James E Lingeman

PURPOSE: Options for treatment of large (greater than 100 gm.) prostatic adenomas have until now been limited to open surgery or transurethral resection by skilled resectionists. Considerable blood loss, morbidity, extended hospital stay and prolonged recovery occur with open surgery for large prostatic adenomas. Endoscopic surgery for benign prostatic hyperplasia has evolved during the last decade to offer the patient and surgeon significant advantages of transurethral removal of ...

OBJECTIVE: Helical CT has become the preferred methodology for identifying urinary calculi. However, the ability to predict stone composition, which influences patient treatment, depends on the accurate measurement of the radiographic attenuation of stones. We studied the effects of stone composition, stone size, and scan collimation width on the measurement of attenuation in vitro.

MATERIALS AND METHODS: One hundred twenty-seven human urinary calculi of known composition and size were ...

Two new therapies, percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy, are revolutionizing the treatment of upper urinary tract calculi. We report the success and morbidity rates in 110 patients undergoing percutaneous nephrostolithotomy and 982 patients treated with extracorporeal shock wave lithotripsy. Staghorn calculi were excluded from this series. The over-all success rate (free of stones plus small asymptomatic residual fragments) was comparable with both ...

PURPOSE: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial.

MATERIALS AND METHODS: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS. The primary outcome measure was stone-free rate on noncontrast computerized tomography at 3 months. Secondary outcome ...

PURPOSE: The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined.

MATERIALS AND METHODS: A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less.

RESULTS: Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone ...

Treatment recommendations and results reported for the management of staghorn calculi are highly variable. In an attempt to provide a more objective means to compare treatment results for staghorn renal calculi, stone burden as measured by stone surface area was used. Stone surface area was determined by computer analysis. A total of 380 cases of staghorn calculi treated at the same institution was evaluated. Treatment consisted of initial percutaneous nephrostolithotomy with or without ...

PURPOSE: The current trend toward ungated shock wave lithotripsy means that more patients are being treated with shock waves delivered at a rapid rate (120 shock waves per minute or greater). However, no benefit of an increased shock wave rate has been shown and in vitro studies indicate that slowing the shock wave rate actually improves stone fragmentation. We tested the effect of the shock wave rate on stone comminution in a new animal model.

MATERIALS AND METHODS: Gypsum model stones ...

OBJECTIVE: To determine the incidence of prostate cancer identified on holmium laser enucleation of the prostate (HoLEP) specimens and evaluate variables associated with prostate cancer identification.

PATIENTS AND METHODS: All patients undergoing HoLEP between 1998 and 2013 were identified. Patients with a known history of prostate cancer were excluded. Multivariable logistic regression assessed variables associated with identification of prostate cancer on HoLEP specimens and Gleason 7 ...

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for the surgical management of benign prostatic hyperplasia (BPH). A significant number of patients who require surgery for BPH are being treated with anticoagulation (AC) or antiplatelet (AP) therapy. We evaluated the efficacy and morbidity of HoLEP in this population.

MATERIALS AND METHODS: One hundred sixteen patients who required AC/AP therapy undergoing HoLEP from 1999 to 2014 were ...

PURPOSE: We determined what metabolic features of the 24-hour urine predict calcium oxalate dihydrate in kidney stones. Prior studies have suggested that low urine magnesium, high urine calcium, high calcium-to-oxalate ratio and high urine supersaturation with respect to calcium oxalate monohydrate predict calcium oxalate dihydrate.

MATERIALS AND METHODS: Stone analyses and results from 2, 24-hour pretreatment urine collections from 96 patients with nephrolithiasis were drawn from 3 ...

PURPOSE: Renal calculi are a significant source of morbidity for patients with neurogenic bladder. Calculi from patients with NB have traditionally been composed primarily of struvite and carbonate apatite secondary to chronic urea-splitting bacteriuria. In the current era there have been great improvements in the urological rehabilitation of patients with NB. We defined the composition of renal calculi in a contemporary cohort of patients with NB due to spinal cord injury or ...

PURPOSE: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial.

MATERIALS AND METHODS: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS. The primary outcome measure was stone-free rate on noncontrast computerized tomography at 3 months. Secondary outcome ...

PURPOSE: In studies to understand better the role of cavitation in kidney trauma associated with shock wave lithotripsy we assessed structural and functional markers of kidney injury when animals were exposed to modified shock waves (pressure release reflector shock pulses) that suppress cavitation. Experiments were also performed in isolated red blood cells, an in vitro test system that is a sensitive indicator of cavitation mediated shock wave damage.

MATERIALS AND METHODS: We treated ...

PURPOSE: Generally treatment decisions for benign prostatic hyperplasia are based on prostate size and surgeon experience. Prostates greater than 100 gm often require open surgery. However, less invasive options are available. Randomized, controlled trials have demonstrated that holmium laser enucleation of the prostate is a viable and effective treatment for benign prostatic hyperplasia. We examined the outcome of holmium laser enucleation of the prostate based on prostate ...

Percutaneous nephrostolithotomy with or without extracorporeal shock wave lithotripsy (ESWL) has been extensively used in the management of staghorn calculi, with stone-free rates varying from 23 to 86%. Explanations for the variability of such results include differences in stone burden, differences in percutaneous techniques and an overreliance on ESWL. The results and changing trends in the relative roles of percutaneous nephrostolithotomy and ESWL in the management of staghorn ...