Renal trauma and the risk of long-term complications in shock wave lithotripsy.
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Animals↗
Biomedical subjects
J E Lingeman
Publications and source records attributed to J E Lingeman.
Quantitation of shock wave lithotripsy-induced lesion in small and large pig kidneys.
BACKGROUND: Shock wave lithotripsy (SWL) is known to cause injury to the kidney. However, it is not known how lesion size varies as the parameters of SWL treatment (number of shocks, kilovoltage, kidney size) are changed. This hypothesis could not be tested because there was no method available to quantitate accurately the SWL-induced renal lesion. METHODS: A dosage of 2,000 shocks at 24 kV delivered by an unmodified Dornier HM3 lithotripter was applied to the lower pole calyx of the right kidney of small and large pig kidneys. A new method was developed to embed a whole pig kidney for serially sectioning, recording, and digitization. Automated computer color recognition made it possible to discriminate regions of hemorrhage from undamaged tissue and allowed quantitation of the lesion in single sections and in the entire kidney. RESULTS: The new protocol resulted in an accurate identification of sites of hemorrhage and calculations of the volume fraction of injured renal tissue. Lesion size induced in small kidneys was significantly larger than that induced in the larger kidneys (7.6 +/- 1.2% and 1.6 +/- 0.7%, respectively). CONCLUSIONS: Computer segmentation of serially sectioned SWL-treated kidneys has determined that kidney size is a risk factor for enhanced renal injury.
Animals↗
Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association.
PURPOSE: The American Urological Association convened the Ureteral Stones Clinical Guidelines Panel to analyze the literature regarding available methods for treating ureteral calculi and to make practice policy recommendations based on the treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles related to ureteral calculi published from 1966 to January 1996. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative treatments of ureteral calculi. RESULTS: The data indicate that up to 98% of stones less than 0.5 cm. in diameter, especially in the distal ureter, will pass spontaneously. Shock wave lithotripsy is recommended as first line treatment for most patients with stones 1 cm. or less in the proximal ureter. Shock wave lithotripsy and ureteroscopy are acceptable treatment choices for stones 1 cm. or less in the distal ureter. CONCLUSIONS: Most ureteral stones will pass spontaneously. Those that do not can be removed by either shock wave lithotripsy or ureteroscopy. Traditional blind basket extraction, without fluoroscopic control and guide wires, is not recommended. Open surgery is appropriate as a salvage procedure or in certain unusual circumstances.
Humans↗
Simultaneous bilateral percutaneous nephrolithotomy.
PURPOSE: We evaluate the results of simultaneous bilateral percutaneous nephrolithotomy. MATERIALS AND METHODS: The charts of 52 patients scheduled for simultaneous bilateral percutaneous nephrolithotomy at the Methodist Hospital of Indiana were retrospectively reviewed. The results of the 48 patients who underwent the procedure were tabulated and analyzed. RESULTS: Mean operative time was 269 minutes and mean hospital stay was 5.6 days. Of the patients 45 were rendered stone-free (96.9% of 96 renal units) and 3 had insignificant debris (fragments less than 4 mm.) unilaterally. Complications were infrequent and included hydrothorax in 5 cases, ureteral obstruction by fragment migration in 2, hematuria causing clot retention in 2, blood transfusion in 2 and ureteral perforation with a guide wire in 1. CONCLUSIONS: Simultaneous bilateral percutaneous nephrolithotomy is a well tolerated, safe, cost-effective and expeditious approach to patients with bilateral renal calculi requiring percutaneous nephrolithotomy.
Adolescent↗
Extracorporeal shock wave lithotripsy. Development, instrumentation, and current status.
In this article, the author briefly reviews the early development of the lithotriptor, provides a detailed review of lithotriptors that are currently available, and gives an overview of the present extracorporeal shock wave lithotripsy indications and techniques. The author also presents a brief overview of the results that are produced by various lithotriptors.
Anesthesia↗
Effects of SWL on glomerular filtration rate and renal plasma flow in uninephrectomized minipigs.
This study tested the hypothesis that the effects of SWL on hemodynamics in solitary kidneys differ from those in kidneys of binephric animals. Five female miniature pigs (Pitman-Moore, 6 months of age, 30-35 kg) were anesthetized for unilateral nephrectomy. Seven pigs served as binephric controls. Two weeks later, each pig was anesthetized, prepared for unilateral or bilateral urine collections, and subjected to SWL (Dornier HM3, 2000 shocks, 24 kV). Clearances of inulin (glomerular filtration rate; GFR) and para-aminohippurate (renal plasma flow; RPF) were measured 1 hour prior to and 1, 4, and 24 hours after SWL. The GFR and RPF were higher in uninephrectomized than in intact pigs at all time points. In both groups, SWL reduced GFR and RPF. In the binephric pigs, RPF was reduced at all times post-SWL, but in the uninephrectomized pigs, RPF was returning toward baseline by 4 hours post-SWL and was not different from baseline at 24 hours. A comparison of whole-animal GFR and RPF (righ plus left clearances in binephric pigs v solitary renal clearances in uninephrectomized pigs) showed that whole-animal GFR and RPF did not differ between the groups before or after SWL. Compensatory renal hypertrophy and improved hemodynamics in solitary kidneys may acutely attenuate the renal vasoconstrictive effect of SWL. The long-term consequences of the compensatory changes are unknown.
