Surgical overview of urolithiasis.
Urinary stones usually require surgical therapy because of impaction, associated infection, unremitting pain or economic hardship created by the presence of the stone. During the last 100 years stones of the kidneys and ureters have overtaken bladder calculi in incidence and importance. In a pattern that parallels development of therapy of bladder stones, surgical treatment of upper urinary tract stones has progressed rapidly through development of safer open operations to percutaneous manipulative procedures to minimally invasive extracorporeal shock wave lithotripsy. Each of these progressions contributed to a significant decrease in immediate morbidity, although therapeutic results remained similar. However, some deficiencies in our data about long-term problems with extracorporeal shock wave lithotripsy exist, including effects on renal function, effects on surrounding organs and development of new hypertension. A most important question that still must be answered is whether the apparent low morbidity associated with extracorporeal shock wave lithotripsy obviates the necessity for medical prophylaxis of urinary stone disease.
Drach
G W
GW
Department of Surgery/Urology, University of Arizona, Tucson.
D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008722:Methods; D011183:Postoperative Complications; D014545:Urinary Calculi / Q000601:surgery* / Q000628:therapy