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To evaluate the safety and efficacy of percutaneous stone removal using a compliant balloon after papillary balloon dilatation.Between March 2014 and May 2020, 123 patients with choledocholithiasis, in whom endoscopy was unsuccessful, were enrolled in this study. The ampulla of Vater was dilated using a noncompliant balloon, and stone removal was attemptedBiliary stones were completely removed in 118 of 123 patients. Major complications occurred in five patients. One patient experienced duodenal bleeding, which was successfully treated by endoscopy. Hemobilia occurred in three patients, which required transfusion, and one patient experienced four days of abdominal pain. Minor complications, including self-limiting pain, effusion, minimal hemobilia, elevated amylase and fever, occurred in 21 patients. Stone size was the only significant risk factor associated with the rate of complications (Odds ratio: 1.14, 95% confidence interval = 1.04, 1.26). Bilirubin and white blood cell levels significantly decreased after the procedure.Percutaneous stone removal using a compliant balloon after papillary balloon dilatation is a safe and effective method in patients in whom endoscopic or surgical treatment is not feasible.

Background In ureterorenoscopy, anaesthesiologists are preferring regional anaesthesia to avoid postoperative complications, while surgeons are preferring general anaesthesia to avoid ureteral trauma. China has not published its guidelines and not referring to the European Association of Urology guidelines. The objectives of study were to evaluate the effects of general, spinal, and epidural anaesthesia on ureter access and surgical outcomes of ureterorenoscopy. Methods Charts of a total of 392 patients with the American Society of Anaesthesiologists grade I or II, and underwent flexible ureterorenoscopy for removal of the proximal, middle, or distal ureteral single stone under general anaesthesia (GA group; n = 145) or spinal anaesthesia (SA group; n = 131) or epidural anaesthesia (EA group; n = 116) were reviewed retrospectively. Results The dilatation time for patients of GA group was fewer than those of SA (104.01 ± 12.77 sec/patient vs. 130.55 ± 22.53 sec/patient, p

The aim of this study was to evaluate the impact of hours worked by a urologist before performing ureteroscopy on its safety and efficacy.Patients treated at a single institution from January 2010 to December 2013 were analyzed. The study assessed patient, stone and surgical parameters, stone-free rates and intraoperative complications performed in three work duration categories: less than 6 h, 6-12 h and more than 12 h of urologist's work. Statistical analyses included the chi-squared test, Kruskal-Wallis test, and univariate and multivariate logistic regression analyses.In total, 469 ureteroscopies were analyzed. Intraoperative complications differed non-significantly in the corresponding time categories: ureteral perforations (6 h 4.4%, 6-12 h 3.2%,12 h 7%, p = 0.46) and avulsions (all 0%). Rates for complete stone removal were 82% within the first 12 h vs 70.2% after 12 h (p = 0.03). Corresponding partial stone-free rates were 4.1% vs 3.5% (p = 0.83) and rates of unsuccessful ureteroscopy were 13.8% vs 26.3% (p = 0.01). In multivariate regression analysis, patients treated after 12 h of urologist's work had a 2.4 times higher risk of an unsuccessful ureteroscopy [odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.2-4.7, p = 0.001] and lower chances of complete stone removal (OR = 0.46, 95% CI 0.24-0.89, p = 0.02). The odds of ureteral perforations were similar (p = 0.28).Work duration before ureteroscopy did not affect its safety. Stone-free rates decreased with increasing working time. Working time exceeding 12 h was identified as an independent risk factor for impaired stone-free rates.

We present the case of a recurrent gallstone ileus in a 76-year old female patient, which presented at our emergency department on January 15th 2015. In both episodes (January 16th and February 1st, 2015), only a simple enterotomy with stone extraction was performed. One year later, she is fully recovered and in good health. Recurrent gallstone ileus most often occurs in elderly patients with multiple co-morbidities. In our aging population, its prevalence is expected to increase. Because of the vague, intermittent symptoms, diagnosis of gallstone ileus is often delayed, contributing to its high mortality rate. CT-scan has become the preferred diagnostic imaging modality. Treatment should be individualized, with stone removal by enterotomy alone being the most commonly used strategy. For symptomatic patients, a two-stage procedure with urgent enterotomy followed by a delayed cholecystectomy can be considered. The one-stage procedure, in which enterotomy is combined with cholecystectomy and fistula closure, should be reserved for those few patients with minimal cholecystitis and in good overall condition.

