Role of percutaneous drainage in management of emphysematous pyelonephritis: a changing concept

To present the outcome of percutaneous drainage in cases of emphysematous pyelonephritis [EPN] and feasibility of avoiding nephrectomy in such patients with poor general condition. EPN was diagnosed in seventeen patients by computerized tomography [CT]. All patients received intravenous fluids and antibiotics. Emergency nephrectomy was carried out in two patients. Three patients died before any surgical intervention due to cerebrovascular stroke, uremia and diabetic coma. Percutaneous drainage was carried out for the remaining 12 patients. Kidney could be saved in 3 and subsequent nephrectomy was done in 9 patients. Two patients who underwent emergency nephrectomy survived. Of the evaluable 12 patients [10 diabetic and 2 nondiabetic]; percutaneous drainage was carried out. Resolution of inflammatory process was found in 3 cases and kidney recovered and preserved. Percutaneous drainage was unsuccessful in 9 patients; thus, secondary nephrectomy was necessary but in a better general condition of the patients. The pathogenic organism was Escherichia coli in 9, klebsiella pneumoniae in 2 and proteus mirabilis in 1. Percutaneous drainage may be considered as an alternative to immediate nephrectomy in emphysematous pyelonephritis. It could be the only treatment required and the affected kidney could be preserved. On the other hand when nephrectomy is inevitable percutaneous drainage can delay it until the general condition of the patient becomes better and the technical difficulties become minimal

laparoscopic management of the impalpable testicle: could it be the standard procedure?

From August 1998 to Jane 2001, we managed 19 patients aged 3 4-28 [mean 21] years with unilateral impalpable testicles [8 right and 11 left]. Inguinal ultrasonography [US] was done to- all patients pre-operatively and one inguinal testicle was detected. Examination under anaesttesia detected another inguinal testicle. Open trans-inguinal ororchidopexy was done for both. The remaining 17 patients were all subjected tolaparoscopy with diagnostic and therapeutic intentions 7 intra-abdominal non-atrophic testicles with long tortuous testicular vessels were managed by laparoscopic one-stage orchidopexy with preservation of testicular vessels. Two intra-abdominal non-atrophic testicles with short direct testicular vessels were managed by laparoscopic two-stage Fowler-Stephens [F-S] procedure at six-month interval. One intra-abdominal atrophic testicle was managed by laparoscopic orchidectomy. One intra-abdominal blind-ending vas deferens needed no further management In 6 patients the vas and vessels were seen entering the internal inguinal ring and inguinal exploration was done at the same setting with the following results; 2 non-atrophic testicles were managed by orchidopexy, 3 atrophic testicles were managed by orchidectomy and one blind-ending vas needed no further management. Among our 19 patients, there were 7 epsilateral hernial sacs, Which were managed by inguinal hernia repair at the same operative setting without recurrences at 6-month follow-up, Laparoscopic localization of testicular position was 100% successful. The success rate of laparoscopic orchidopexy [7 one-stage and 2 two-stage F-S] was 89%, which was defined as scrotal testicular position without atrophy at 6 months follow-up. Apart from one minor self-limited subcutaneous emphysema, laparoscopic procedures were not attended by complications. Our study confirms the safety and efficacy of laparoscopic diagnosis and therapy of impalpable testicles in adults

Management of unique operative and post operative surgical complications of renal transplantation

Renal transplantation is a successful and widely accepted treatment for patients with chronic renal failure [CRF]. Patient and graft survival continued to show better results secondary to improved surgical techniques and potent immunosuppressive drugs. Nevertheless, technical and infectious problems continued to contribute to the morbidity and mortality of renal transplant recipients. This paper presents the way we managed renal transplant recipients who experienced unique and uncommon operative and post operative surgical complications. Anuria secondary to neglected broken double [J] ureteric catheter, aneurysm of renal artery, complete rupture of renal artery and complete rupture of renal vein due to venous hypertension were managed successfully. In conclusion, renal transplant recipients need close observation and regular follow up. Prompt decision making and rapid and wise intervention are necessary to circumvent major complications that may jeopardize renal graft and threaten patient's life can save both of them