Urinary stone disease: Great progress with promise for the future.

Urinary calculus disease has been a scourge on mankind since ancient times. Research in the field has been hampered by lack of funds and the lack of cachet with the public such as seen with cancer or heart disease. In recent years there have been marked changes led by urologists in the diagnosis, treatment and long-term management of calculi

Ureteroscopic lithotripsy.

There is a wide array of endoscopic lithotriptors presently available. Each of these has its own advantages and disadvantages. No single lithotriptor is suitable for all applications and none can meet the goal of fragmenting all calculi while remaining harmless to tissue

Ureteroscopic treatment of larger renal calculi (\u3e2 cm).

OBJECTIVES: To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of \u3e2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. METHODS: We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi \u3e2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. RESULTS: In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23-84)%, 87.1 (79-91)% and 94.4 (90.1-96.7)%, respectively. Overall, the success rate was \u3e90% with a mean of 1.2-2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). CONCLUSIONS: UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist\u27s options treating renal calculi of \u3e2 cm

Ureteroscopic laser treatment of upper urinary tract neoplasms.

BACKGROUND: Endoscopic management of upper urinary tract transitional cell carcinoma has assumed an important role in diagnosis and treatment. The introduction of small diameter rigid and flexible ureteroscopes has permitted access to the upper tract. Biopsy techniques have been developed for accurate diagnosis, and the addition of lasers has given the urologists an excellent tool for treatment. METHODS: Medical literature available relative to the endoscopic laser treatment of upper tract neoplasms has been reviewed. RESULTS: Ureteroscopic treatment has been characterized by good success with high recurrence rates, both in the upper tract and in the bladder. Bladder recurrence rates are similar to those seen after surgical treatment of upper tract tumors. Surveillance has been ureteroscopic since the other diagnostic options are inadequate. The holmium and neodymium:YAG lasers are the devices most commonly used now for the endoscopic treatment of upper tract tumors. CONCLUSION: Ureteroscopic treatment of upper tract neoplasms usually with ablation and resection using the neodymium and holmium: YAG lasers is a current acceptable procedure. This should be considered as one of the options in tumor treatment

Fluoroscopic placement of double-pigtail ureteral stents.

Purpose: Double-pigtail ureteral stent is placed cystoscopically after ureteroscopy. We describe a technique for fluoroscopic placement of ureteral stents and demonstrate its use in a non-randomized prospective study.Materials and methods: Double-pigtail stents were placed either fluoroscopically or cystoscopically in 121 consecutive patients. In the fluoroscopic method, the stent was placed over a guide wire using a stent pusher without the use of cystoscopy. Conversely, stents were placed through the working channel of the cystoscope under vision. The procedure, stent length, width, type, method, ureteral dilation, and use of a retrieval string were noted.Results: A wide range of stent sizes were used. The success with fluoroscopic placement of double-pigtail ureteral stents was 100% (89 of 89 cases). No stents migrated or required replacement. Stents were placed after ureteroscopic laser lithotripsy (53/89) and ureteroscopic tumor treatment (22/89). Cystoscopic visualization was used in 32 additional procedures requiring precise control (15 ureteral strictures and nine retrograde endopyelotomy).Conclusions: The fluoroscopic placement of ureteral stents is a safe and simple technique with a very high success rate. We have used cystoscopic placement only after incisional procedures such as retrograde endopyelotomy, stricture or ureterotomy

Leader of the Pack: A Proposal for Disclosure of Board Leadership Structure

To reform corporate governance, this article proposes that the New York Stock Exchange and the National Association of Securities Dealers amend their listing policies to require a listed company to disclose in its proxy statement (1) whether or not there is a separate independent chair of its board of directors, and if there is not, (2) whether or not its board of directors has designated a senior independent director who functions as a leader of its independent directors. The proposals are designed to encourage directors to select an independent chair or a lead director, thereby increasing the likelihood that a company\u27s independent directors will not be beholden to a CEO. The authors survey management under-performance in publicly traded U.S. companies and the practical effects of implementing their proposal to show the benefits to shareholders from independent directors

Prevention of stone migration with the Accordion during endoscopic ureteral lithotripsy.

