Extracorporeal shock wave lithotripsy versus lasertripsy for the treatment of upper ureteric calculi

Objectives: To compare the efficacy, cost effectiveness and safety of both ESWL and Holmium:YAG laser lithotripsy for the management of upper ureteric stones.Patients and Methods: One hundred and eight patients of various age groups and of both sexes who had primary or recurrent unilateral or bilateral upper ureteric stones underwent 108 primary procedures and 19 ancillary procedures (total: 127) including in-situ ESWL (60 patients) using the Dornier MPL 9000 machine and ureteroscopy combined with Holmium:YAG laser lithotripsy (46 patients). Results: The overall stone-free rate was (93.75%) for cases subjected to uretero-scopy in combination with laser lithotripsy and (91.7%) for cases subjected to ESWL. For stones < 1 cm, the success rate was 100% in the laser and 95.65% in the ESWL group. For stones > 1 cm, the success rate was 90% in the laser and 78.6% in the ESWL group. For impacted stones, the success rate was 92.85% in the laser and 72.7% in the ESWL group. The EQ for the laser and ESWL groups was 0.86 and 0.73, respectively. The complication rate was 12.53% in the laser and 11.7% in the ESWL group. The average cost (in Egyptian pounds) was 1618.1 £E for Holmium: YAG laser treatment and 1069.1 £E for ESWL treatment. Conclusion: Apart from impacted stones and stones larger than 1 cm, ESWL is the first line of choice as a treatment modality for upper ureteric stones. However both ESWL and URS combined with holmium: YAG laser lithotripsy may be complementary to each other in treating upper ureteric stones

Changing the window of shock wave application : how it improves the results of ESWL for renal calculi

Objectives: The aim of this work is to study the impact of using multiple windows of shock wave application on the results of ESWL therapy for renal calculi. Patients and Methods: Between January 1996 and October 2002; 676 patients with single pelvic stones ? 2.5 cm and either no or mild back pressure changes were treated by lithotripsy using the Dornier MPL 9000 with ultrasonic localization. Our patients were divided into two groups according to the total stone burden (15 mm and 15 - 25 mm) Every group was divided into two subgroups: the first subgroup was treated by a single window of shock wave coupling and the second subgroup by changing the window of shock wave coupling every 500 SW from the posterior to the postero-lateral and to the lateral side of the patient. The results were recorded and statistically evaluated. Results: For stones 15 mm we found no difference between the two subgroups regarding the total SW energy; number of sessions; pattern of disintegration and the complication and clearance rate. But the need for additional doses of analgesia was significantly decreased for the patients who were treated by multiple windows. For stones sized 15 - 25 mm; we found a statistically significant decrease in the total SW number; in the number of sessions and the need for additional doses of analgesia when multiple windows of coupling were adopted. Changing the window of coupling also resulted in a statistically significant improvement in the pattern of disintegration of the stones. The rate of complication; clearance and auxiliary measures was comparable in all subgroups. Conclusion: Changing the window of SW application improves the pattern of disintegration; reduces the number of shock waves necessary for effective treatment; decreases the number of sessions and the need for additional doses of analgesia when ESWL is done for renal pelvic stones 15 mm

Distally folded onlay flap : a new technique for repair of hypospadias

Objective: This study was carried out to evaluate the cosmetic and functional results of this new technique for repair of hypospadias. Patients and technique: 28 patients (2-22 years) with distal penile hypospadias were included in the study. Eleven of them had had a failed previous repair. An unhealthy urethral plate and/or thin ventral penile skin were found in 17 patients. The technique follows the steps of the island onlay preputial flap or dorsal penile fasciocutanous flap except in that the length of the flap is; at least; 1 cm longer than the length of the urethral plate. The proximal part of the flap is used for urethral reconstruction. The distal free part of the flap is reflected back to be sutured to the edges of the glanular wings and the penile skin. The urethral stent is removed after 5 days. The patients were followed monthly up to 6 months. Results: In 26 patients an excellent cosmetic appearance of both the penile shaft and glans was achieved with a slit-like or elliptic neo-meatus resulting in a good urine stream satisfying both the patients and their parents. Partial disruption of one side of the suture line and urethrocutanous fistula was reported in one patient each. These two complications were corrected surgically with good results. Conclusion: We conclude that this new technique that we named distally folded onlay flap is easy and versatile with excellent cosmetic and functional results and a low rate of complications when used for the repair of distal and mid-shaft hypospadias in either virgin or redo cases. It should also be considered as a salvage procedure when other techniques are no feasible options

Assiut experience in the application of holmium laser in treatment of ureteral calculi in adults

Objective This study was carried out to evaluate the safety and efficacy of holmium:YAG laser in the treatment of ureteral calculi in adults. Patients and Methods Between April 1999 and November 2000; one hundred and seven patients presented to the urology department of Assiut university with symptomatic ureteral stone disease in different locations. The patients were divided into three groups according to the stone location which was determined radiologically. Group I included 38 patients with stones located in the upper third of the ureter; Group II included 19 patients with stones located in the middle third of the ureter and Group III included 50 patients with stones located in the lower third of the ureter. Lithotripsy was done in all patients using the Holmium:YAG laser machine. The stone-free status was checked three months after the procedure. Patients with residual stones were scheduled for another session. Results In Group I; 38 patients with 38 stones underwent 39 procedures for intracorporeal lithotripsy. Eight patients presented with obstructive anuria and elevated blood urea and serum creatinine. Complete stone fragmentation was achieved in 37 cases; while in one case the stone migrated to the kidney and was treated by ESWL. In Group II; 19 patients underwent 20 procedures. Re-treatment after three weeks was necessary in one case due to ureteral wall injury and minimal extravasation. Four patients presented with obstructive anuria; while in 6 patients the stones were impacted. Complete fragmentation could be achieved in all cases. In Group III; 50 patients underwent 51 procedures. A re-treatment session was required in one patient after three months due to a residual stone (5 mm) detected during follow up. In eleven cases the stones were impacted; and one patient had bilateral lower ureteral stones treated in the same session. Out of 50 patients with 55 stones; 54 stones (98.1) were completely fragmented and cleared in a single session. Conclusion Holmium:YAG laser lithotripsy is a safe and effective modality for the treatment of ureteral stones.Key Words Holmium:YAG laser; ureter; lithotripsy

