By J. C. Gingell (auth.), J. Clive Gingell MB, BCh, FRCS, FRCS(Ed), Paul H. Abrams MD, FRCS (eds.)
The name of this booklet is a problem. an individual with the least wisdom of ultra-modern urology will understand that there are lots of very debatable features of this topic. Urology isn't really on my own during this unsettled atmosphere for there are related debates in just about all different facets of surgical procedure. as well as the quick alterations in expertise, an enormous a part of the reason for those controversies is just that extra surgeons are ready to confess that no region in their paintings is so proven that it doesn't undergo extra scrutiny and evaluation. Argument may be tedious yet debate is fit. This ebook goals to offer fabric that's controversial: skilled practitioners of every subject clarify why an opinion or choice may be sustained. The purist could desire to have those critiques resolved through a well-planned medical trial, yet adventure of medical trials exhibits that they don't continuously produce effects which are simply translated right into a confident swap in scientific perform. might the reader be persuaded extra by means of a statistically major distinction or through an skilled clinician who has reached yes conclusions? either are dicy, yet given that surgical strategies are frequently now not simply switched over into acceptable reviews or trials the Editors have received the simplest opinion on each one controversy and innovation. The media adore controversy for its personal sake. The scientific career accepts controversy yet is familiar with that few occasions in medication are absolute and few tactics might be performed in simple terms by means of one method.
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Additional info for Controversies and Innovations in Urological Surgery
N. Whitfield The technique of percutaneous nephrolithotomy (PCNL) has been developed over the past 5 years and is now established as a standard method of removing stones from the kidney (Reddy et al. 1985; Segura et al. 1985; Whitfield 1983a). Firstly, a transparenchymal track must be established between the collecting system of the kidney and the skin. Secondly, the stone must be removed. These two steps may be performed under the same general or epidural anaesthetic as a one-stage procedure; alternatively, the track may be established under local anaesthesia and kept patent for 48-72 h by a nephrostomy tube before the stone is removed.
A large ureteric catheter is passed and direct pressure on the stone from below may result in the stone moving backwards into the renal pelvis. Sometimes, normal saline forced through the catheter under pressure succeeds in blowing the stone back. On other occasions the stone can be disimpacted from the ureter by passing a guide wire through the ureteric catheter and jiggling the stone from below with it. Stones which remain impacted can be removed from the upper third of the ureter with a flexible nephroscope, or sometimes a rod lens instrument can be passed down the ureter.
There is an increasing rate of ureteric obstruction because of the formation of prevesical Steinstrasse. This results in a higher number of auxiliary measures following ESWL (Figs. 12). 5). 8). We observed a significant difference between the two groups with regard to pain, fever, auxiliary measures and hospital stay (Eisenberger et al. 1985a, b; Gumpinger et al. 1985). 7. 8. 5 cm) 5% 1% 22% 4% 2% UC, ureteric catheter; URS, ureteroscopy. In the case of borderline stones, PCNL guarantees a better retrieval of the stone fragments (Fig.