Monopolar electrocautery, an alternative novel method of hemostasis during radical cystectomy: preliminary report

During radical cystectomy, local hemostasis is a critical factor for surgical success. It can be accomplished with a variety of techniques including mechanical compression, ligatures, auterization and laser. The aim of this work was to evaluate monopolar electrocautery alone for achieving hemostasis during radical cystectomy. In this prospective study 30 patients were scheduled for radical cystectomy over a period of 2 years at Al-Azhar University Hospitals using monopolar electrocautery as the only hemostatic tool. The parameters studied were: operative time, estimated blood loss and incidence of complications. The data were analyzed clinically and statistically. Monopolar electrocautery as the only hemostatic tool during radical cystectomy resulted in a short operative time [35 +/- 5 minutes]. The mean estimated blood loss was 150 +/- 50 ml. Intraoperative bleeding was encountered in 2 patients only and they received blood transfusion. The overall post-operative early [within the fi rst month] complication rate was low [13.3%] and all complications were managed conservatively. Monopolar electrocauterization is a safe method for achieving hemostasis during radical cystectomy, with a signifi cantly short operative time, low cost, low blood loss, a low cystectomy-related complication rate and a short hospital stay

Impact of lymph nodes involvement after radical cystectomy on patient survival

To evaluate the role of pelvic lymph node dissection [PLND] during radical cystectomy for bladder cancer as regards to the extent of nodal dissection and the necessary number of lymph nodes to be removed. Retrospective study was done on 198 patients with invasive bladder cancer treated with radical cystectomy and urinary diversion. Regional PLND include internal iliac, external iliac, and obturator nodes. The study evaluates the impact of pelvic lymph node involvement and the number of nodes removed during surgery on survival of patients. Lymph node metastases were detected in 54 patients [27.3%]. The average number of nodes removed in the node-positive and node-negative patients was 13.7 and 14.4 respectively. Although no difference was found in disease-specific survival in the node-negative patients when stratified by the number of nodes removed [13 or more versus less than 13], a significant survival advantage was found in the node-positive patients with 13 or more nodes removed versus less than 13 nodes removed. The patients with four or more positive nodes had a worse outcome than those with less than four positive nodes. However, even if the patients had less than four positive nodes, the survival of patients with less than 13 nodes removed was as poor as that of the patients with four or more positive nodes. In this series, the removal of 13 or more pelvic lymph nodes was essential for more accurate pathologic examination to predict patient outcome and contributed to an increased chance of survival

Imaging follow-up diagnosis of post-extracorporeal shock-wave lithotripsy [ESWL] complications

Pre and post extracorporeal shock wave lithotripsy [ESWL] imaging follow-up was performed during the treatment of 100 kidneys and ureters with calculi through two years period, our study looking for kidey and urinary tract changes from ESWL effect. Before and after lighotripsy was performed, plain x-ray. Excretory urography, ultrasonography studies were done. C.T. maybe done when necessary to determine the effect of ESWL on the kidney and urinary tract. Multiple changes were noted in the form of renal subcapsular hematomas in nine patients [9%] [two large, six small and almost asymptomatic, intrarenal trematomas in two [2%] of patients. Perirenal subcapsular urinoma in two patients 92%] one of ten have had periureteric hematoma collection. Passage of the fragmented stone material was variable. 90% were stone free gradually after 3 months. Obstructive hydronephrosis in 20% due to inadequate stone fragmentation from the initial ESWL procedure especially with large stones 2 of these patients demonstrated pyonephrosis. Accumulation of an extensive amount of stone debris in the lower ureter were 30% of patients. So the imaging follow up of the patients is mandutory and good tool for diagnosis of post ESWL complications

Bacterial and non-bacterial prostatitis: detection of chlamydia trachomatis, cytomegalovirus and herpes simplex virus

Eighty-six patients with persistent symptoms of chronic prostatitis were screened for possible aetiological organisms affecting the prostate. Our study entailed a culture of expressed prostatic secretion [EPS] for bacteria. A positive culture was obtained in 40 [46.5%] patients with chronic bacterial prostatitis [CBP]. Forty-six patients [53.5%] were negative for a bacterial culture of EPS and therefore categorized as having non-bacterial prostatitis [NBP]. Immunofluorescence study of the EPS revealed that 12 [26%] out of these 46 patients with non-bacterial prostatitis were positive for Chlamydia trachomatis. Prostatic specimens taken by perineal needle biopsy from all patients with non-bacterial prostatitis were tested for vira antigens by immunoperoxidase study [15.2%] of these prostatic biopsies gave positive results for Cytomegalovirus [CMV] antigen, while 3 [6.5%] showed a positive immunoperoxidase reaction for Herpes Simplex virus type II [HSV-2]. In the remaining 24 [27.8%] patients, no definite organism could be isolated. The results demonstrate that chlamydial and viral prostatitis cover a reasonable group of patients with non-bacterial disease in whom the effort should be directed to eradicating these organisms from the prostate

