You have accessJournal of UrologyModerated Poster, Saturday, May 20, 2006, 1:00 - 3:00 pm1 Apr 200647: Endoscopic Treatment of Upper Tract Urothelial Carcinoma in Patients with Solitary Kidneys R. Houston Thompson, Amy E. Krambeck, David E. Patterson, Joseph W. Segura, Michael L. Blute, and Daniel S. Elliott R. Houston ThompsonR. Houston Thompson More articles by this author , Amy E. KrambeckAmy E. Krambeck More articles by this author , David E. PattersonDavid E. Patterson More articles by this author , Joseph W. SeguraJoseph W. Segura More articles by this author , Michael L. BluteMichael L. Blute More articles by this author , and Daniel S. ElliottDaniel S. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32314-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "47: Endoscopic Treatment of Upper Tract Urothelial Carcinoma in Patients with Solitary Kidneys." The Journal of Urology, 175(4S), pp. 16–17 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 16-17 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information R. Houston Thompson More articles by this author Amy E. Krambeck More articles by this author David E. Patterson More articles by this author Joseph W. Segura More articles by this author Michael L. Blute More articles by this author Daniel S. Elliott More articles by this author Expand All Advertisement PDF DownloadLoading ...

Purpose: SWL has revolutionized the management of nephrolithiasis and it is a preferred treatment for uncomplicated renal and proximal ureteral calculi. Since its introduction in 1982, conflicting reports of early adverse effects have been published. However, to our knowledge the long-term medical effects associated with SWL are unknown. We evaluated these adverse medical effects associated with SWL for renal and proximal ureteral stones.Materials and Methods: Chart review identified 630 patients treated with SWL at our institution in 1985. Questionnaires were sent to 578 patients who were alive in 2004. The response rate was 58.9%. Respondents were matched by age, sex and year of presentation to a cohort of patients with nephrolithiasis who were treated nonsurgically.Results: At 19 years of followup hypertension was more prevalent in the SWL group (OR 1.47, 95% Cl 1.03, 2.10, p = 0.034). The development of hypertension was related to bilateral treatment (p = 0.033). In the SWL group diabetes mellitus developed in 16.8% of patients. Patients treated with SWL were more likely to have diabetes mellitus than controls (OR 3.23, 95% CI 1.73 to 6.02, p < 0.001). Multivariate analysis controlling for change in body mass index showed a persistent risk of diabetes mellitus in the SWL group (OR 3.75, 95% Cl 1.56 to 9.02, p = 0.003). Diabetes mellitus was related to the number of administered shocks and treatment intensity (p = 0.005 and 0.007)Conclusions: At 19 years of followup SWL for renal and proximal ureteral stones was associated with the development of hypertension and diabetes mellitus. The incidence of these conditions was significantly higher than in a cohort of conservatively treated patients with nephrolithiasis.

