Urolithiasis: Therapy - Prevention

ISBN-13: 9783642707148 / Angielski / Miękka / 2011 / 356 str.

P. Alken; D. Bach; C. Chaussy

Opis

Since the early days of medicine one concern of doctors has been the removal of kidney stones and prevention of recurrence. Owing to the hesitancy of progress in the prevention of initial stone formation and of relapse, however, removal of stones from the kidney and ureter were developed to highly refined techniques and they formerly accounted for a major proportion of the urological operations performed. In the last few years developments in the treatment of kidney stones have taken a completely different turn. In the majority of cases suit able methods are available to bring about spontaneous passage of the stones, while in a smaller proportion drug-induced litholysis is pos sible. Stones that cannot be passed are now treated mainly with extra corporeal shockwave lithotripsy, percutaneous litholapaxy or uretero renoscopy. These methods are often used in combination and comple ment each other. Nonetheless, despite the accumulating experience with the new methods there will still be situations in which stones can not be removed except by open surgery. "Our skill as surgeons and the management of the brilliantly designed equipment would amount to nothing more than highly skilled mechanical work if they did not go hand in hand with enhanced insight into the cause of lithiasis and thus into ways of preventing it - or at least of preventing the relapse that is the lot of most patients."

Spis treści

Drug Therapy of Urinary Calculi and Prevention of Recurrence.- I. Introduction.- II. General Preventive Measures.- III. Special Preventive and Therapeutic Measures.- 1. Calcium Oxalate Calculi (Mono- and Dihydrates).- a) Diet and Fluid Intake: Quantity and Choice of Drinks.- b) Drug Therapy of Calcium Oxalate Lithiasis.- c) Calcium Oxalate Stones: Drug Therapy and Recurrence Prevention.- 2. Infective Calculi.- 3. Uric Acid Stones: Treatment, Recurrence Prevention, Oral Chemolysis.- a) Diet, Fluid Intake and Choice of Drinks in Uric Acid Lithiasis.- b) Preventive Drug Treatment of Uric Acid Lithiasis.- 4. Urate Calculi.- a) Sodium Hydrogenurate Monohydrate.- b) Ammonium Hydrogenurate.- 5. The Treatment of Cystine Calculi.- a) Cystinuria Diets and Associated Problems.- b) Fluid Intake, Volume, and Composition.- c) Drug Treatment of Cystine Stones.- d) Chemical Conversion of Cystine to Cysteine.- 6. The Treatment of Rare Stones.- a) Xanthine Lithiasis.- IV. Childhood Urolithiasis.- 1. Dietary and Medical Treatment of Oxalosis and Hyperoxaluria.- 2. Dietary and Medical Treatment of Cystinuria.- a) Disorders of Purine Metabolism.- b) Renal Tubular Acidosis.- 3. General Comments on the Drug Treatment of Juvenile Urolithiasis.- V. Conclusion.- References.- The Treatment of Ureteric Colic and Promotion of Spontaneous Passage.- I. Introduction.- II. Pathophysiology.- 1. Innervation of the Ureter.- 2. Urodynamics of Obstruction.- III. The Treatment of Colic (Initial Analgesia).- 1. Metamizole (Novaminsulfone).- 2. Pentazocine.- 3. Morphine.- IV. Passage of the Stone.- 1. Spasmoanalgesia.- 2. Extended Spasmoanalgesia.- 3. Herbal Remedies.- 4. Adjuvant Therapy.- a) Anti-Edematous Drugs.- b) Increased Diuresis.- c) Physical Activity.- V. Complications of Conservative Treatment.- 1. Urinary Obstruction.- 2. Infection.- References.- Surgical Treatment of Renal Calculi.- I. Introduction.- II. The Classification of Kidney Stones.- III. The Indication for Surgery.- IV. Preoperative Investigations and Patient Preparation.- V. Surgical Access to the Kidney.- 1. The Modified Posterior Lumbotomy Incision.- 2. The Supracostal Approach.- 3. The Anterior Approach.- 4. Access for Recurrent Disease.- VI. Pyelolithotomy.- 1. Simple Pyelolithotomy.- 2. Coagulum Pyelolithotomy.- 3. Extended Pyelolithotomy (Intrasinusal Pyeloinfundibulotomy).- References.- Ischemia and Regional Hypothermia in Renal Stone Surgery.- I. Introduction.- II. Renal Ischemia.- III. Drug-Mediated Prolongation of Renal Ischemia Tolerance.- IV. Increasing Ischemia Tolerance by Hypothermia.- References.- Radial Nephrolithotomy Under Ultrasound and Doppler Probe Control.- I. Introduction.- II. Preoperative Investigation.- III. Apparatus.- 1. Doppler Probe.- 2. The B-Scanner.- IV. Practical Application.- 1. Sterilization.- 2. Exposing the Kidney.- 3. Intraoperative Ultrasonography.- 4. Limitations of B-Scanning.- a) Stone Surface and Density.- b) Air.- c) Scars.- d) Urine, Clots.- e) Vasculature.- 5. Doppler Ultrasonography.