By David S. Chou MD, Elspeth M. McDougall MD, FRCSC (auth.), Stephen Y. Nakada MD, Margaret S. Pearle MD, PhD (eds.)
Although such a lot medical urologists use a number of simple endourological innovations of their practices, the complicated higher tract pathology and anatomy frequently calls for extra complicated endoscopic abilities and instrumentation. In complex Endourology: the entire medical advisor, top nationwide and foreign urologists within the box of endourology describe usual and complex endoscopic approaches for treating top tract pathology. The authors offer step by step directions for the newest endoscopic tactics, starting from top urinary tract calculi and strictures to urothelial melanoma.
Authoritative and hugely instructive, complicated Endourology: the full medical consultant deals lively urologists and urology citizens not just a entire, illustrated consultant to endourological procedures-particularly the extra complex techniques-but additionally a realistic capability to extend the variety and scope of the approaches they perform.
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Extra resources for Advanced Endourology: The Complete Clinical Guide
Denstedt JD, Wollin TA, Sofer M, Nott L, Weir M, Honey D’Art. A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 2001; 165(5): 1419–1422. 25. Wollin TA, Denstedt JD. The holmium laser in urology. J Clin Laser Med Surg 1998; 16(1): 13–20. 26. Chen YT, Chen J, Wong WY, Yang SS, Hsieh CH, Wang CC. Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial. J Urol 2002; 167(5): 1977–1980.
The risk of steinstrasse was reduced by two times for energies delivered at 18 to 22 kV and reduced by three times at energies of 14 to 18 kV (21). High-energy shock waves have been shown to produce larger stone fragments compared with more frequent lower powered shocks which result in finer stone fragments (22). Chapter 2 / Access, Stents, and Urinary Drainage 23 These studies suggest that ureteral stents should be placed prior to SWL for large stones (>20-mm diameter). Some studies, particularly those treating large stones with SWL, must be considered with caution as percutaneous nephrolithotomy is usually the treatment of choice in stones greater than 20 or 25 mm.
Radiographic appearance as the guidewire is withdrawn and the stent curls in the bladder. Table 4 Algorithm for Passing a Guidewire Past an Obstructing Stone 1. Attempt passage with a hydrophilic guidewire. 2. Attempt passage using a retrograde ureteral catheter, or use to push stone into renal pelvis. 3. Pull ureteral catheter back, re-insert guidewire using the catheter to buttress the guidewire and give it support (Note: careful of ureteral perforation, only soft-tipped guidewires should be used in this situation).