You have accessJournal of UrologyPodium, Tuesday, May 23, 2006, 8:00 - 10:00 am1 Apr 20061028: Percutaneous Image Guided Cryotherapy is a Minimally Invasive Option for Select Renal Tumors W. Scott Webster, Michael Farrell, J. William Charboneau, Thomas Atwell, Matthew R. Gallstrom, Eugene D. Kwon, Michael L. Blute, Horst Zinke, and David E. Patterson W. Scott WebsterW. Scott Webster More articles by this author , Michael FarrellMichael Farrell More articles by this author , J. William CharboneauJ. William Charboneau More articles by this author , Thomas AtwellThomas Atwell More articles by this author , Matthew R. GallstromMatthew R. Gallstrom More articles by this author , Eugene D. KwonEugene D. Kwon More articles by this author , Michael L. BluteMichael L. Blute More articles by this author , Horst ZinkeHorst Zinke More articles by this author , and David E. PattersonDavid E. Patterson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33253-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1028: Percutaneous Image Guided Cryotherapy is a Minimally Invasive Option for Select Renal Tumors." The Journal of Urology, 175(4S), p. 331 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 331 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information W. Scott Webster More articles by this author Michael Farrell More articles by this author J. William Charboneau More articles by this author Thomas Atwell More articles by this author Matthew R. Gallstrom More articles by this author Eugene D. Kwon More articles by this author Michael L. Blute More articles by this author Horst Zinke More articles by this author David E. Patterson More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyPodium, Tuesday, May 23, 2006, 8:00 - 10:00 am1 Apr 20061026: Radiofrequency Ablation of Renal Mass in Solitary Kidneys Amy E. Krambeck, Michael A. Farrell, J. William Charboneau, David S. Dimarco, Matthew R. Callstrom, Thomas D. Attwell, David E. Patterson, Joseph W. Segura, Horst Zincke, and Michael L. Blute Amy E. KrambeckAmy E. Krambeck More articles by this author , Michael A. FarrellMichael A. Farrell More articles by this author , J. William CharboneauJ. William Charboneau More articles by this author , David S. DimarcoDavid S. Dimarco More articles by this author , Matthew R. CallstromMatthew R. Callstrom More articles by this author , Thomas D. AttwellThomas D. Attwell More articles by this author , David E. PattersonDavid E. Patterson More articles by this author , Joseph W. SeguraJoseph W. Segura More articles by this author , Horst ZinckeHorst Zincke More articles by this author , and Michael L. BluteMichael L. Blute More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33251-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1026: Radiofrequency Ablation of Renal Mass in Solitary Kidneys." The Journal of Urology, 175(4S), pp. 330–331 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 330-331 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Amy E. Krambeck More articles by this author Michael A. Farrell More articles by this author J. William Charboneau More articles by this author David S. Dimarco More articles by this author Matthew R. Callstrom More articles by this author Thomas D. Attwell More articles by this author David E. Patterson More articles by this author Joseph W. Segura More articles by this author Horst Zincke More articles by this author Michael L. Blute More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyModerated Poster, Tuesday, May 24, 2005, 8:00 - 10:00 am1 Apr 20051081: Image-Guided Radiofrequency Ablation of Renal Tumors Gregory S. Schenk, David S. DiMarco, Michael A. Farrell, William J. Charboneau, David E. Patterson, and Horst Zincke Gregory S. SchenkGregory S. Schenk More articles by this author , David S. DiMarcoDavid S. DiMarco More articles by this author , Michael A. FarrellMichael A. Farrell More articles by this author , William J. CharboneauWilliam J. Charboneau More articles by this author , David E. PattersonDavid E. Patterson More articles by this author , and Horst ZinckeHorst Zincke More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35237-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1081: Image-Guided Radiofrequency Ablation of Renal Tumors." The Journal of Urology, 173(4S), p. 293 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 293 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Gregory S. Schenk More articles by this author David S. DiMarco More articles by this author Michael A. Farrell More articles by this author William J. Charboneau More articles by this author David E. Patterson More articles by this author Horst Zincke More articles by this author Expand All Advertisement PDF DownloadLoading ...

PURPOSE:To review the utility of antegrade pyelography in detecting crossing vessels as the cause of uretero-pelvic junction (UPJ) obstruction prior to planned endopyelotomy.MATERIALS AND METHODS:A retrospective review of the medical records, surgical reports, and medical images was performed in 109 consecutive adult patients in our practice who underwent antegrade pyelography just prior to planned endopyelotomy for symptomatic UPJ obstruction between January 1996 and December 2002.RESULTS:Fourteen patients were identified in whom a specific antegrade pyelographic appearance was detected in the diagnosis UPJ obstruction caused by crossing vessels. Surgical plans were changed in all 14 patients from antegrade endopyelotomy to open surgical pyeloplasty, during which the anterior (ventral) crossing vessels causing obstruction were confirmed. An additional three patients in the reviewed endopyelotomy group clinically failed their initial endopyelotomy procedure and were shown at the time of subsequent open or laparoscopic reconstructive surgery to have UPJ obstruction caused by anterior crossing vessels, but that diagnosis was missed at the time of the initial antegrade pyelogram.CONCLUSION:A specific antegrade pyelographic appearance was identified to diagnose UPJ obstruction caused by anterior crossing vessels with a sensitivity of 82.4% and a specificity of 100%. The direct obstructing effect of the vessels on the ureter is defined with pyelography as an acute posteriorly angulated ureteral deformity just below a patent UPJ. Recognition of this specific antegrade pyelographic appearance permits use of an appropriate surgical technique for UPJ obstruction repair.

