Ureteral stent versus percutaneous nephrostomy for diversion of stone-induced hydronephrosis

Urinary diversion of the obstructed hydronephrosis kidney is indicated by symptoms, such as persistent renal colic, febrile UTI [urosepsis], and uraemia. This study is an attempt to evaluate [PCN] versus ureteral stent in cases of stone-induced hydronephrosis regarding relief of symptoms and quality of life. A total of 40 patients with stone-induced hydronephrosis were randomized into either [PCN] or stent insertion groups. These patients were then evaluated regarding to [a]- the procedure [use of analgesics, x-ray exposure, success of insertion], [b]- relief of accompanying symptoms [duration of diversion, intravenous administration of antibiotics for high temperature]; and [c]- the quality of life. Two groups of patients: [a] - the group of [PCN] has an average age of 55 years, and a male-to-female ratio of 12:8. [b]- The group of ureteral stent has an average age of 49 years, and a male-to-female ratio of 9:11. - [PCN] was successfully completed in 100% of patients and stents were successful in 80%, with a 20% conversion to [secondary PCN].- The x-ray exposure was shorter in the [PCN] group [p = 0. 052].- Administration of analgesics was more frequent in the stent group [p = 0. 061]. - [PCN] indwelling time was shorter [50% less than 2 weeks] than that of stents [25% less than 2 weeks] [p = 0.043]. - Antibiotics were administered for greater than 6 days in 0% of patients who underwent [PCN] versus 70% in those with stents [p = 0.174]. - Reduction in quality of life was moderate but more pronounced in patients with stents compared to those who underwent [PCN], and was more distinct in males and younger patients. The quality of life progressively improved in the course of diversion with [PCN] but deteriorated with stents. Our results demonstrated that [PCN] is superior to ureteral stents when diversion is indicated in cases of stone-induced hydronephrosis, especially in patients with a high temperature, as well as in males

Clinically insignificant residual fragments [CIRFs] after [ESWL]

To assess the significance of asymptomatic residual stone fragments of less than 4 mm [clinically insignificant residual fragments [CIRFs] after extracorporeal shock wave lithotripsy [ESWL]. Eighty-one patients were followed up for 6 to 60 months [mean 15] after ESWL to determine the fate of the CIRFs. -Of the 81 patients, 6 were lost to follow-up, leaving 75 patients. -During follow-up, fragments passed spontaneously in 18 patients, remained stable in 13 patients, and became clinically significant in 44 patients who developed one or more complications. For the latter patients, repeated ESWL was done in 16, percutaneous nephrolithotomy in 3, and ureteroscopic stone removal in 4 patients. The remaining 21 patients were treated conservatively with analgesics. -We found that: a]- 53% of the CIRFs located in the pelvis passed spontaneously, and most of the CIRFs in caliceal location became clinically significant. b]- as the stone burden and number of stone fragments increased, the risk of CIRFs becoming clinically significant increased. c]- The clearance rate was highest in the first 6 months. Finally, as the duration of follow-up increased, the rate of complications increased. Patients with residual stones after ESWL require close follow-up and timely adjuvant therapy. As the number and size of residual fragments increased, the risk of complications increased. A pelvic location was a favorable factor for spontaneous passage. Although the complete clearance rate of CIRFs with repeated ESWL was lower than for the operative interventions, most patients improved with this modality

Serum P.S.A level in clinical prostatitis

This work is an attempt to find out a practically applicable correlation between the changes of serum [P.S.A] in patients with symptomatic, clinical Prostatitis [acute and chronic] and the natural history of the disease. A total of 45 cases, age ranges 22-47 years and U/S prostate volume ranges 18-30 ml, 8 cases of acute prostatitis [A.P], 14 cases chronic bacterial prostatitis [C.B.P], and 23cases of chronic non-bacterial prostatitis [N.B.P]. Medical therapy for 6 weeks to all patients, and Serum [P.S.A] was measured at presentation then 3 and 6 weeks after starting medical therapy, and the degree of serum [P.S.A] elevation was assigned as mild [>the age-specific range but < 4 ng/ml], moderate [from 4 to 10 ng/ml] and significant [>10 ng/ml].All patients have attended follow-up for 9-12 months to evaluate for clinical relapse. Using the Age-Specific reference range; at presentation Serum [P.S.A] was elevated in 25 patients [55.6 percent of the total], it includes all cases of [A.P], 8 out of 14 cases of [C.B.P] and 9 out of 23 cases of [N.B.P]. The elevation was mild in 13 cases, moderate in 8 cases and significant in 4 cases. After 3-6 weeks of medical [antibiotics] treatment, serum [P.S.A] has decreased to the normal range in 21 out of the 25 cases [84 percent] and it was associated with significant clinical improvement during 9-12 months. Although clinical improvement and no growth cultures of the Expressed Prostatic Secretion [E.P.S] are achieved within 1-2 weeks of treatment, substantial reduction or normalization of [P.S.A] isn't achieved before 3-6 weeks of therapy; and it may be a better indicator regarding control of the inflammatory process and a hallmark of infrequent clinical relapse