Animals↗
Urologic applications of the Holmium laser.
The Holmium laser has now been in clinical use in urology for several years. The indications for its use continue to expand, and now include lithotripsy and urothelial tumor ablation anywhere in the urinary tract, resection of the prostate, incision of various urinary tract strictures, and vaporization of cutaneous lesions of the external genitalia. The 2100-nm wavelength provides the Holmium laser with a unique combination of vaporization and coagulation, allowing a precise cutting action when higher energy levels are applied. A shallow depth of penetration (< 0.5 mm) in water and tissue allows precise energy application and provides a margin of safety. The machine's user-friendly setup facilitates its operation by urologists and assistance by allied health-care personnel. The multiple urologic applications make the Holmium laser an attractive instrument for everyday utilization by any medium to large urological unit.
Clinical Trials as Topic↗
Use of extracorporeal shock wave lithotripsy for treatment of nephrolithiasis and ureterolithiasis in five dogs.
The safety and efficacy of extracorporeal shock wave lithotripsy in 5 dogs with nephrolithiasis and ureterolithiasis was assessed. Three dogs had bilateral nephrolithiasis, 1 had bilateral nephrolithiasis and unilateral ureterolithiasis, and 1 had unilateral nephrolithiasis and unilateral ureterolithiasis. A first-generation lithotriptor was used for all treatments. None of the dogs developed clinically important complications during or after treatment, except for 1 dog treated for bilateral nephrolithiasis that developed transient ureterolithiasis. Renal function was unchanged in all dogs following treatment. Clinical signs resolved in all dogs. Extracorporeal shock wave lithotripsy appears to be a safe and effective means of treating nephrolithiasis and ureterolithiasis in dogs and appears to cause less renal parenchymal damage and renal function loss than does nephrotomy.
Animals↗
Branching patterns of the renal artery of the pig.
BACKGROUND: The pig kidney is similar in structure and function to the human kideny, thus making it a useful model in understanding the human kidney in health and disease. However, little is known about the branching pattern of the pig renal artery as compared with the human and other animals. METHODS: The right and left kidneys from 11 juvenile pigs were injected with either Mercox compound to form a vascular cast or contrast media to obtain a renal arteriogram. Branching patterns of the renal artery were then examined to the level of the interlobar arteries. RESULTS: Examination of all 22 kidneys showed the main stem renal artery branching into two predictable patterns, designated I and II. The renal artery in pattern I (17 of 22 kidneys) divides into upper and lower polar arteries that then form anterior and posterior segmental arteries. Pattern I has two variations. Pattern II (5 of 22 kidneys) has a variable blood flow to the upper pole. Not only do anterior and posterior segmental arteries pass to the upper pole, but additional vessels arising from the lower polar artery also supply the upper pole. CONCLUSIONS: The most common branching pattern of the main stem renal artery is pattern I, which divides the blood flow of the entire kidney into two distinct regions. Pattern II is less frequently seen and shows more variability in number and location of branches.
Animals↗
Value of laparoscopy in the management of calculi complicating renal malformations.
A minimally invasive approach for urolithiasis patients with complex anatomic abnormalities occasionally necessitates the use of laparoscopic techniques, either alone or in combination with endourologic techniques. The management of these patients is best accomplished in centers with the facilities to provide a spectrum of endourologic and laparoscopic techniques. Two illustrative cases are described.
Aged↗
Lithotripsy and surgery.
Advances in surgical techniques have dramatically altered the management of patients with symptomatic urolithiasis requiring intervention. Extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy allow virtually any stone to be removed from the upper urinary tract without resorting to open surgical techniques. Extracorporeal shock wave lithotripsy is the preferred initial treatment for approximately 80% to 85% of calculi. Percutaneous nephrolithotomy is the preferred approach when dealing with more voluminous stone material (ie, > 2 cm). Ureteroscopy is generally reserved for distal ureteral calculi, although the recent advent of small flexible ureteroscopes have extended ureteroscopic techniques effectively into the proximal ureter and even the kidney. Staghorn stones are usually best managed initially with percutaneous nephrolithotomy followed by the addition of extracorporeal shock wave lithotripsy, if necessary. The relative advantages, disadvantages, and complications of extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy will be reviewed.
