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R C Tiptaft

Publications and source records attributed to R C Tiptaft.

At least 19 recordsLinked to original sources
PubMed2004

Prolonging the life of the flexible ureterorenoscope.

The lifespan of medical equipment must be maximised to ensure cost-effectiveness. Flexible ureterorenoscopes have become widely used in the diagnosis and treatment of urolithiasis. They are relatively expensive and current literature shows that they require frequent repair and replacement. We have analysed our data for the number of procedures and repairs required for each new instrument we have used. So far we have used four new flexible ureteroscopes, which have been used for a total of 375 procedures, an average of 94 procedures each. On average each required repair twice. We believe that a few simple precautions taken during use and storage help to maximise the lifespan of the flexible ureterorenoscope and our results would appear to support this.

Durable Medical Equipment↗
PubMed2004

Flexible ureterorenoscopy: prospective analysis of the Guy's experience.

OBJECTIVE: To report our outcomes with small diameter, actively deflectable flexible ureterorenoscopy from a prospective database. PATIENTS AND METHODS: 114 flexible ureterorenoscopies were performed in 105 patients (mean age, 49.5 years; range, 19-85 years; 71 males, 34 females) over a 9-month period. Of these, 101 were for refractory stones following failed ESWL and 13 for diagnostic reasons. An Olympus URF P3 flexible ureteroscope with pressure irrigation was used. Electrohydraulic lithotripsy was used to fragment stones and the fragments were retrieved with Graspit, triradiate graspers or tipless baskets. RESULTS: Stents had previously been placed in 53% and dilatation of the ureteric orifice was necessary in 15%. In the stone group, the median operating time was 55 min (range, 15-210 min) and the median screening time 2.2 min (range, 0.3-9.1 min). Success was defined as complete stone clearance or good fragmentation to 2 mm or less. Overall success in this group was 72.3%. There was no statistically significant difference between lower and other calyces (P=0.83 Chi-square test). Successful outcome was achieved in 72% for stone size 10 mm or less, 80% for 11-20 mm and 50% for greater than 20 mm. Two or more procedures were needed in 8 patients. In the diagnostic group, the median operating time was 45 min (range, 20-60 min) and the median screening time 2 min (range, 0.3-8.3 min). The majority were for upper tract filling defects. Access and successful diagnosis was achieved in all cases. The major complication rate was 2.6%. The ureteroscope needed repair once during this series. CONCLUSIONS: Flexible ureterorenoscopy is an effective diagnostic and therapeutic tool in a select group of patients. It should be considered for ESWL-resistant upper tract stones but the results are poor in stones larger than 20 mm and percutaneous nephrolithotomy may be a better option in these patients.

Adult↗
PubMed1998

Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates.

Over a period of 57 months, 404 patients with distal ureteral calculi were treated by in situ SWL on a Storz Modulith SL 20 lithotripter and 163 by ureteroscopy (URS) and Swiss Lithoclast stone fragmentation. The case notes on these patients were reviewed for comparison of the initial stone number and individual length and for the calculation of the stone-free, treatment, retreatment, secondary procedure, and complication rates. Complete data were available on 447 patients. The median stone length was 7.0 (range 4-25) mm in the SWL group and 8.0 (range 5-13) mm in the URS group. The single-treatment stone-free rates for the SWL and URS groups were 74.8% and 89.7%, respectively, for single stones and 50.0% and 88.9%, respectively, for multiple (>1) stones. The mean treatment rates for the SWL and URS groups were 1.97 and 1.03, respectively, for single stones and 2.83 and 1.00, respectively, for multiple stones. The mean treatment rate for single stones subjected to SWL increased with increasing stone length (1.57 for stones <8 mm and 2.38 for stones >8 mm), whereas this was not the case for patients submitted to URS (1.20 and 1.27, respectively). The re-treatment rate for each group showed a reciprocal trend. Of the SWL group, 25.9% of the patients eventually required URS to render them stone-free. Nearly all (96%) of the patients undergoing SWL were treated as outpatients. The mean hospitalization in the URS group was 1.1 days. Three patients who underwent URS sustained a ureteral perforation, which was managed successfully by double-J stent insertion. The ideal primary treatment for small (<8 mm) distal ureteral calculi is in situ SWL, with URS plus Lithoclast fragmentation being reserved for failed SWL, single stones >8 mm in length, and multiple stones.

Adolescent↗
PubMed1995

Microwave hyperthermia in benign prostatic hypertrophy: a controlled clinical trial.

OBJECTIVE: To compare the effects of microwave hyperthermia in benign prostatic hypertrophy (BPH) to sham treatment. PATIENTS AND METHODS: The trial included 96 patients with proven symptomatic bladder outflow obstruction (BOO) caused by BPH. Patients underwent a full subjective and objective assessment (including urodynamics) before inclusion and again 3 and 6 months later. They were randomly assigned to receive 1 h of microwave hyperthermia or a sham treatment. Of the 96 patients, 93 were assessed at 3 months and 62 at 6 months after treatment. RESULTS: There was no statistically significant difference in the objective measures of BOO between the treated and control groups of patients. There was an improvement of approximately 40% in all the subjective measures, but there was no significant difference between the treated and control groups. CONCLUSION: Microwave hyperthermia, within the parameters defined in this trial, resulted in no significant difference from sham treatment in subjective or objective outcome.

Aged↗
PubMed1992

Extracorporeal shock wave lithotripsy with the Storz Modulith SL20: the first 500 patients.

