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J W Segura

Publications and source records attributed to J W Segura.

At least 19 recordsLinked to original sources
PubMed1992

Transurethral microwave thermotherapy for prostatism: early Mayo Foundation experience.

As part of a multicenter investigative trial, transurethral microwave thermotherapy of the prostate was used in 60 men with symptomatic benign prostatic hypertrophy. A single office treatment on the Prostatron, a device that provides concurrent microwave heating of the prostate and conductive cooling of the urethra, was well tolerated and caused no major adverse events. Symptomatic improvement, especially the decrease in nocturia and urgency, was dramatic, and urinary flow was improved at 6 weeks. Continued follow-up suggests that further improvement will be achieved and that transurethral microwave thermotherapy has a role in the treatment of benign prostatic hypertrophy.

Academic Medical Centers↗
PubMed1991

National High Blood Pressure Education Program (NHBPEP) review paper on complications of shock wave lithotripsy for urinary calculi.

This decade has witnessed dramatic advances in the surgical management of urinary calculi. Today, most stones can be removed by minimally invasive means. In fact, the treatment of choice in 60% to 90% of patients with renal and ureteral calculi that need to be surgically removed is extracorporeal shock wave lithotripsy (ESWL). This article reviews indications for ESWL and discusses deleterious effects of ESWL.

Animals↗
PubMed1991

Early experience with percutaneous cholecystolithotomy.

Percutaneous cholecystolithotomy should be added to the list of alternatives to elective open cholecystectomy for the management of patients with gallstones. Our initial experience with percutaneous cholecystolithotomy in 13 patients (7 men and 6 women who ranged in age from 47 to 83 years) demonstrated that the procedure could be accomplished successfully with acceptable morbidity and no mortality. After a mean duration of follow-up of 10.7 months, only one patient had recurrent cholelithiasis. Because of rapid changes in the therapeutic approach to patients with cholelithiasis, percutaneous cholecystolithotomy may seldom be used.

Aged↗
PubMed1990

Branched, struvite calculus and clear cell carcinoma in same kidney. Rare condition with significant implications for management.

The concomitant existence of a branched (partial staghorn) calculus and clear cell carcinoma (hypernephroma) in the same kidney is rare. Herein, we report the eighth such case in the world literature, and to our knowledge, the first patient with a parenchymal tumor identified preoperatively. In all of the previous 7 cases, the calculus was managed with open renal exploration, and only at the time of surgery was the incidental renal cell carcinoma identified; the surgical procedure was modified accordingly. With open surgery no longer the cornerstone of therapy for renal calculi, it is imperative that the kidney be evaluated in a meticulous and compulsive manner prior to extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PNL). The finding of a coexisting renal cell carcinoma will radically alter the patient's treatment.

Adenocarcinoma↗
PubMed1990

Ureteroscopy in children.

The development of ureteroscopy has led to a dramatic change in the management of ureteral stones as well as other ureteral pathological conditions in adults. Until recently, size limitations have prevented the technique from being used in small children. We have used ureteroscopy for diagnosis and therapy in 4 children less than 10 years old. There was no significant morbidity from the procedure in our patients.

Child↗
PubMed1990

Technical consideration in radical retropubic prostatectomy: blood loss after ligation of dorsal venous complex.

The estimated blood loss and blood transfused in 641 patients undergoing bilateral pelvic lymphadenectomy and radical retropubic prostatectomy were analyzed to compare ligation and nonligation of the deep dorsal venous complex. Group 1 (325 men) had no attempt at deep dorsal vein ligation and group 2 (316) had ligation of the deep dorsal venous complex. Group 2 was subdivided into group 2a-137 men in whom an attempt at a nerve-sparing procedure was made and group 2b-179 in whom no such attempt was made. Estimated intraoperative blood loss was significantly different between the groups: group 1--mean loss 1,262 ml. and group 2--mean loss 1,020 ml. (p less than 0.0001). The amounts of blood transfused intraoperatively were significantly different: group 1-1.73 units and group 2-1.21 units (p less than 0.0002). Intraoperative blood loss was not significantly different between subgroups 2a and 2b but the mean amount of blood transfused intraoperatively was lower in group 2a than in group 2b (0.99 and 1.39 units, respectively p less than 0.02). The greatest amounts of blood lost and transfused were in group 1 (no ligation) and the least amounts were in group 2a (ligation and nerve-sparing), representing highly statistically significant differences (p less than 0.0001).

Adenocarcinoma↗
PubMed1990

Safety of same-day sequential extracorporeal shock wave lithotripsy and dissolution of gallstones by methyl tert-butyl ether in dogs.

