Renoprotective effect of mannitol infusion during extracorporeal shock lithotripsy

To evaluate the role of mannitol infusion in preventing or ameliorating renal injury that accompanies shock wave lithotripsy as measured by changes in resistive index [RI]. Between February and September 2006, 38 patients [28 men and 10 women] underwent extracorporeal shock wave lithotripsy [ESWL] for radiologically documented renal stones in The Surgical Specialties Hospital ESWL unit, Baghdad, Iraq. The 38 patients aged 20-50 years with renal stones of 10-20 mm size, scheduled for ESWL therapy, were divided into a control group [20 patients] and mannitol group [treatment group of 18 patients]. All patients had their renal RI measured before ESWL, immediately after ESWL, then 3 and 7 days later. While patients in the mannitol group were given 0.5 gm/kg mannitol infusion during lithotripsy, the control group patients were given nothing. Changes in renal RI in both groups were evaluated statistically within the group and between the 2 groups. A significant rise in renal RI was found in the control group immediately after ESWL, then 3 and 7 days after. It increased from an initial value of 0.5875 to 0.6500, 0.6300, and 0.6245. The mannitol group showed fewer changes, yet still significant from 0.5850 to 0.6061, 0.6022, and 0.5967. This elevation of renal RI in the control group when compared to the mannitol group was statistically significant. Mannitol has a renoprotective function when given during ESWL, as evidenced by the statistically significant reduction in renal RI

Preoperative vascular evaluation of living renal donors Gadolinium-enhanced magnetic resonance angiography [MRA] versus conventional renal angiography

The aim is to assess the accuracy and sensitivity of Magnetic Resonance Angiography [MRA] in preoperative vascular evaluation of living renal donors. Twenty five individuals [donors] coming up for renal donation, eleven related and fourteen unrelated donors with ages between 20-45 years. Each donor had 3D MRA as an outpatient procedure and intra-arterial DSA [Digital Subtraction Angiography] as an inpatient procedure. The operative findings were considered as a standard for comparison between MRA and DSA results. No difference was found between MRA and DSA. The accuracy of MRA when compared with operative finding was 96%. MRA is a non-invasive, accurate and pretty safe procedure for the evaluation of healthy renal donors

Lower ureteral obstruction and leakage in the first month following renal transplantation

Transplantation has revolutionized treatment of end- stage renal disease [ESRD] by proving more cost effective than hemodialysis, with a lower morbidity and improved quality of life. To evaluate the development of these complications in the first month postoperatively and correlate their development to the type of donation whether related or unrelated. Fifty [50] patients aged [15-62] years, with a mean age [34.46 +/- 12.4 SD] years with [ESRD], who underwent renal transplantation from September 2000 to October 2002, were followed-up for one month postoperatively clinically and by assessment of renal function tests, sonographic and Doppler examinations. Ureteral obstruction was considered in those patients who had allograft dysfunction, ultrasonic evidence of peritransplant collection, moderate-severe dilatation of upper urinary tract of transplanted kidney and postoperative ipsilateral or bilateral leg edema. Ureteral leakage was considered in those patients who had persistent drainage of urine with or without allograft dysfunction. Two patients were excluded from the follow-up due to death in the first 24-hour postoperatively. Six [6] patients [12.5% of cases] developed ureteral obstruction due to peri-ureteral fluid collection. In five patients the collection decreased and upper urinary tract dilatation improved gradually, as shown by ultrasound, on watchful waiting. One patient had surgical evacuation of a large hematoma. Four [4] patients [8.3% of cases] developed ureteral leakage. The leakage stopped in one patient after keeping the urethral catheter for a longer period. Three patients had surgical exploration due to persistent urinary leakage. Redo implantation of allograft ureter was done in two cases. Development of ureteral complications was compared with the type of donation [related or unrelated]. The comparison was not statistically significant. The development of ureteral complications in not related to the type of donation. Extravesical ureteral anastamosis with the use of a stent is less likely to be associated with postoperative ureteral complications

Non tunneled, non stented ureterovesical anastomosis in kidney transplantation

Many methods have been proposed for reconstructing the urinary tract after renal transplantation. It remains unclear whether an antireflux procedure is better than a simple non-tunneling anastomosis. We studied the fate of their ureteroneocystostomy. One hundred cases in an eight-year period with an age range of 14-54 years receiving a living related donor graft were reviewed. All had an intravesical uretero-vesical anastomosis without tunneling or stenting. Twelve patient had a simple urinary leak that responded to catheterization. Two patients had their anterior bladder wall gapping sutured with uneventful course. No morbidity of morality, directly related to the type of anastomosis occurred. Conclusions: The simple non-tunneled non-stented uretero-vesical anastomosis in kidney transplantation seems to be an easy procedure that dose not carry a higher rate of complications than the other currently used methods