Our initial experience of extracorporeal shock wave lithotripsy (ESWL) with the Storz Modulith SL20 is reported. A total of 500 patients with 551 renal and 120 ureteric stones, mean diameter 11.9 mm, underwent 746 treatments; 68.2% of patients required a single treatment. The mean treatment rate for renal calculi was 1.4 and for ureteric calculi it was 1.5, rising to 4.2 for staghorns; 62.2% of treatments were performed on an out-patient basis. Analgesia (intravenous fentanyl) was required in 60.9% of treatments for renal calculi but in only 38.2% of those for ureteric calculi. The overall stone-free rate at 3 months was 77.6%, with a further 14.7% of patients having fragments less than 3 mm in diameter that required no further treatment. The stone-free rate was dependent on the site of the stone, with the majority of residual fragments lying in a lower pole calix. There were few complications. The Modulith is an efficient and safe lithotripter capable of treating stones in the kidney and throughout the ureter.

Adult↗
PubMed1992

Transurethral resection syndrome. A prospective study.

Significant hyponatraemia has been reported following transurethral prostatectomy (TURP) in 11-41% of cases. The majority of previous studies have been performed retrospectively. A prospective study was undertaken of 100 patients undergoing TURP. In all, a 24-Charr sheath with non-irrigating, resectoscope and 1.5% glycine as irrigant was used. Volume of irrigant used, weight of prostate and length of procedure were recorded. Serum electrolytes were measured at anaesthetic induction and immediately on transfer to the recovery room. In none of the 100 patients was there a statistically significant fall in serum sodium following resection. No clinical changes of transurethral resection (TUR) syndrome occurred. This study confirms that TUR syndrome and a significant fall in serum sodium can be virtually prevented in TURP and the use of an irrigating resectoscope or a trocar in the average case is not necessary.

Aged↗
PubMed1990

Microbiological study of bladder tumors, their histology and infective complications.

The microbiology of bladder tumors and the infective complications of transurethral resection (TURBT) were studied prospectively in 51 patients. Patients taking antimicrobials were excluded. Those with significant preoperative bacteriuria were included in the study when results of the preoperative urine specimen were unavailable at the time of operation. Infected tumors were found in 18 percent of males and 75 percent of females. A wide range of bacteria, including anaerobes, was isolated; when streptococci or coliforms were cultured from the tumor, they were always found in significant numbers in the preoperative urine specimen. Perioperative bacteremia and postoperative complications requiring parenteral antibiotics were more common in females and in patients with significant preoperative bacteriuria. No correlation was found between tumor infection and histologic grade or stage of tumor. Patients with sterile preoperative urine and positive bacterial cultures from tumors were no more likely to have postoperative urinary tract infections than those with negative tumor cultures.

Aged↗
PubMed1989

Transitional cell carcinoma of the renal pelvis and ureter.

In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was greater than 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post-operative radiotherapy did not improve survival.

Adult↗
PubMed1988

Reappraisal of the role of radical radiotherapy and salvage cystectomy in the treatment of invasive (T2/T3) bladder cancer.

One hundred and eighty-two patients with invasive (T2/T3) bladder cancer were treated by radical radiotherapy at the London Hospital between 1974 and December 1985. Cystectomy was reserved for patients whose tumours either did not respond completely to radiation or recurred later, provided they were fit for surgery and had not developed distant metastases. The overall corrected 5-year survival rate was 40%; 75 patients responded to radiation and did not relapse during the period of follow-up; 20 patients had an initial response to radiation but subsequently relapsed, with a 5-year survival rate following relapse of 20%. Of these, 11 patients had a cystectomy with a 5-year survival following relapse of 36%, whereas all 9 patients who did not have a cystectomy died within 3 years; 87 patients who did not respond to radiation had a 5-year survival rate of 18%. Of these, 22 patients underwent salvage cystectomy with a 5-year survival of 47%, whereas the 65 patients who did not have a cystectomy had a 5-year survival of 3%. These results justify a policy of radical radiotherapy and salvage cystectomy rather than elective cystectomy in the treatment of invasive bladder cancer.

Adult↗
PubMed1988

Chemotherapy for carcinoma in situ of the bladder.

In an 8-year period, 71 patients were diagnosed as having carcinoma in situ of the bladder. Twenty patients with primary carcinoma in situ were treated with systemic cyclophosphamide or intravesical mitomycin C and 19 of them survived 3 years. Three patients required cystectomy: 1 for invasive cancer and 2 for intractable symptoms in the absence of tumour. Fifty-one patients had either secondary or concomitant carcinoma in situ. Systemic or intravesical chemotherapy was given to 28 patients in whom carcinoma in situ was associated with G1 or G2 exophytic superficial tumour: there was only one cancer death in 3 years. Fifteen patients with G3 carcinoma in situ associated with a G3 or invasive exophytic tumour were treated with radiotherapy: 9 responded but 4 of the 6 with radio-insensitive tumours died of cancer within 3 years. Eight patients with secondary carcinoma in situ were managed by transurethral resection alone: in 6 there was spontaneous regression and 2 developed muscle invasion within 1 year. These results compare well with those of immunotherapy or early radical surgery and suggest that chemotherapy should be given a trial in patients with carcinoma in situ.

Administration, Intravesical↗
PubMed1987

Early repair of accidental injury to the ureter or bladder following gynaecological surgery.

Operative injury to the ureter or bladder in 59 women who had received no previous pelvic radiotherapy was repaired as soon as possible after referral. In 32, this was less than 6 weeks from the injury, while in 27 patients the delay in referral was greater than 6 weeks. Ureteric injuries in 40 patients (43 ureters) were repaired by the Boari-Ockerblad technique. Post-operative vesicovaginal fistulae in 19 women were repaired transvesically with an omental patch. Primary healing was obtained in all cases whether early or late. These results support our recommendation for early intervention in these injuries.

Female↗