Document Detail


Primary ureteroscopic treatment for obstructive ureteral stone-causing fornix rupture.
MedLine Citation:
PMID:  15663675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Management of fornix rupture (FR) by obstructive stone is comprised of extravasation control and the elimination of the obstruction. For all patients, management initially remains conservative under close follow up. Endoscopic management of FR involved with an obstructive stone of the ureter or the pelvi-ureteric junction (UPJ) consists mainly of stenting the ureter. Our endoscopic approach to this pathological entity comprises of the sole stenting of the ureter, as well as primary ureteroscopic lithotripsy followed by ureter stenting. PATIENTS AND METHODS: In the Department of Urology at the General Hospital of Rhodos Island, Rhodos, Greece, over the last 15 years, 51 of 86 patients with FR due to an obstructive stone, were treated endoscopically. Twenty-two patients underwent sole stenting of the ureter (option A) and 29 patients underwent primary ureteroscopic lithotripsy and stenting (option B). RESULTS: The overall primary 'successful outcome' was achieved in nine of the 22 patients (40.9%) in the group treated with sole stenting, while the remaining 59.1% required secondary interventions. However, 27 of the 29 patients (93.1%) treated with primary ureteroscopic lithotripsy and stenting required no auxiliary treatment. The primary successful outcome results for obstructive middle and lower ureteral stones with FR were eight out of 12 (66.6%) and 26 out of 27 (96.3%) for therapeutic options A and B, respectively. Upper obstructive ureteral stones with FR required secondary intervention in most cases, regardless of the therapeutic option chosen. (In nine out of 10 and one out of two cases for options A and B, respectively). The mean duration of hospitalization for options A and B were 7.6 and 5.3 days, respectively. The mean duration that the ureter stent remained in situ for A and B treatment options was 30.9 and 10.2 days, respectively. CONCLUSIONS: Sole stenting of the ureter is reserved for infected FR or for stones of the upper ureter or the UPJ. Ureteroscopic lithotripsy followed by double-J stenting of the ureter may offer a quick and safe therapeutic alternative for distal and middle obstructive ureteral stones with FR.
Authors:
Panagiotis Kalafatis; Konstantinos Zougkas; Anastasios Petas
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  International journal of urology : official journal of the Japanese Urological Association     Volume:  11     ISSN:  0919-8172     ISO Abbreviation:  Int. J. Urol.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2005-01-24     Completed Date:  2005-04-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9440237     Medline TA:  Int J Urol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1058-64     Citation Subset:  IM    
Affiliation:
Department of Urology, General Hospital of Rhodos Island, Rhodos, Greece. P_kal@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Follow-Up Studies
Humans
Kidney Diseases / diagnosis,  etiology,  surgery*
Kidney Medulla / surgery
Kidney Pelvis / surgery
Length of Stay
Lithotripsy*
Male
Middle Aged
Retrospective Studies
Rupture, Spontaneous / diagnosis,  etiology,  surgery
Stents*
Treatment Outcome
Ureteral Calculi / complications,  diagnosis,  surgery*
Ureteral Obstruction / diagnosis,  etiology,  surgery*
Ureteroscopy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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