Hi Andy,
The short answer to your question is yes, there are ways to use the
Double J stent without without a 1 cm fragmentation of the renal
calculus.
This answer is based on a lab report, "Endoscopic Treatment of the
Lower Ureteral Stones", done by several MDs:
Nihat Satar, MD,
Sinan Zeren, MD,
Yildirim Bayazit, MD,
Bülent Soyupak, MD,
Ugur Erken, MD,
Ruhi K. Türkyilmaz, MD
The procedure was developed at Çukurova University, School of
Medicine, Departments of Urology, Balcali- Adana,Turkey.
The following is from the section of the methodology description that
applies to your question:
"Ureteroscopy using an 11.5F rigid ureteroscope was performed with the
patient under general anesthesia. Access to the calculus was
accomplished by coaxial dilatation of the ureteral orifice at 7 to 8
atmospheres for 2 minutes with a balloon catheter over a 0.035-inch
straight tip guide wire placed alongside the calculus. When a guide
wire was inaccessible, metal dilators were applied sequentially to
dilate the ureteral orifice. Depending on size of the stone, either
grasping forceps, basket or electrohydraulic lithotripsy was applied
for manipulation. A 5F ureteral catheter or Double-J catheter was
placed as a stent if the manipulation time was longer than 30 minutes
and/or if a ureteral injury was suspected.
Immediate postoperative evaluation included a plain. Long term
follow-up included a plain film of the kidneys, ureters and bladder
and evaluation to rule out obstruction, such as renal ultrasound,
excretory urography or nuclear renal scan. Patients were followed
after the procedure for a minimum of one month or until the stones
cleared. Usually Double-J catheters were removed on an outpatient
basis 2 weeks after discharge from the hospital. Six week later
evaluation of drainage from the treated side, any future medical
evaluation or treatment was discussed with the patient. All patients
were given intravenous antibiotics preoperatively. A limited course of
parenteral or oral antibiotics was continued postoperatively.
Biochemical analysis was performed on all available stones."
The results of this alternative method is as follows:
"In 63 patients (90%) were stones removed successfully. They were
fragmented by electrohydraulic lithotripsy in 18 (28.6%), extracted by
basket catheter in 16 (25.4%) and extracted by grasping forceps in 29
(46.0%). An ureteral stent was inserted following the procedure in 36
cases (51.4%). 57 patients (81.4%) were discharged from the hospital
within two days. We did not observe any serious complications."
http://ams.cu.edu.tr/July1997Vol6No2/endoscop.htm
The procedure is described in full detail at the link above if you
would like to find out information pertaining to patient demographics,
indications for treatment, and treatment details.
The method above seems a lot less painful in comparision to the
fragmentation to which your original question referred. Since this was
done in an academic environment, I looked for a medical facility
(specifically in North America) that claims to perform this procedure.
Unfortunately, I couldn't come across any such information. It appears
that any institution performing an operation like this doesn't want to
be contacted directly by patients, but rather through the referral of
another physician. I suggest this is the route you take if you need
this procedure. Your physician will also be able to relate your
medical situation to the effects of this operation and how effective
an alternative it actually is :)
Good luck, and feel free to post a clarification if you do not
understand the above information.
Cheers!
answerguru-ga |