Removal of large bile duct stones by endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been proven safe and effective. Little evidence supports the benefits of a preceding EST in reducing complications. Recent studies suggest that large bile duct stone removal by EPLBD alone may be safe and effective.We removed large bile duct stones by EPLBD with EST from March 2008 to February 2010 and without EST from March 2010 to October 2011. Efficacy and safety of EPLBD with or without EST and late biliary complication outcomes were assessed.Forty-two patients (men/women, 27/15; mean age, 76 years) underwent EPLBD: 14 underwent EPLBD with EST and 28 underwent EPLBD without EST. The mean stone size was 14 mm (9-30 mm). Overall complete stone removal rate was 98%, with 83% achieved in 1 session. Complete duct clearance by EPLBD alone was achieved in 79%. Mechanical lithotripsy was required in 4 (10%) patients. Extracorporeal shock wave lithotripsy and electrohydraulic lithotripsy were required in 4 (10%) and 1 (2%) patients, respectively. Pancreatitis and perforation occurred in 2 (5%) and 1 (2%) patients, respectively. Patients treated by EPLBD with EST and by EPLBD alone did not differ in complication outcomes. Six (14%) patients had recurrent bile duct stones, with a significant correlation to dilated common bile duct (p = 0.0351).EPLBD is safe and effective in patients with large bile duct stones. Preceding EST may be unnecessary.

Although endoscopic papillary large balloon dilation (EPLBD) with limited endoscopic sphincterotomy (ES) showed excellent outcomes for treatment of large bile duct stones, hemorrhage and recurrence of stones are problematic complications. Recent studies suggest that EPLBD alone is safe and effective for removal of large bile duct stones. This study aimed to determine the therapeutic outcomes and safety of EPLBD, compared with ES, for removal of large bile duct stones.Eighty-three patients above 45 years of age with bile duct stones1 cm in diameter were randomized to EPLBD and ES groups for removal of common bile duct stones from September 2010 to August 2011. Prophylactic gabexate mesilate was given to all patients.Baseline characteristics were not significantly different, except diabetes and gallbladder stones between the EPLBD group (n = 40) and ES group (n = 43). The overall complete stone removal rate in each group was 97.5% (39/40) and 95.3% (41/43), respectively (p = 0.600). Requirement of mechanical lithotripsy was not significantly different between the EPLBD and ES group (10% vs. 21%, p = 0.171). Complete ductal clearance in one session was achieved in 82.4% and 81.4% of cases in each group, respectively (p = 0.577). There were no differences in complication rates between the EPLBD and ES group; pancreatitis, 5.0% vs. 7.0%; hemorrhage, 10.0% vs. 16.3%; acute cholangitis, 5.0% vs. 2.3%, and perforation, 2.5% vs. 0%.The therapeutic outcomes and complications of EPLBD for removal of large bile duct stones are comparable to those of ES.

During the past four decades there have been dramatic developments in the methods used for active stone removal from the urinary tract, and the need for open surgery has been almost entirely replaced by extracorporeal shockwave lithotripsy, percutaneous surgery, ureteroscopy and retrograde intrarenal surgery. Residual fragments and the pronounced risk of recurrent stone formation remain important problems for the future development of urolithology and for the optimal low-risk management of this large group of patients. It is emphasized that all aspects of the care of patients with stone disease are the responsibility of the urologist.

Endoscopic sphincterotomy (ES) is a highly successful and preferred method for common bile duct (CBD) stone removal. In the rare instance when ES is unsuccessful and CBD stones are removed percutaneously, improved biliary drainage remains desirable to prevent stone recurrence. To this end, percutaneous transhepatic sphincterotomy (PTS) has been performed in nine patients. All patients presented with ascending cholangitis due to biliary obstruction from CBD stones. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy was unsuccessful due to previous upper Gl reconstructive surgery (n = 8) and technical failure (n = 1). Percutaneous biliary drainage (PBD), followed by transhepatic stone removal, was performed prior to the transhepatic sphincterotomy using a standard endoscopic papillotome. Fluoroscopic guidance was used in the first three patients and in the remainder both fluoroscopy and percutaneous choledochoscopy were used. Sphincterotomy was successfully performed in all ...

