Laparoscopic ureterolithotomy: is it an alternative technique replacing open surgery

To assess and evaluate the technique as a replacement to open surgical uretero-lithotomy. Fifteen patients with failed either ESWL or endoscopy and large calculi at the upper ureter were included in this study for performing transperitoneal laparoscopic uneterolithotomy Mean age was 47.2 7 +/- 9.32SD. 9 patients had right sided stones and 6 were left sided. Stone size range was 10-20 mm with mean 14.67 +/- 2.89 SD. 14 cases the stones were in the lumbar region and only 1 case at the iliac region. Successful laparoscopic stone removal were in 13 out of 15 [86.6%]. Two operative conversion to open surgery due to migration of stone in one case and in other conversion is due to injury of left common iliac artery. Operative times was 119.3 +/- 38.03 SD minutes [60-180min] estimated blood loss 62.3 +/- 11.6 [30-100] cc.. mean drain removal time was 3.4 days. mean post operative parentral analgesia was 150 mg of diclofenac sodium [75-300mg], mean hospital stay was 4.3 [3-8days] and mean resuming normal activity was 11.6[8-21 days]. Laparoscopic ureterolithotomy is a safe technique with a shorter hospital stay and rapid return to normal activity and offers an alternative modality than open surgery after treatment failure [ESWL, endoscopy] or for large size calculi. Open surgery has a role for managing laparoscopic converted cases

Role of urodynamic findings in revision of many concepts about chronic prostatitis syndrome

Objective: to evaluate urodynamic ally, patients with chronic prostatitis syndrome to define a specific urodynamic pattern in each prostatitis group that might add information about the pathogenesis of the syndrome and treating such patients more efficiently

Patients and Methods: fifty patients aged from 24-50 years with symptoms suggestive of chronic prostatitis, were evaluated by standard four-glass test using direct microscopy and culture for all specimens. Patients were classified according to National Institutes of Health Classifications System into non-inflammatory chronic pelvic pain syndrome [NiCPPS [Group1]], chronic bacterial prostatitis [CBP [Group 2]], and inflammatory chronic pelvic pain syndrome [ICPPS [Group 3]. Patients with documented urethritis urinary tract infection, lower urinary tract neuropathy or history of lower urinary tract surgery are excluded from the study. Furthermore all patients were evaluated by transrectal ultrasound and through urodynamic study including flowmetry, filling cystometry, pressure flow study [PFS] and electromyography of distal urethral sphincter [EMG]. Out of 50 patients pressure flow study [PFS] and EMG are conducted in only 27 patients, while the remainder cannot complete these urodynamic sturdies. Results were statistically analyzed rising F tests where P>0.05 was significant

Results: the common urodynamic finding represent decreased mean Q max the three groups of chronic prostatitis syndrome [l6 +/- 3 ml/sec]. However no significant difference between groups regarding the Q max [P value ~0.05] Out of the 50 who underwent filing cystometry, 30 patients [60%] had a first sensation of filling and 33 patients [66%] had a desire to void at low volumes [0.05]. Of 27 patients who underwent IPFS] and EMG, 16 patients had an obstructed pattern of micturition. However there was no significant difference between NICPPS and CBP group regarding [PFS] [P>0.05]. EMG study of distal urethral sphincter [27 patients] reveal that 9 patients from 16 patients with NICPPS and 2 patients from 11 with CBP show EMG activity during voiding, and there was a statistically significant difference between both groups [P <0.05, Chi square 3.9]

Conclusion: complaints, transrectal ultrasound and urodynamic findings were generally similar in the 3 groups of prostatitis syndrome. Therefore, the differentiation of the syndrome into 3 groups based on results of direct microscopic examination and cultures of the 4-glass test seem to be not logical. In addition, urodynamic evaluation explores sensory and motor dysfunctions, which may not only help in pathophysiological explanation of this syndrome but also in planning treatment

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

Effect of varicocelectomy on semen parameters in patients with subclinical varicocele

This study was carried out to assess the importance of subclinical grade of varicocele in evaluation of subfertile men. A total of 60 subfertile men with subclinical varicocele diagnosed by scrotal color dupplex ultrasound. Patients were randomly assigned to group I in whom high ligation varicocelectomy was performed and group II who received placebo treatment. Patients were followed up by seminogram at 3 and 6 months. Patients underwent high ligation varicocelectomy Group I showed statistically significant improvement in sperm count after. 3 months and highly statistically significant improvement in sperm count after 6 months. The statistically significant. Improvement in the percentage of abnormal forms was noticed only after 6 months postoperatively. In group II follow up showed non-significant improvement in sperm count, percentage of abnormal forms and grades of sperm motility at either 3 or 6 months. We concluded that the effect of varicocele on semen parameters has no relation to its size and consequently varicocelectomy for subclinical varicocele. diagnosed by color dupplex ultrasound, has benificial effect on semen parameters