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Chapter 138 - Management of upper urinary tract calculi

from Section 26 - Urologic Surgery

Published online by Cambridge University Press:  05 September 2013

Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

The term “Endourology” has been adopted for the minimally invasive endoscopic surgery of upper urinary calculus disease. Since the introduction of shock wave lithotripsy, this modality has become the most common form of stone therapy, allowing an almost completely hands-off treatment for radio-opaque calculi. Due to the technological advances of endourologic procedures such as ureteroscopy and percutaneous nephrolithotomy (PCNL), the incidence of open kidney stone surgery is almost non-existent. Due to the popularity of the daVinci robot (Intuitive, CA), traditional open calculus surgeries are being performed robotically for stones that would otherwise require several endoscopic procedures. It is important to note that as advanced as surgical intervention has evolved for nephrolithiasis, medical management and prevention of complicated urolithiasis still fall short of the ideal.

Nephrolithiasis affects as much as 12% of the population in industrialized nations. Urolithiasis patients will agree that the sensation of stone passage is perhaps the most painful and intense experience of their lives, surpassing even childbirth. Urolithiasis may present as hematuria (ranging from asymptomatic microscopic hematuria to painful gross hematuria), abdominal/flank/back pain, urinary tract infection, renal failure, or as an incidental radiologic finding.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 787 - 789
Publisher: Cambridge University Press
Print publication year: 2013

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References

Collado, SA, Huget, PJ, Monreal, GF et al. Renal hematoma as a complication of extracorporeal shockwave lithotripsy. Scand J Urol Nephrol 1999; 33: 171–5.Google Scholar
Hemal, AK, Nayyar, R, Gupta, NP et al. Experience with robotic assisted laparoscopic surgery in upper tract urolithiasis. Can J Urol 2010; 17: 5299–305.Google ScholarPubMed
Kraft, K, Pattaras, JG.Medical management of urolithiasis. AUA Update Series 2007; 26 (Lesson 36): 353–64.Google Scholar
Preminger, GH, Assimos, DG, Lingeman, JE et al. AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005; 173: 1991–2000.CrossRefGoogle ScholarPubMed
Preminger, GH, Tiselius, HG, Assimos, DG et al. 2007 guideline for the management of ureteral calculi. J Urol 2007; 178: 2418–34.CrossRefGoogle ScholarPubMed

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