ABSTRACT
Objective: To evaluate the role of flexible ureterorenoscopy in diagnosis and treatment of lateralizing essential haematuria
Patients and Methods: Twenty-three patients suffering from unilateral haematuria were included in the study and underwent flexible ureterorenoscopy. Their age ranged from 17 to 68 years [mean age: 36 years]. Unilateral gross haematuria was demonstrated cystoscopically. The patients were subjected to a careful history taking, full laboratory and radiological investigations which, however, failed to localize the cause of haematuria. We therefore applied flexible ureterorenoscopy on the affected ureterorenal unit
Results: The collecting system was inspected in 21/23 patients. Discrete lesions were identified in 11 patients [haemangioma on a renal papilla in six, small vascular lesions in three, a small calculus in one and a small papillary growth in one]. Non-specific abnormalities [erythema of the infundibulum or abnormal configuration in the renal papilla] were found in six patients. No lesion was detected in 4 patients. Patients with non-specific abnormalities were biopsied and coagulated. The remaining 11 patients with discrete lesions underwent laser fragmentation of the calculus, nephroureterectomy for the papillary transitional cell carcinoma [TCC] and 9 patients underwent fulguration with or without biopsies. The haematuria resolved in all patients with discrete lesions. Patients with non-specific abnormalities had a poor outcome in our series, since all had recurrent or persistent bleeding. Follow-up ranged from 6-18 months [mean 9 months]
Conclusion: Flexible ureterorenoscopy can be of value in the diagnosis and treatment of lateralizing haematuria. Patients with discrete lesions respond well to endoscopic treatment [electrocoagulation]
ABSTRACT
Objectives: To compare the outcome of laparoscopic versus open varicocelectomy in sub-fertile obese men presenting with bilateral testicular varicoceles
Materials and Methods Forty obese [body mass index > 30] primary sub-fertile males with bilateral varicoceles were selected for this study and randomly subjected to either laparoscopic varicocelectomy [Goup I, n=20] or high retroperitoneal open ligation [Group II, n=20]. Semen analysis was performed preoperatively and three months or more postoperatively. Scrotal duplex was done for each case preoperatively and 6 months post-operatively
Results: The average operative time in Group I and Group II was tilde 77.3 minutes and tilde 58 minutes, respectively [P< 0.05]. Analgesia requirements were significantly less in the laparoscopic group. Only one patient of Group I developed subcutaneous haematoma, while in Group II three developed wound infections and six patients developed wound seroma. The average hospital stay of the patients of Groups I and II was 8.4 hours and 52 hours, respectively [P< 0.05]. The patients of Group II returned to their usual daily activities after an average of 5.3 days, while the patients of Group II needed an average of 8.4 days [P< 0.05]. Hydrocele occurred in none of the patients of Group I and in three patients [15. 7%] of Group II [P<0.05]. Recurrence of the varicocele occurred in none of the patients of Group I, but in three patients [15.7%] of Group II [P< 0.05]. The semen parameters improved after surgery in both groups. The mean improvement in sperm concentration was tilde 32.5 million sperm/ml in Group I and tilde 25 million sperm/ml in Group II [p>0.05]. The mean improvement in the total sperm count was tilde 96 million sperms in Group I and tilde 92 million sperms in Group II [p>0.05]. The mean percentage of improvement in sperm motility was tilde 16.5% in Group I and 14.1% in Group II [p< 0.05]. The mean decrease in the percentage of abnormal forms was tilde 20% in Group I and tilde 5.5% in Group II [p< 0.05]. Moreover, the quality of motility [grades] improved significantly after laparoscopic varix ligation, to a higher extent than after open surgery
Conclusion: The laparoscopic approach is an excellent option for varix ligation in obese patients. Morbidity is less and convalescence is shorter compared to open surgery. A particular advantage of laparoscopy over conventional surgery is the possibility of treatment of bilateral varicoceles through the usual three laparoscopic ports. In this study, improvement in some semen parameters was significantly better following laparoscopic varix ligation. This may be explained by the better view and magnification offered by laparoscopy
ABSTRACT