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 12, 2004, 8:00am- 12:00 pm1 Apr 20041883: Percutaneous Ultrasonic Lithotripsy (PUL) After Extra Corporeal Shock Wave Lithotripsy (ESWL) Failure Amy E. Krambeck, David E. Patterson, Andrew J. LeRoy, Kent G. Krejci, and Joseph W. Segura Amy E. KrambeckAmy E. Krambeck , David E. PattersonDavid E. Patterson , Andrew J. LeRoyAndrew J. LeRoy , Kent G. KrejciKent G. Krejci , and Joseph W. SeguraJoseph W. Segura View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)39075-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1883: Percutaneous Ultrasonic Lithotripsy (PUL) After Extra Corporeal Shock Wave Lithotripsy (ESWL) Failure." The Journal of Urology, 171(4S), p. 497 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 497 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Amy E. Krambeck More articles by this author David E. Patterson More articles by this author Andrew J. LeRoy More articles by this author Kent G. Krejci More articles by this author Joseph W. Segura More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:Technical advances in ureteroscopy allow for more aggressive management of upper tract pathology. We evaluate to what extent clinical practice and treatment efficacy have been impacted by improvements in technology and technique.MATERIALS AND METHODS:In 1998, 176 consecutive patients underwent 182 ureteroscopic procedures at our institution. Retrospective chart review was performed. Factors such as clinical indication, pathology location, type of ureteroscope, procedure duration, procedure success, complication rate and length of stay were evaluated. Data from the 1998 cohort were compared to those obtained from a cohort of patients from 1992. Statistical analysis was performed using chi-square test.RESULTS:Overall stone extraction rate was 94.4% (1992) vs 88.5% (1998) (p = 0.05). Proximal stones were treated in 13.5% (1998) vs 28.3% (1998) of cases. Distal stone extraction rate was 97.2% (1992) vs 95.1% (1998) (p = 0.43) and proximal stone extraction rate was 76.5% (1992) vs 71.9% (1998) (p = 0.73). Diagnostic inspection success rate was 98.3% (1992) vs 98.3% (1998). Use of flexible ureteroscopy was 11.5% (1992) vs 29.4% (1998). Complication rate was 12% (1992) vs 10.2% (1998) (p = 0.76). Of the cases 76.1% were outpatient in 1998 vs only 50% in 1992.CONCLUSIONS:Recent advances in ureteroscopic technology permit more aggressive instrumentation of the upper tract as reflected in higher use of flexible ureteroscopy and more frequent attempts to manage proximal ureteral calculi. These advances have not translated into better efficacy of calculus treatment. Furthermore, our data reflect a nationwide trend toward outpatient treatment.

Objectives. To evaluate the endoscopic management of upper urinary tract transitional cell carcinoma (TCC) as a first-line treatment in patients with a normal contralateral kidney. Methods. During an 11-year period, 21 patients diagnosed with upper tract TCC were treated with conservative endourologic techniques using either neodymium:yttrium-aluminum-garnet laser or electrocautery at our institution. The 21 patients were followed up for a mean of 6.1 years (range 1 to 11.6). Results. A total of 8 renal pelvic tumors and 13 ureteral tumors were found. All tumors were Stage T1 or less and grade 3 or less. All tumors were less than 2 cm in the greatest dimension (range 0.4 to 2). Of the 21 patients, 7 (33%) had one local recurrence and 1 (4.7%) developed two local recurrences. Of the 13 ureteral tumors, 6 (46%) recurred; 1 (12%) of the 8 renal pelvic tumors recurred. No recurrent tumor was shown to have an increase in grade. Of the 21 target renal units, 17 (81%) were preserved; 4 (19%) of 21 patients required nephroureterectomy because of tumor recurrence. Overall, 11 patients in the series died, 10 of non-TCC etiology and 1 secondary to invasive bladder TCC that developed after treatment for upper tract TCC. No patients died as a result of conservative management of their upper tract TCC. Conclusions. Endourologic techniques and conservative treatment of upper tract TCC is an evolving field; however, in properly selected patients, endoscopic treatment can be safely and effectively used as a first-line treatment for upper tract TCC.

