Ureteral catheterization for uterine cancer

Analyzing the issue of the treatment of inoperable uterine cervix cancers with the danger of uremia, Holz (Zentr f. Gyn., 1924, No. 13) does not agree with HoIzbach, who proposed, in order to avoid uremia due to compression of the ureters by tumor masses, their preventive preparation.

Minipercutaneous nephrolithotomy without ureteric catheterization. Comparison with the standard procedure

Introduction. Percutaneous nephrolithotomy (PNL) is the method of choice for the treatment of patients with kidney stones larger than 2 cm. Mini-percutaneous nephrolithotomy (mini-PNL) became widespread due to reduction of injury associated with surgical approach. Creation of puncture access to the pelvicalyceal system without ureteral catheterization is also recently described. The main benefits of such technique are reduction of total operative time and the radiation exposure to the patient and medical personnel. The results of using mini-PNL without prior ureteral catheterization remain insufficiently studied, which predetermined the goal of our study. Purpose. Compare the efficacy and duration of mini-PCNL with and without ureteral catheterization. Materials and methods. We analyzed the treatment outcomes of 111 patients with a single kidney stone. Group I included 60 patients who underwent mini-PCNL according to the standard technique. Group II included 51 patients who underwent mini-PCNL without prior catheterization of the ureter. The average stone size was 19.2 0.92 mm and 18.6 0.93 mm in groups I and II, respectively. The puncture of the pyelocaliceal system of the kidney was performed under X-ray control and US guidance using the free-hand technique. Results. In group I, complete elimination of the stone was achieved in 55 (92%) patients and the mean duration of the operation was 108,3 34,85 min (range: 60 to 210). In group II, complete elimination of the stone was achieved in 50 (90%) patients and the mean duration of the operation was 69,7 22 min (range: 25 to 120 min). In all cases, the severity of complications did not exceed grade II according to Clavien classification, and their rate was 6,7% and 5,9% in group I and group II, respectively. Conclusions. According to the results of the study, the compared groups did not differ in their post-operative complication and stone-free rates. Avoidance of routine ureteral catheterization significantly reduces the operation time and hence the anesthetic risk and radiation load.

Comparative evaluation of the effectiveness of dilatation correction of the pyelocaliceal system of the kidneys in the context of using various options for drainage of the upper urinary tract

Introduction. Upper urinary tract (UUT) obstruction remains a socially significant problem due to its high frequency and serious pathogenetic consequences. Dilation of calyx-pelvic system (CPS) remains one of the pathognomonic manifestations of this condition, which should be immediately corrected. Percutaneous puncture nephrotostomy, internal stenting, and ureteral catheterization are the most commonly used methods for draining the upper urinary tract. However, the problem of choosing a drainage method in a specific clinical situation based on the criterion of the effectiveness of elimination of CPS dilatation has not yet been resolved. Purpose of the study. Comparative analysis of the efficiency of drainage of the upper urinary tract under the conditions of the use of three alternative methods –распредеpercutaneous puncture nephrostomy, internal stenting and ureteral catheterization – followed by substantiation of the choice in a specific clinical situation according to the criterion of the effectiveness of correction of the dilatation of the CPS. Materials and methods. We included in this study 300 patients with obstruction of the upper urinary tract due to urolithiasis, oncourological and oncogynecological pathology. The presence and resolution of dilatation of the CPS was determined using ultrasound diagnostics and intravenous urography. Results. Percutaneous puncture nephrostomy is the most effective in treating upper urinary tract obstruction in terms of eliminating CPS dilatation, ureteral catheterization is less effective, and internal ureteral stenting occupies an «intermediate position». Conclusion. When planning and implementing the treatment of upper urinary tract obstruction, one of the main criteria should be taken into account the effectiveness of correction of the dilatation of the CPS. In a specific clinical situation in which dilatation of the PCS will be of the greatest importance, percutaneous puncture nephrostomy will be the optimal method of drainage.

The preliminary experience of methylene blue assisted laparoscopy in the treatment of renal parapelvic cysts

Renal cyst is a common disease in humans and laparoscopic renal cyst decortication is the gold standard for treatment. However, specialized surgical skills are required for the treatment of renal parapelvic cysts. In this study, we describe an improved laparoscopic method for the treatment of renal parapelvic cysts involving the use of continuous infusion of methylene blue. Sixteen patients with renal parapelvic cyst were enrolled in this study. All patients underwent retrograde ureteral catheterization, with continuous perfusion of the renal pelvis using a solution of 0.2% methylene blue and saline, during laparoscopic decortication of the parapelvic cyst. In one patient, the cyst communicated with the renal collection system which was injured, but this was immediately repaired intraoperatively. All operations were successful, and none was converted to open surgery. There were no occurrences of persistent urinary fistula, bleeding, or other complications postoperatively. All patients were followed-up for 3–24 months, and results of postoperative imaging investigations revealed that all of our patients experienced either complete recovery or a greater than 50% decrease in size of the cysts. Our study demonstrates that methylene blue-assisted laparoscopic treatment is a safe, effective and practical method for the treatment of renal parapelvic cysts.

Usefulness of a long sheath in ureteral catheterization after failure of antegrade ureteral stent placement using a short sheath

Background When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. Purpose To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. Material and Methods Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. Results The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher’s exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. Conclusion Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture.