Hyperoxaluria and renal calculi in children: the role of extracorporeal shock wave lithotripsy.
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Child↗
Biomedical subjects
H N Whitfield
Publications and source records attributed to H N Whitfield.
Second generation lithotripsy: an experience of 200 patients.
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Adolescent↗
Lithotripsy.
In the last few years dramatic changes have occurred in the surgical treatment of stones in the upper urinary tract. Ninety-five per cent of all stones that previously necessitated open surgery are now amenable to less invasive techniques. Percutaneous nephrolithotomy (PCNL), developed in the early 1980s, has been complemented by extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopy (URS). This article traces the history of ESWL, defines its place in the management of patients with upper urinary tract stones, and looks forward to further advances.
Cholelithiasis↗
Extracorporeal shockwave lithotripsy: first 1000 cases at the London Stone Clinic.
One thousand patients underwent extracorporeal shockwave lithotripsy for renal and ureteric calculi at this clinic. An overall success rate of 91.8% was achieved (stone free or less than 2 mm fragments at three months) and for stones measuring 1 cm 96.3%. Lithotripsy produced extremely low morbidity, and no deaths have occurred at the clinic. Patients who had lithotripsy alone had a mean hospital stay of three days and in most instances were able to perform their full range of activities on discharge. Planned combination of lithotripsy with minimally invasive endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy has allowed us to extend the range of treatable cases to include large stones. Prophylactic use of Double-J ureteric stents in selected cases has reduced the incidence of obstruction by stone fragments after lithotripsy, thereby decreasing morbidity and hospital stay.
Adolescent↗
Tissue effects of an ultrasonic scalpel for clinical surgical use.
The effects of a new ultrasonic scalpel were studied in laboratory animals. Tissue heat conduction from the tip of the ultrasonic blade was measured. Tissue damage was assessed by light microscopy of histochemically stained sections. The ultrasonic scalpel incised nonfibrous tissue effectively, with minimal heat conduction, and the incisions healed with no evidence of fibrosis nor of tissue destruction.
Animals↗
The effects of a gonadotropin-releasing hormone agonist on testicular histology.
We have described the histologic changes in the testes of men treated with buserelin for prostatic cancer. If these changes are reversible, then the agonist analogues, together with testosterone replacement therapy, could be used safely for male contraception. If the changes are irreversible, then boys with central precocious puberty treated with such compounds would be of normal height, but sterile.
Aged↗
Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in children.
The possibilities for treating children with renal stone disease by extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) have not been widely explored. We report ten children, aged between 5 and 16 years, treated by PCNL, and six children, aged between 6 and 15 years, treated by ESWL alone. A 16-year-old spina bifida child with a staghorn calculus was treated electively by a combination of the two methods. Hospital stay was 3 to 8 days for treatment by PCNL or ESWL, and was only 11 days for the combination treatment. Complete stone clearance was achieved in 12 children followed for 3 months. No significant complications occurred. ESWL and PCNL are suitable methods for the management of renal calculi in children.
Adolescent↗
The treatment of 100 consecutive patients with ureteral calculi in a British stone center.
Of all ureteral calculi 20 per cent will require removal. The use of extracorporeal shock wave lithotripsy has changed dramatically the treatment of ureteral stones requiring intervention. We reviewed 111 procedures for 108 stones in 100 consecutive patients. Primary techniques included extracorporeal shock wave lithotripsy after retrograde manipulation (63 cases), percutaneous nephrolithotomy alone (1) and after retrograde manipulation (3), ureteroscopic removal (29), cystoscopic removal (2) and open ureterolithotomy (2). These techniques and the results are discussed. Of the patients 11 required a secondary procedure, including extracorporeal shock wave lithotripsy in 3, ureterorenoscopy for failed extracorporeal shock wave lithotripsy in 2, an open operation for complications of ureterorenoscopy in 2 and correction of associated stricture in 2. All patients ultimately were free of stones. Our experience with in situ extracorporeal shock wave lithotripsy is described. An open operation was done only when less invasive forms of treatment failed or electively to correct an associated anatomical abnormality.
Adult↗
Obstructive nephropathy: comparison between parenchymal transit time index and frusemide diuresis.