- a) Limitations of Doppler Ultrasonography.- 6. Siting the Nephrotomy.- 7. Making the Nephrotomy.- V. Results.- References.- Intraoperative Pyeloscopy.- I. Introduction.- II. Rigid Nephroscopes.- III. Flexible Nephroscopes.- 1. Equipment.- 2. Technique.- a)Inspection.- b) Stone Extraction.- c) Indication of a Nephrotomy Site.- IV. Results.- V. Complications.- References.- Intraoperative Radiology.- I. Introduction.- II. X-Ray Equipment.- 1. Stationary or Mobile X-Ray Sets.- 2. Renodor.- 3. The C-Arm Image Intensifier.- 4. Film Stock and Intensifying Screens.- 5. Polaroid Film.- a) Packing and Sterilizing Film Material.- III. Aids to Intraoperative Radiology.- IV. Alternative Techniques.- References.- Percutaneous Manipulation of Renal Calculi.- I. Introduction.- II. Anatomical Considerations.- III. Percutaneous Access.- 1. Patient Preparation.- 2. Patient Positioning.- 3. Imaging Guidance.- 4. Puncturing the Kidney.- 5. Tract Dilatation.- 6. Nephrostomy Tubes.- IV. Nephroscopy.- 1. Rigid Nephroscopes.- 2. Flexible Nephroscopes.- V. Mechanical Stone Extraction.- VI. Intrarenal Stone Disintegration.- 1. Mechanical Disintegration.- 2. Ultrasonic Lithotripsy.- 3. Electrohydraulic Lithotripsy.- 4. Microexplosion Lithotripsy.- 5. Stone Disintegration by Laser Irradiation.- VII. Percutaneous Chemolysis.- VIII. Results and Complications.- IX. The Choice of Treatment.- References.- The Instrumentation and Surgery of Ureteric Calculi.- I. Introduction.- II. History.- III. Significance of Symptoms.- IV. Investigations.- V. Spontaneous Passage and Size of Stone.- VI. Stone Removal.- 1. Retrograde Techniques Under X-Ray Control.- a) Indications.- b) Technique.- c) Other Techniques.- d) Ureteric Stone Disintegration Under Radiologie Control.- 2. Ureterorenoscopy.- a) Technique.- b) Endoscopy.- c) Eliminating the Stone.- d) Aftercare.- e) Complications.- f) Results.- 3. Antegrade Removal.- 4. Shockwave Lithotripsy.- 5. Open Surgery.- References.- Treatment of Bladder Stones.- I. Surgical Removal of Bladder Stones.- 1. Historical Perspective.- a) Perineal Lithotomy.- b) Suprapubic Lithotomy.- c) Transurethral Lithotresis.- d) Litholapaxy.- 2. Indications.- a) Patient Selection.- b) Anesthesia.- c) Prerequisites.- d) Contraindications.- e) Conclusion.- II. Techniques of Litholapaxy.- 1. The Ultrasonic Lithotrite.- a) Definition of Ultrasound.- b) The Effect of Ultrasound on Urinary Calculi.- c) The Instrument.- d) The Technique of Ultrasound Litholapaxy.- e) Technical Reliability of the Lithotrite.- f) The Complications of Ultrasonic Litholapaxy.- g) Conclusion.- 2. Electrohydraulic Litholapaxy.- a) Definition of Electrohydraulic Shockwaves.- b) Principle of the Operation.- c) Instrumentation.- d) Technique of Electrohydraulic Lithotresis.- e) Reliability.- f) Complications.- g) Contraindications.- h) Conclusion.- 3. Microexplosion Cystolithotresis.- a) Definition and Physical Principles of Microexplosion Cystolithotresis.- b) Experimental Studies.- c) Instrumentation.- d) Clinical Experience and Complications.- e) Conclusion.- 4. Viewing Litholapaxy.- 5. Blind Litholapaxy.- 6. Combined Transurethral and Suprapubic Litholapaxy.- 7. Unusual Transurethral Techniques.- a) The Stone Basket.- b) The Proctoscope.- 8. Suprapubic Cystotomy.- 9. Pregnancy and Litholapaxy for Bladder Calculi.- 10. Conservative Treatment.- 11. Drug Therapy for Bladder Calculi (Cystolitholysis).- 12. Stones in Conduits.- References.- Treatment of Urethral Stones.- I. Prevalence.- II. Pathogenesis.- III. Symptomatology and Diagnosis.- IV. Treatment.- References.- Extracorporeal Shockwave Lithotripsy (ESWL) in the Treatment of Kidney and Ureter Stones.- I. Introduction.- 1. Method.- 2. Fundamentals.- 3. Shockwaves — Ultrasonic Waves.- II. Shockwave Generation and Focussing.- 1. Equipment.- 2. Stone Localization.- 3. Respiratory Mobility.- 4. Procedure.- 5. Trial Runs.- 6. Anesthesia.- 7. Shockwave Exposure.- 8. ECG Triggering.- 9. Readjustment Düring Treatment.- III. Subsequent Treatment After ESWL.- 1. Results.- 2. Auxiliary Procedures.- 3. Renal Function.- IV. Indications.- l.Infected Stones.- 2. Stone Size.- 3. High-Risk Patients.- 4. Ureteric-Stone Patients.- 5. Obstruction and Noncontrastive Stones.- V. Conclusion.- References.- Preventive Measures.- I. The Role of Prevention in the Management of Urolithiasis.- II. Risk Factors and Persons at Risk.- 1. Nutrition.- 2. Metabolic Disorders.- 3. Drugs.- 4. Infection and Outflow Obstruction.- 5. Occupation and Environment.- 6. Calculating the Risk of Stone Formation.- III. Health Education and Behavior Patterns.- References.