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.
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.
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.
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`In summary, this is an excellent resource for the clinician caring
for patients with urinary stones, irrespective of practice locale.
It provides clear and concise information regarding most clinical
issues relevant to this topic. More importantly, it fills a niche
by addressing the economic impact of the technological revolution
in managing urolithiasis in the developing world, where strategies
to confront and adapt to limited resources, including monetary, are
neccessary. These are important lessons that are becoming more
tangible to those of us practicing in the West.'
L.S. Palmer, Pedriatric Nephrology 12:527 (1998)
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