Interventional radiology in the treatment of uretero-pelvic-junction

Numerous authors have reported successful results with both antegrade or retrograde endopyelotomy. Both procedures have proved to be efficient in primary as in secondary obstructions. Some additional etiological factors, such as crossing vessels high-grade hidronephrosis and poorly functioning kidney, may decrease the success rate of these minimally invasive techniques. The development of a cutting balloon catheter used under fluoroscopic control simplified the retrograde technique. This technique proved to be easier to perform than antegrade or retrograde endoscopic incision and did not require specialized instrumentation. In our experience 6 patients from 30 to 65 years old (average age 52) with an ureteropelvic-junction obstruction secondary to open surgery underwent endopyelotomy with the cutting balloon device. At the three month followup 4 patients had renographic patent ureteropelvic junction and no modifications were seen at one year follow up The retrograde endopyelotomy under fluoroscopic control seems to offer a rapid and effective treatment of UPJO. It is indicated for all primary and secondary UPJO obstruction apart forpatients with a concomitant renal stone or with high-insertion ureteropelvic junction

Supine percutaneous nephrolithotomy (PCNL) in a tetraparetic patient with skeletal deformity

Purpose: To achieve an almost 100% stone-free rate by means of further developing and standardizing the procedure. Patients and Methods: 100 consecutive patients with single or multiple renal calculi were prospectively enrolled in the study. Flexible ureterorenoscopy was performed as a completely standardized operation by the same two experienced surgeons. Primary outcome was an "endoscopic" (immediate) stone-free status as determined by endoscopic inspection at the end of surgery. In cases of residual fragments, a reevaluation by CT was performed after 3 months. Results: The endoscopic stone-free rate was 97%. In three patients with a cumulative stone size >20 mm, a completely stone-free status could not be achieved in the primary procedure. In these patients, a CT scan after 3 months showed complete clearance from all residual fragments in two; this translates into a primary (after one procedure) stone-free rate after 3 months of 99%. Medium cumulative stone size was 9.8 mm (4-40 mm); in 44 patients, multiple calculi were extracted. Forty-nine patients received a ureteral stent at the end of the operation; two patients had to have stent placement for new onset hydronephrosis and/or colicky pain or fever. Overall complication rate was 7%. Results are limited, because no routine CT scan was used to evaluate stone clearance. Conclusion: By means of a standardized surgical approach and use of technical equipment of the newest generation, it is possible to achieve very high stone-free rates without compromising safety. This approach, however, necessitates use of considerable resources, both technical/surgical and financial

Supine percutaneous nephrolithotomy (PCNL) in a horseshoe kidney

Purpose: To achieve an almost 100% stone-free rate by means of further developing and standardizing the procedure. Patients and Methods: 100 consecutive patients with single or multiple renal calculi were prospectively enrolled in the study. Flexible ureterorenoscopy was performed as a completely standardized operation by the same two experienced surgeons. Primary outcome was an "endoscopic" (immediate) stone-free status as determined by endoscopic inspection at the end of surgery. In cases of residual fragments, a reevaluation by CT was performed after 3 months. Results: The endoscopic stone-free rate was 97%. In three patients with a cumulative stone size >20 mm, a completely stone-free status could not be achieved in the primary procedure. In these patients, a CT scan after 3 months showed complete clearance from all residual fragments in two; this translates into a primary (after one procedure) stone-free rate after 3 months of 99%. Medium cumulative stone size was 9.8 mm (4-40 mm); in 44 patients, multiple calculi were extracted. Forty-nine patients received a ureteral stent at the end of the operation; two patients had to have stent placement for new onset hydronephrosis and/or colicky pain or fever. Overall complication rate was 7%. Results are limited, because no routine CT scan was used to evaluate stone clearance. Conclusion: By means of a standardized surgical approach and use of technical equipment of the newest generation, it is possible to achieve very high stone-free rates without compromising safety. This approach, however, necessitates use of considerable resources, both technical/surgical and financial

Soft prosthesis implant and relaxing albugineal incision with saphenous grafting for surgical therapy of Peyronie's disease: a 5-year experience and long-term follow-up on 145 operated patients

Most surgical therapies used to date for Peyronie's disease produce good results but cause penis retraction. The authors propose a personal surgical technique that makes use of an intracavernous cylinder, soft but axially rigid in consistency, in association with tunical relaxing incisions and saphenous vein grafting, in this exact sequence. Between March 1997 and March 2003, 145 patients presenting with Peyronie's disease underwent this 3-phase personal surgical procedure. Complete plaque excision was necessary only for 13 patients (8.9%); in the remaining 132, a single incision was placed in 113 cases (77.9%) and double incisions were used for 19 patients (13.1%). Penile length was measured intraoperatively, after drug-hydraulic erection, then at the later control visits. Distance follow-up ranged from a minimum of 6 months to a maximum period of 3 years (mean 13 months); the latter follow-up period was possible for 38 patients. All patients and partners with at least one year follow-up were asked to answer a questionnaire administered over the telephone at 12 months post-surgery. Average penile lengthening was approximately 1.5 cm. 80 patients answered the questionnaire (70.75%): 76 expressed complete satisfaction, while 4 patients reported glans paresthesia. No major complications were noted; for 8 patients circumcision was repeated because of preputial edema. In 6 cases there was a local, postoperative infection, that was treated conservatively with a prolonged antibiotic therapy. This technique allows to successfully solve penile retraction, caused by traditional surgery for Peyronie's disease. The technique is easy to carry out, has low risks of complications and ensures very high rates of patient satisfaction. (copyright) 2004 Elsevier B.V. All rights reserved