Failure to pass urine following transurethral resection of the prostate [TURP]: does the patient's mode of presentation determine the outcome of TURP?

To elucidate possible predictive factors for failure to pass urine following transurethral resection of the prostate [TURP] in patients subjected to TURP for lower urinary tract symptoms [LUTS] secondary to benign prostatic hypertrophy [BPH]. Prospective Study. Urology Unit, Department of Surgery, Mubarak Hospital, Kuwait. Three hundred and fifteen consecutive patients who presented with LUTS secondary to BPH and underwent TURP were included in the study. TURP. Main Outcome Measure: Ability to void after TURP. Out of 315 patients, 26 [8.3%] failed to void after TURP. The mean age of patients was 67 [range 57-92] years. The causes of failure to void after the catheter removal were: hypotonic bladder [10 / 26, 38%], persistent infra-vesical obstruction [9/ 26, 35%], diabetic neuropathy [4/ 26, 15%], end stage renal failure neuropathy [1 /26, 4%] and old age [2/ 26, 8%]. 21 / 26 [80.7%] patients who failed to void presented with acute on chronic or chronic urinary retention. The etiology of failure to void post-TURP is multi-factorial but is more common in patients presenting with acute on chronic or chronic urinary retention secondary to hypotonic bladder, diabetic neuropathy and occasionally very old age. Careful pre-operative patient selection and counseling is required in patients with chronic urinary retention about to undergo TURP to minimize the frustrations associated with the management of patients failing to void post-TURP

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

Comparative study of treating the obstructing ureteric stones by extracorporeal shock wave lithotripsy with or without preliminary drainage

In an attempt to assess the usefulness of a ureteral stent or percutaneous nephrostomy tube [PCN] in facilitating disintegration of obstructing ureteral stone with extracorporeal shock wave lithotripsy [ESWL]; a prospective randomized study on 98 patients with criteria of obstructing ureteric stones were allocated into three treatment groups: group 1: in situ ESWL without any stone manipulation; group 2: by pass stones with a stent followed by ESWL: group 3: PCN to relive the obstruction followed by ESWL. Group one 30 patients group two 22 patients and group three 18 patients. Number of patients available for follow up for a period of [3] months with sufficient data for analysis only 70 patients. The success rates [stone free or doesn t needed further intervention] were 83%, 81.8%, 77.8% in-group 1, 2 and 3 respectively. Forty one percent of patients in-group two needed two sessions or more. In-group one only 23.3% of patients needed two sessions or more, in-group three 33.3% of them needed two sessions or more. With proximal ureteric stones success rates were 92.3%, 93.3%. 87.8% in-group 1 and 2 and 3 [no significant difference]. With mid ureteric stones, success rates were 83.3%, 66.6%, 66.6% in-group 1, group 2, group3 [no significant difference]. With lower ureteric stones success rates were 60%, 50%, 71.4% in-group 1, 2, 3 [no significant difference.]. Ancillary procedures were needed in 20% of all cases, most of them treated by ureteroscopy and stone extraction with or without intracorporeal lithotripsy, most of the cases are lower ureteric stones. JJ stent or PCN do not increase the stone free rate over in situ ESWL alone. So treating ureteric stones with ESWL does not need any preliminary drainage

Pubo-scrotal incision for repair of penile fractures

Fracture penis is a urologic emergency, which should be managed with prompt exploration and repair of the tunical tear. In this study we have evaluated a puboscrotal incision for the repair of penile fractures. Between Feb. 1995 till Dec. 2000, 42 cases of fracture penis were operated upon for repair using a puboscrotal incision. Patients presented at the emergency room and outpatient clinic of our department Full history, clinical examination and preoperative cavernosogram were done to all the patients to delineate the sites of Tunical tear. If urethral injury was suspected urethrography was performed. All cases included in this study presented to our department within 3-72 hours from injury. Their ages ranged from 18 to 44 years [mean 27.5 +/- 6.95 years]. Urethral injury was found in 5 cases [12%]. The follow-up of cases ranged from 12 to 34 months [average was 18 months]. The puboscrotal incision gave almost no complications in 30 cases [62.5%] and complications when happened were minimal and self-limiting. They included wound infection in one case [2.4%], residual fibrotic area in 3 cases [7.1%] minimal penile curvature in 2 cases [4.8%], painful erection during coitus in one case [2.4%], hematoma formation [small] in 2 cases [4.8%] and finally weak erection that resolved after 3 months postoperative in one case [2.4%]. In conclusion the puboscrotal incision is a good exposure of the penis with satisfactory repair of penile fractures and concomitant urethral injury. It avoids incision into markedly edematous penile skin

Suprapubic endoscopic procedures: a percutaneous approach

This study was carried out to assess whether suprapubic endoscopic surgery can be helpful in situations where trans urethral access is inadequate, difficult or likely to be associated with urethral damage. We have applied a new technique for percutaneous access to the bladder by using the self-retaining [locking] laparoscopic trocar. Forty male patients with lower urinary tract disorders were selected from the patients who attended the urology department at Benha University Hospitals during the period from June 1997 to October 1999. The patients ages ranged from 2 to 80 years old with a mean age of 48.1 years. According to the procedures done, 30 patients underwent percutaneous stone bladder clearance: 4 of them underwent a concomitant antegrade bladder neck incision. 6 patients treated with antegrade endoscopic dilatation [cut-to-the light of stricture posterior urethra] and 4 children underwent antegrade ablation of posterior urethral valve [PUV]. We concluded that, percutaneous access to the bladder by using the locking trocar is simple and safe technique. It avoids drawbacks of the other technique of creating and dilating the tract over a guide wire

Comparing the effect of topical eutectic mixture of local anesthesia and lidocaine infiltration on pain response and analgesia requirement during extra corporeal lithotripsy procedure [using the storz modulith SL20]

Fifty adult male patients [mean age 35 +/- 15 ys.] with renal pelvic stones were selected for this study, all patients required 3 ESWL sessions. First session was performed without any form of preoperative analgesia or anaesthesia. Second session, patients received 25mg of EMLA cream applied locally to cover a skin area overlying the treated kidney, 90 minuets before ESWL session. Third session was started 10 minuets after subcutaneous infiltration to the area overlying the treated kidney with 20 ml, 1% lidocaine. Using EMLA cream and lidocaine subcutaneous infiltration lead to decrease the pain score perception when compared to without anaesthesia session. During the first 500 shock waves of ESWL, pain score of 2 or more was reported by 6%, 10% and 35% of patients using EMLA cream, lidocaine infiltration and without anaesthesia respectively, and 38%, 32% and 70% during the following 2500 shock waves. This decrease in pain score lead to less need for I.V. alfentanil analgesia to 38% in case of using EMLA cream, 32% in case of using lidocaine infiltration, while it was 70% when nothing was used. Local anesthesia is an effective means to reduce the pain score and analgesia requirement during extra corporeal lithotripsy procedure. Both EMLA and local infiltration are effective. However EMLA cream is easy to apply and has no complications. It is only drawback is its price