Evaluation of impotent male by doppler ultrasound and cavernosography

Examination of the penile artery by duplex scanning in the assessement of impotence was evaluated in 140 impotent men. Scanning was by Technicare, Diasonic DRF400, and penile artery measurements were taken before and after intra-corporeal injection of papaverin hydrochloride 60 mg. The penile brachial index was measured in 80 patients and its predictive value compared with the resuls of duplex scanning and papaverine induced erection. On scanning evidence of good arterial in flow but poor erections, indirect evidence of venous leakage was assumed. The results showed that the deep artery responses best characterised the erectile response, with the dorsal artery being less helpful. All 30 patients with full erections following papavrine exhibited bilateral deep artery peak Velocities of > 25 cm/s, of the remaining 110 sub-optimal responders, 20 also has this finding; all had undergone dynamic cavernosograpliy, with 19 exhibited venous leakae. A critical value of deep artery response to attain erection is postulated, enabling more logical use of cavernosogrpahy. The penile/brachial index was shown to be suspected and it was concluded that duplex scanning is a useful, non-invasive method in the assessment of imptence

Doppler ultrasound and cavernosography evaluation in infertile man with non-erection

Examination of the penile artery by duplex scanning in the assessment of impotence was evaluated in 140 impotent men. Scanning was done by Technicare, Diasonic DRF400, and penile artery measurements were taken before and after intracorporeal injection of papaverine hydrochloride 60 mg. The penile brachial index was measured in 80 patients and its predictive value compared with the results of duplex scanning and papaverine induced erection. On scanning evidence of good arterial inflow but poor erections, indirect evidence of venous leakage was assumed. The results showed that the deep artery responses best characterized the erectile response, with the dorsal artery being less helpful. All 30 patients with full erections following papaverine exhibited deep artery peak velocities of <25 cm/s, of the remaining 110 sub-optimal responsers, 20 also had this finding, all had undergone dynamic cavernosography, with 19 exhibited venous leakage. A critical value of deep artery response to attain erection is postulated, enabling more logical use of cavernosography. The penile/brachial index was shown to be suspected, and it was concluded that duplex scanning is a useful, noninvasive method in the assessment of impotence

Single incision for prostatectomy and repair of inguinal hernia

Inguinal hernia has high incidence with benign enlargement of the prostate among elderly patients. The anatomical relation of inguinal hernia to the enlarged prostate raises the possibility of joint, concurrent surgical treatment of both disorders. A successful repair via a Pfannenstiel incision of 52 inguinal hernias [both direct and indirect] was reported in 50 patients who underwent retropubic prostatectomy, owing to benign enlargement of the prostate and/or operation on the urinary bladder and lower ureters. The results showed recurrence in one patient and no major complications in the wake of the combined operation. So, prostatectomy combined with inguinal hernia repair via retropubic approach can be safely used in urological and general surgical practice provided

Oxidized regenerated cellulose effect on local wound infection following surgery

This controlled prospective study was carried out to investigate the potential local antibacterial activity of a local hemostatic agent, oxidized regenerated cellulose [ORC-Surgicel]. One hundred and two cases were operated upon for various indications. Selected cases were located with ORC for local haemostasis of their surgical wounds. Results were compared with a control group for bacterial counts pre- and postoperatively. Preliminary reports suggested superior local antibacterial effect whenever ORC was used

Doppler stethoscope for evaluation of varicoceles in infertile men

The Doppler stethoscope was used to evaluate twenty-eight infertile patients with oligo-asthenospermia suspected of having varicoceles but with inconclusive physical examination, as well as two control groups: 38 infertile patients with clinically detectable varicoceles and a third group of normal fertile men [20]. The results obtained showed high accuracy and sensitivity rates. So we can recommend the pre and post operative use of Doppler stethoscope for evaluation of subclinical varicoceles as it is an easy, non invasive non time consuming and inexpensive diagnostic tool