Contemporary "urologic" intervention in the pancreaticobiliary tree.
OBJECTIVE
To evaluate the role of minimally invasive "urologic" interventional techniques for the treatment of pancreaticobiliary calculi in contemporary practice.


METHODS
Fourteen patients with retained cystic duct (n = 2), hepatic duct (n = 5), common duct (n = 2), pancreatic duct (n = 4), or gallbladder (n = 1) calculi were treated with 19 procedures, including shock wave lithotripsy (n = 9) and percutaneous flexible endoscopy with electrohydraulic or holmium laser lithotripsy (n = 10). Previous attempts using standard gastroenterologic or radiologic interventions before the urologic referral had failed in all 14 patients.


RESULTS
A successful result, defined by the resolution of stones and symptoms, was achieved in 12 patients (86%); 2 patients (14%) had residual calculi that ultimately required an open operative procedure. The hospital stay for each intervention was 0 to 2 nights, and no patients had any significant complications.


CONCLUSIONS
Even in this age of advanced gastroenterologic technology, including laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatoscopy, and percutaneous transhepatic cholangiography, the urologist can play a significant role in the minimally invasive treatment of patients with complicated biliary disease such that the need for open operative "salvage" procedures will be further minimized.
Ponsky
L E
LE
Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Geisinger
M A
MA
Ponsky
J L
JL
Streem
S B
SB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002137:Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D002758:Cholangiography / Q000379:methods; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D020709:Ureteroscopes