Serum levels of total testosterone and the severity of erectile dysfunction

The aim of this study was to correlate the severity of erectile dysfunction [ED] with the total testosterone serum levels [TT], 208 men aged 40 to 80 years, were asked to answer the questionnaire of the Simplified International Index of Erectile Function [IIEF-5] as a method to diagnose and classify ED. The IIEF-5 scores ranged from 1 to 25 and the ED was classified into five groups according to the score: severe [1-7], moderate [8-11], mild - moderate [12-16], mild [17-21], and no ED [22-25]. Also, all subjects had their TT serum levels determined based on the blood sample obtained between 08:00 and 10:00. The analysis of the relationship between the different degrees of ED and TT levels were then studied. The prevalence of all degrees of ED was 49.0 percent. The degree of ED was mild in 15.38 percent, mild to moderate in 13.46 percent, moderate in 6.25 percent and severe in 13.94 percent. The variation of TT serum concentrations was similar [P > 0.05] in the different age groups. Furthermore, the TT serum levels were not different for individuals with and without ED [P > 0.05] and similar concentrations of TT was observed in different severity degrees of ED [P > 0.05]. ED presented a clear association with the subjects' aging, but neither correlation between TT levels and ED, nor with its severity, could be demonstrated in the present study

Resistance index [R.I] as a predicitive in the treatment of erectile dysfunction [E.D]

The aim of this work is to utilize the Pharmaco-Penile Duplex Ultrasonography [P.P.D.U] as a treatment-directed instead of an etiology-directed approach in cases of Erectile Dysfunction [E.D]. The intended treatment is Intra-Corporeal Injection [I.C.I] therapy using PEi; and the approach aims at 1- nullifying the most feared complication of prolonged erection; and 2- assessing the predictive value of the Resistance Index'[R.I] regarding an adequate erectile response with subsequent dose escalation. 68 cases of [E.D], all have started with a low dose [4mg of PEi] during the [P.P.D.U] and two parameters were traced in all cases 1- the patient's self report of erectile response. And 2- Resistance Index [R.I]: a] 8cases[41.8 percent] have achieved an adequate erectile response with this low dose [responders], all have adhered to self-injection therapy and within 4-7 months of follow-up, 75 percent of them experienced recovery of spontaneous erection. b] 40 cases [58.8 percent] failed to achieve an adequate erectile response with the low dose [non-responders], all have adhered to self-injection with dose escalation; 91.6 percent of the cases with R.I > 0.8 [during the initial P.P.D.U test] have achieved an adequate erectile response with dose escalation, while only 12.5 percent of the cases with R.I<0.8 have achieved an adequate erectile response with dose escalation [the maximum dose per injection did not exceed 20mg]. No cases of prolonged erection have been reported. The treatment-directed approach helps to: 4 Obviate the risk of prolonged erection. 4 Greatly simplify and nullify the limitation of operator dependency of the [P.P.D.U test] because; It doesn't require the measurement of pre- and post-injection diameters of the small cavernously arteries with its inherent inaccuracy. It relies on the measurement of [R.I], therefore; variations and/or possible errors in measurement of [P.S.V] and [E.D.V] are filtered out in the ratio R.I-P.S.V - E.D.V / P.S.V. R.I > 0.8 strongly predicts an adequate erectile response with subsequent dose escalation

In-situ extra corporeal shock-wave lithotripsy as a primary treatment for ureteral stones

The aim of the study was to evaluate the results of extracorporeal shock-wave lithotripsy [ESWL] as a primary treatment for ureteral calculi at different levels. We treated 166 consecutive patients with solitary ureteral stones [73 at the upper, 4 at the middle, and 89 at the lower ureter] by primary in situ ESWL on an outpatient basis. A maximum of three treatments were individually given before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates, complications and time to complete stone clearance were recorded. Complete stone clearance was achieved in 152 patients [91.6 percent] after an average of 10.2 days [range 1-28]. The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter, and the difference was statistically significant. However, the differences in the final success rate and time to stone clearance were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure or in cases of larger stones in the lower ureter when it might be the first option