By J. C. Gingell (auth.), J. Clive Gingell MB, BCh, FRCS, FRCS(Ed), Paul H. Abrams MD, FRCS (eds.)
The identify of this booklet is a problem. someone with the least wisdom of modern-day urology will understand that there are lots of very arguable facets of this topic. Urology isn't really on my own during this unsettled surroundings for there are comparable debates in just about all different points of surgical procedure. as well as the fast alterations in expertise, a massive a part of the reason for those controversies is just that extra surgeons are ready to confess that no zone in their paintings is so proven that it doesn't endure extra scrutiny and evaluate. Argument may be tedious yet debate is fit. This e-book goals to provide fabric that's arguable: skilled practitioners of every subject clarify why an opinion or choice may be sustained. The purist may well desire to have those reviews resolved via a well-planned scientific trial, yet adventure of medical trials indicates that they don't continuously produce effects which are simply translated right into a confident swap in scientific perform. may the reader be persuaded extra by way of a statistically major distinction or via an skilled clinician who has reached convinced conclusions? either are dicy, yet on account that surgical concepts are frequently now not simply switched over into applicable experiences or trials the Editors have acquired the simplest opinion on every one controversy and innovation. The media adore controversy for its personal sake. The clinical occupation accepts controversy yet understands that few occasions in drugs are absolute and few strategies could be performed merely through one method.
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Additional resources for Controversies and Innovations in Urological Surgery
Fig. 12. ESWL monotherapy in a case of partial staghorn calculus. The KUB X-ray series demonstrates complete disintegration of the stone following 2500 shock waves. However, on the third day (right) a large Steinstrasse is seen in the upper ureter which finally had to be removed by ante grade ureteroscopy. 25 Development, Indications and Clinical Experience Staghorn Calculi (Partial, Complete) Larger calculi up to partial and complete staghorn stones are treated with PCNL as the first step. Any residual particles are then disintegrated by shock waves in a second or third session after 4 days (Fig.
52 Controversies and Innovations in Urological Surgery Double-J Stent Insertion While standard J stents do not require ureteroscopy for insertion, a frequent problem remains the curling up of the stent in the bladder. To overcome this it is often easier to insert the ureteroscope into the lower third of the ureter. The telescope can then be removed and the stent inserted through the sheath. This is particularly useful when dealing with malignant compression of the ureters, where resistance to the stent insertion can be overcome by the rigid sheath of the ureteroscope.
Ureteroscopy may then be carried out, or the tube may be left in situ to act as a stone shoot following extracorporeal shock wave lithotripsy (ESWL). After the ureter has been dilated, endoscopy can proceed. The appropriate endoscope should be selected. ), which are based on the paediatric bronchoscope. The newer shorter ureteroscopes are soon to become available. These are highly recommended and are much more manoeuvrable than their longer counterparts. It should be remembered that large scopes have better flow and allow the use of better and larger accessories.
Controversies and Innovations in Urological Surgery by J. C. Gingell (auth.), J. Clive Gingell MB, BCh, FRCS, FRCS(Ed), Paul H. Abrams MD, FRCS (eds.)