Iintravesical instillation of bacillus calmette guerin versus intravesical instillation of hyaluronic acid in the treatment of interstitial cystitis

The study included thirty adult female patients with a mean age of [40-50y] with a interstitial cystitis. Patients were divided into two equal groups. First group was treated with intravesical installation of hyaluronic acid 40 my in 50-ml solution weekly repeated for 4 weeks then once monthly for 6 months. The second group was treated with intravesical installation of BCG [Tic strain] 40 my in 50-ml solution weekly repeated for 6 weeks. Evaluation was done according to symptom score. Improvemen occurred in both groups. With hyaluronic acid, maximum response reached by 24 weeks in which positive response occurred in 66.6% [complete response 13.3% and partial response 53.3%]. By the end of 48 weeks positive response decreased to 40% [complete response 6.6% and partial response 33.3%]. No reported complication in this group. With BCG, maximum response reached by 12 weeks in which positive response occurred in 73.3% [complete response 20% and partial response 53.3%]. However by the end of 48-week positive response decreased to 60% [complete response 13.3% and partial response 46.6%]. Microscopic haematuria occurred in 53.3% and symptoms of bladder irritability were increased in 20%, but disappeared spontaneously in 6 weeks. Both intravesical BCG and hyaluronic acid installation are effective in the treatment of interstitial cystitis. With BCG the maximum response started early, maintained for prolonged duration and persisted for the period of follow up of 48 3 weeks in 60%. But with intravesical hyaluronic acid the response persisted for the period of follow up of 48 weeks in 40% only

Extra corporeal shockwave lithotripsy for the management of urinary calculi: experience with 453 patients

Extracorporeal shock wave lithotripsy [ESWL] has revolutionized the treatment of urinary calculi. In this study, we analyze our experience of using ESWL as a monotherapy in the treatment of urinary calculi of different sizes and at different sites. Patients presenting to our urology unit with urolithiasis were subjected to ESWL monotherapy with or without preliminary insertion of 'J' ureteric stents. Preliminary investigations included routine hematological and biochemical assessment, urine culture, coagulation profile and intravenous urography [I.V.U.]. The outcome of treating calculi in the kidneys, ureters, and bladder using ESWL was analyzed. Success was defined as either becoming completely stone-free or by the presence of residual, but insignificant, calculi. ESWL was performed on 453 patients using a Storz Modulith SL-20 lithotriptor. Pre-ESWL procedures included insertion of 'J' stents in 84 patients [18.5%], "push" and 'J' stenting in six patients [1.3%], and ureteral catheterization in six patients [1.3%]. A total of 225 patients had renal calculi [49.7%], 225 patients had ureteral calculi [49.7%], and three patients had bladder calculi [0.6%]. Out of the 453 patients, 417 patients completed ESWL. The success rate was 92.5%. The number of treatment sessions for 417 patients increased in accordance with the stone size and averaged 2.4 sessions. Post-ESWL ancillary procedures included ureteroscopy and Dormia basket extraction in 21 patients, and 'J' stent fixation in 12 patients. Complications encountered included steinstrasse in 33 [7.3%] patients, septicemia in six [1.3%] patients, acute pyelonephritis in three [0.66%] patients and three [0.66%] patients had subcapsular hematoma. ESWL, as a monotherapy is a safe and efficient outpatient procedure for the initial treatment of urinary calculi