To study the effect of bladder outlet obstruction due to benign prostatic hyperplasia [BPH] on type III collagen deposition in bladder wall and it's correlation with the clinical outcome. 33 patients with benign prostatic hyperplasia planned for intervention were included in this study. Patients age ranged from 58-72y [average 66y], patients were divided into 3 groups representing spectrum of condition. Group I included 9 patients who failed medical therapy with moderate IPSS 8-18 and <100 ml residual urine. Group 2 included 18 patients with moderate to high IPSS 20-35 and 100 ml residual urine. Group 3 included 6 patients with chronic urinary retention. All patients had interventions, TURP in 28 and surgical adenectomy in 7 during which bladder biopsies were taken for immunohistochemical studies to determine type III collagen content within the bladder wall. 3 control biopsies were taken from nonobstructed bladders in patients undergoing ureterovesical implantation. Group 1 showed mild to moderate type III collagen deposition in bladder wall, they had the most favorable outcome following relief of obstruction. Qmax 18-25 ml/sec and no residual urine. Group 2 showed moderate to severe type III collagen deposition in bladder wall, they voided adequately postoperatively, Qmax 15-20 ml sec and insignificant residual urine. Group 3 showed extreme form of type III collagen deposition, they had the least favorable outcome with high residual urine. Bladder outlet obstruction increases deposition of type III collagen in the bladder wall. Severe and extensive deposition of type III collagen is associated with pathological bladder function that may affect the outcome of surgery
Subject(s)
Humans , Male , Prostatic Hyperplasia , Collagen Type III , Urinary Bladder/pathology , Biopsy , ImmunohistochemistryABSTRACT
Aim of work to evaluate the role of extracorporeal shock wave lithotripsy versus ureteroscopy in management of lower third ureteric calculi. 60 patient with symptomatic distal ureteric calculi, with age range from 20-54y. [average 36y] were divided into 2 groups. Group 1, 30 patients with average stone size 8mm had ESWL monotherapy for management of their stones with Siemens lithoster plus lithotripor. Group 2, 30 patients with average stone size 10 m.m had ureteroscopy with stone extraction with or without disintigration done for their stones as management. Results Group I: 26 patients [86.6%] became stone free, retreatment rate was [34.5%]. Group2: 29 patients [96.6%] became stone free with no retreatments ureterescopy remains the gold standard treatment for distal ureteric calculi. ESWL might be considered in stones
Subject(s)
Humans , Male , Female , Ureteroscopy/instrumentation , Lithotripsy/statistics & numerical data , Comparative Study , Treatment OutcomeABSTRACT
Objectives: The aim of this study is to evaluate the use of the saphenous vein in grafting the tunica albuginea defect after excision/incision of Peyronie's plaque in cases of disabling penile deformity
Patients and Methods: A total of 12 patients with significant penile curvature due to Peyronie's disease interfering with their sexual activity were subjected to plaque excision/ incision and corporoplasty by saphenous vein patch grafting of the tunica albuginea
Results: Penile straightening was achieved in 9 patients. One patient had a minimal residual curvature with induration at the graft site which, however, did not interfere with his sexual activity. Two patients complained of less rigid erections and are currently responding to oral measures and ICI. Penile numbness occurred in four patients with dorsal plaques, and it was self limiting within six months. We encountered no complaint of penile shortening or impotence
Conclusion: The saphenous vein presents a reasonable alternative grafting material for the repair of tunica albuginea defects in patients with Peyronie's disease after plaque excision/incision. It is particularly useful in large plaque remnants and yields a satisfactory and appreciable outcome
ABSTRACT
Treatment of ureteroceles in children varies according to the anatomicopathological form and the-choice of the surgical team. This study tries to determine the exact value of the endoscopic management of ureteroceles in children. In our study we treated 11 ureteroceles in 10 children by endoscopic incision, 7 of them were intravesical ureteroceles [4 single system and 3 duplex system] and 4 were duplex system ectopic ureteroceles. The procedure consists of a tiny transversal incision at the lower and median aspects of the ureteroceles. In our study the dilation of the upper tract disappeared or decreased in all cases of intravesical ureteroceles and in half the cases of ectopic ureteroceles. The incision of the ureterocele led to a vesicoureteral reflux in the associated ureter in 6 cases 54.5% [43% of the intravesical ureteroceles, 75% of the ectopic ureteroceles]. Following endoscopic treatment, no further surgery was required in 5 of the 7 cases with intravesical ureteroceles [71.5%], while every case of ectopc ureterocele needed a further operation [lower tract surgery in 3 cases and upper tract surgery in 1 case]. Endoscopic incision of ureteroceles is a simple and quick procedure which allows obstruction to be removed and the dilation of the upper tract and its corresponding kidney function to be improved, particularly in the neonate. The endoscopic management of ureteroceles may in itself suffice, without necessity of further surgery. These favorable results can more readily be seen in cases of intravesical ureterocele than in those of ectopic ureterocele