Holmium laser ureterocele excision with transurethral incision of the prostate

ABSTRACT Introduction: Ureteroceles present a diagnostic and treatment challenge in adults (1). With an estimated prevalence of 1/500 to 1/4000, it is not uncommon for any urologist to encounter ureteroceles in clinical practice (2). The incidence of prolapsed ureteroceles in adults is unknown (3). Materials and Methods: We present an interesting case of a 53-year-old male with a 20-year history of obstructive voiding symptoms who presented with urinary retention with a Foley catheter in place. Pre-operative evaluation included a transrectal ultrasound of the prostate which revealing prostate volume of 20cc. Urodynamics revealed a high-pressure, low flow voiding pattern with a functional detrusor muscle. Cystourethroscopy was performed revealing an orthotopic ureterocele on the left side that was prolapsed into the prostatic urethra, and the bladder neck was elevated. The patient then underwent holmium laser ureterocele excision with transurethral incision of the prostate (TUIP). Using MOSES technology and laser settings of 30Hz and 1.5J, the ureterocele was completely excised and a TUIP was performed. Results: The patient was discharged home on the day of surgery with a Foley catheter in place. On post-operative day 1 he passed a voiding trial with a post-void residual volume of 25cc. Renal ultrasonography was performed 3 months postoperatively revealing no hydronephrosis. His postoperative International Prostate Symptom Score of 2 was improved compared to his preoperative score of 34. Conclusion: Holmium laser ureterocele excision with a TUIP is an effective treatment modality in the management of a prolapsed orthotopic ureterocele causing bladder outlet obstruction in a male patient.

To Establish Haematological Reference Ranges among Indigenous Normal Ugandans

Methodology: Eligible subjects were HIV-1 negative; with no demonstratable medical or emotional problems. The parameters considered were absolute lymphocyte counts (AL C); absolute CD4 and CD8 (ACD4; ACD8) and CD4/CD8 count ratio (ABSR). The central 95area under the distribution curve (ACD) of the parameters of interest was considered as well as mean distributions between the sexes. Results: 183 subjects; 69(37.7) females and 114 (62.3) males were submitted to the study. The 95range for the combined groupe for ALC was 1452.5 - 4447.5; for ACD4 558.6-2332.8; for ACD8 252.0-1396.1; and for ABSR 0.682 - 4.37. There was a significant difference (p0.5) in mean ALC and mean (ABSR between sexes. Discussion: This p[ilot study was necessitated by the absence of up-to-date haematological and especially immunologic parameters (CD4; CD8) among normal Ugandans. Currently many laboratories and clinicians use North American and European haematologic reference; and also use various manual methods for determination of CD4 and CD8. These ranges which were established with more accurate method of flow cytometry gives a scientists in Uganda (and by implication Central Africa) and calls for a more extensive study to establish more representative and accurate haematological and immunological parameters