Failure of ESWL to cure

To Study the causes of failure of ESWL in the management of urinary stones. The treatment of urinary calculi has been changed during the last two decades from open surgery to percutaneous and endoscopic precedures to extra-corporeal shock wave lithotripsy. In this study, failure of ESWL to cure urinary stone patients was studied in detail. Material and Between April 1999, and April 2003, 1090 patients presenting with a total of 1180 renal and ureteric stones were treated by extra-corporeal lithotripsy [Siemens Lithostar Lithotriptor] in Urology Department of Alexandria University. No anasethesia was performed during 3400 sessions required. Extra-corporeal shockwave lithotripsy was considered a failure if residual stone fragments remained after 3 months, or an auxiliary procedure or re-treatment was required. Fragmentation was obtained in 84% of cases. The complete success rate was 69%, the partial success rate was 15% and the failure rate was 16%. An average of 5,255 impulses [3460-11.340] per patient. The failure cases included 48 calyceal stonees [21 of them in a calyceal diverticulum], cystine, calcium phhosphate [brushite] stones and calcium oxalate menohydrate were the most difficult type of stone to fragment in ESWL [100 stones] and big impacted lower third ureteric stones were also difficult to be fragmented [40 stones]. Complications appeared in 210 patients: 80 had renal colic, 30 steine-strasse, 26 haematuria, 50 fever and 24 subcutaneous hematoma. Failure of ESWL to treat urinary stones is due mainly to: site of the stone [calyceal, lower third ureter], size of the stone [bigger than 2 cm], type of the stone [cystine, calciumphosphate and calcium oxalate monohydrate], degree of impaction of the stone, presence of infection, and finally severity hydronephrosis

Would mirosurgical testicular sperm extraction replace the conventional technique for non-obstructive azoospermia?

To study the effectiveness of microsurgical testicular sperm extraction in non-obstructive azoospermia. Testicular sperm extraction [TESE] is well-defined procedure for surgical sperm retrieval in obstructive and non-obstructive azoospermia. This study was focused on the evaluation of the effectiveness of microsurgical testicular sperm extraction [TESE] in intracytoplasmic sperm injection [ICSI] for non-obstructive azoospermia. Material and Forty-two [42] male patients were included in this study. They were classified into 4 groups. Group I: Patients with normal sized tests and normal FSH, with previous diagnostic biopsy [10 patients]. Group II: Patients with normal sized tests and normal FSH, with previous conventional TESE [10 patients]. Group III: Patients with small sized tests and high FSH, and without previous testicular biopsy [20 patients]. Group IV: Patients with kleinfelter's syndrome [2 patients]. Microsurgical TESE was compared with conventional TESE as regard sperm recovery rate and complications were assessed by ultrasonographic and endocrinological methods. Microsurgical technique could extract sperm in 7 patients [70%] of group 1, 6 patients [60%] of group II and in in 5 patients [50%] of group III. It also succeded to extract sperm in group IV [kleinfelter's syndrome]. The sperm retrieval rate by microdissection TESE [60%] appeared higher than by conventional TESE [40%]. However, this observation failed to reach statistical significance. Microsurgical TESE could retrieve sperm in 100% of patients with hypospermatogenesis while conventional TESE retrieved sperm in 87.5%. Microsurgical TESE could retrieve sperm in 58.3% of patients with Sertoli only syndrome while conventional TESE retrieved sperm in only 8.3%. This was statistically significant [p < 0.05]. Microsurgical TESE could retrieve sperm in 20% of patients with maturation arrest while non-microsurgical TESE retrieved sperm in 40%. The complication rate was indifferent between microdissection and conventionol TESE. Microsurgical testicular sperm extraction is an ideal methodss for harvesting the sperm specially in difficult cases [small sized tests, cases of failed previous diagnostic biopsy or conventional TESE, repeated TESE, and in Kleinfelter's syndrome]. It allows selection of seminiferous tubules more likely to contain sperm specially in Sertoli only syndrome and Kleinfelter's syndrome. It also allows identification and avoidance of tessticular vessels, minimizing complications