EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND PERCUTANEOUS NEPHROLITHOTOMY
| Autor: | Dietrich Gravenstein |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Urinary system Convalescence media_common.quotation_subject Urology urologic and male genital diseases medicine.disease Extracorporeal shock wave lithotripsy Surgery Kidney Calculi Anesthesiology and Pain Medicine Lithotripsy Nephrostomy medicine Coagulopathy Humans Anesthesia Ureteral Stricture Bladder stones business Percutaneous nephrolithotomy Nephrostomy Percutaneous media_common |
| Zdroj: | Anesthesiology Clinics of North America. 18:953-971 |
| ISSN: | 0889-8537 |
| Popis: | Urinary tract stone disease is a common affliction. As much as 10% of the North American population suffers from renal, ureteral, or bladder stones sometime in their life. Of those affected, 10% to 30% require urologic intervention. 30 The traditional approach to renal stones was through open surgical procedures that required general anesthesia and long convalescence. In the late 1970s, however, percutaneous nephrolithotomy (PCNL), a minimally invasive technique for the treatment of renal calculi, was introduced. 32 Although this technique also relied on general anesthesia, it allowed effective and safe removal of most renal and some ureteral stones with shorter postoperative recovery times, and quickly became a widely accepted treatment option for renal calculi. 87 A few years later, a revolutionary device made it possible to treat most renal calculi through entirely noninvasive means. Chaussy et al 19 introduced extracorporeal shock wave lithotripsy (ESWL [Dornier Medical Systems, Kennesaw, GA]) for treatment of renal stones in 1980. Today, ESWL represents the initial treatment modality in approximately 90% of patients with urinary tract stones, and is done predominantly on an outpatient basis. 27 Although ESWL has eclipsed all other methods of treatment for urinary tract stones, there are situations in which it may not be beneficial. Nearly 6% of patients experience an inadequate ESWL result, and may require endourologic or operative stone removal. 8 Pregnancy and the presence of a coagulopathy are contraindications to ESWL. Large calculi and patients with distal ureteral stricture or obstruction may not be candidates for ESWL monotherapy. 87 Patients with calcium oxalate monohydrate, calcium phosphate, or cystine calculi, which are resistant to fracture with ESWL, may require alternate techniques. PCNL alone or with ESWL and open surgical intervention remain alternative treatment options for these patients. |
| Databáze: | OpenAIRE |
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