Bladder exstrophy: treatment and results

67 patients [49 males and 18 females] presented with bladder extrophy with ages ranging from 30 days 28 years and have been followed for up to 12 years. The surgical procedures were multiple and included primary or secondary closure [with or without iliac osteotomy], ileocystoplasty, tightening of bladder neck, creation of a urinary pouch to replace the bladder, ureterosigmoid anastamosis, and repair of epispadius. Closure was eventually achieved in all the cases who attended for the completion of their treatment, and with the repair of epispadius, continence was not achieved although bladder augmentation helped in keeping the patients dry for longer hours especially on supine position. Although the treatment of bladder extrophy should start immediately after birth, yet older patients should not be denied the long painstaking procedures to let them lead an almost a normal life

living related kidney doner findings, results and effects

One hundred kidney donors over the legal of 18 years [622 males and 38 females] were reviewed. The left kidney was chosen in 65 donors and the right in 35 preferring the kidney with a single artery [as it was in 78 donors]. The hot ischemic time ranged from six and a half to fourteen and a half minute and the cold ischemic time ranged from 95 to 195 minutes. The morbidity included pleural injury [4 patients] and jaundice [1 patient]. Only 82 donors appeared for follow up in a period raging from 3 months to 10 years after the operation. There was no signifidant hypertension. Eleven out of thirty-eight female patients had one or multiple pregnancies and all donors returned to their original work or activities, there was no mortality. The results of donor nephrectomy are encouraging and until cadaveric kidneys become available in our country we need to continue using living related donors with good selection preoperative and postoperative care

Spontaneous rupture of the kidney due to congenital pelviureteric junction obstruction presenting as an acute abdomen

Three adults with congenital pelviureteric junction [PUJ] obstruction who presented with acute abdomen, they had vague symptoms prior to this incident that were not specific to their urinary tract. All had uroperitoneum and all had no obvious macroscopical site of urinary extravasation from the involved kidney. This underlying pathology should be born in mind when dealing with cases of acute abdomen. Spontaneous rupture of the kidney is considered to be a relatively rare condition The underlying cause may be renal or ureteral tumors[however fewer still are the cases of rupture that are secondary to congenital pelviureteric junction obstruction Here in 3 of such cases are reported

prognostic importance of previously treated bilharziasis stage T1 transitional cell carcinoma of the bladder

84 patients were presented with stage T1 transitional cell carcinoma of the bladder. 29 of them had a history of treated bilharzial infestation earlier in their life. The advent of better hygienic conditions and the prompt use of anti- bilharzial drugs made this infestation a minor incidence in well treated cases. This subgroup of patients may fall later into the standard incidence rate of the same age and sex group of population that may develop stage T1 transitional cell carcinoma of the bladder Bilharziasis was calculated as a prognostic factor in the assessment of tumor recurrence rate. There was a significant increase in the tumor recurrence rate in patients with history of bilharziasis at a p

Smooth muscle tumors of the scrotum: Report of 3 new cases

Three cases of non-epithelial tumours of the scrotum are presented. A suggestion for the management was made which would depend on the grade of the smooth muscle tumour. This can be decided from the first operation by doing a frozen section examination

Ventral diverticual of the anterior urethra: single-staged open surgical excision

Four male patients with anterior urethral diverticulum are presented. In three of the patients the diverticulum contained calculi. All were treated successfully by single-staged open surgical excision and urethral closure

Prostatectomy: the trend to perform more by the transurethral route

Two hundred and twenty five patients underwent transurethral resection of the prostate [TURP] from 1982 to 1986. This accounted for 89.1% of the prostatectomies performed in this period. Complications are discussed as TURP syndrome has not been encountered. The mortality rate was 0.44%. These findings support the current trend of performing the majority of prostatectomies by the transurethral route, and stresses. the need for training more surgeons to carry out this type of surgery

first five years experience with optical urethrotomy in Iraq

Optical urethrotomy was performed on 102 male patients with urethral strictures. The majority [67.7%] of the patients required no further procedures. The rest required multiple urethrotomies until they were asymptomatic with a good urinary stream. Optical urethrotomy is a simple and efficient initial treatment for male urethral strictures

Urodynamics in chronic bilharziasis

Cystometry and uroflowmetry were performed in thrity three patients with symptomatic chronic vesical schistosomiasis, in eighteen patients the bladders had diminished capacity, however larger than normal capacity bladders were found in fifteen patients, this was an unusual finding which was first attributed to bladder neck obstruction, yet flowmetry showed normal urinary flow in the later group. Few suggestions have been made