Percutaneous nephrolithotomy in children: a preliminary report

The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy [PNL] in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children [47 renal units] underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months [range: 6-24]. The median age at presentation was 8-year [range: 3-12]. The operative time ranged from 30 to 120 min [median [0]. Overall stone clearance rate was [1.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients [nephroscopic clearance in one and shockwave lithotripsy in 3]. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 [10.6%] of all procedures [Clavien Grade II in 4 and Clavien Grade IIIa in 1] and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children

Diagnosis of unilateral single system ectopic ureter in girls in the era of magnetic resonance urography [MRU]

Objective: The ectopic ureter frequently drains an ectopic dysplastic or hypoplastic kidney. The present study aims at defining the role of MRU in establishing the diagnosis of this anomaly

Patients and Methods: Between February 1996 and March 2000, 11 girls presented or were referred to our department for management of urinary incontinence. Their age at presentation ranged from 4-9 years [mean 6.5 years]. Radiological work up included abdominal ultrasound [US], excretory urogram [IVU], voiding cystourethrography [VCUG], [99 m] technetium-dimercaptosuccinic acid [[99m] Tc-DMSA] renal scan, enhanced spiral computed tomography [CT] and magnetic resonance urography [MRU]

Results: Ultrasound showed evidence of a solitary kidney with failure to visualize a contralateral kidney in 7/11 patients. In the remaining 4 patients [36.4%], US revealed a pelvic kidney in two and a pelvic cystic mass in another two patients. IVU revealed only one functioning renal unit in all cases. None of the patients showed vesicoureteral reflux on VCUG. On [99 m] Tc-DMSA, a single kidney was seen in 9/11 patients and ectopic pelvic kidneys with normal contralateral kidneys in 2/11 patients. The 7 patients, in whom US and [99m] Tc-DMSA scan had failed to localize the kidney, underwent CT scanning which visualized a pelvic hypoplastic kidney with a normal contralateral kidney in 2/7 patients. The remaining 5 patients underwent MRU that disclosed a normal kidney with a contralateral lumbar hypoplastic kidney in one and a pelvic ectopic kidney in four. The patients were managed by nephrectomy [n=9] and ureteroneocystostomy [n=2]

Conclusions: A single system ectopic ureter should be suspected in all girls with continuous urinary dribbling after the age of successful toilet training. With the inclusion of MRU into radiological workup, dysplastic or hypoplastic kidneys can be accurately localized. MRU is indicated for the diagnosis and for therapeutic planning in such cases

Endoscopic transurethral resection of bilharzial ulcers of the urinary bladder: Single-center experience with 1000 patients

Objective: To report on the results of endoscopic transurethral resection of chonic bilharzial ulcers of the urinary bladder at the Assiut University Hospital, Assiut, Egypt

Patients and Methods: Between June 1995 and April 2001, 1000 patients [87.3% males and 12.7% females] with chronic bilharzial ulcers [78% de novo and 22% recurrent ulcers after previous open partial cystectomy] were treated by endoscopic transurethral electroresection [TUR] at our department. Single ulcers were diagnosed in 612 [61.2%], double ulcers in 261 [26.1%] and multiple ulcers in 127 [12.7%] patients. Ulcers of a moderate diameter [1-2 cm] were present in 505 [50.5%] patients. Electroresection was done until healthy fibers of the detrusor muscle or even the prevesical fat was reached

Results: The mean duration of the resection was 19.8 minutes. Extraperitoneal bladder perforation was recorded in 11 patients [1.1%]. In all these patients conservation was successful. Intraperitoneal bladder perforation was recorded in 16 patients [1.6%]. In six out of these patients conservation was successful, while peritoneal drainage was necessary in the remaining cases. Conservative management was successful in 5 cases [0.5%] of secondary haemorrhage. Hospitalization was one day in 920 patients [92%]. After six months 862 patients [86.2%] were available for follow up. 745 [86.4%] were symptom-free and 794 [92.1%] reported complete healing of the resected ulcer at follow-up cystoscopy

Conclusion: Endoscopic transurethral electroresection is a satisfactory modality for the treatment of bilharzial ulcers of the urinary bladder

Charleston pouch with in-situ appendix and concealed umbilical stoma

Objectives : To evaluate the functional outcome of the Charleston pouch procedure as a continent catheterizable urinary reservoir using an unaltered in-situ appendix with a triangular skin flap at its umbilical stoma with few modifications to the original technique

Patients and Methods: Between February 1999 and October 2002, 34 patients [31 males and 3 females] were studied at the Urology Department, Assiut University Hospital, Assiut, Egypt. The indications for urinary diversion were radical cystectomy for invasive carcinoma of the bilharzial bladder in 27 males and three females, and incontinent epispadias in four male patients. The age of the patients ranged between 18 and 60 years [mean 48.1 +/- 6.1 years]. Mean follow up was 30 +/- 4.2 months [range 11-40 months]. The evaluation during the follow-up period included clinical, laboratory, imaging and urodynamic studies to evaluate the functional outcome

Results: All patients are continent [day and night]. No stomal stenosis was recorded. Laboratory investigations were within normal. The upper urinary tract remained unchanged in all patients.Pouchometry revealed that the Charleston pouch is a low-pressure [4 -21 cm H2O] reservoir with a good capacity [average750 ml]. Cancer recurrence was recorded in 3 patients at 12, 27 and 32 months

Conclusions: The Charleston pouch with in-situ appendix is an efficient versatile technique for the creation of a catheterizable continent cutaneous urinary reservoir. The umbilical stoma with triangular skin flap provides excellent cosmetic results