Transurethral drainage of prostatic abscess: points of technique

The incidence of prostatic abscess [PA] has markedly declined with the widespread use of antibiotics and the decreasing incidence of urethral gonococcal infections. To evaluate different treatment methods for prostatic abscess and to describe technical points that will improve the outcome of transurethral [TUR] drainage of pro-static abscess. We performed a retrospective study of a series of 11 patients diagnosed with prostatic abscess, who were admitted and treated in Farwaniya Hospital, Kuwait, between February 2008 and November 2010. Drainage was indicated when antibiotic therapy did not cause clinical improvement and after prostatic abscess was confirmed by TRUS [Transrectal ultrasonography] and/or CT computed Tomographyscan. TUR drainage was indicated in 7 cases, ultrasound-guided transrectal drainage was performed in 2 cases, and ultrasound-guided perineal drainage was performed in 2 cases. All patients that underwent TUR-drainage had successful outcomes, without the need of secondary treatment or further surgery. TUR drainage of a prostatic abscess increases the likelihood of a successful outcome and lowers the incidence of treatment failure or repeated surgery. Less invasive treatment, with perineal or transrectal aspiration, may be preferred as a primary treatment in relatively young patients with localized abscess cavities

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

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

Effect of varicocelectomy on semen parameters in patients with subclinical varicocele

This study was carried out to assess the importance of subclinical grade of varicocele in evaluation of subfertile men. A total of 60 subfertile men with subclinical varicocele diagnosed by scrotal color dupplex ultrasound. Patients were randomly assigned to group I in whom high ligation varicocelectomy was performed and group II who received placebo treatment. Patients were followed up by seminogram at 3 and 6 months. Patients underwent high ligation varicocelectomy Group I showed statistically significant improvement in sperm count after. 3 months and highly statistically significant improvement in sperm count after 6 months. The statistically significant. Improvement in the percentage of abnormal forms was noticed only after 6 months postoperatively. In group II follow up showed non-significant improvement in sperm count, percentage of abnormal forms and grades of sperm motility at either 3 or 6 months. We concluded that the effect of varicocele on semen parameters has no relation to its size and consequently varicocelectomy for subclinical varicocele. diagnosed by color dupplex ultrasound, has benificial effect on semen parameters