analysis percutaneous ultrasonic lithotripsy and anatrophic nephrolithotomy for staghorn stones were compared to evaluate morbidity. In 46 patients treated percutaneously and 29 patients treated by open surgery, the procedure time, success rate, complication rate, length of hospitalization, disability period, and amount of analgesics needed in the postoperative period were analyzed. 5 patients treated during the learning period were not considered for this study, no matter whether they were treated by open or percutaneous surgery. Complete removal of all stone fragments was achieved in 73.8% of the patients treated percutaneously. Calculi were removed successfully in 82.1% of the patients submitted to anatrophic lithotomy. The group treated percutaneously showed shorter procedural time (mean 120 versus 210 min), shorter hospitalization period (5 versus 7 days), less need for analgesics (mean 1.6 versus 4.7 doses per patient), and an earlier return to normal physical activities (9 versus 43 days). Among the patients who underwent open surgery, 14 (50.0%) required additional interventions to treat complications. Although in the percutaneous group 28.5% required more than one percutaneous intervention, the overall complication rate per surgery of 20.0% was significantly lower, with no need for open surgery. Percutaneous nephrolithotomy proved to be of significantly lower morbidity than anatrophic lithotomy.

Adult↗
PubMed1988

Comparison of the Stamey bladder neck suspension procedure with a modified endoscopic suspension for the treatment of stress urinary incontinence.

Endoscopic vesicourethral suspension is an acceptable procedure for the treatment of stress urinary incontinence and is associated with a high success rate and little morbidity. Classical endoscopic vesical neck suspension was performed in 93 patients with cure of incontinence in 89 (95.7%). Cost-effectiveness and simplification were introduced to Stamey's technique. Modifications introduced to the Stamey technique were found to be simpler and to provide cost savings with fewer complications. Eighty-six women were operated on by this method, with 84.9% of success. A total of 133 (74.3%) of the patients had previous surgical procedures to correct incontinence, demonstrating the indication of the endoscopic vesicourethral suspension in case of failures with other techniques.

Adult↗
PubMed1986

Urologic aspects associated with isolated hypogastric artery aneurysm.

The isolated hypogastric artery aneurysm may give rise to urologic symptoms. This occurs as a consequence of extrinsic compression exerted by the aneurysm itself to the urinary tract or the involvement of the urinary tract by the perianeurysmatic fibrosis. We report 2 cases of isolated hypogastric artery aneurysm. One of the patients had unilateral ureteral obstruction while the other revealed a mass on rectal examination. In both cases surgery was performed and the urologic manifestations were relieved completely.

Aged↗
PubMed1986

Methodology for endoscopic treatment of ureteral calculi.

The records of 27 patients undergoing endoscopic treatment of ureteral calculi were reviewed. The percutaneous nephrostomy approach was used for calculi located above the iliac vessels, while the transurethral approach was used for those below the iliac vessels. The success rates achieved for these calculi were 82.3 and 90.0 per cent, respectively. Endoscopic treatment has proved to be safe and effective in patients with ureteral stones.

Adult↗