Sixty-three patients presenting with the clinical problem of renal outflow disorder were studied using 99mTc DTPA. The techniques of frusemide diuresis and parenchymal transit time index analysis were compared and both shown to be successful in aiding the decision as to the presence or absence of significant outflow obstruction.
Adult↗
Extracorporeal shock wave lithotripsy. Is sessional access worthwhile?
One hundred and fifty-three patients with renal stones referred to one teaching hospital have received extracorporeal shock wave lithotripsy (ESWL) treatment as a result of a monthly sessional arrangement organised with a neighbouring lithotripter unit. The results of treatment, assessed 3 months after lithotripsy, showed results comparable with those from any lithotripter centre. Sessional access for lithotripsy may provide a satisfactory way of increasing the number of patients who are treated with lithotripsy by reducing the demand for beds at the hospitals where a lithotripter is sited.
Adolescent↗
Idiopathic retroperitoneal fibrosis. A retrospective analysis of 60 cases.
Sixty patients with idiopathic retroperitoneal fibrosis presenting between 1965 and 1984 are reviewed. Their mean age at presentation was 56 years and the male:female ratio was 3:1. The commonest presenting symptoms were flank and abdominal pain, weight loss, nausea and polyuria. Physical examination was usually normal, expect for the presence of hypertension. Anaemia and elevation of erythrocyte sedimentation rate were usually present. Proteinuria was found in less than a third of patients at presentation and significant bacteriuria was uncommon. The correct diagnosis was made or suspected in very few patients before referral. The cumulative actuarial survival rate was 86% at 1 year and 78% at 2 years. Seventeen patients died; they were significantly older and more uraemic at the time of referral than those who survived. A few patients did well with either corticosteroid therapy or ureterolysis alone. In the majority, both operation and steroid treatment were necessary. In bilateral obstruction with residual function in both kidneys, bilateral ureterolysis proved superior to unilateral operation (each followed by steroid therapy) in conserving renal function. Operation alone or steroid therapy alone should be considered in cases where steroids or surgery respectively present particular hazards. The less traumatic unilateral operation should be considered in poor risk patients and in those whose renal function is absent on one side. In many survivors, disease activity has persisted for many years. Life-long follow-up is recommended.
Adrenal Cortex Hormones↗
Urothelial reaction to ureteric intubation. A clinical study.
Urothelial biopsies from ureters intubated with silicone (11) and other polymer (13) double J stents revealed features of mucous metaplasia in 12/24 cases. These changes were associated with encrustation of the stents and occurred principally in stone-forming patients.
Epithelium↗
Radionuclide evaluation pre- and post-extracorporeal shock wave lithotripsy for renal calculi.
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Humans↗
Radionuclide evaluation pre- and postextracorporeal shock wave lithotripsy for renal calculi.
Forty-two patients were evaluated pre- and postextracorporeal shock wave lithotripsy (ESWL) using [99mTc]DTPA renography. A quantitative evaluation showed that the relative renal function decreased 2-3 days post-ESWL on the treated side, and the parenchymal transit time index (PTTI) increased 2-3 days post-ESWL (p less than 0.001) on the treated side and returned to the pretreatment level by 3 wk post-ESWL. The untreated side showed an increase in PTTI 2-3 days post-ESWL (p less than 0.01), which returned to normal by 3 wk post-ESWL. A significantly greater increase in PTTI was seen in patients who received greater than 1,000 shocks as compared with those who received less than 1,000 shocks. Five patients developed obstructing uropathy post-ESWL, when stone fragments caused ureteric obstruction.
Humans↗
An experimental study of hydrophilic plastics for urological use.
Hydrophilic graft copolymers of polyethylene vinyl acetate (PEVA) were extruded into tubular form. These materials increase both external and internal diameters by 60% on contact with water. The tubes were used as ureteric stents in an experimental study and were superior to silicone stents of the same calibre in the limitation of urinary extravasation. Histological, cytotoxic and electron microscopic studies showed that PEVA is a biocompatible material suitable for clinical use in urology.
Animals↗
The complications of extracorporeal shockwave lithotripsy: management and prevention.
Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.
Adolescent↗
Combination of percutaneous surgery and extracorporeal shockwave lithotripsy for the treatment of large renal calculi.
Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCNL and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.
Combined Modality Therapy↗