Equipment Design↗
Endoscopic management of total ureteral occlusion and ureterovaginal fistula.
Between August 1991 and June 1994, endoureterotomy was performed in nine patients for total ureteral occlusion. Four of these patients had an associated ureterovaginal fistula. The total ureteral occlusions were iatrogenic in eight patients and the result of trauma in one. The prone split leg position was used to facilitate simultaneous antegrade and retrograde ureteroscopy in all nine patients. The "cut-to-the-light" technique was utilized in six patients and a new technique employing a fascial incising needle was used in five patients. Five patients developed ureteral strictures within 5 months of the primary procedure that were corrected endoscopically. With a mean follow-up of 22 months, all nine patients have a successful outcome. Endoscopic management of difficult urteral disease such as total urteral occlusion and ureterovaginal fistula is a useful alternative to open surgery.
Adult↗
Metabolic evaluation of infected renal lithiasis: clinical relevance.
Complete metabolic evaluation was performed in 21 patients with infected renal lithiasis. Patients with pure struvite stones (struvite +/- carbonate apatite) were significantly less likely to have metabolic abnormalities than patients who had struvite +/- carbonate apatite+calcium oxalate (2 of 14 v 7 of 7, P = 0.0003). Urine calcium excretion was markedly higher in the mixed stone group than the pure struvite group (342 +/- 98 mg/24 h v 136 +/- 82 mg/24 h; P < 0.0001). The differing opinions among researchers regarding the likelihood of finding metabolic abnormalities in patients with urolithiasis and infection probably reflect differences in the definitions of the populations studied. If patients with calculi containing only struvite +/- carbonate apatite are evaluated, we believe that few significant metabolic abnormalities will be identified.
Adolescent↗
Shock wave lithotripsy with the Dornier MFL 5000 lithotriptor using an external fixed rate signal.
PURPOSE: We examine the effects of fixed rate shock wave administration on the cardiac rhythm and treatment efficacy of a tubless lithotriptor (Dornier MFL 5000*). A secondary goal was to examine the treatment efficacy of fixed shock wave administration compared to R wave triggered lithotripsy. MATERIALS AND METHODS: In this prospective study Holter monitoring was used before, during and after nonR wave triggered shock wave lithotripsy. RESULTS: An increase in premature ventricular contractions was noted during shock wave lithotripsy. However, there were no episodes of significant ventricular ectopia, ventricular tachycardia, asystole or heart block as a result of nonR wave triggered shock wave administration. NonR wave gated shock wave lithotripsy expedited patient treatment and (mean treatment time 46 +/- 21 minutes)., minimized the use of sedation during treatment and produced results similar to R wave gated shock wave lithotripsy with the MFL 5000 lithotriptor. CONCLUSIONS: With adequate precautions, fixed rate shock wave administration would appear to be a reasonable option to treat urolithiasis with the MFL 5000 lithotriptor as with other newer lithotriptors.
Adult↗
Commentary on ESWL and blood pressure.
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Follow-Up Studies↗
Management of lower pole nephrolithiasis: a critical analysis.
The results of extracorporeal shock wave lithotripsy (ESWL*) and percutaneous nephrostolithotomy for the treatment of lower pole nephrolithiasis were examined in 32 consecutive patients undergoing percutaneous nephrostolithotomy at the Methodist Hospital of Indiana and through meta-analysis of publications providing adequate stratification of treatment results. Of 101 cases managed with percutaneous nephrostolithotomy 91 (90%) were stone-free, a result significantly better than that achieved with ESWL (1,733 of 2,927 stone-free, 59%). Stone-free rates with percutaneous nephrostolithotomy were independent of stone burden, whereas stone-free rates with ESWL were inversely correlated to the stone burden treated. The morbidity of patients undergoing percutaneous nephrostolithotomy at our hospital was minimal, with a mean hospital stay of 4.7 +/- 2.8 days. No blood transfusions were required. All patients became stone-free. The percentage of urolithiasis patients with lower pole calculi is increasing. Because of the significantly greater efficacy of percutaneous nephrostolithotomy for lower pole calculi, particularly stones larger than 10 mm. in diameter, further consideration should be given to an initial approach with percutaneous nephrostolithotomy.
Adult↗
Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel.
The American Urological Association Nephrolithiasis Clinical Guidelines Panel recommendations for managing struvite staghorn calculi are based on a comprehensive review of the treatment literature and meta-analysis of outcome data from the 110 pertinent articles containing viable, unduplicated data. The panel concluded that the 3 most significant outcome probabilities are those of being stone-free, undergoing secondary unplanned procedures and having associated complications. Panel guideline recommendations for most standard patients are that neither shock wave lithotripsy monotherapy nor open surgery should be a first-line treatment choice but that a combination of percutaneous stone removal and shock wave lithotripsy should be used.
Humans↗