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M J Kellett

Publications and source records attributed to M J Kellett.

At least 19 recordsLinked to original sources
PubMed1996

A three centre audit of IVU referrals in patients with asymptomatic microscopic haematuria.

There is considerable debate concerning the investigation of patients with asymptomatic microscopic haematuria. Urine dipstick testing is a sensitive screening test but may be positive in some normal individuals. The present consensus is that urine microscopy should be performed to confirm haematuria prior to further investigation. We have performed a retrospective study to establish whether urine microscopy was used in addition to dipstick testing before a request for intravenous urography (IVU) in three centres. IVU request forms from a District General, a Teaching Hospital and a Uroradiological Referral Centre were audited over a 9-month-period. Patients referred with asymptomatic microscopic haematuria were selected. The case notes and urine microscopy results were reviewed. The date of microscopy and its result and the interval between the result and the IVU request were established. One hundred and two cases have been examined, 17 (16.7%) of which were under the age of 40. Only 37 in total had significant haematuria on microscopy and of these, 32 results (31.4% of all cases) were available before the IVU request. In eight patients there was no evidence that urine microscopy had been performed. Fourteen patients had a urinary tract infection. Our findings show that IVUs are often requested on the basis of dipstick testing alone. Only one third of patients had confirmed significant haematuria at the time of IVU request and in some patients infection had not yet been excluded. Although prompt investigation of microscopic haematuria is important, it is essential that the diagnosis is established by microscopy before an IVU is requested.

Adult↗
PubMed1996

Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis.

PURPOSE: The application of conservative surgery has been established in the treatment of transitional cell tumors of the renal pelvis. We reviewed retrospectively the long-term outcome after percutaneous treatment of select patients referred to a tertiary center with transitional cell tumors of the renal pelvis. MATERIALS AND METHODS: We studied 28 patients referred with a presumptive diagnosis of transitional cell carcinoma of the renal pelvis based on filling defects noted on excretory urograms. At percutaneous endoscopy tumor was resected in 26 patients, while no tumor was found in 2. All 19 men and 7 women smoked, and mean age at presentation was 65 years. Of the patients 18 presented with hematuria and 6 had bilateral upper tract tumors. After percutaneous resection, the access tract was irradiated either with iridium wire in 12 patients or a commercial high dose rate radiation delivery system in 12. Thiotepa was instilled into the nephrostomy tube without brachytherapy in 1 patient and 1 received no adjuvant treatment in all. All patients were followed by excretory urography and urine cytology. Cystoscopy and retrograde pyelography were performed when technically possible. RESULTS: After percutaneous tumor resection 6 patients (23%) had local recurrence in the treated renal pelvis, including 3 at 44, 55 and 60 months, respectively. Further conservative treatment was initially possible in 4 of these patients but ultimately only 2 (both of whom had late recurrences) retained the treated kidney. Of the 11 patients with recurrence elsewhere in the urinary tract the bladder was invariably involved (11), while synchronous or metachronous ureteral recurrence was less common (3). Nine patients remained free of any urothelial recurrence in the upper or lower tract. No patient had recurrent tumor in the nephrostomy tract. Of the patients 7 suffered from procedure-related complications, including 1 who had a persistent urinary fistula that failed to heal after brachytherapy and required nephroureterectomy. There have been 6 deaths during followup, of which 2 were disease related. The 3-year estimated local recurrence-free survival rate was 86% (95% confidence interval 63 to 95%), cause-specific survival rate 91% (95% confidence interval 67 to 98%) and overall survival rate 78% (95% confidence interval 55 to 90%). Differences in recurrence-free survival, comparing those with recurrence in the treated renal pelvis or elsewhere in the urothelium and those remaining disease-free, did not translate to a significant overall survival difference (p < 0.5) between these groups. CONCLUSIONS: Our results suggest that the combination of percutaneous local resection and tract irradiation offers an effective long-term alternative to radical extirpation in the management of select patients with superficial transitional cell carcinoma confined to the renal pelvis. When the postoperative nephrostogram demonstrates a leaking renal pelvis, tract irradiation should not be given.

Aged↗
PubMed1995

Nephrostomy track brachytherapy following percutaneous resection of transitional cell carcinoma of the renal pelvis.

