Balloon dilatation for male urethral strictures "revisited"

To analyze the results of balloon dilatation for short segment male urethral strictures. Retrospective analysis was done on 120 patients undergoing urethral balloon dilatation since January 2004 to January 2012. The inclusion criteria for analysis was a short segment [less than 1.5 cm] stricture, exclusion criteria were pediatric, long [more than 1.5 cm], traumatic, malignant strictures. The parameters analyzed included presentation of patients, ascending urethrogram [AUG] and descending urethrogram findings, pre- and postoperative International prostate symptoms score [IPSS], uroflowmetry [Q max], and post-void residue [PVR]. Need for self calibration/ancillary procedures were assessed. Failure was defined as requirement for a subsequent endoscopic or open surgery. A urethral balloon catheter [Cook Urological, Spencer, Indiana] is passed over a guide wire after on table AUG and inflated till 180 psi for 5 minutes under fluoroscopy till waist disappears. Dilatation is followed by insertion of a Foley catheter. Patients were followed up at 1, 3, and 6 months. Mean age was 49.86 years. Mean follow-up was 6 [2-60] months. IPSS improved from 21.6 preoperative to 5.6 postoperatively. Q[max] increased from 5.7 to 19.1 and PVR decreased from 90.2 to 28.8 [P < 0.0001*] postoperatively. At 1, 3, and at 6 monthly follow-up, 69.2% [n = 82] patients were asymptomatic. Balloon dilation is a safe, well-tolerated procedure with minimal complications. Further randomized studies comparing balloon dilatation with direct internal visual urethrotomy are warranted

Management of nephrolithiasis in autosomal dominant polycystic kidney disease - a single center experience

To evaluate available options for the management of nephrolithiasis in patients with autosomal dominant polycystic kidney disease [ADPKD]. Case files of all the patients with ADPKD treated in our hospital in the last 18 years were evaluated. Their demographic details, clinical presentations, investigations, treatments, and outcomes were critically analyzed. There were a total of 19 patients [23 renal units] with nephrolithiasis among 452 consecutive cases of ADPKD. Male-to-female ratio was 3.75:1. The mean age of the patients was 43.3 years [range 23 to 60 years]. The most common presentations were pain and hematuria [27.7% each]. Mean serum creatinine was 7.2 mg/ dl [range 0.8-18.1 mg/dl] at presentation. The mean stone size was 115 mm[2] [range 36 to 980 mm[2]]. The majority of the stones were calyceal [n = 10]. Ten renal units [nine patients] required intervention, while the rest were treated conservatively. Treatment offered included open nephrectomy for non-functioning infected kidney [n = 1], extracorporeal shock wave lithotripsy [ESWL, n = 3], ureterorenoscopy [URS, n = 3], and percutaneous nephrolithotomy [PCNL, n = 3]. All patients undergoing URS and PCNL had complete clearance, while those undergoing ESWL had a residual stone. Two failed ESWL patients required an auxiliary procedure [retrograde intrarenal surgery, RIRS] and the other was kept under observation. Mean follow-up after treatment was 4.2 years [one month to six years]. None of the patients had major complications. Careful selection of the endourological procedure can give good results in patients of ADPKD with nephrolithiasis

Urological manifestations of Chikungunya fever: a single centre experience

Chikungunya is a viral infection often associated with lower urinary tract dysfunction. This study evaluates the urological squeal of Chikungunya fever in a single centre after an epidemic in 2006-2007 in India. Retrospective analysis of medical records of 13 patients with lower urinary tract symptoms after Chikungunya fever was evaluated and outcome following intervention assessed. A total of 13 patients [M:F=9:4], with age ranging from 30 to 72 years, were included in the study. They presented with chronic urinary retention [n=9, 69.23%] of which two had paraparesis, voiding symptoms alone [n=7, 53.8%], storage symptoms alone [n=3, 23%], and acute urinary retention [n=1, 7.6%]. Presentation with lower urinary tract symptoms after an episode of Chikungunya fever was after a mean period of 163 days [range 30-360 days]. Mean serum creatinine on presentation was 1.8 mg/dl [0.6-6.5 mg/dl]. Evaluation revealed dilated upper tract in four [30.7%] patients. Cystometrography showed acontractile detrusor [n=3, 37.5%], hypocontractile detrusor [n=3, 37.5%], overactive detrusor [n=1, 12.5%] and normal study [n=1, 12.5%]. At the mean follow up of 11 months, 11 patients [84.6%] had satisfactory functional outcome after intervention, namely supra pubic diversion and bladder training [n=5, 38.4%], alpha blocker [n=3, 23%], timed frequent voiding [n=2, 15.3%], clean intermittent catheterization [n=2, 15.3%], trial void with alpha blocker [n=1, 7.6%] while two are on continuing supra pubic diversion due to persistent neurological deficit. Chikungunya fever is an uncommon entity in urological practice, often associated with urinary symptoms. An accurate assessment of the symptoms and timely intervention prevents upper tract deterioration and improves the quality of life