By Stephen Y. Nakada, Margaret S. Pearle
Major nationwide and foreign urologists within the box of endourology describe typical and complicated endoscopic tactics for treating upper-tract pathology. The authors offer step by step directions for the most recent endoscopic strategies, starting from higher urinary tract calculi and strictures to urothelial melanoma. An accompanying DVD comprises movies that truly illustrate severe elements of the strategies and supply assistance and methods from the specialists. complicated Endourology: the entire medical consultant deals working towards urologists and urology citizens not just a entire, illustrated consultant to endourological techniques-particularly the extra complex procedures-but additionally a pragmatic capability to extend the diversity and scope of the tactics they practice.
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Extra info for Advanced Endourology
Many variables must be taken into account to determine whether a percutaneous nephrostomy tube or ureteral stent should be placed in patients with obstructing stones. Ureteral Stenting Effects on Ureteral Physiology and Stone Passage Animal studies have demonstrated that ureteral stents decrease the frequency and amplitude of ureteral contraction in animals. In an animal model of ureteral stones causing obstruction, ureteral dilatation was observed proximal to the obstruction in the stented 22 Chew and Denstedt group whereas a nephrostomy tube group had no dilatation (4).
Rarely, patients may be treated conservatively and alternative methods, such as SWL, open ureterolithotomy, or a second attempt at ureteroscopy in 7 to 14 days may be considered. CONCLUSION Retrograde access to the urinary system is the first step in many endourologic procedures and all urologists should be adept at dealing with the nuances of achieving access. Ureteral stents are a vital part of the urological armamentarium and play a role in the treatment of stones, reconstructive urology, ureteropelvic junction obstruction, hydronephrosis of pregnancy, and ureteral obstruction.
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). In pregnant women less than 22 weeks gestational age, a percutaneous nephrostomy tube can be inserted and changed multiple times with relative ease (44,47).