Miki M
Dept. of Urology, Tokyo Medical College.
Gan To Kagaku Ryoho. 1989 Aug;16(8 Pt 1):2671-8.
Several kinds of nonvascular interventional radiology of the urinary tract are reviewed. Transurethral balloon dilation of the prostate (TU-DP) is a newly developed nonsurgical treatment for benign prostate hyperplasia, which is performed under local anesthesia with minimal morbidity and requires no hospitalization. The TUDP technique involves dilating the prostatic urethra and bladder neck to 75 F for 10 minutes under fluoroscopic control using a high-pressure dilating balloon. Long-term follow-up studies are required. Percutaneous nephrolithotomy (PNL) and transurethral ureterolithotomy (TUL) have signified a revolution in stone surgery of upper urinary tract. Indications for these treatments, endoscopic manipulation, complications and their clinical features are presented. The procedure of PNL consists of 3 steps, puncture for nephrostomy tract, tract dilation and stone removal. Among these steps the most important is the puncture and it should be effected through the calyx. During the operation, if there is too much bleeding, it can be discontinued at any time while keeping the track open. It is no longer necessary for the kidney to be free of stones at the end of the operation. TUL is performed with a rigid or flexible ureterorenoscope. Dilation of the ureteral orifice and the intramural ureter is necessary for passing the scopes. When they have been sufficiently dilated, the ureterorenoscope can be passed to the level of the renal pelvis through the urethra. Calculi have been removed successfully at a higher rate in lower ureter. Endopyelotomy may be performed safely as an initial procedure to correct congenital obstruction of the ureteropelvic junction. Recent advancements have permitted an approach to percutaneous resection for renal pelvic tumor in a solitary kidney or bilateral synchronous disease. There are great expectations for continuing important innovations in the field of interventional radiology.
本文综述了几种泌尿系统非血管介入放射学技术。经尿道前列腺球囊扩张术(TU-DP)是一种新开发的治疗良性前列腺增生的非手术方法,该操作在局部麻醉下进行,发病率极低,无需住院。TUDP技术是在荧光透视控制下,使用高压扩张球囊将前列腺尿道和膀胱颈扩张至75F并维持10分钟。该技术需要长期随访研究。经皮肾镜取石术(PNL)和经尿道输尿管取石术(TUL)标志着上尿路结石手术的一场革命。文中介绍了这些治疗方法的适应症、内镜操作、并发症及其临床特征。PNL手术包括三个步骤:穿刺建立肾造瘘通道、通道扩张和结石取出。其中,穿刺步骤最为重要,应通过肾盏进行。手术过程中,若出血过多,可随时停止手术,同时保持通道开放。手术结束时,肾脏不必完全无结石。TUL使用硬性或软性输尿管肾镜进行。为使输尿管肾镜通过,需扩张输尿管口和壁内段输尿管。当输尿管充分扩张后,输尿管肾镜可经尿道进入肾盂水平。输尿管下段结石的成功取出率较高。肾盂内切开术可作为纠正肾盂输尿管连接处先天性梗阻的初始安全手术。最近的进展使得可以采用经皮切除的方法治疗孤立肾或双侧同步性肾盂肿瘤。人们对介入放射学领域持续的重要创新寄予厚望。