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Biomedical subjects

R V Clayman

Publications and source records attributed to R V Clayman.

At least 19 recordsLinked to original sources
PubMed1992

Endopyelotomy: comparison of ureteroscopic retrograde and antegrade percutaneous techniques.

To date 2 approaches have been developed for performing endopyelotomy, that is the antegrade and retrograde approaches. Experience with antegrade transnephrostomy endopyelotomy is quite large and the results have been excellent. However, the need for percutaneous nephrostomy and prolonged hospitalization have been 2 drawbacks to this approach. In contrast, experience with retrograde transureteral endopyelotomy is scant. However, a ureteroscopic approach is attractive from the standpoint of eliminating the need for a large nephrostomy tube and because of the possibility of performing this procedure on an outpatient basis or during a short hospital stay. We report our experience with antegrade and retrograde endopyelotomy in 41 patients. The hospital stay (3.4 versus 4.0 days), nephrostomy tube size (8F to 10F versus 20F to 22F) and nephrostomy tube duration (2.9 versus 3.8 days) were all less with the retrograde approach. The initial success rate was similar between the 2 methods: 79% (retrograde) versus 78% (antegrade). However, the analgesic requirements (5.3 versus 3.5 doses) and the occurrence of significant complications (that is late ureteral stricture in 20%) were greater with the ureteroscopic approach. With the methods currently available, we believe that antegrade endopyelotomy is the preferred approach for endopyelotomy.

Adult↗
PubMed1992

Percutaneous management of urolithiasis during pregnancy.

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 patients. In 2 patients recurrent nephrostomy tube obstruction, fever and pain led to percutaneous stone removal during pregnancy. In the remaining 4 patients the nephrostomy tubes were left indwelling through delivery. During the postpartum period 3 patients successfully underwent ureteroscopic stone extraction and 1 passed the stone spontaneously. Bacteriuria developed in each patient despite the use of preventive antibiotics. All 6 women had uncomplicated vaginal deliveries of healthy newborns and are currently asymptomatic with no evidence of obstruction. Percutaneous drainage of an acutely obstructed kidney in a pregnant woman is an effective temporizing alternative to ureteral stent placement until definitive treatment can be performed.

Adolescent↗
PubMed1992

Arteriovenous fistula complicating endopyelotomy.

We report a case of arteriovenous fistula and pseudoaneurysm formation following endopyelotomy. Presentation, successful management with interventional radiology techniques, and the relationship between variant renal artery anatomy and endopyelotomy are discussed.

Adult↗
PubMed1992

Laparoscopic ureterolysis.

We report a case of an obstructed right kidney due to retroperitoneal fibrosis. Ureterolysis, biopsy of the retroperitoneal tissue and intraperitonealization of the ureter were accomplished laparoscopically.

Adolescent↗
PubMed1992

Organ entrapment system for removing nodal tissue during laparoscopic pelvic lymphadenectomy.

When performing a laparoscopic pelvic lymph node dissection, the tissue specimen may be too large to remove through the laparoscopic trocar. An organ entrapment system has been developed that allows en bloc retrieval of nodal tissue via an 11 mm. trocar site. This system facilitates tissue removal, and minimizes the risk of tissue loss and possible peritoneal or wound contamination.

Humans↗
PubMed1992

Caveat emptor: caliceal stones and the missing calix.

The failure of a stone-containing calix to visualize on an imaging study (that is a missing calix) is often the initial and only sign of an associated pyocalix, since the patient may present without fever and with sterile urine. Extracorporeal shock wave lithotripsy (ESWL*) in these patients may lead to life-threatening systemic sepsis. Therefore, the treatment of choice for the stone-laden missing calix is percutaneous drainage of the affected calix followed by percutaneous stone removal and, when necessary, an endoinfundibulotomy to reestablish communication between the obstructed calix and the renal pelvis.

Adult↗
PubMed1992

Long-term comparison of renal function in patients with solitary kidneys and/or moderate renal insufficiency undergoing extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy.

We compared the long-term effects of extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy monotherapy on renal function in 31 patients with a solitary kidney and/or chronic renal insufficiency who were all more than 2 years after treatment (mean 41.5 months). The change in the reciprocal of serum creatinine was used as an index to estimate changes in the glomerular filtration rate. A change of 20% or greater in the glomerular filtration rate was considered a clinically significant deterioration of renal function. The rate of deterioration of renal function in patients with a solitary kidney and creatinine of less than 2 mg./dl. was 22% for ESWL and 29% for percutaneous nephrolithotomy, respectively. All patients with a creatinine between 2 and 3 mg./dl. demonstrated long-term improvement of renal function regardless of the treatment modality. All 4 patients with creatinine greater than 3 mg./dl. undergoing ESWL had short-term improvement but eventual long-term deterioration of renal function. Indeed, 3 of these patients required dialysis within 2 years from the treatment dates. One patient with creatinine greater than 3 mg./dl. who underwent percutaneous nephrolithotomy demonstrated stabilization of the renal function after treatment. From our data, no convincing evidence could be found to suggest that ESWL results in long-term deterioration of renal function in patients with chronic renal insufficiency or a solitary kidney. We conclude that the choice between ESWL and percutaneous nephrolithotomy should be based on the stone composition, stone location and stone burden, rather than on the preexisting renal function or presence of a solitary kidney.

Adult↗
PubMed1992

Endoureterotomy for treatment of ureteral strictures.

