ABSTRACT
To evaluate the outcome of extracorporeal shock wave lithotripsy [SWL] for solitary stones = . 20 mm located within the renal pelvis based on their radiodensity. Between March 2004 and January 2006, one hundred and eight patients with solitary renal pelvic stones measuring $ 20 mm were enrolled into the study. ESWL was performed using a Domier Compact Alpha lithotriptor under sedation. Patients were grouped according to the size and radiodensity of the stone using the pre-operative KUB, into foul-groups. The first group of patients [n=22] had stones = 10 mm and stone radiodensity less than or equal to the ip-silateral !2th rib. The second group [n=31] had stones = 10 mm and stone radiodensity more than the ipsilateral 12th rib. The third group comprised 28 patients v/ith stones between 11 and 20 mm and stone radiodensity less than or qua! to the ipsilateral 12th rib. The fourth group included 27 cases with stones between 11 and 20 mm and stone radiodensity more than the ipsilateral 12th rib. Stone-free rates [SFR] were determined at 3 months by KUB. Follow-up SPR information was available in 102 patients. For stones with radiodensity less than or equal to the ipsilateral 12th rib [group 1] the overall SFR was 72% [36/50] while in cases with stone radiodensity more than the ipsilateral 12th rib the overall SFR was 67.2% [39/58]. Considering stone size, for stones = 10 mm within the renal pelvis, the SFRs were nearly similar 77.3% [17/22] and 74.2% [23/31] regardless of stone radiodensity. For stones between 11 and 20 mm, the SFR was 59.3% [16/27] if the stone had a radiodensity > 12th rib compared to a SFR of 67.9% [19/28] if the stone radiodensity was < 12 th rib. Stone composition was available in 68.5% of treated patients [n=74], but no correlation was found between stone radiodensity and stone composition. On the Domier compact alpha machine, stone radiodensity alone does not predict lithotripsy treatment outcome for stones = 10 mm within the renal pelvis. This parameter is probably only useful as the stone size becomes larger than 10 mm, and should be used in conjunction with other stone parameters to select appropriate therapy
Subject(s)
Humans , Male , Female , Lithotripsy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
To evaluate the feasibility and effectiveness of transrectal ultrasound [TRUS]-guided transrectal drainage of prostatic abscesses [PA]. Between March 1998 and October, 2004 fifty patients [Mean age was 48.6 years] were diagnosed and treated for PA. All cases were assessed regarding to predisposing factors, associated diseases, and diagnostic and therapeutic methods. Clinical presentation included lower urinary symptoms in 48 cases [96%] and urinary retention in two cases. Fever was found in 24 cases [48%]. Fluctuation at digital rectal examination [DRE] was present in only 15 patients [30%]. TRUS confirmed the diagnosis of PA in all cases. All cases received antibiotic treatment. All patients were submitted to TRUS-guided transrectal puncture and drainage. There was no recurrence after single transrectal drainage in 42 cases. The procedure of transrectal drainage was repeated in 8 cases. Four out of the eight cases were cured after repeated transrectal aspiration and lavage with no recurrences. Only two cases of recurrent abscesses needed transurethral deroofing of the abscess after repeated transrectal drainage and the remaining two cases were lost to follow up. Most frequent bacterial agents were E-coli and Staphylococcus aureus. No mortality has been reported in this series. PA should be treated with broad-spectrum antibiotics and drainage. TRUS guided transrectal drainage of PA is an effective minimally invasive method of treatment with low morbidity
Subject(s)
Humans , Male , Abscess , Drainage , Urination Disorders , Urinary Retention , Anti-Bacterial Agents , Escherichia coli , Staphylococcus aureus , Ultrasound, High-Intensity Focused, TransrectalABSTRACT
Seventy patients with symptomatic simple renal cysts were enrolled in this study. Their mean age was 41 [30-70] years. They were managed either by ultrasound guided drainage mono-therapy [40 patients, group A] or drainage with single injection of ethyl alcohol [97%] concentration [30 patients, group B]. All patients were followed up with abdominal ultra-sonography at monthly intervals in the first three months, then every three months for the next 18 months. Complete disappearance of renal cysts was achieved in 24 patients of group A and in 26 patients of group B. It was concluded that ultrasound guided drainage of symptomatic simple renal cysts is attractive minimally invasive procedure. The injection of sclerosing agent as ethyl alcohol after drainage improved the outcome and reduced the recurrence rate