Management of ureteral calculi with the use of transurethral ureteroscopy and electrohydraulic lithotripsy: 101 patients experience.

To evaluate the results of transurethral ureteroscopy and electrohydraulic lithotripsy for ureteral calculi needing surgical management. From 1993 to 1995, 101 patients with ureteral calculi were retrospectively analyzed. The locations and sizes of the calculi were examined and the success rate of the procedure was assessed. The overall success rate was 74%. The success rates of upper and lower ureteral calculi were 67% and 81%, respectively. The stone size did not affect the success rates. Among the failure patients, there were no serious complications and they could be subsequently treated with either ureterolithotomy or double J stent replacement. The median hospitalization was 4 days. Transurethral ureteroscopy and electrohydraulic lithotripsy is an effective and safe procedure for ureteral calculi treatment. This method is a minimally invasive procedure and involves a short hospital stay.

Bladder cancer in Siriraj Hospital from 1991 to 1995.

A retrospective study was under taken of 284 patients with blander cancer seen at Siriraj Hospital from 1991 to 1995. Of the total 284 patients, new patients comprised 158 cases, while recurrent cases numbered 126. The average ages were 60-70 years. The male to female patients ratio was 235 to 59 (4:1), with the most common symptom being haematuria. Most of the patients (both new and recurrent cases) were in stage A, and the common histology was transitional cell carcinoma. A total of 39 patients in stages O and A were treated by TUR and adjuvant intravesical BCG therapy, while 62 patients with invasive bladder cancer underwent cystectomy.

A retrospective study of carcinoma of the prostate between 1993-1995 (phase 2).

In Thailand, carcinoma of the prostate gland is the tenth most common malignancy in males. Here we report the incidence of carcinoma of the prostate during 1993-1995, as the previous report in 1990-1992. The average number of patients was about 32 per year. The incidence was common at the age of 70-79 years. The common symptoms were difficulty in urination 51 per vent, hematuria 13 per cent, back and bone pain 9 per cent and urinary retention 18 per cant. Level of serum PSA (prostate specific antigen) is low in stage A, and high in stage C and D. Most patients were in stage C and D, and treatments were TUR (transurethral resection) and orchidectomy with or without hormonal adjuvant therapy. Radical prostatectomy was done in one patient with stage A and he is showing satisfactory recovery.

Prostatic carcinoma at Siriraj Hospital.

In Thailand, carcinoma of the prostate gland ranks at the number tenth of the most common malignancy in male. Here we report the incidence of carcinoma of the prostate during 1990-1992. The average number of patients was about 30 per year. The incidence was common at the age of 70-79. The common symptoms were difficulty in urination 48%, hematuria 19%, back and bone pain 16%, urinary retention 14.4%,Most of them were in stage C and D and treatment of choice were TUR and orchidectomy. Only one patient, the histologic section was transitional cell carcinoma.

The pattern of lymph node metastasis of penile cancer in Thais.

The prognosis of penile cancer is dependent on ilioinguinal lymph node metastasis. However, some controversy still exists concerning the management of those lymph nodes because the pattern of lymph node metastasis, especially in Thai males, is questionable e. Hence a prospective study of the pattern of lymph node metastasis was undertaken in 26 penile cancer patients from 1992 to 1995. All patients had the same pattern of lymph node metastasis. From primary lesion, tumour metastasized first to the inguinal lymph node, and then to the ipsilateral pelvic lymph node. There was no skip pattern. There was no correlation between Jackson staging, degree of cell differentiation, extension of primary lesion, palpability of clinical inguinal lymph node and pathological staging of lymph node metastasis after bilateral ilioinguinal lymphadenectomy. The primary lesion with poor differentiation was highly related to lymph node metastasis at the initial diagnosis. In patients with a clinically negative inguinal lymph node, 50 percent had inguinal lymph node metastasis and 12.5 percent had inguinal lymph node metastasis. In patients with a clinically positive inguinal lymph nod, 83.3 percent had inguinal lymph node metastasis and 38.8 percent had pelvic lymph node metastasis. In conclusion, lymph node metastasis in penile cancer is unpredictable by clinical evidence. Therefore prophylactic bilateral inguinal lymphadenectomy is recommended in all patients, and especially in cases with poor differentiation of the primary lesion, low education or low compliance with follow up. If there is inguinal lymph node metastasis, ipsilateral pelvic lymphadenectomy is recommended.

