Outpatient transurethral cystolithotripsy of large bladder stones by holmium laser

Introduction: To assessment of the efficacy and safety of transurethral Cystolithotripsy of large bladder stones by holmium laser in the outpatient setting

Methods: In a prospective study 48 consecutive adult patients with large bladder stones, were enrolled for transurethral Cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded

Results: Patients mean age was 46 +/- 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 +/- 3.5. Mean stone size was 3.7 +/- 1.6 cm. Mean operation time was 43.5 +/- 15.5 minutes. Nearly complete stone clearance [98.5%] was achieved in all patients. Mean hospital stay was 6.5 +/- 1.3 hours. No major complications were seen. Mean visual analog pain score [VAS] was 4.2 +/- 2.1 and 1.4 +/- 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 +/- 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected

Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting

Comparative study of serum levels of perforin in prostate cancer and benign prostatic hyperplasia patients

Perforin[p] is the primary mediator of short term cytotoxicity, it is accumulated in response to proinflammatory cytokines and stored in T lymphocyte, NK cells and NKT cells are released upon activation. Perforin is a prototypical cytotoxic molecule involved in cell mediated immunity against various pathogens, alloantigens and particularly different tumors.The purpose of this study was to determine perforin level in prostate cancer [P.Ca] and Benign Prostatic Hyperplasia [BPH] This is study was performed on 59 patients consisting of 28 patients with P.Ca and 31 patients with BPH.Perforin and PSA levels were measured in cancer and BPH patients using ELISA method. Mean Perforin value was significantly lower in P.Ca patients than in BPH patients [p < 0.01] where as mean serum PSA level was significantly higher in the cancer patients in comparison to the BPH group [P < 0.01 Our finding indicate probability of problem in expression of cytotoxic molecule ,perforin in and around the tumor

Direct vision internal urethrotomy with application of holmium: YAG laser

Male urethral stricture is a complicated urologic disease that could be successfully treated using internal urethrotomy. Laser internal urethrotomy has been used in many cases with favorable outcome in many studies. Holmium: YAG laser with its incisional properties on tissue is one of the laser types applied for internal urethrotomy. We present a 19 year-old male with history of aortic valve stenosis and metallic aortic valvoplasty on prescription of oral anti-coagulant therapy [Warfarin] who was a candidate for internal urethrotomy due to bulbar urethral stricture. Holmium laser core-through urethrotomy was performed for him. Internal urethrotomy was done using the ablative 50-watt Holmium: YAG laser 2140 nm [manufactured by the Atomic Energy Organization of Iran [AEOI]]. No complication was observed intra- and post-operatively. After 6 months of followup no evidence of urethral stricture was observed. According to our study, Ho-YAG laser core through urethrotomy is a safe and effective procedure. It is a less invasive alternative to more complex urethroplasty procedures for patients with post-traumatic urethral stricture with high risk of urethral bleeding due to anti-coagulant therapy

Trans-ureteral ureterolithotripsy of ureteral calculi: which is the best; pneumatic or holmium laser technique?

Our aim was compare of two types of lithotripter include holmium: YAG laser and pneumatic one in transurethral ureterolithotripsy [TUL] for the management of ureteral calculi >/-1 cm. 112 patients with ureteral calculi more than 1 cm were selected in randomized order for pneumatic or holmium: YAG laser transurethral ureterolithotripsy [56 patients in each group]. Ultrasonography and intravenous urography were performed for all patients before surgery. Complete clearance and success was defined as the absence of any fragments on post operation KUB and ultrasonography images. Success rate was 85.7% in pneumatic group and 100% in holmium: YAG laser group [p =0.003]. Stone migration up in the pelvicalyceal system was observed only in 8 cases of pneumatic group. No statically differences were observed in terms of patient's age, hospital stay, and complications between two groups. According to our experience, for ureteral stone larger than 1 Cm treatment with ureteroscopy and laser lithotripsy is a preferring approach with favorable operation time and hospital admission, and no more significant complication

Effect of KTP laser on surgically resected adenomas of prostate

Transurethral resection of prostate [TURP] is the most common urological operation performed. Regarding the complications of this surgery, studies are looking for alternative endoscopic techniques in order to reduce risk of complications. Use of high energy lasers is the most promising method for managing patients with benign prostate hyperplasia [BPH]. In this study, we evaluated the effect of homemade KTP laser on resected prostate adenoma after open prostatectomy. A total of forty resected prostate adenoma by open prostatectomy, assigned in to the study groups. One part of specimens without any intervention was sent to the pathology department and the rests divided to four KTP dose response groups [10 patients in each group]. The prostate specimens were ablated by KTP laser in one, two, three, and four sessions according to their number of subgroups. Prostate tissue was irradiated by 5-watt KTP laser for 15 seconds in each stage. All prostate specimens ablated with laser were sent to pathology for evaluation of tissue ablation capacity and tissue penetration depth. Mean age of the participants was 73.25 +/- 6.8 years with mean serum level PSA of 3.65 +/- 2.1 ng/dl. 1 to 2 mm of the tissue was ablated at each session of laser administration. In pathologic examination, 0 to 2 mm of tissue destruction with disappearance of nuclei of the cells, basophilia of the stroma, and damaged tissue [cutter like effect] were witnessed. Findings were compatible with burn effect. KTP laser prostatectomy is a safe and effective procedure with low risk of complications in which bladder outlet obstruction symptoms will relieve. According to our study, extra penetration of prostate tissue during laser irradiation is rare. This finding could be suggestive this theory that KTP laser has little risk of capsule perforation

Fistula repair after hypospadias surgery using buccal mucosal graft

The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hyposadias repair. We reviewed records of our patients with urethrocutaneous fistula developed after hypspadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 +/- 1.00 years old [range, 4 to 11 years]. Seven fistulas were in the midshaft, 4 were in the penoscortal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients [78.6%]. In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. Our findings showed that fistula repair using buccal mucosal graft can be on the acceptable techniques for repairing fistulas developed after hypopadias repair

Desmopressin as an alternative solution for urinary leakage after ureterocaliceal surgeries

Presistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration. Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty [n = 9], pyelolithotomy [n = 4], and ureterocaliceal anastomosis [n = 1]. All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients [control group] did not receive any medical treatment. The duration of urinary leakage was compared between the two groups. The patients were 5 women and 10 men with the median age of 37 years [range, 26 to 58 years]. None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 +/- 7.2 days in the patients of desmopressin group and 47.7 +/- 8.8 days in those of the control group [P= .04]. Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin