The Management of Lithiasis

The last twenty years has seen the biggest revolution in the treatment of renal tract stone that has ever been experienced in the history of urolithiasis. The treatment of upper tract renal stone has progressed from the days of a very traumatic and morbid procedure to the relatively innocuous, walk in/walk out therapy of extracorporeal lithotripsy. This progression of events has resulted in a complete reappraisal of management of all types of urinary calculi. From an initial reluctance to treat many stones because of the trauma involved, we have now passed to a situation where smaller and asympto matic stones may be pre-emptively treated before the treatment of serious clinical problems. It is true to say that in Westemized societies the problem of urolithiasis has almost completely been solved by the advent of advanced technology. In this volume, attention is drawn to the fact that there are still persistent difficulties in treating urolithiasis in the less developed and less affluent societies. The differences in epidemiology of urolithiasis in various areas of the world are highlighted, noting a rapid decrease in the incidence of bladder calculi in impover ished areas where affluence increases. Coupled with this progression of affluence however is the well documented increase in the incidence of upper tract renal stones of oxalate nature. This scenario has been almost universal across all coun tries in the last few decades.

Klappentext

The Management of Lithiasis: The Rational Deployment of Technology addresses the latest developments in the treatment of urolithiasis and biliary stones. The emphasis of the book is on the selection of the cheapest and most effective treatment and is based upon the experience of editors and authors from both the Western countries as well as developing countries in Asia. With health care budgets becoming increasingly restricted, there is a growing interest in cost-controlled and effective treatment methods. This volume covers urinary tract calculi as well as biliary tract calculi, including epidemiology, etiology, choices in the management of calculi, efficacy and safety of treatment and the prevention of urolithiasis.

Inhalt
Section I: Epidemiology and Aetiology of Urinary Tract Calculi.- 1 Urolithiasis: Composition, symptomatology and pathology.- 2 Radiology in urolithiasis.- 3 Epidemiology of urolithiasis in Pakistan.- 4 Urolithiasis in the Middle East: Epidemiology and pathogenesis.- 5 Epidemiology of urolithiasis in the Western world.- 6 Metabolic and dietary risk factors for urolithiasis.- 7 Oxalate and urolithiasis.- 8 Familial clustering and sex incidence of urolithiasis.- Section II: Choices in the Management Of Urinary Tract Calculi.- 9 Decisions! Decisions.- 10 Advantages and hazards of open surgery.- 11 Choices, limitations, hazards and value of technology in the treatment of lithiasis.- 12 Bioeffects of shock waves: An overview.- 13 Laser fragmentation of urinary calculi.- 14 ESWL today: Spectrum of stone disease treated on the extracorporeal lithotriptor.- 15 Manageent of renal stones by operation.- 16 ESWL for kidney stones and options for calyceal calculi.- 17 Percutaneous nephrolithotomy for renal stones.- 18 Management of staghorn calculi.- 19 Management of ureteric stones.- 20 Clinical results of laser fragmentation of ureteric stones.- 21 Management of vesical and urethral stones.- Section III: Enhancement of Efficacy and Safety of Treatment.- 22 Patients at risk for excessive post-ESWL bleeding.- 23 Patients with pacemakers.- 24 Safeguarding foetus and gonads.- 25 Other high-risk patients.- 26 The role of ESWL in patients with leprosy and stone disease.- 27 Factors determining need for multiple treatments on the Dornier HM.- 28 Factors determining need for multiple treatments: Decisions based on stone bulk, composition and acoustic efficiency.- 29 Prevention of steinstrasse.- 30 Urinary tract infection, stones and ESWL.- 31 The judicious use of stents.- 32 Protection ofhospital personnel.- Section IV: High Technology at Affordable Cost.- 33 Introduction: High technology at affordable cost.- 34 The economics of stone disease therapy: An economist's views.- 35 Selecting a lithotriptor: Hospital perspectives.- 36 Lithotriptor sharing.- 37 Cost factors in equitable care.- 38 Commencing and expanding lithotripsy services.- 39 Financing the lithotriptor.- Section V: Prevention of Urinary Tract Calculi.- 40 Introduction: Prevention of urinary tract calculi.- 41 The residual calcular fragment: A risk factor for recurrent stone disease.- 42 Primary hyperparathyroidism in urinary tract stone disease in Pakistan and the West.- 43 The role of diet in the prevention of urolithiasis.- 44 Systematic follow-up of patients with recurrent nephrolithiasis: A guide for the practising urologist.- 45 Follow-up of urolithiasis patients: A guide for urologists in developing countries.- Section VI: Paediatric Urolithiasis.- 46 Urolithiasis in children.- Section VII: Biliary Tract Stones.- 47 ESWL in gallstone therapy: History, current status and expectations.- 48 Current management of gallstone disease: Perspective from a developing country.- Epilogue.- Appendix: Non-visual laser Lithotripsy T. K. Shah, Z. X. Jiang, G. W. Watson.