ABSTRACT
The aim of this study is to assess the accuracy of radiologic findings of renal masses by comparing them with the histopathologic diagnoses from our personal experience in partial nephrectomy specimens. We reviewed the histopathological reports of 49 patients who underwent partial nephrectomy in a 10 year duration at Prince Hussein bin Abdullah urology and organ transplant centre. Only 32 patients of 49 harbored renal cell carcinoma in their specimens with a percentage of 65.4%. The remaining 15 patients had benign renal conditions in a percentage of 30.6%. Partial nephrectomy is gold standard for small renal masses, which lead to preserve renal tissue and decrease morbidity and mortality from chronic kidney disease knowing that not all masses proved to be renal cell carcinoma. Despite the fact that renal CT-Scan with IV contrast is considered as the modality of choice for the diagnosis of renal tumors still there is a false positive rate although low but exist
ABSTRACT
To evaluate the management of forgotten ureteral JJ stent with sever encrustation and stone formation. This is a retrospective study which was conducted at King Hussein Medical Center during the period January 2005- April 2009, fifteen patients [10 male and 5 female] aged between 25- 60 years, with severe JJ stent encrustations were incorporated in this study. Three with severe encrustation of the whole stent, 5 with severe encrustation of both ends, 5 with ureteric part and bladder end encrustation, and 2 with bladder end encrustation only. The duration of forgotten JJ range from 6 months -12 years. Multimodal therapies were used for the management. All patients were stents and stone free after 1-4 approach [ureteroscopy, percutaneous nephrolithotomy, cystoliholapaxy and open surgery] in multisessions. All patients were treated by minimally invasive endourological procedure in all sessions except one which required open ureterolithotomy. One major complication was encountered, small bowel injury which was managed without events. Severe encrustation of the JJ stents requires multimodal therapy for managing this complex problem; each patient may need multiple approaches in one or multiple sessions. Open surgery may be indicated when minimally invasive procedures fail
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Stents/adverse effects , Disease Management , Treatment Outcome , Ureteroscopy , Retrospective StudiesABSTRACT
To describe our experience in the management of primary and secondary urinary bladder stone, we use different options of surgical intervention for clearance of the stones. Between January 2005 and May 2009, we treated 242 patients with urinary bladder stones in our center, 208 males and 34 females. Transurethral cystolitholapaxy was the first option for single stone less than 4cm and multiple stones each less than 2cm. Open cystolithotomy was performed in presence of hard stone more than 4cm and in presence of concomitant huge obstructing prostate > 100gm or bladder surgery. Percutaneous suprapubic cystolithotripsy was performed among pediatric age group and patients with permenant cystostomy. Extracorporeal shockwave lithotripsy was a reserved for high risk patients. Out of 242 patients, 190 patients underwent transurethral cystolitholapaxy; Transurethral Resection of Prostate and optical urethrotomy were performed among 105 patients [55.3%]. Presence of foreign bodies as in retained ureteral stents, eroded tension free vaginal tape mesh, suture materials were main causes of the rest of the patients. The duration of urethral catheterization was 24-48 hours, complete clearance was achieved in 185 patients [97.4%], complications were detected in 24 patients [12.6%], hematurea and transient pyrexia were the main complications. Cystolithotomy was performed in 35 patients, concomitant open prostatectomy in 15 cases, bladder diverticulectomy in two cases and 18 cases excluded from cystolitholapaxy criteria. The mean duration of urethral catheterization was 9 days [average 5-14 days] and wound infection was the commonest complication. Percutaneous suprapubic cystolithotripsy was done in 11 cases, failure occurred in one patient [9%], the average duration of catheterization was 3 days and transient pyrexia was detected in two [18%]. Extracorporeal shockwave lithotripsy was a first option in 6 high risk patients with stone clearance rate 83% and significant hematurea occurred in one patient. Transurethral cystolitholapaxy offers the first choice of management for single urinary bladder stones less than 4cm, and multiple small bladder stones. Percutaneous suprapubic cystolithotripsy is a safe procedure and it is an option of management in pediatric age group and in patients with permenant cystostomy. Extracorporeal shockwave lithotripsy can be used in high risk patients. In concomitant prostate or bladder surgery and in hard stones or stones that are more than 4cm, Open surgery is the first treatment of choice
