Ureteral calculi during pregnancy: review of the management at Ramathibodi Hospital.

OBJECTIVE: To review our experiences with diagnosis and management of symptomatic ureteral calculi complicating pregnancy. MATERIAL AND METHOD: Medical records of all pregnant patients documented with symptomatic ureteral calculi treated at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital from 1990 to 2000 were reviewed. Presenting symptoms, diagnostic studies and management of ureteral stone were evaluated. RESULTS: Twenty patients were found in this study with the mean age of 27.5 years (18-36). The mean gestational age at presentation was 18.5 weeks (12-33). Severe flank pain was the common presenting symptom (100%), 60 per cent were on the right side and 40 per cent were on the left side, 20 per cent had associated fever and 20 per cent had irritative voiding symptoms. All of the cases had micro or macroscopic hematuria. Ultrasonography was the initial test confirming the diagnosis and visualized stones were obtained in 60 per cent of the cases. Plain KUB film was done in 6 cases and stones could be seen in 5 cases (83%). Limited IVP was done in 3 cases and the diagnosis could be done in all of them (100%). Spontaneous passing of stones was noted in 14 cases (70%) and double J stents were placed in 6 cases. Ureterolithotomy was done in 2 cases and percutaneous nephrostomy with subsequent definite stone treatment in the post partum period was done in 2 cases. No abortion and no congenital anomalies of the infant were noted. Four cases had premature labor but there was no correlation with the procedures performed for treating the ureteral stone. CONCLUSION: This study provides evidence for effectiveness of diagnosis and treatment of ureteral stone during pregnancy. The appropriate management may be helpful to reduce morbidity of urinary calculi during pregnancy.

Ureterocalicostomy for reconstruction of complicated ureteropelvic junction obstruction.

OBJECTIVE: To review our experience with ureterocalicostomy using the treatment of complicated ureteropelvic junction (UPJ) obstruction. MATERIAL AND METHOD: Medical records of all patients with complicated ureteropelvic junction obstruction treated by ureterocalicostomy from 1985 to 2000 were reviewed. Causes of UPJ obstruction, surgical techniques, peri-operative course and outcome were noted. RESULTS: Fifteen patients were enrolled in this study (6 males and 9 females) with the mean age of 39 years old (28-45). Twelve patients were after stone surgery, 2 were after pyeloplasty for congenital UPJ obstruction and one patient was after blunt abdominal trauma. All the procedures were done by flank incision. After excision of the lower pole, the ureter was anastomosed to the lower caliceal mucosa without tension over an internal stent. Nephrostomy tubes were used in all of the patients. The mean hospital stay was 14 days (10-20). Twelve cases (80%) were found to be successful and are still doing well with the mean follow-up time of 2.5 years (0.5-12). Three patients (20%) were found to have failed, and subsequently nephrectomy was done in one case and permanent nephrostomy was used in 2 cases due to a solitary kidney. CONCLUSION: Ureterocalicostomy is one of the options for treatment of complicated UPJ obstruction that can provide good drainage as well as excellent long term results.

Penile fracture: long-term outcome of treatment.

OBJECTIVE: Penile fracture is a rare injury, usually resulting from direct trauma to the erect penis during sexual intercourse. Immediate surgical treatment is the basis for the treatment of this injury due to the high rate of complications associated with delayed management. The aim of this study was to evaluate the clinical presentations, diagnostic methods, and outcomes of the treatment. MATERIAL AND METHOD: We retrospectively studied patients with penile fracture treated at Ramathibodi Hospital from 1975 to 2000. Clinical presentation, diagnostic methods, technique of treatment and outcomes of treatment were noted. RESULTS: Twelve patients were found in this study. The mean patient age was 32 years old (range 19-42). The interval from time of injury to presentation was 3-48 hours. Of these patients 10 had been injured during sexual intercourse (83%) while 2 had been injured during masturbation. All patients presented with a very suggestive clinical picture (pain, detumescence and hematoma). No further investigation was needed for confirming the diagnosis. One case had urethral bleeding, therefore, retrograde urethrogahpy was performed but no extravasation of contrast media was noted. All patients were treated by immediate surgery, through a circular subcoronal incision and degloving of the penis to allow a thorough exploration. All of the patients had a tunica albuginea tear that was promptly repaired. No associated urethral larceration was noted. All of the patients did very well after surgery and two had mild curvature, which had not hindered intercourse at follow-up (mean time of 24 months). CONCLUSIONS: Penile fracture has very typical clinical signs and no further investigation is usually needed. Early surgical treatment is associated with a low incidence of late complications.

Clinical trial of the phytoestrogen-rich herb, pueraria mirifica as a crude drug in the treatment of symptoms in menopausal women.

The clinical trial to evaluate the estrogenic effects of the crude drug derived from dry powder of a phytoestrogen-rich Thai herb Pueraria mirifica (White Kwao Krua) in five female volunteers with menopausal symptoms showed that the crude drug clearly improved the signs and symptoms related to menopause such as, hot flushes, frustration, sleep disorder, skin dryness, high blood cholesterol, oligomenorrhoea and amenorrhoea, with no change in the blood cells, liver and kidney functions, as well as other physiological status after four months of treatment. In four volunteers, treatments were continued to complete the one-year test period with half the dose and was found to maintain their satisfied menopausal relief status. The crude drug dosage was administered at 200 mg daily for three weeks a month during the first four months of treatment and 200 mg every other day for 20 days per month for the remaining of eight months. These doses were effective and safe as phytoestrogen treatment of menopausal symptoms.

Public relation media for promotion of male sterilization.

The Thai Association for Voluntary Sterilization provided counseling in family planning to 450 families in 24 slum areas. The instruments were systemic records. A public advertising campaign was done in newspapers 62 times, by handout 3,000 times, through 900 home visits, 44 mobile unit excursions covering 4,400 people. The data indicated 120 male sterilizations carried out on 391 interested parties in family planning, 59.15% of those sterilized learned of the pregramme through posters and public relations, 36.74% by mouth to mouth suggestion, and 35.54% through the newspaper.