Passage of stone fragments after extracorporeal shock wave lithotripsy (ESWL) of gallstones has resulted in biliary colic, duct obstruction, and pancreatitis in some patients. Rapid dissolution of these fragments with methyl tert-butyl ether (MTBE) may prevent such side effects and achieve complete clearance of gallstones within hours rather than several months to a year or longer. This study examines the safety of same-day ESWL fragmentation and MTBE dissolution of surgically implanted human gallstones in 15 dogs. The animals were randomly assigned to one of four treatment groups to assess MTBE absorption from the gallbladder and to observe hematology and chemistry profiles after 0, 400, and 1,200 shock waves from a lithotriptor followed by MTBE dissolution therapy. They were sacrificed either immediately after treatment (12 dogs) or 2 weeks later (3 dogs). The results demonstrated that although ESWL causes moderate trauma to the gallbladder, this did not result in increased MTBE absorption or histologic evidence of mucosal disruption. Blood profiles demonstrated an increase in only the level of aspartate aminotransferase. The three dogs that were sacrificed 2 weeks after the combined treatment had no residual evidence of gallbladder injury or remaining stone material. In all animals, severe injury occurred where shock waves passed through lung or air-filled colon. This study suggests that same-day sequential fragmentation of gallstones by ESWL followed by dissolution of stone fragments with use of MTBE may be associated with only mild to moderate and reversible gallbladder trauma and can rapidly achieve clearance of gallstones.

Animals↗
PubMed1990

Current surgical approaches to nephrolithiasis.

Shock wave lithotripsy is the cornerstone of the modern management of surgical stone disease and is the procedure of choice for small stones in uncomplicated situations. As complexity increases and as the stone size increases, percutaneous lithotripsy becomes more important. Ureteroscopy is preferable for lower ureteral stones and is useful for many mid and upper ureteral stones. Occasional large, complicated stones, or stones that can be reached no other way, require open surgery. Successful management of a wide variety of patients with urinary calculi requires the recognition that multiple forms of therapy are necessary. Identification of the situations best managed by these different treatments will ensure optimal management of patients with surgical stone disease.

Humans↗
PubMed1990

Surgical management of urinary calculi.

Shock wave lithotripsy is the cornerstone of the modern management of urinary calculi and is the preferred treatment for most small renal stones. Percutaneous lithotripsy is preferred for large stones and in combination with ESWL for staghorn calculi. Upper ureteral stones should be pushed back to the kidney for ESWL, if possible; otherwise they should be treated in situ. Lower ureteral stones are preferentially managed with ureteroscopy, but ESWL may also be used. A variety of methods of power lithotripsy are available: ultrasound, electrohydraulic lithotripsy, and pulsed dye laser lithotripsy. Only 1% to 2% of stone patients require open surgery; it is an important judgment to identify these patients to avoid inappropriate use of newer techniques in cases where success is unlikely. It is apparent that modern management of the patient with a urinary calculus requires access to all methods of stone removal. The surgeon and internist should not forget that the goal is to remove the stone safely, efficaciously, and economically.

Endoscopy↗
PubMed1990

Role of percutaneous procedures in the management of renal calculi.

Appropriate management of the variety of patients with stone disease demands access to all methods of stone removal. Percutaneous procedures are an integral aspect of the surgical management of stone patients, and the urologist must recognize when a patient's situation is best served by percutaneous surgery. Percutaneous stone removal procedures are preferred when: 1. The stone is large, i.e., greater than 2 to 3 cm. 2. The stone is staghorn in configuration, with percutaneous measures being used either as primary treatment or in combination with shock wave lithotripsy. 3. The stone is composed of cystine 4. When certain removal of the stone is important. 5. When there is obstructive uropathy. 6. When other modalities have failed. 7. In morbidly obese individuals and others whose body habitus precludes use of the shock wave machine. 8. In children, at least until the issue of long-term safety of extracorporeal lithotripsy is settled.

Adult↗
PubMed1989

Extracorporeal shock-wave lithotripsy and methyl tert-butyl ether for partially calcified gallstones.

To explore the possibility that gallbladder stone fragments might be able to be safely dissolved using methyl tert-butyl ether immediately after extracorporeal shock-wave lithotripsy (ESWL), a feasibility study in 8 patients with one to four partially calcified gallbladder stones was performed. The gallstones averaged 2.2 cm in diameter (range 1.3-3 cm) and contained layered or diffuse calcium detectable by computed tomography scan only (7 patients) or plain film (1 patient). After a 5F (1.7 mm) pigtail catheter was placed percutaneously into the gallbladder, ESWL fragmentation was performed using a renal stone lithotriptor. The patients were under general anesthesia and in the prone position on a support gantry designed for gallbladder stone ESWL. Following ESWL, methyl tert-butyl ether was infused and aspirated via the gallbladder catheter until no further stone material was radiologically detectable or could be dissolved. After 8-26 h (mean = 13 h) of methyl tert-butyl ether therapy, no radiologically detectable gallstones remained in 6 of 8 patients. Shell fragments of three peripherally calcified stones in 1 patient and the densely calcified, predominantly pigment stone in a second patient were refractory to combined therapy. Both ESWL and treatment with methyl tert-butyl ether were well tolerated in all patients, although bile leakage after catheter removal occurred in 3 patients, one of whom was treated by cholecystectomy. Additional measures to prevent bile leakage may be advisable if these two modalities are to be used in tandem. We found no evidence, however, that predissolution stone fragmentation with ESWL predisposed the gallbladder to either mucosal damage by methyl tert-butyl ether or increased absorption of it.

