By Stephen Y. Nakada, Margaret S. Pearle
Prime nationwide and overseas urologists within the box of endourology describe commonplace and complex endoscopic tactics for treating upper-tract pathology. The authors supply step by step directions for the newest endoscopic approaches, starting from higher urinary tract calculi and strictures to urothelial melanoma. An accompanying DVD comprises movies that in actual fact illustrate severe elements of the options and supply assistance and tips from the specialists. complex Endourology: the entire medical advisor bargains training urologists and urology citizens not just a accomplished, illustrated consultant to endourological techniques-particularly the extra complex procedures-but additionally a pragmatic capability to extend the variety and scope of the techniques they practice.
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Extra resources for Advanced Endourology
The incidence of urolithiasis ranges from 1 in 200 to 1 in 2500 pregnancies (40). The majority of calculi presenting during pregnancy will pass spontaneously with conservative management (41–44). If an obstructing calculus fails spontaneous passage, the options are to decompress the kidney and treat the stone after delivery, or to definitively treat the stone during pregnancy. Prolonged indwelling stents or nephrostomy tubes may lead to encrustation, biofilm formation, and infection as pregnant women have physiologic hyperuricosuria and hypercalciuria (45,46); therefore, some studies suggest that ureteral stents should only be placed after 22 weeks gestational age to avoid the need for multiple stent changes (44).
Stones: Stenting as an Adjunct to Shockwave Lithotripsy Stenting prior to SWL is thought to preclude renal obstruction from stone fragments following SWL (9). More recently, the prophylactic efficiency of pre-SWL stenting has been called into question and is now a debated topic where some believe that stents in SWL patients not only lack efficacy to prevent renal obstruction, but may, in fact, impede the passage of stones fragments following SWL (10). Steinstrasse, or the “street of stone” occurs with an overall rate of 3 to 6% of patients undergoing SWL (11) and in 13 to 26% of nonstented patients with stone burdens greater than 25 mm in diameter (12,13).
14. Al Awadi KA, Abdul HH, Kehinde EO, Al Tawheed A. Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU Int 1999; 84(6): 618–621. 15. Sulaiman MN, Buchholz NP, Clark PB. The role of ureteral stent placement in the prevention of Steinstrasse. J Endourol 1999; 13(3): 151–155. 16. Sheir KZ, Madbouly K, Elsobky E. Prospective randomized comparative study of the effectiveness and safety of electrohydraulic and electromagnetic extracorporeal shock wave lithotriptors.
Advanced Endourology by Stephen Y. Nakada, Margaret S. Pearle