Pseudosarcomatous tumor of urinary bladder.

The first case in Thailand ofpseudosarcomatous tumor of the urinary bladder is reported. A 32-year-old female, presented with gross hematuria and dysuria. Cystoscopy showed large mass floating in the bladder and biopsy of the tumor showed to be leiomysarcoma. IVP was normal but CT scanning showed huge mass occupied the whole bladder and invasion outside the anterior wall was suspected. The bladder was explored and the tumor with part of the bladder around the tumor’s stalk was resected. A microscopic section revealed spindle cell proliferation exhibiting mitotic activity within myxoid stroma. The election microscopic finding showed myofibroblast. The final diagnosis was pseudosarcomatous fibromyxoid tumor. The patient was followed up for 5 years and no evidence of recurrence has been detected.

Bladder augmentation: Siriraj experience.

Since 1987, 13 patients with low compliance bladder secondary to genitourinary tuberculosis, neuropathic bladder and contracted bladder from other causes underwent augmentation cystoplasty. Ileal segments were used in all of them and no serious complication was found. All eight patients with tuberculous cystitis and chronic scarring of the bladder from other causes, who had been suffering from frequent voiding, were free of these symptoms postoperatively. Three patients could void by themselves but the others required intermitted catheterization to remove residual urine. In five cases of neuropathic bladder, four patients with reflex incontinence were continent postoperatively and in one case with vesicoureteral reflux the symptoms subsided. All patients were satisfied with the outcome following surgery. Augmentation cystoplasty appears to offer a reliable procedure for low compliance bladder.

Adjuvant therapy with mitomycin C intravesically for superficial bladder cancer.

A retrospective study was carried out using the OPD cards of 25 cases (stage A, grade 2) with transitional cell carcinoma (superficial bladder cancer), to determine effects of Mitomycin C on preventing tumor recurrence. Of these patients, 13 had been managed by surgery (TUR/TUF) only (group 1). The remaining 12 cases (group 2) were given Mitomycin C (intravesically) administration at two weeks post surgery (4 cases/group 2 A) and after several tumor recurrence was found in eight cases (group 2 B). The study compared the mean recurrence rate per year of these three groups. The mean recurrence rate per year of group 1, group 2 A and group 2 B was 0.34, 0.68 and 1.22, respectively, and there was no statistical difference between them. The percentage of recurrence in group 1, group 2 A and group 2 B was 61.5, 50 and 75, respectively. In conclusion, Mitomycin C dose not significantly reduce the recurrence of tumors, but if used two weeks after surgery it dose reduce the percentage of recurrence.

The epidemiological study of patients with renal and ureteral calculi treated at Siriraj Hospital, 1986.

The epidemiological study of patients with renal and ureteral calculi was carried out among patients admitted for treatment at Urology Unit, Department of Surgery, Siriraj Hospital, in 1986. There were 220 patients underwent surgical treatment but only 168 medical records were available for the study. These were renal calculi, ureteral calculi, and renal with ureteral calculi encountered in 109 (64.9%), 36 (21.4%) and 23 (13.7%) cases respectively. the were 104 (61.9%) males and 64 (38.1%) females with the mean age of 44.6+15.2 years. Seventy patients (41.7%) were residents of Bangkok while the rest were resident of control north-eastern northern and southern Thailand encountered in 41 (24.3%), 29 (17.3%), 20 (11.9%) and 8 (4.8%) patients respectively. These patients were employees, house wives and government officials encountered in 32.1%, 20.8% and 6.5% respectively. the rest were farmers, merchants and others. The patients presented with azotemia in 14.9% of cases and necessitated peritoneal dialysis before surgery in 14.3%. The average hospital stay after surgery were 11.3+6.5, 10.3+4.7 and 13.1+7.5 days among patients with renal, ureteral and renal with ureteral calculi respectively. The postoperative complications were secondary bleeding (3.6%), disrupted wounds (1.8%) and prolonged urinary leakage (0.6%). There was no death reported. The patients’ status at discharge were (6%), azotemic (10.1%), with urinary diversion (4.8%) and retained stones (15.5%).