Background and Objectives: Stone composition, as reflected in radiographic appearance, is important to help choose between SWL and percutaneous/endoscopic procedures. Predicting a stone's composition accurately from a plain radiograph would be a useful tool in clinical decision-making. However, the ability of physicians to predict composition has not been adequately assessed. A prospective study was designed to quantify the accuracy of a panel of physicians who routinely deal with stones in classifying stone composition solely from radiographs,'Materials and Methods: A panel of six members was created to review 100 plain-film radiographs from patients with renal stones of known composition, The panel consisted of two urologists, two radiologists, and two nephrologists, all of whom have expertise in stone disease. If the composition guessed was at least 40% of the total stone composition, the response was deemed correct,Results: Overall, there was an average 39% correct response score among the six panelists. When the stones were divided by size, 35% were <1 cm, and 65% were larger. The accuracy of chemical composition determination did not improve with greater stone size, nor was there a difference in accuracy for pure and mixed stones. The most frequently misclassified stone was calcium phosphate, with only 14% being correctly diagnosed.Conclusions: With a random sampling of plain radiographs, a panel of physicians specializing in stone disease correctly diagnosed the composition of renal calculi less than half of the time without being given clinical information.

PURPOSE:We compared a current cohort of patients who underwent ureteroscopy to a cohort from the early 1980s to determine changes in success, indications and long-term complications of the procedure.MATERIALS AND METHODS:A chart review was performed of 194 patients who underwent 209 ureteroscopic procedures at our institution during 1992. This group was then statistically compared to 317 patients who underwent 346 ureteroscopies between 1982 and 1985.RESULTS:The current indications for ureteroscopy were calculus extraction (67% of the cases), diagnosis (28%) and stent manipulation (5%). These indications differed from those of the early series, in which 84% of all ureteroscopies were performed for calculus extraction and 16% for diagnosis. Overall ureteroscopic success rate increased from 86 to 96% (p < 0.001). Success of stone extraction improved from 89 to 95% (p = 0.08, distal success rate 95 to 97% and proximal success rate 72 to 77%). Success of diagnostic inspections increased from 73 to 98% (p < 0.001). In the early series failure was usually due to inability to traverse the ureter (54% of the cases), while currently failure is due almost exclusively to impassable ureteral strictures (63%). The overall complication rate decreased from 20 to 12% (p = 0.01) and the rate of significant complications decreased from 6.6 to 1.5% (p < 0.05). Clinical followup (mean 36 months) for all patients and radiological followup (mean 9.8 months) for 67% of eligible patients detected only 1 ureteral stricture. The remaining patients were asymptomatic after the ureteroscopic procedure.CONCLUSIONS:Improvements in ureteroscope design, accessories and technique have led to a significant increase in the success of diagnostic and therapeutic ureteroscopy while decreasing morbidity. Outpatient ureteroscopic stone extraction, particularly for distal ureteral calculi, is almost uniformly successful with low morbidity. The long-term complication rate of ureteroscopy is 0.5%.

