Calculus obstruction

There are no contraindications. However, there are limitations In the presence of poor renal function, accurate estimation of DRF and/or drainage may not be possible. In the presence of marked hydronephrosis, the interpretation of poor drainage is difficult since this could be due to either partial hold-up or simply because of the reservoir effect of the dilated system. In the presence of calculus obstruction, a renogram may be undertaken, but no furosemide should be administered. 

Obstruction of the pancreatic duct by a calculus or by carcinoma of the pancreas may increase serum LPS activity depending on the location of the obstruction and the amount of remaining functioning tissue. In patients with a reduced glomerular filtration rate, the serum LPS activity is increased. Thus care should be exercised in the interpretation of elevated serum LPS values in the presence of renal disease. Finally, investigation of the biliary tract by endoscopic retrograde pancreatography or treatment with opiates (which causes the sphincter of Oddi to contract) may increase serum LPS activity. 

Rowatinex has also been used with success in the removal of residual stone fragments after extracorporeal shock wave lithotripsy (ESWL), a situation that occurs in up to 72% of patients given this therapy. These fragments are important to remove since they may lead to calculus regrowth, infection, or obstruction. With 50 patients, it was found that Rowatinex decreased the number of calculi debris, reducing the number of late complications and further interventions. By day 28, 82% of patients were free of calculi, whereas this situation is normally reached after 3 months without Rowatinex treatment (Siller et al., 1998). 

The comparison between non-contrast-enhanced CT and IVU in adults suspected of a ureteric obstruction by stone demonstrated that non-con-trast-enhanced CT is more effective than IVU in precisely identifying ureteric stones (Smith et al. 1995). Spiral CT underscores the concept that the radiolucent calculus is a thing of the past-virtu-ally all urinary calculi are visible on CT (Mindell and Cochran 1994). Because of the sedation and the radiation dose, spiral CT is very seldom used for detecting urinary tract stones in children, and then only in late childhood as low-dose CT (Fig. 20.7) (Kluner et al. 2006 Poletti et al. 2007). 

Endurology is minimally invasive therapy involving the urinary tract. It is the natural evolution of techniques developed for treatment of renal obstruction using percutaneous access. Access to the collecting system is via a puncture identical to that used in placement of percutaneous nephrostomy. Sequential dilatation of the track allows for placement of an introducer sheath that allows for the endosurgical treatment of a variety of conditions. Endourologic procedures include ureteral dilatation, ureteral stenting, calculus removal (percutaneous nephrolithotomy), and endopyelotomy (percutaneous pyelo-plasty). 

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