Surgical complications in live related kidney transplant patients at the royal medical services: review of the last three years

To determine the surgical complications in live related kidney transplant patients at the Royal Medical Services. Over the period of three years from January 2008 through December 2010, all patients who underwent living related kidney transplant at Prince Hussein Bin Abdullah Urology Center at the Royal Medical Services were included in the study with a minimum follow up of 6 months for surgical complications. A total of 188 patients were included in the study. 11 patients were children and 63 were females. The frequency of surgical complications is 20.7%. General surgical complications were 4.25% that included deep vein thrombosis [1.06%], wound infection [1.06%], urinary tract infections [1.59%] and myocardial infarction [0.53%]. The frequency of vascular complications was 12.2% including two cases of renal artery stenosis [1.06%], others included lymphocele [8.5%], hematomas [1.59%] and two cases of reopening for bleeding [1.06%]. Urological complications frequency was 4.3%, three [1.59%] urethral strictures, three [1.59%] with lower ureteral stenosis and two [1.06%] with prolonged urine leak. Kidney transplant is a viable treatment option for renal failure. Our results were compatible with the international figures. Prompt and early identification of the complication allows quick and proper management

Tubeless percutaneous nephrolithotomy: our experience at Queen Rania urology center

To assess the outcome and safety of tubeless percutaneous nephrolithotomy in managing renal and upper ureteric stones in selected patients. Between June 2003 and July 2006, 85 patients with mean age of 35 years [range 17-67], were selected by simple random sampling method where two patients were chosen on weekly basis [2 patients every week] for the whole study period at Queen Rania Urology Center to undergo tubeless percutaneous nephrolithotomy for renal and upper ureteric stones. Of 85 patients, 50 cases were on the left side and 35 cases were on the right side, stone size was less then 3 cm in all cases. Nephrostomy tubes were not used in any patient. The incidence of complications, transfusion requirement, stone free rate and length of hospital stay were obtained. From 85 patients, 63 [74%] patients had solitary renal stone, 18 [21%] patients had multiple stones and 4 [5%] patients had upper ureteric stones. Average hospital stay postoperatively was 2 days [1-3]. The mean duration of percutaneous nephrolithotomy was 60 minutes [45-110], complete stone clearance was achieved in 77 patients [91%], 8 patients [9%] had small residual stones [<5mm] from which 3 patients [3.5%] required Extra Corporeal Shock Wave. Lithotripsy, while other patients required no further management. Blood transfusion was required in one patient because of postoperative hematuria which subsided spontaneously. Tubeless percutaneous nephrolithotomy is a safe, effective procedure for renal and upper ureteric stones in selected patients

Laparoscopic evaluation of non-palpable undescended testis

To evaluate the laparoscopic technique as a diagnostic and therapeutic tool in the management of patients with impalpable testis. During the period from January 2002 to September 2003, sixteen patients with mean age of years underwent laparoscopic to evaluate impalpable testis. Special attention was paid to the value of laparoscope in the diagnosis of these testis, in regards to their presence or absence, quality of the testis and the state of the spermatic vessels and character of the vas deferens. The laparoscope was also used in management after diagnosis. Laparoscopic orchidectomy was performed. Sixteen patients underwent laparoscopy to localize 19 impalpable testis, 13 patients had unilateral disease, while 3 patients had bilateral disease. Six testis were congenitally absent while 13 were atrophic. None were salvageable. All were removed laparoscopically. Histopathological report of the removed testis revealed atrophic testis in all cases. There was no perioperative or postoperative reported complication in all of our 16 patients. Laparoscopy is safe, minimally invasive procedure with low morbidity. It enable precise diagnosis and management of impalpable testis

Extravesical ureteral reimplantation [Lich-Gregoir] and our experience at King Hussein medical center

Various techniques of ureteral reimplantation have been described for the correction of vesicoureteral reflux. We report our experience regarding the efficacu of Lich-Gregoir method in the treatment of vesicoureteral reflux. During the period September 1999 - May 2002, 14 patients [6 males and 8 females] were treated by the Lich-Gregoir method for the treatment of vesicoureteral reflux. The procedure consisted of suprahiatal detrusor myotomy and exposure of the bladder mucosa followed by placing the ureter over bladder mucosa and detrusor muscle was closed over it using 4/0 polyglycolic acid suture. This procedure was initially successful in all patients. However, one of our patients who had bilateral grade IV reflux continued to have mild degree of reflux in the left side, which was treated conservatively for one year with improvement. Thus the success rate was 93% after surgery and the one-year success rate was 100%. Urinary retention developed in one child and successful recovery after conservative management with urethral catheter drainage for 5 days. Hopitalization after surgery ranged from 1-3 days. The Lich-Gregoir method of extravesical ureteral reimplantation is successful, simple to perform, reproducible and associated with low morbidity. It also requires minimal hospital stay. These results should encourage the use of this technique when indicated to correct vesicoureteral reflux in children

comparison between laparoscopic varicocelectomy and the open method. Our experience at the hospitals of the Royal Medical Services

To report our experience in laparoscopic varicocelectomy in the treatment of varicocele in adults and to compare the results with those treated by the open method. During the period from January 1998 till January 2001 two groups of adult patients with varicocele were simultaneously operated on at the hospitals of the Royal Medical Services, group I by laparoscopy and group II by open method. Each group included 100 patients. There was no significant difference regarding the operative time between the two groups. However, group I patients had significantly less consumption of pethidine equivalent for postoperative pain control, they were mobilized earlier, had a shorter hospital stay, and a faster return to normal activities and less complication rates. None of this group needed conversion to the open method. Laparoscopic varicocelectomy has results similar to those of the open method. However, its postoperative advantages compared to the open approach are obvious

Laparoscopic total extra peritoneal hernioplasty: a retrospective study at Royal Medical Services at Queen Alia Hospital/Jordan

Aim : to evaluate the role and benefits of laporoscopic total extraperitoneal hernioplasty. Patients and methods this is a retrospective study of 25 patients who underwent laporoscopic total extra-peritoneal [I.T.E.P.] hernioplasty in Royal medical services between January 1998 and January 2000.Twenty-three patients were males and two patients were females, the age range was 20-50 years. Eight patients had right sided hernia, thirteen patients had left sided hernia and the rest four patients had bilateral hernia. Results one case converted to trans-peritoneal laporoscopic hernioplasty; another case had peritoneal puncture during surgery but the operation was continued extra peritoneally. The mean operative time was one hour and the mean post operative hospital stay was one day. Bleeding occurred in 2 patients [8%] the average of estimated blood loss during the procedure is 25 cc .One patient developed surgical emphysema which resolved spontaneously. we think that this procedure seems to be the method of choice at centers with laparoscopic experience because our results confirm the safety and the efficacy of laparoscopic extra peritoneal repair for the treatment of inguinal hernia with very low conversion and low serious complication rates

Electrovaporization of the prostate

To evaluate the technique of transurethral electrovaporization of the prostate at King Hussein Medical Center. This study included 12 patients who underwent transurethral electrovaporization of the prostate [TUEVP] with very minimal complications. The average weight of the prostate was 35 grams. Result: All results were satisfactory with no operative or post operative morbidity, except in one patient who developed hematuria which was treated conservatively. Transurethral electrovaporization of the prostate [TUEVP] alleviates symptoms and signs in patients with benign prostatic hyperplasia [BPH] and is a very promising method in prostates weighing less than 50 grams. The advantages of TUEVP include: the surgeon's familiarity with transurethral route, the use of safety instruments, the lower cost of the necessary equipment, excellent intra-operative hemostasis and lack of bleeding or fluid absorption