Mini-Flank incision assisted laparoscopy versus transperitoneal laparoscopy for dismembered pyeloplasty

To define the impact of the combined approach on the minimally invasive style of laparoscopic approach. From July 2005 to September 2007, 21 patients with unilateral primary pelvi-ureteric junction [PUJ] obstruction underwent Anderson Hynes pyeloplasty. Patients were divided into two groups. Group 1: consisted of 11 patients who had combined transperitoneal laparoscopic approach and then mini-open approach. The surgical procedure was divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter and then accomplishing the pyeloplasty through mini-flank [5 cm], muscle splitting incision which was planned under laparoscopic guidance to be accurately overlaying the PUJ. Group 2: consisted of 10 patients who underwent the whole procedure through laparoscopic approach. Perioperative records and postoperative assessment were compared between the two groups. The mean operating time [135 versus 189 min] and Analgesic requirement [90 versus 36 mg, morphine equivalent] were significantly different between group 1 and 2, respectively. There was no intraoperative complication in both groups and the postoperative complications were minor and similar in both groups [10%]. Postoperatively, time to resume the full activity was significantly different between the groups 1 and 2, at 2 weeks [54.0 versus 80%, respectively] however, it was similar [100%] at 4 weeks. Postoperative, assessment of the all patients, based on IVU and diuretic renogram at 3 and 6 months, were similar in both groups. Dismembered pyeloplasty through a combined approach save time and ensures high quality of anastomosis while maintaining the minimally invasive fashion of laparoscopic approach

Outcome of post-TUR-BT combined chemo and immuno intravesical therapy in the management of papillary transitional cell carcinoma of the urinary bladder

To evaluate the outcome of post-TUR-BT combined chemo-and immune-intravesical therapy in papillary transitional cell carcinoma of the urinary bladder. From Sept 2001 to August 2007 in Alnoor specialist'hospital, Holly Makkah K.S,A and Urology Department, Benha Faculty of Medicine 158 patients of papillary transitional cell carcinoma Ta,T1,T2 were treated by TUR-BT plus combined intravesical chemotherapy and immunotherapy. TUR-BT was repeated and intravesical combined therapy if recurrence occurred on 3, 6 months cystoscopic follow up, percentage of the disease-free patient, recurrence, progression and survival with intact bladder were compared and analyzed. Follow up of the patients up to 5 years was done. At median follow up of about 24 months; 82 patients [53.6%] were disease free and recurrence was detected in 31 patients [20%] and progression was in 4 patients [2.6%]. The results of the follow up at the end of the 5 years revealed that the disease-free percentage was 64 patients [41.5%], recurrence was detected in 41 patients [26.8%] and progression was [14.4%] in 22 patients were shifted to cystectomy. Overall 5 year survival with intact bladder was 85.6% [131 patients], we did not follow cystectomy patients. Post TUR-BT combined intravesical chemo and immuno-therapy is an appropriate option for the management of papillary transitional cell carcinoma of the urinary bladder and could preserve the intact bladder for a long period and should be applied even in muscle invasive T2 tumor before shifting to cystectomy

Ureteroscopic lithotripsy of ureteric stones; holmium: Yag laser versus pneumatic lithoclast

To compare efficacy and safety of pneumatic lithoclast [PL] and Holmium: YAG laser lithotripsy [LL]. From May 2004 to October 2006, ninety patients with single ureteric stones of 10 - 20 mm size underwent a single session of ureteroscopic lithotripsy with either pneumatic lithoclast [40 patients] or holmium: YAG laser [50 patients]. A 9/ 9.8 Fr semi rigid ureteroscope was used in all patients. Holmium: YAG laser with 365m probe was employed in LL group and pulse frequency was set between 5-10 HZ at a power of 10 - 12W. Pneumatic lithoclast with single or continuous pulse mode was used accordingly in PL group. Success is defined by fragmentation of the stone into fragment not bigger than 3 mm with stone free status achieved 6 weeks postoperatively by single session lithotripsy without retrograde stone migration to pelvicalyceal system. Patients were followed by plain KUB X ray or plain helical CT all stone free status. Then underwent TVP evaluation 3 months postoperatively. Both groups were demographically homogenous. Fragmentation into small that can be removed easily with stone basket or forceps or pass eventually was higher in LL than PL group [96% versus 80%] and the stone free status was achieved in 94% in LL and 75% in PL group. Partial ureteral perforation was detected in 7.5% versus 2% in PL and LL group. Hospital stay was 2.9 versus 1.7 days in PL and LL group, respectively. Time to achieve stone free status was shorter in LL than PL group [22 versus 37 days]. Holmium YAG lasertripsy is superior to pneumatic lithotripsy since it effectively fragments all stone types and sizes into smaller fragments even if impacted and if used with care, operative and postoperative complications is negligible