ABSTRACT
The aim of this study was to evaluate and to review our experience with percutaneous nephrolithotomy [PCNL] in management of large renal stones. Between January 2005 and December 2009, 786 patients underwent PCNL for treatment of renal stones at our center, 108 renal units were with big stone burden. All procedures were performed in prone position after retrograde insertion of ureteral catheter under fluoroscopic guidance for creating the PCNL tract. 27F rigid nephroscope was used to identify the stones, fragmentation was done using electrohydrulic or pneumatic lithoclast. Stones fragments were removed by forceps and suction. 20F foley catheter inserted in all cases as nephrostomy, and postoperative stone clearance was documented by plain abdominal X-ray KUB. 108 renal units of 92 patients were treated [67 men and 25 women] with mean age of 41 years [range 17- 74 years]; the average stone size was 4.9cm [range 3.0-6.8cm]. 83 renal units were treated with PCNL monotherapy [76.9%], with mean operative time of 75 minutes [range 55-100 minutes]. 18 renal units required a second look for significant residual stones through the same tract after 72 hours [16.7%], 7 renal units required a second look through a different calyx [6.5%]. Complete stone removal achieved by PCNL alone in 89 renal units [82.4%], with ESWL for the residual small stones we achieved 91.7% stone clearance rate. The mean hospital stay was 3.7 days [mean 3-8 days]. No Serious complications were encountered, 9 patients required blood transfusion [8.3%], 18 patients developed transient post operative pyrexia [16.7%] and three patient had persistent urine leak [2.8%]. PCNL is the first line treatment option for management of large renal stones. Selection of the patient, establishing percutaneous renal access, a well standardized technique and post-operative follow up are mandatory for early detection of complication and achieving a high stone free clearance rate. With significant residual stones in PCNL procedure, a second look at 48-72 hours interval is preferable in centers where flexible instruments and laser therapy are not available
Subject(s)
Humans , Male , Female , Aged , Adolescent , Adult , Middle Aged , Kidney Calculi/surgery , Treatment Outcome , Postoperative ComplicationsABSTRACT
The aim of this retrospective study is to evaluate if the early repair of varicocele in children and adolescents can prevent testicular growth arrest and male infertility later on. During a three year period [2004- 2006], 70 children and adolescents with varicocele who were operated on at Prince Rashid Hospital were reviewed [mean age 15 years, 9-19 years]. All patients had been evaluated by a urologist or a pediatric surgeon. High ligation of the internal spermatic vein was carried out either by open retroperitoneal approach or transperitoneal laparoscopic approach. Of the 70 patients 39 had grade II varicocele and 31 had grade III varicocele. In 33 patients [49%], the disease was associated with ipsilateral testicular growth arrest. In seven patients [10%], the disease was associated with impaired seminal fluid analysis parameters, four patients had recurrence of varicocele, and three patients developed hydrocele. Of 33 patients with testicular growth arrest, 32 [97%] regained normal testicular volume post operatively, while six of the seven patients with impaired seminal fluid analysis achieved normal parameters after surgery. Varicocele can affect ipsilateral testicular growth and seminal fluid analysis parameters, which may adversely affect fertility. We recommend early recognition and treatment
ABSTRACT
This retrospective study was designed to evaluate the success rate of urethrocutaneous fistula repair using the simple technique and support with vascularized dartos flap. During the period 1999-2005, 62 patients underwent urethrocutaneous fistula repair following hypospadias surgery. Forty patients had distal urethrocutaneous fistula, seven had mid shaft and 15 had proximal urethrocutaneous fistula. All procedures were done by the same surgical team. The repair was performed primarily after six months of the last intervention. Most cases performed over urethral stent and in few complicated cases sialastic foley catheter and suprapubic cystocath for urinary diversion were used. Through the follow-up period of 3.5 years, the results were successful .The success rate at the first attempt was about 84% and 100% after the second attempt. Simple urethrocutaneous fistula repair with applying the basic principles and covering with well-vascularized dartos flap can provide a high success rate. It decreases urethrocutaneous fistula formation especially if the careful harvesting technique is utilized