Advances in endosurgical technology have provided the urological surgeon with an alternative to open surgery for the treatment of ureteral strictures. We report the use of an endoscopic intraureteral incision (endoureterotomy) followed by balloon calibration to treat benign ureteral strictures in 13 patients. With an average subjective and objective followup among successful endoureterotomies of 20 months (all cases 12 months or greater), the overall success rate for this procedure is 62%. Of these patients 5 also received triamcinolone injections into the stricture bed following incision and dilation. This method appeared to influence favorably subsequent ureteral patency. The only operative complication was a urinoma, which resolved without intervention. Endoureterotomy appears to be a safe and reasonably effective modality for the treatment of ureteral stricture disease.

Adult↗
PubMed1992

Retroperitoneoscopy: foreign body retrieval.

Retroperitoneoscopy is a rarely indicated procedure for the urological surgeon. However, it can be a useful means to approach some types of ureteral pathology and foreign bodies. We describe a case in which a severed surgical drain was removed from deep within the retroperitoneum by using a percutaneous retroperitoneal approach.

Aged↗
PubMed1992

Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part I. Swine model.

An animal model was developed to study ureteral occlusion produced by steel coils and gelatin sponge. A coil nest was formed in the ureter, and in all but one pig, gelatin sponge pledgets were incorporated in the coil nest. Animals were killed at 2 hours, 1 week, 1 month, and 2 months. High-grade obstruction was present immediately following the procedure in all animals and was documented to be persistent by means of antegrade nephrostograms obtained just prior to death. At gross examination after death, ureteral thickening and strictures were evident. Histologic studies helped confirm the presence of acute and chronic inflammatory changes. In the in vivo model, gelatin sponge was not found necessary for acute ureteral occlusion. However, in an ancillary in vitro study in which a rigid plastic tube was used, gelatin sponge was necessary in addition to coil occlusion to provide acute total obstruction. The authors' findings suggest that in a compliant ureter, coil occlusion alone produces sufficient mechanical occlusion. Long-term obstruction is probably due to mechanical obstruction and stricture formation.

Animals↗
PubMed1992

Laparoscopic nephrectomy: a review of 16 cases.

Laparoscopic nephrectomy is a new procedure in which the entire kidney is removed via an endoscopic technique using a surgical sack entrapment method in combination with a recently developed high-speed 10-mm electrical tissue morcellator. Since June 25, 1990, this procedure has been successfully accomplished in 16 consecutive patients. The average operating room time was 5.6 h. Two patients received a blood transfusion (one and three units, respectively). The average hospital stay was 4.6 days, and convalescence was completed within an average of 12 days. We believe the methods developed for laparoscopic nephrectomy will allow surgeons in other disciplines to broaden their indications for laparoscopic surgery as the entrapment sack and morcellator can potentially be applied to the removal of many other solid intraabdominal and pelvic tissues.

Adolescent↗
PubMed1992

Comparison of early postoperative results for laparoscopic versus standard open cholecystectomy.

Alternative (nonresective) therapies of symptomatic cholelithiasis have been followed by frequent recurrence of gallstones. Great interest has been generated by the recent development of laparoscopic cholecystectomy, which in addition to preventing recurrence, may be associated with less patient discomfort, shorter hospital stays and more rapid return to work than standard cholecystectomy. We compared the first 25 patients who underwent laparoscopic cholecystectomy at our institution to the most recent 25 patients undergoing standard cholecystectomy by the same surgeon. The results of analysis of the two patient groups showed that they were similar in age, weight and gallstone burden. A slightly longer operative time (mean plus or minus S.E.M., 122 +/- 9 minutes versus 95 +/- 5 minutes, p) was required to perform laparoscopic cholecystectomy than standard cholecystectomy during this early experience. However, patients undergoing laparoscopic cholecystectomy had a markedly diminished usage of parental narcotic analgesia during the first 24 hours postoperatively (1.7 +/- 0.5 milligrams of morphine sulfate versus 34.5 +/- 4.1 milligrams of morphine sulfate). They also were discharged from the hospital (1.0 +/- 0 days versus 4.1 +/- 0.3 days) and returned to work or unrestricted activity (8.5 +/- 1.1 days versus 35.6 +/- 4.5 days) much sooner postoperatively than those treated by standard open cholecystectomy. Based on these favorable results, we conclude that laparoscopic cholecystectomy should be the procedure of choice for most patients with symptomatic cholelithiasis.

Adult↗
PubMed1992

Laparoscopic cholecystectomy and choledochoscopy for the treatment of cholelithiasis and choledocholithiasis.

A 33-year-old woman with symptomatic cholelithiasis underwent laparoscopic cholecystectomy. Preoperative evaluation did not suggest the presence of choledocholithiasis, but intraoperative cholangiography showed a totally obstructing stone in the distal common bile duct. Laparoscopically directed, transperitoneal choledochoscopy was performed by passing a 9.4 F flexible ureteroscope through the cystic duct into the distal common bile duct. A single calculus was visualized and removed with a basket. The patient was discharged the next day, returned to full activity within 1 week, and has done well in the subsequent postoperative interval. The management of incidentally discovered common bile duct stones during performance of laparoscopic cholecystectomy is discussed.

Adult↗
PubMed1991

Laparoscopic nephrectomy: initial case report.

A tumor-bearing right kidney was completely excised from an 85-year-old woman using a laparoscopic approach. A newly devised method for intra-abdominal organ entrapment and a recently developed laparoscopic tissue morcellator made it possible to deliver the 190 gm. kidney through an 11 mm. incision.

Adenoma↗
PubMed1991

Ureteronephroscopic marsupialization of obstructing peripelvic renal cyst.

Flexible ureteronephroscopy has been used for numerous therapeutic applications in the upper urinary tract. We report a case of a large peripelvic renal cyst causing obstruction to the ureteropelvic junction, which was treated by incising the wall of the cyst into the renal pelvis with the ureteronephroscope.

Endoscopes↗