BACKGROUND AND PURPOSE: Endoscopic lithotripsy is often prolonged secondary to the retrograde migration of calculous fragments. Various balloons, baskets, and other devices have been used to prevent this migration. Our purpose is to analyze the effect of the Accordion(®) on stone migration and overall efficiency during lithotripsy. PATIENTS AND METHODS: We prospectively evaluated 21 patients with a total of 23 distal ureteral stones. Patients underwent lithotripsy using an endoscopic impact lithotriptor. The Accordion was randomly used in 11 of these 21 patients. Data were collected regarding stone migration, stone size, stone ablation, ureteral clearing, and lengths of time for various stages of each procedure. RESULTS: Patients who were treated with the Accordion device experienced significantly less retrograde migration during fragmentation (P=0.0064). When stone volume was taken into account (but not on a per stone basis), ablation and ureteral clearing were also expedited, and fewer lithotripter hits and basket sweeps were needed. CONCLUSION: The Accordion device is effective in preventing the migration of stone fragments during endoscopic ureteral lithotripsy. Our data suggest that this device may also increase efficiency of the fragmentation and clearance of ureteral calculi

A Preliminary Study on Expanding and Financing State Water Development

The effects of recent energy price increases, domestic inflation rates, financial market fluctuations, and changing public attitudes toward federally sponsored water resource development and management have brought economic and financial consideratiosn to the forefront of Western water management issues. Recently enacted federal policies place increased responsibility on the states and localities for the development and management of their water resources. A response common to many of the western states has been to stengthen traditional, and often small, water financing and development programs. In creating and sustaining such a posture, however, state governments must address the important questions pertaining to the economic and financial impact of greater state involvement, the distributional impacts of state taxing and lending programs, and the state social goals relating to such managerial involvement. The traditional and recently expanded water development programs of the State of Utah have been reviewed in the light of such management issues. The demand for state financing of water projects was addressed through an examination of economic indicators and an inventory of potential projects. State options for obtaining capital financing also were examined. This review indicates taht increased financing activity and the potential for increased concentration of water development project benefits to specific social groups have created a need for greater clarity in the legislative mandate and greater accounting and visibility of water project impacts through the use of improved economic and social evalution procedures. Moreover, in the absence of such safeguards, the continued investment of state funds might be considered premature and not always in the best interest of the state\u27s residents

Water Yields in Utah Developing a State Water Plan

Need and Importance of Study Utah\u27s problems of water use and water supply are becoming increasingly important. They are also becoming increasingly complex as competition for our water resources becomes more keen among various types of uses. In the formulation of plans for sound and efficient use of water it is essential to know the characteristics of occurrence and use of water supplies so that requirements can be balanced most effectively and economically against supply. This ordinarily requires basic hydrologic data to determine relations among climate, water losses, and water yield from watersheds. Such data are often unavailable - especially for the smaller basins and streams which characterize many parts of Utah. With greater emphasis on small watersheds and small project development, some way of estimating quantities and characteristics of streamflow which are vital to hydraulic design is essential. In spite of increased emphasis and expenditures for development of water, the expansion of basic data programs still lags behind actual development. At present, investigations and data gathering are not completely adequate to delineate the potential water resources nor to determine the extent of possible development. Without an expanded program of surface and underground water investigations, we cannot hope to outline our potentials completely. However, a broad picture of long-time average annual runoff, developed indirectly or from data at hand, should have considerable value in first stage planning on a statewide basis. The total hydrologic picture must be outlined to evaluate better the effect of individual project development on future regional development programs. Piecemeal development frequently does not fit into an ultimate patterns for most complete and efficient use of the water resource within a region or state. To avoid this kind of development, those responsible for formulating water programs and policies need all the hydrologic information they can get. Deficiencies of such information lend great emphasis to the need for developing dependable indirect methods and techniques to speed preliminary hydrologic surveys. This study was undertaken to develop techniques useful in making was undertaken to develop techniques useful in making rapid and economical estimates of water supplies. The study is restricted to the estimation of mean annual values. Much other information regarding extremes and variations is necessary for detailed project planning. The objective in this study, however, is to provide means of getting a broad perspective of the state\u27s water supply of sufficient accuracy for initial planning a regional nature