Objectives. This report focuses on the long-term follow-up of patients with endoscopically treated upper tract transitional cell carcinoma (TCC) to determine the effectiveness of endoscopic therapy.Methods. From May 1983 to April 1994, 44 patients with TCC of the upper urinary tract underwent conservative endourologic treatment with either electrocautery fulguration or neodymium :yttrium-aluminum-garnet laser at our institution. The mean follow-up period was 5 years (range, 3 months to 11 years).Results. Renal pelvic tumor sizes ranged from 0.4 to 4.0 cm (mean, 1.5) and ureteral tumors from 0.2 to 1.0 cm (mean, 0.5). The majority of tumors were of pathologic grade 3 or less, and all were Stage T2 or less. Seventeen of 44 patients (38.6%) had local tumor recurrence (mean time to recurrence, 12.8 months; range 1.5 to 64). Mean recurrence time was 7.5 months for renal pelvic tumors and 17.8 months for ureteral tumors. Nineteen of 44 patients (43.2%) developed bladder tumors. The overall 5-year disease-free rate was 57%. No recurrent tumor was shown to have increased in grade, and one recurrent tumor was proved to have progressed in stage. Six patients (14%) ultimately required a nephroureterectomy for recurrence. There were no major complications as a result of endoscopic therapy. Six patients (14%) died of the effects of metastatic TCC, 5 of whom had known muscle invasive bladder TCC.Conclusions. Endourologic techniques and the conservative treatment of upper urinary tract TCC is an evolving field and can be safely and effectively used as a first-line treatment for upper tract TCC in selected patients.

Between 1988 and 1993, 50 percutaneous antegrade endopyelotomies were performed for ureteropelvic junction obstruction at this institution. The success of the procedure was based on radiological parameters as well as patient symptomatology. The overall success rate of the procedure was 88%. Endopyelotomy was successful in 9 of 11 patients (82%) who presented after failing previous renal procedures. When endopyelotomy was used as the initial treatment modality the success rate was 90%. These results support the argument that endopyelotomy should be considered as first line therapy for most adults with ureteropelvic junction obstructions [corrected].

As part of a multicenter investigative trial, transurethral microwave thermotherapy of the prostate was used in 60 men with symptomatic benign prostatic hypertrophy. A single office treatment on the Prostatron, a device that provides concurrent microwave heating of the prostate and conductive cooling of the urethra, was well tolerated and caused no major adverse events. Symptomatic improvement, especially the decrease in nocturia and urgency, was dramatic, and urinary flow was improved at 6 weeks. Continued follow-up suggests that further improvement will be achieved and that transurethral microwave thermotherapy has a role in the treatment of benign prostatic hypertrophy.

A forty-two-year-old man with a traumatic, membranous urethral disruption underwent initial suprapubic catheter urinary diversion followed by a primary realignment twenty-one days after injury. Realignment was accomplished radiologically using an anterograde guide wire engaged by a retrograde stone basket and subsequent Foley catheter placement over the wire. The patient has remained totally continent, having partial erections, two years after injury, with no further intervention.

In a prospective, randomized study, continuous infusion of epidural fentanyl citrate (group E) was compared with patient-controlled intravenously administered morphine sulfate (group P) for analgesia in 66 men after radical retropubic prostatectomy. Although both methods provided satisfactory analgesia, the mean comfort level scores were lower (that is, greater comfort) in group E than in group P at all observation times. The difference in mean resting comfort level scores between groups E and P was statistically significant (P < or = 0.05) at 9 of the 11 observation times. In addition, significant differences in comfort level scores were noted at 8 of the 11 observation times during deep breathing, 5 of 11 during coughing, and 3 of 9 during ambulation. Maximal and minimal comfort level scores recorded by each patient during the course of the study were significantly lower (that is, less pain) in group E than in group P for all four categories of activity. The percentage of patients who reported no pain was significantly higher in group E than in group P at 9 of 11 observation times during resting and 5 of 11 observation times during deep breathing. No significant differences were noted in side effect profiles or duration of hospital stay. In summary, when two effective methods of analgesia used after radical retropubic prostatectomy were compared prospectively, patients who received epidural infusion of fentanyl were more comfortable than those with patient-controlled intravenous administration of morphine, as evidenced by lower mean, maximal, and minimal comfort level scores and a greater proportion of patients with complete relief of pain.