title: Transurethral ureterolithotripsy and extracorporeal shock wave lithotripsy in patients with idiopathic thrombocytopenic purpura.
abstract: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease defined by a low platelet count secondary to accelerated platelet destruction by anti-platelet antibodies. The resulting bleeding diathesis can present a therapeutic dilemma. We have treated two cases of ITP in which ureteral stones were successfully extracted by transurethral ureterolithotripsy (TUL) and extracorporeal shock wave lithotripsy (ESWL) after high-dose gamma-globulin therapy. The first case was in a 52-year-old woman and the second case was in a 65-year-old woman. Intravenous pyelography revealed a left ureteral stone in the first case and bilateral ureteral stones in the second case. High-dose gamma-globulin therapy and platelet transfusion elevated their platelet counts to safe levels; TUL and ESWL were then performed successfully with no bleeding complications. This is the first case report of ITP being treated by ESWL after high-dose gamma-globulin therapy. High-dose gamma-globulin therapy effectively provides adequate platelet counts for surgical treatment in patients with ITP.
authors.affiliation: Department of Urology, Kitasato University School of Medicine.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tsuboi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Fujita
authors.forename: Norio
authors.initials: N
authors.lastname: Maru
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
mesh_terms: D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy; D014514:Ureteral Calculi / Q000628:therapy*; D005719:gamma-Globulins / Q000008:administration & dosage
chemical_list: D005719:gamma-Globulins