Is varicocelectomy in non-obstructive azoospermic patients has an effective role?

Objective: Evaluation of the role of varicocelectomy in azoospermic patients

Patients and Methods: From Oct. 1998 to April 2007 188 nonobstructive azoospermic patients have undergone varicocelectomy; all patients were examined clinically and generally especially for the presence of varicocele, clinical or subclinical and classified in grades, testicular volume was estimated and routine investigations, including complete hormonal assay were done semen analysis for at least 3 times and U/S scrotum with Doppler for all cases. All patients were with history of primary infertility except 6 cases of secondary infertility, prevaricocelectomy and 3 to 6ms post-varicocelectomy semen parameters were compared and analyzed

Results: Postoperative semen analysis revealed overall sperm detection in 36 patients 18.8% of cases and 19 patients 10.6% of cases have shown spermatid and many spermatogenic cells in subsequent semen analysis. It was shown that 14, 8 patients [40%, 31%] respectively of huge or large preoperative varicocele were improved in detection of sperms in the ejaculate,9 patients 13% of grade II or moderate varicocele have been improved but grade I and subclinical varicocele showed little improvement. Regarding the relation with testicular volume there was significant improvement in 8,10 patients [49%, 45.6%], in cases presented with accepted or within normal testicular volume

Conclusions: Our study revealed that varicocelectomy in azoospermic patient can play an effective role in the management of male infertility and can result in pregnancy in some patients with accepted testicular volume or in the presence of preoperative large or evident varicocele, also there was considerable improvements in spermatogenesis in the other patients which could improve the assisted reproductive techniques results

Complications and functional results of standard orthotopic diversion: studer`s pouch

Objective: The purpose of this study was to evaluate early and late complications, reservoir functional outcome, continence status and upper tract functional throughout the follow up after Studer ileal neobladder

Patients and methods: Thirty two patients were included in this study and followed at a regular interval of three months for one year postoperatively. Early and late complications, urinary continence and upper tract configuration and function were evaluated. Patients were assessed by interviews and history taking, voiding diary, continence questionnaire, abdominopelvic ultrasound, IVU and urodynamic study

Results: No postoperative mortality. Early and late postoperative complications rates were 28.1% and 12.5% respectively. Out of 32 patients, febrile urinary tract infection occurred in 4 patients, prolonged urinary leakeage in 2 patients, unilateral hydronephrosis in 3 patients, urethroileal stricture in 3 patients, and metabolic acidosis in one patient. The mean functional pouch capacity increased over time from 298 +/- 65ml at 3month postoperatively to 423 +/- 93 at 9 month of follow up and became fixed thereafter. The mean post voiding residual urine estimated by ultrasound was 46 +/- 18 at 6 month of follow up. All patients underwent urodynamic evaluation at 6 and 12 month postoperative. The maximal pouch capacity was 395 +/- 75 ml with the pouch pressure at maximal capacity was 30 +/- 6 cm water at 6 month postoperative with similar value at 12 month and thereafter. Continence status improved over time, meanwhile the night time continence rate was lower than daytime, unsatisfactory night continence who need more than one pad per night was recorded in 12.5% then reduced to 3.1% at 6 month and 12 month postoperative respectively .IVU at 6 month show no upper tract ectasia or dilatation in all patients through out next follow up period

Conclusion: Studer ileal neobladder is easy and satisfactory surgical technique of orthotropic urinary diversion. It provides an acceptable rate of postoperative complications with good functional reservoir outcome and continence status while preserving upper tract function