Urolithiasis during pregnancy, though rare, can be challenging both diagnostically and therapeutically. It is helpful if the physician is quick to suspect the presence of stones in the presence of appropriate signs and symptoms, particularly flank pain and tenderness, hematuria, or unresolved bacteriuria. Ultrasonography is the diagnostic imaging method of choice, but modified intravenous urography should be performed whenever this study is necessary for a prompt diagnosis. In the absence of sepsis, renal failure, or intractable pain, conservative management with hydration, analgesics, and (if infection is present) antibiotics is the favored initial approach. If conservative management fails, stent insertion or placement of a percutaneous nephrostomy tube may be appropriate. Ureteroscopy with stone manipulation for distal ureteral stones during pregnancy has also been reported in some cases. If these methods fail, open surgery should be used for stone removal.

Summary. More than 10 years after its clinical introduction, extracorporeal shock wave lithotripsy (ESWL) has proved to be the safest treatment modality for more than 90% of urinary stones. Absolute contraindications are untreated coagulopathy, urinary tract infection and pregnancy. After careful preparation, even patients with severe coagulopathy (haemophiliacs A/B, thrombocytopenia) can be treated successfully by ESWL. Shock wave lithotripsy for an increasing amount of small symptomatic renal calculi resulted in a stone-free rate of 50% and a complaint-free rate of 52%. A 50% chance of success justifies initial ESWL treatment for stones in caliceal diverticula. A stone-free rate of 70% was reported for stone-bearing horseshoe kidneys, but the recurrence rate was 29%. Therefore, percutaneous stone removal may become necessary in such cases.The utilization of indwelling stents has contributed to the extension of indication for ESWL monotherapy, even for staghorn calculi, as acute morbidity is reduced. Dou...

Between 1978 and 1988 5,035 urinary calculi have been analysed by X-ray diffractometry. 1,615 of these stones have additionally been investigated by scanning electron microscopy (SEM). The overall sex-ratio was 1.86 (m/f). Ca-stones and uric acid containing stones are more frequent in male patients (m/f = 2.08 and 3.86, respectively) whereas infection stones and cystine stones show a higher rate of appearance in female patients (m/f = 0.6 and 0.88, respectively). The percentage of open surgery ranged about 30% in the first few years but decreased to 5-7% in the last few years due to the new methods of stone removal. The rate of occurrence of the crystalline phases does not differ remarkably from other statistics except for a higher incidence of apatite because of the high sensitivity of detection of this phase by SEM. The recurrence rate of brushite stones amounting to 66.7% is very high and exceeds even that of cystine stones (60.7%).

In patients with bacteriuria and small and otherwise asymptomatic renal stones, the infection should be linked to the stone before surgical removal of the stone is considered. In this study the level of infection was determined by ureteric catheterisation. The method could discriminate between stone-related infections (70%) and infections confined to the lower urinary tract (30%) in virtually all of the patients. Even very small stones (3 mm) were shown to be the cause of decade-long bacteriurias. The results of operative stone removal were encouraging, with eradication of the infection in 87% of the patients with stone-related infection.

Patients with recurrent kidney stone disease or stone formers at increased risk of recurrence deserve a thorough metabolic workup. This should be based on a careful history and include urinalysis, serum chemistry studies, and analysis of 24-hour urine collections. Measures to prevent recurrent stone formation are aimed at correcting the metabolic imbalances detected in the workup. A variety of drugs are available that target one or more of the metabolic abnormalities that may be involved. For "surgically active" renal and ureteral stone disease, newer techniques make surgery unnecessary in most cases. Extracorporeal shock wave lithotripsy is becoming the preferred technique for disintegration of upper urinary tract stones. Percutaneous ultrasonic lithotripsy and electrohydraulic disintegration also are widely used. For lower urinary tract stones, the ureteroscope permits either extraction under visualization or ultrasonic disintegration.