Rationale of percutaneous nephrostomy in malignant obstructive uropathy

Percutaneous nephrostomy [PN] was done for 28 patients presenting with malignant obstructive uropathy and impaired renal function. The mean serum creatinine was 15.3 mg% +/- 4.9 mg%. The procedure was performed under local anaesthesia with ultrasound guidance. The renal function improved in 23 patients [82%] with significant decrease in serum creatinine to 3.5 mg% +/- 1.3 mg% [P < 0.001]. There were no serious complications related to PN in any of the patients. Minor complications occured in 8 patients [28.6%] and managed successfully. After improvement in renal function 11 patients underwent radiotherapy and 8 patients underwent chemotherapy for the primary malignancy. 19 patients out of 24 patients [79%] followed up survived more than 2 months. In conclusion, percutaneous nephrostomy in patients with malignant obstructive renal failure is a minimal invasive procedure that improves the renal function and if further treatment is available, the survival may be improved

Postmenopausal stress urinary incontinence: clinical and urodynamic evaluation of combined hormonal replacement therapy

Thirty postmenopausal women suffering from genuine stress urinary incontinence [SUI] were given 0.625 mg of conjugated estrogen and 2.5 mg of medroxyprogesterone acetate for 3 months. They were evaluated clinically and urodynamically before and after combined hormonal replacement, therapy [H R T], Clinically, 10 patients out of 15 [66.7%] with grade I stress urinary incontinence [SUI] had been improved, while 3 patients out of 15 [20%] with grade II SUI had been improved. There was no significant difference in the cystometrogram [CMG] before and after treatment. In those patients who reported clinical improvement, the maximum urethral pressure increased significantly after treatment [40.2 +/- 9.5 cmH2O Vs 65.7 +/- 6.6 cmH2O P < 0.05]. In addition, both the urethral closure pressure and the functional urethral length increased significantly after treatment [38.2 +/- 7.4 cmH2O Vs 59.6 +/- 10.3 cm H2O and 22 +/- . 0.5cm Vs 3.4 +/- 0.2cm respectively P<0.05]. These clinical and urodynarnic data add to the evidence that HRT has a role in conservative treatment in mild to moderate degrees of postmenopausal stress urinary incontinence