Percutaneous nephrostomy can be used to resect transitional cell carcinoma (TCC) from the renal pelvis, to avoid nephrectomy in selected patients. This procedure carries a potential risk of tumour seeding along the nephrostomy track, which it is our policy to irradiate prophylactically. A total of 25 procedures on 23 patients have been carried out since 1982. The 18 males and five females had a median age of 64 years (range 46-81) at the time of treatment. Of the ten patients with only one functioning kidney, nine had undergone contralateral nephroureterectomy, seven for TCC, one for a non-functioning kidney, and one for renal tuberculosis; one patient had received radical radiotherapy for an inoperable contralateral renal tumour. The other 13 patients had asked for a conservative treatment approach to be adopted. From 1982-1989, low dose rate 192Ir wire was used in 13 patients to deliver a median dose of 45 Gy (range 40-50) to the full length of the track at the surface of nephrostomy tube. Since 1989, we have used a high dose rate (HDR) 192Ir microSelectron to treat 12 patients with a single fraction of 10-12 Gy, including two who had undergone previously 192Ir wire track irradiation of the same kidney. One patient required a nephroureterectomy after developing a non-healing renal pelvis leak following combined modality treatment. Otherwise, no early or late radiation-related morbidity has been seen, and no nephrostomy track recurrences have occurred during a median follow-up of 5 years (range 1-9). The HDR microSelection has enabled us to deliver this treatment quickly and simply during the standard postoperative stay in hospital following percutaneous nephrostomy.

Aged↗
PubMed1994

Sonographic features of renal obstruction mimicked by peripelvic cysts.

Peripelvic cysts can closely mimic the sonographic changes of renal pelvicalyceal dilatation. Three cases are described in which a particular feature was the presence of linear septations extending to the hilum which represented the walls of tubular peripelvic cysts. The cluster of cysts centrally in the renal sinus was originally interpreted as a dilated pelvicalyceal system. Excretion urography is usually necessary to exclude pelvicalyceal dilatation conclusively.

Diagnosis, Differential↗
PubMed1994

The misplaced double J ureteric stent: technique for repositioning using the nitinol 'gooseneck' snare.

An antegrade method for repositioning a prematurely released double J ureteric stent is described. The technique is applicable when the proximal pigtail is still within the renal parenchyma or in the perinephric space. A custom-made Nitinol gooseneck snare was used in this case, but suitable alternatives should be readily available in a standard interventional suite and these are described.

Aged↗
PubMed1991

Extrusion of calculi from upper urinary tract into perinephric and periureteric tissues during endourologic stone surgery.

We report on 11 patients in whom fragments of calculi were extruded into the perinephric or periureteric tissues at the time of endourologic stone surgery. All patients have been managed conservatively. In 2 patients ureteric strictures developed, but these were probably secondary to an electrical injury as a result of electrohydraulic lithopaxy. The remaining 9 patients have not experienced serious sequelae as a result of the calculus extrusion.

Humans↗
PubMed1991

Percutaneous nephrolithotomy and the solitary kidney.

We reviewed 53 patients with stones in a solitary kidney who had undergone percutaneous nephrolithotomy. Previous surgery on that kidney had been performed in 35.8%, and 50.9% had other medical conditions including 26.4% who had impaired renal function. Staghorn or partial staghorn calculi were present in 52.9% and an additional 18.8% had multiple stones. Postoperative complications in 18.8% of the patients included sepsis, the need for transfusion and 1 death of bronchopneumonia. Percutaneous nephrolithotomy alone resulted in a 77.3% rate free of stone or fragments of 2 mm, or less. This rate increased to 86.8% with the addition of extracorporeal shock wave lithotripsy, ureteroscopy or open surgery (2 patients). Only 1 patient suffered long-term deterioration in renal function. Percutaneous nephrolithotomy is a safe procedure in the solitary kidney. It should be considered in those patients with complex stone burdens and impaired renal function when reduction in stone bulk and improved renal function may allow other treatment modalities to be used.

Female↗
PubMed1991

Percutaneous nephrolithotomy for calculi in horseshoe kidneys.

Between 1983 and 1988, 15 patients (18 kidneys) underwent percutaneous nephrolithotomy at this unit for calculi in horseshoe kidneys. A standard 1-stage percutaneous access technique with minor modifications was used. In situ disintegration with ultrasound or electrohydraulic lithotripsy was necessary in 15 moieties (83.3%) and nephrostomy drainage was required in 12 (66.7%). Percutaneous access was not a problem and there were minimal perioperative problems. Blood transfusion was required postoperatively in 2 patients. A total of 14 kidneys (77.8%) were rendered free of stone with percutaneous nephrolithotomy alone and 2 kidneys were left with asymptomatic stone fragments of 2 mm. or less. Another 2 kidneys became free of stone after extracorporeal shock wave lithotripsy, thus giving an over-all stone clearance rate of 88.8%. We conclude that percutaneous nephrolithotomy is an acceptable treatment for stones in horseshoe kidneys and it is the treatment of choice for patients in whom imaging is difficult or impossible.