Aged↗
PubMed1989

Amyloidosis of the urethra.

Primary, localized amyloidosis of the urethra is rare. The patient usually presents with hematuria and the appearance of urethral carcinoma. However, the disease is benign and it is treated effectively with local removal. We report our experience with 5 cases.

Adult↗
PubMed1989

The role of percutaneous surgery in renal and ureteral stone removal.

Percutaneous procedures are appropriate for a wide variety of renal and ureteral stones. In the era of shock wave lithotripsy percutaneous procedures usually are indicated in stones for which extracorporeal shock wave lithotripsy is not appropriate. Many of these situations occur in patients with large stones, and stones associated with obstruction and other problems. Indications for percutaneous stone removal and indications for open surgery are discussed.

Humans↗
PubMed1989

Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer.

The technique of transurethral ureteropyeloscopy was used in 43 patients with upper urinary tract urothelial tumors. Diagnosis was confirmed in 19 of 22 renal pelvic tumors (86 per cent) and 19 of 21 ureteral tumors (90 per cent). The major complication rate in this series is low (7 per cent) and did not appear to influence unfavorably subsequent management or outcome. A total of 21 patients underwent conservative endourological management of the upper tract tumor. The local recurrence rate was 20 per cent (1 of 8) for renal pelvic tumors and 15 per cent for distal ureteral tumors (2 of 13). The technique of ureteropyeloscopy should be added to the standard diagnostic regimen for the investigation of upper tract filling defects and conservative endourological techniques can be used safely for management of selected cases of upper tract urothelial tumor.

Aged↗
PubMed1989

Primary hyperparathyroidism and urolithiasis: concomitant surgical management.

Urolithiasis occurs in about 20% of patients undergoing cervical exploration for primary hyperparathyroidism. A small number of these patients may require surgical removal of the renal stones because of either obstruction or infection. The traditional surgical modalities for stone removal have been replaced by extracorporeal shock-wave lithotripsy, ureteroscopic stone removal, and percutaneous lithotripsy. During the period 1980 through January 1989, 22 patients underwent combined cervical exploration for primary hyperparathyroidism and treatment of renal or ureteral stones with a single general anesthetic at our institution. This study demonstrates that this approach can be performed safely with a high success rate and negligible morbidity and that this approach may have cost-effective implications.

Female↗
PubMed1988

Long-term followup in patients with cystine urinary calculi treated by percutaneous ultrasonic lithotripsy.

From February 1983 through 1986, 15 patients (17 renal units) with cystine urinary lithiasis were treated by percutaneous ultrasonic lithotripsy. Three patients were lost to followup. Of the 13 renal units in the remaining 12 patients 7 (54 per cent) had retained stone fragments and 6 (46 per cent) were free of stones. While on medical management 7 of the 13 renal units (54 per cent) had new stones, 5 (38 per cent) remained unchanged and in 1 (8 per cent) the retained stones dissolved. The rate for reoperations was 43 per cent for the group with retained stones (3 of 7) and 17 per cent for the group that was free of calculi after percutaneous ultrasonic lithotripsy (1 of 6). Our study suggests that the optimal treatment with percutaneous ultrasonic lithotripsy should result in a patient who is free of stones.

Adolescent↗
PubMed1988

Angiomyolipoma: clinical metamorphosis and concepts for management.

In 10 years the diagnosis of renal angiomyolipoma was made in 44 patients (female-to-male ratio 8:1) at our institution; 4 cases were associated with tuberous sclerosis. Of these patients 29 underwent surgical exploration because of a renal mass; 11 patients with renal masses that were consistent with angiomyolipoma radiologically have not undergone exploration. Of the 4 patients with and the 29 patients without tuberous sclerosis 1 (25 per cent) and 2 (7 per cent), respectively, had renal cell cancer in association with angiomyolipoma. Metachronous involvement of the contralateral kidney has not been noted in any of our patients who underwent nephrectomy for unilateral involvement, nor has there been progression of the contralateral lesion in 3 patients with bilateral disease without tuberous sclerosis during a followup of about 6 years. Furthermore, we have not noted progression of lesions in the 11 patients under observation for a mean followup of almost 3 years. We recommend elective exploration and a renal preserving operation when possible, not only for patients with pain and hemorrhage but also for the complex multiple lesions occasionally seen in patients who do not have tuberous sclerosis. Lesions associated with tuberous sclerosis require surgical intervention only when they become symptomatic or enlarge silently.

Adolescent↗