Comparison of the modified lateral position and prone position techniques in percutaneous nephrolithotomy

Objectives: To evaluate the feasibility, operative time, efficacy and safety of the modified lateral position in percutaneous nephrolithotomy [PCNL] for renal calculi, comparing it with the standard prone position PCNL

Material and Method: The patient is placed with the thorax in the lateral position and the pelvis in an oblique position. Then the lower limbs are split and bent in the lowest position. Initial placement of a retrograde ureteral catheter, tract formation, stone fragmentation and retrieval, and optional extra procedures were accomplished with the patient in the same position

Results: The study comprised 82 patients; 29 in split-leg modified lateral position [SL-MLP] group and 53in conventional prone position [PP] group. Three patients [all in PP group] underwent sequential bilateral percutaneous nephrolithotomy [PNL] during the study period and each procedure was considered as an independent case. So, the studied cases, according to the number of PNL procedures, were 85; 29 in SL-MLP group and 56 in PP group

Conclusions: split-leg modified lateral position in percutaneous nephrolithotomy [SL-MLP PNL] has significantly lower operative time compared with conventional PP PNL. The stone free rate, need for ancillary procedures and complication rate were equal in both groups

Efficacy of an Enuresis Alarm, Desmopressin, and Combination Therapy in the Treatment of Saudi Children With Primary Monosymptomatic Nocturnal Enuresis

PURPOSE: We evaluated and compared the effectiveness of an enuresis alarm, desmopressin medication, and their combination in the treatment of Saudi children with primary monosymptomatic nocturnal enuresis (PMNE). MATERIALS AND METHODS: A total of 136 children with PMNE were randomly assigned to receive an enuresis alarm alone (EA group, n=45), desmopressin alone (D group, n=46), or a combination of both (EA/D group, n=45). Patients were followed weekly during treatment and for 12 weeks after treatment withdrawal. RESULTS: During treatment, wetting frequencies were significantly reduced in all groups and remained significantly lower than pretreatment values until the end of follow-up. In the D and EA/D groups, an immediate reduction in wetting frequencies was observed, whereas a longer time was required to reach a significant reduction in the EA group. The full and partial response rates were 13.3% and 37.8% in the EA group, 26.1% and 43.5% in the D group, and 40.0% and 33.3% in the EA/D group. A significant difference was observed only between the EA and EA/D groups (p=0.025). Relapse rates were higher in the D group (66.6%) than in the EA (16.6%) and EA/D (33.3%) groups. A significant difference was observed between the D and EA groups only (p=0.019). CONCLUSIONS: Desmopressin, an enuresis alarm, and combined therapy are effective in the treatment of Saudi children with PMNE. Desmopressin produced an immediate effect but relapses were common. The enuresis alarm provided gradual effects that persisted posttreatment. The combined therapy was superior to the alarm in achieving an immediate response; however, its effect was not better than that of the alarm long term.

Tamsulosin versus Alfuzosin in the Treatment of Patients with Distal Ureteral Stones: Prospective, Randomized, Comparative Study

PURPOSE: We evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones. MATERIALS AND METHODS: A total of 87 patients with distal ureteral stones of < or =10 mm were randomly divided into 3 groups. Group I patients (n=29) received 0.4 mg tamsulosin daily, group II patients (n=30) received 10 mg alfuzosin daily, and group III patients (n=28) were not given tamsulosin or alfuzosin. Patients in all groups received Diclofenac sodium regularly for 1 week and then on demand. Follow-up was done on a weekly basis for 30 days. RESULTS: The mean stone size was comparable in the 3 groups (4.97+/-2.24, 5.47+/-2.13, and 5.39+/-1.81 mm, respectively). The stone expulsion rate was 86.2%, 76.6%, and 50% in groups I, II, and III, respectively. The difference in groups I and II with respect to group III was significant (p=0.0028 and 0.035). The mean expulsion time for groups I to III was 7.52+/-7.06, 8.26+/-7.34, and 13.90+/-6.99 days, respectively. The expulsion time was significantly shorter in groups I and II than in group III (p=0.0097 and 0.026). Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (1.24+/-0.57 vs. 1.43+/-0.67 vs. 1.75+/-1.17). Only 3 cases of drug side effects, 2 in group I and 1 in group II, were recorded. CONCLUSIONS: The use of tamsulosin or alfuzosin for the medical treatment of lower ureteric stones proved to be safe and effective. Moreover, tamsulosin did not have any significant benefits over alfuzosin.

Combined transurethral prostatectomy and inguinal hernioplasty

The purpose of the present study was to evaluate the combination of TURP and inguinal hernia repair with VyproII mesh in order to assess its safety, reliability and effectiveness in comparison with the patients undergoing TURP and hernioplasty sequentially. Thirty patients were randomly categorized into 2 groups through computer randomization program. Group I included 15 patients operated by TURP and inguinal hernioplasty in same session. Group II included 15 patients operated by TURP followed by inguinal hernioplasty in separate sessions. Mean operative time was 84.6 +/- 23.4 minutes in group I versus 95.5 +/- 15.3 minutes in group II. Mean hospitalization time was 3.07 +/- 0.46 days in group I and 4.07 +/- 0.59 days in group II. No significant increase in the complication rates was seen when the TURP and inguinal hernioplasty operations performed together. Hernia recurrence did not occur in either group. Hospitalization cost reduced by 26% on doing the two operations on the same session. Numerical patient satisfaction score 3 months after surgery was 8.87 +/- 0.99 for Group I patients versus 7.80 +/- 0.94 for Group II patients. We concluded that, Combined TURP and inguinal hernioplasty is a practical, safe and effective operative procedure that can reduce hospitalization cost. It allows patients to undergo only one anesthetic procedure, hospital admission and convalescence

Safety and efficacy of supracosatal access for percutaneous nephrolithotomy: a 3-year experience

Successful removal of stones in percutaneous nephrolithotomy requires the accurate placement of a percutaneous track that provides direct access for stone manipulation. Supracostal approach is usually avoided be-cause of concerns about potential chest complications. We evaluated the hazard, safety and efficacy of supracostal approach for percutaneous nephrolithotomy. During the years 2003-2005 a total of 24 patients underwent PCNL through a supracostal track at Al-Hussain University Hospital. The indications for a supracostal approach were upper caliceal stone resistant to ESWL, upper caliceal stone with narrow neck, upper ureteric stone, Staghorn stone and sizable pelvic stone in a highly situated kidney. In 22 patients the punctures were performed just above the 12th rib; while in 2 cases the punctures were performed above the 11th rib. The data were analyzed for stone clearance, intra-operative and post-operative complications. Twenty one patients [87.5%] were rendered stone-free or had clinically insignificant residuals by PCNL alone. Overall complication was [20.8%]. Chest complications developed in only 2 patients [8.3%] in the form of hydro-pneumothorax and were managed successfully by intercostal chest tube drainage with an under water-seal connection. The study concluded that with proper choice of candidates, supracostal access for PCNL is safe and effective. The possible inadvertent pleural injury is rare and is easily manageable