Adult↗
PubMed1990

Percutaneous cholecystolithotomy: the first 60 patients.

OBJECTIVE: To assess the feasibility and possible complications of percutaneous removal of gall stones. DESIGN: Prospective study of the first 60 patients treated. SETTING: The London Clinic. PATIENTS: 60 Consecutive patients with symptomatic gall stones who agreed to have them removed percutaneously. RESULTS: 56 Patients had stones successfully removed percutaneously. In four patients failure of access necessitated a cholecystectomy under the same anaesthetic. Two patients had an empyema of the gall bladder drained initially, followed by a second operation to remove the stones one week later. Seven patients had postoperative complications, and two had recurrences of biliary calculi. CONCLUSIONS: The techniques and instruments used in percutaneous nephrolithotomy can successfully be adapted for percutaneous removal of gall stones. The procedure is suitable for a wider range of patients than other techniques that leave the gall bladder intact.

Adult↗
PubMed1990

The changing practice of percutaneous stone surgery. Review of 1000 cases 1981-1988.

A review was carried out on 1000 cases of percutaneous nephrolithotomy (PCNL), Group 1 (500), 1981-1985, being compared with Group 2 (500), 1985-1988. Previous renal surgery had been performed in 17.4% of patients in Group 1 and 36% in Group 2. There were 17.2% complicated patients in Group 1 and 51% in Group 2. The stone burden included 30.2% multiple, partial staghorn and staghorn calculi in Group 1 and 47.2% in Group 2. The use of in situ stone disintegration increased from 22.2% in Group 1 to 73.4% in Group 2 and nephrostomy drainage was necessary in 29.6% compared with 75%. Post-operative complications increased from 13.6 to 24%. Stone-free rates decreased from 92 to 51%, but the addition of other methods of treatment and the inclusion of patients with stone fragments of 2 mm or less increased these figures to 98% in Group 1 and 83% in Group 2. More complicated patients with complex stones are now being referred for PCNL. These patients require multiple treatments, including extracorporeal shock wave lithotripsy (ESWL) and percutaneous surgery, in combination with other endoscopic and radiological procedures.

Adolescent↗
PubMed1989

The expansion of interventional radiology. Report of a survey conducted by the Royal College of Radiologists.

The Interventional Radiology Group of the Royal College of Radiologists sent a questionnaire to major hospitals in the United Kingdom in 1982 and 1987 in order to assess the impact of the introduction and growth of interventional procedures on patient management over the 5-year period and to consider the implications of these data for the future staffing and equipment requirements of radiology departments. In the 194 hospitals correctly completing the most recent survey, a total of 30,794 interventional procedures were performed in a 12 month period, representing an overall increase of 116% since the previous survey of 1982.

Angioplasty, Balloon↗
PubMed1989

Clinical experience using the Wolf Piezolith device at 2 British stone centers.

Machines using the principle of piezoelectric extracorporeal shock wave lithotripsy have been developed. This has allowed the prospect of painless treatment for renal and ureteral calculi. The experience with use of 2 Wolf Piezolith machines for 1 year is presented. Different second generation lithotriptors have varying techniques of production of shock waves and different imaging methods. The Wolf Piezolith device uses ultrasound imaging and piezoelectric crystals for shock wave generation. Between June 1987 and May 1988, 545 patients 5 to 84 years old were treated with the Wolf Piezolith device. Of these patients 2-month followup data are available for 367 (398 renal units). Outpatient treatment was used routinely. For renal calculi complete fragmentation (into particles less than 2 mm. in size) was achieved in 94 per cent of the patients, with 53 per cent being completely free of stone at 2 months. For ureteral stones treated in situ the best results were obtained in the upper and lower ureter. Over-all, 62 per cent of the patients required more than 1 treatment, with the number of treatment sessions required increasing with the size of the stone treated. Morbidity was low. Ultrasound imaging has proved to be as effective as x-ray imaging. Compared to Dornier HM-3 lithotripsy, installation and running costs were low. The machine offers a favorable alternative to first generation lithotriptors.

Adolescent↗