W-neobladder and modified T-pouch: preferable forms of orthotopic diversion with 117 patients

Objective: the purpose of this study is to asses the W-neobladder and T-pouch in the surgical technique, functional results and complications as the preferable orthotopic diversion in our department

Patients and Methods: the study was conducted in our department with 117 patients with invasive bladder cancer after performing radical cystectomy. ninety five patients performed W-neobladder and 22 patients performed modified T-pouch in cases of hugely dilated or short ureters. Patients were followed up at regular intervals of 3 months for the first post operative year and every 6 months thereafter. Early and late complications, urinary continence and upper tract function were evaluated

Results: ninety five patients [81.2%] performed W-neobladder, 86 males and 9 females and 22 patients [18.8%] performed T-pouch,19 males and 3 females, due to hugely dilated and short ureters, age ranged from 42-73yswith median 59ys. no intraoperative mortality, 3 post operative mortality [2.6%]. Early complications were in 37 patients [31.6%], 30 patients were diversion unrelated [25.6%] and 7 patients [6%] were diversion related. Late complications were in 20 patients [17%] including 9 patients [7.7%] diversion unrelated and 11 patient [9.3%] diversion related. 71 patients with W-neobladder [85.5%] and 14 patients with modified Tpouch [82.3%] had good day time continence. sixty one patients with W neobladder [73.4%] and 13 patients with modified T-pouch [76.4%] had good night time continence, 66 patients with W-neobladder [79.5%] and 14 patients with T-pouch [82.3%] void to completion. upper tract evaluation revealed stable or improved upper tract in 79 patients with W [95%] and 15 patients with T [88.2%]

Conclusion: upper tract preservation and voiding control are the corner stone for the ideal urinary reservoir which had been achieved successfully in our study with W and T-pouch. Both techniques have proved their efficiency, durability and versetality.Surgeon preference of the type of diversion is a hallmark for the type of diversion selected to the patient

Laparoscopic decortication of symptomatic simple renal cysts

To investigate the technique and assess results of laparoscopic decortication of symptomatic simple renal cysts. Ten patients underwent trans-peritoneal laparoscopic decortication of symptomatic simple renal cysts. Complex renal cysts were excluded. Out of the 10 patients, 8 had undergone previous cyst aspiration with injection of sclerotic material for intended ablation. Out of these cysts, 8 were peripheral and 2 were peripelvic. The mean operative time was 116 +/- 37.7 minutes [range 90- 180] and blood loss was minimal. Symptomatic success was achieved in 9 patients with a mean follow up of 7 months [range 3-9], and radiologic success was achieved in 8 patients. Laparoscopic decortication of simple renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Peripelvic cyst location makes laparoscopic decortications more challenging in the term of technical dissection yet feasible for the clinical outcome

Laparoscopic ureterolithotomy: is it an alternative technique replacing open surgery

To assess and evaluate the technique as a replacement to open surgical uretero-lithotomy. Fifteen patients with failed either ESWL or endoscopy and large calculi at the upper ureter were included in this study for performing transperitoneal laparoscopic uneterolithotomy Mean age was 47.2 7 +/- 9.32SD. 9 patients had right sided stones and 6 were left sided. Stone size range was 10-20 mm with mean 14.67 +/- 2.89 SD. 14 cases the stones were in the lumbar region and only 1 case at the iliac region. Successful laparoscopic stone removal were in 13 out of 15 [86.6%]. Two operative conversion to open surgery due to migration of stone in one case and in other conversion is due to injury of left common iliac artery. Operative times was 119.3 +/- 38.03 SD minutes [60-180min] estimated blood loss 62.3 +/- 11.6 [30-100] cc.. mean drain removal time was 3.4 days. mean post operative parentral analgesia was 150 mg of diclofenac sodium [75-300mg], mean hospital stay was 4.3 [3-8days] and mean resuming normal activity was 11.6[8-21 days]. Laparoscopic ureterolithotomy is a safe technique with a shorter hospital stay and rapid return to normal activity and offers an alternative modality than open surgery after treatment failure [ESWL, endoscopy] or for large size calculi. Open surgery has a role for managing laparoscopic converted cases