Mini-Flank incision assisted laparoscopy versus transperitoneal laparoscopy for dismembered pyeloplasty

To define the impact of the combined approach on the minimally invasive style of laparoscopic approach. From July 2005 to September 2007, 21 patients with unilateral primary pelvi-ureteric junction [PUJ] obstruction underwent Anderson Hynes pyeloplasty. Patients were divided into two groups. Group 1: consisted of 11 patients who had combined transperitoneal laparoscopic approach and then mini-open approach. The surgical procedure was divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter and then accomplishing the pyeloplasty through mini-flank [5 cm], muscle splitting incision which was planned under laparoscopic guidance to be accurately overlaying the PUJ. Group 2: consisted of 10 patients who underwent the whole procedure through laparoscopic approach. Perioperative records and postoperative assessment were compared between the two groups. The mean operating time [135 versus 189 min] and Analgesic requirement [90 versus 36 mg, morphine equivalent] were significantly different between group 1 and 2, respectively. There was no intraoperative complication in both groups and the postoperative complications were minor and similar in both groups [10%]. Postoperatively, time to resume the full activity was significantly different between the groups 1 and 2, at 2 weeks [54.0 versus 80%, respectively] however, it was similar [100%] at 4 weeks. Postoperative, assessment of the all patients, based on IVU and diuretic renogram at 3 and 6 months, were similar in both groups. Dismembered pyeloplasty through a combined approach save time and ensures high quality of anastomosis while maintaining the minimally invasive fashion of laparoscopic approach

Detrusor blood flow as a measure of bladder outlet obstruction in patients with benign prostatic hyperplasia

In patients with benign prostatic hyperplasia [BPH], detrusor blood flow was evaluated by color Doppler ultrasonography [CDU] with the aim of revealing its possible usefulness as a measure of bladder outlet obstruction [BOO]. A total number of 30 men with lower urinary tract symptoms [LUTS] suggestive of BPH underwent pressure flow study [PFS] and detrusor CDU. Pulsatile blood flow was measured at three sites, the anterior bladder wall and the two lateral walls, and detrusor resistive index [DRI] was calculated. The findings were compared between patients with and without BOO. Between patients with and without BOO, there were significant differences for age [69.2 Vs. 62.1 years, p<0.005], PSA [3.9 Vs 2.6, p<0.05], prostate volume [45.5 Vs, 34.7, p<0.05], bladder wall thickness [5.6 Vs 3.2, p<0.001], blood flow detection [16/18 Vs 3/12, p<0.001] and DRI [0.82 by 0.65, p<0.005]. BOO was detected with a diagnostic accuracy of 83.3% [25/30] by CDU. Color Doppler ultrasonography has the promise to become a possible indicator for the diagnosis of BOO. To ascertain its clinical utility in terms of BOO predictability, a prospective study in a large cohort is needed

Does urge incontinence contraindicates surgery for stress urinary incontinence?

Urge incontinence is commonly associated with female stress urinary incontinence [SUI]. Many surgeons hesitate to operate for SUI if associated with urgency. Our aim is to define whether urge incontinence contraindicates surgery for SUI or not. This study was conducted on 35 female patients complaining of mixed incontinence [Urge and stress]. Patients with uninhibited detrusor contractions in cystometrogram [CMG] excluded from the study. All patients underwent preoperative assessment by history, physical examination, oblique cystogram, urodynamics [CMG, flowmetry and Valsalva leak point pressure [VLPP]] and cystoscopy. All patients were managed with fascial patch sling either from anterior rectus sheath or fascia lata [in patients with previous suprapubic incision or scarring]. All patients were followed up for one year with the same preoperative parameters. SUI was cured in 34 patients [97.1%] while urge incontinence was cured in 25 patients [71.4%] and persisted in 10 patients [28.6%]. In conclusion, patients complaining of mixed incontinence with urodynamically proved signs of urethral relaxation, as the main component of urge incontinence, will benefit significantly from surgery of SUI

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