Lead exposure and sociodemographic parameters affecting the cognitive function of a sample of children in Qalyoubia governorate

This cross-sectional, short term study is conducted in Benha city at randomly selected primary school. The target group is 100- randomly chosen- children of the 4th and 5th grades. They were subjected to a structured questionnaire for personal and familial data. IQ - is assessed using Stanford Beneit test. Blood samples were drawn to determine haemoglubin level as well as blood lead level. Scholastic achievement of the target group was measured using the mean of the last 3 months marks. Analysing data of the study reveals that 64% of children included in the study were urban residents while the remaining 36% were rural inhabitants. Urban inhabitants show statistically significant higher percentage for normal IQ. The present study reveals that Hb.%, blood lead level, mother's smoking as well as residence significantly affect the IQ. of children. Regarding scholastic achievement as an indicator for cognitive function it was found that Hb.%, blood lead level as well as I.Q. are the best predictors. Monitoring [Both environmental and Biological] is required to assess lead level in the environment as well as blood lead level. Environmental sources of lead and its hazards are required to be highlighted. Mass screening of school children for anaemia is required and subsequently proper treatment for anaemia and anaemia predisposing conditions. Finally hazards of smoking, especially by mothers, is required to be highlighted

epidemiological study of female circumcision in Benha city, Kalyoubia governorate

This cross-sectional study was conducted on 350 target females having at least one female child daughter between 5 and 15 years old, who attended MCH center in Benha city, Kalyobia Governorate during the period from July to September 2000. The study aimed at determining the magnitude of the female circumcision problem in Kalyoubia Governorate and to highlight some factors that influence the attitude of mothers towards its practice. Results revealed that the circumcised mothers were 84.6% and 73.4% of their daughters were circumcised, 63.4% were performed at age 5-9 years, 67.7% of them were carried-out by non medical personnel, 73.2% were performed without anesthesia and 30.7% of them had complications. Also, the study illustrated that significant associations exist between some sociodemographic characters of mothers and their attitude and practice of female circumcision. Mothers aged 30 years and above, rural mothers, those married at age less than 20 years, the illiterate and read and write, those with illiterate husband, housewives and mothers who belonged to low social class were more significantly agreed with performance of female circumcision. The study revealed the dire necessity to an integrated educational program to be delivered through primary health care services to change the attitude of population towards the practice of female circumcision

Geriatric health problems in rural area in Kalyobia governorate

Geriatric population have multiple health problems, through detection of these problems, it is possible to reduce their incidence. A cross-sectional study was conducted in El shukr village in Kalyobia Governorate for elderly people [>/= 60 years] during the period from June to August 1998. This study was carried out to determine the relation between some sociodemographic factors and health status of the elderly people. The study included 324-target population [>/= 60 years], males were constituted 38.9% and females were 61.1%. The mean ages of males and females were 61.3 +/- 9.2 and 64.3 +/- 3.9 respectively. A questionnaire including information about some sociodemographic characteristics, past and present history of common diseases was used. It was found that, the highly prevalent health problems among the studied population were sensory organs disorders [61.1%], neuromuscular impairment [37.7%], hypertension [36.7%] and gastrointestinal disorders [35.2%]. The lowest prevalent health problem was mental changes [7.1%]. It is recommended that. Geriatric health program for prevention and management of health problems that are prevalent among the elderly, should be fully integrated with the primary health care services

KAP study of family planning among married rural females in kalyobia Governorate

This work was conducted on attendants of a rural health unit in El-Shokre Village, Kalyobia governorate. Three hundreds and twenty married women in the child bearing period were the target sample. The aim of this study was to assess the knowledge, attitude and practice [KAP] of married rural women towards family planning in kalyobia governorate. This research showed that 92.1% of contraceptive users aged 25 years or more compared to 75.0% of the non-users. Illiteracy was significantly prevalent among non-users who were mainly not working and bearing more number of children than contraceptive users. The most popular and practiced contraceptive methods were intrauterine device and contraceptive pills. A significant gap was also found between users and non-users regarding their opinion about the ideal number of children and the ideal interconceptional period where non-users preferred more number of children as well as shorter period [P < 0.05]. Mass media was found to be an effective source of knowledge among users than nonusers [72.6% and 39.3% respectively] while neighbours and relatives had a significant effect on the group of non-users than contraceptive users [P < 0.05]. The findings pointed to the minimal effect of rural health unit as a source of knowledge to the studied women. The study showed that interpregnancy spacing and having enough number of children were the main causes of acceptance of contraception among users. The results also, revealed satisfaction of contraceptive users where the discontinuation rate was 18.5%. The prominent reason for discontinuation was the desire to get more children while the main cause of rejection, given by non-users, was related to health factors and fear of side effects [57.2%]. The researchers stress on the importance of health education program, integrated with the other activities of primary health care units, to provide illiterate rural inhabitants with the correct knowledge about family planning as well as the effectiveness and safety of the contraceptive methods in order to creat a favourable attitude and practice