Outcome of varicocele surgery and infertility at Prince Hussein Urology Center

To describe the outcome of surgical techniques for the treatment of testicular varicosity to improve fertility among infertile males at Prince Hussein Urology Center. This descriptive study was conducted on a total of 844 patients who underwent Varicocele surgery at Prince Hussein Urology Center, for infertility between the period of June 2003 and June 2008, surgery was performed for patients upon presenting to our clinic complaining of infertility for one year or more in the absence of female factor for infertility. Patients were non-randomly selected. Sperm concentration, motility and morphology was assessed by analysis of at least two different semen specimens each obtained after a 5 days period of sexual abstinence and separated by three weeks interval. Post surgery patients were classified as responders [more than 50% increases in sperm parameters] and non-responders. Simple descriptive statistical methods [frequency, mean and percentage] were used to describe the study variables. Surgical treatment of clinical palpable Varicocele successfully cured over 95% of Varicocele. Post surgery spermatogenesis was improved among 256 patients [30.3%]. Sperm concentration increased to variable degrees from 6.23 to 12.1 million among these patients with mean of 9.2 million, sperm motility improved from 5.2% to 18.7% with mean of 8.3%. Spontaneous pregnancy was achieved in 194[23%] couples within 12 months following surgery. Varicocelectomy is a safe, effective and associated with a rapid recovery and minimal morbidity. Varicocelectomy resulted in the induction or enhancement of spermatogenesis in several men with clinical Varicocele and abnormal semen parameters. Despite the absence of definitive studies on the infertility outcome of varicocele surgery, it is reasonable to be considered as an option in selective patients with semen abnormalities

Radical retropubie prostatectomy: a review of 8 years of experience

Different modalities for treating prostate cancer are evolving worldwide. Radical prostatectomy is still ranking on top of the list for organ- confined disease. This study was conducted out to describe the indications, surgical technique, complications and outcome of radical retropubic prostatectomy for prostate cancer over an 8- year period at Prince Hussein Center of Urology and Organ Transplant, King Hussein Medical Center. Between August 1999 and June 2007, a total of 81 patients [age range 50-68 years] underwent radical retropubic prostatectomy for organ confined prostate cancer [stage Tla-T2c] based on Prostate Specific Antigen values, histopathology reports [Gleason Score 4-7] and negative metastatic work up. Follow-up of these patients ranged between 1 and 7 years. The medical records of these patients were reviewed, and analyzed regarding indications, surgical technique, complications, and outcome. None of the patients had pelvic lymph node involvement, and surgery accomplished in 2.5-3.5 hours. Estimated blood loss was between 500 and 2000ml. Early continence, within 4 weeks after surgery, was achieved in 51/81 [62.9%] and in 98.7% after one year. Potency within 1 year was achieved in 42 patients [51.8%], but with medications this number reached 52 [64%]. Margin positive histopathology reports were seen in 12 patients [14.8%] warranting further treatment with either radiotherapy or hormonal therapy. Mortality rate in the study group was 2.5% as a result of disease progression and dissemination. Radical Retropubic Prostatectomy stands the gold standard method of treatment for localized prostate cancer with excellent results in cure and tumor control

Ureteroscopy in the treatment of ureteral calculi: efficacy and safety

To present our experience with ureteroscopy for the treatment of ureteral calculi. A retrospective review of 904 ureteroscopies for ureteric lithiasis performed in 810 patients [mean age 39.3 years: range 14-70 years; 485 males, 325 females] at Prince Hussein Bin Abdullah Urology Center between January 2006 and January 2008 was conducted. A 9.5F rigid ureteroscope was used in all patients. Pneumatic lithoclast was used to fragment stones and the fragments were retrieved with forceps and/or baskets. Hospital and follow-up records of the patients were reviewed in this study. Success and complication rates are presented. Sixty one [7.5%] of the stones were located in the upper, 204 [25.2%] in the middle and 545 [67.3%] in the lower ureter. The size of the stones treated ranged between five to 20 mm. Ureteroscopy resulted in successful stone removal in 750 patients [92.6%]. Six hundred and fifty six stones were treated in a single session. Repeat ureteroscopy was performed in 94 patients [11.6%]. In 53 patients [6.5%] the stones were pushed up and successfully underwent ESWL. Antegrade renoureteroscopy was performed in three cases of ureteroscopy failure for fixed tipper ureteric stones. A total of four patients with ureteroscopy failure were referred for open surgery. Gross hematuria was observed in eight [1.0%] patients, 15 [1.9%] patients suffered from postoperative fever for an average of two days [range 1-4 days], 17 [2.1%] patients had persistent renal colic. Nine cases [1.1%] of ureteral perforation were successfully treated by JJ stent, and only one case of ureteral avulsion [upper ureter] was treated by open surgery. Four cases of postoperative ureteral stricture have been observed. On the basis of our experience, ureteroscopy is an effective interventional modality for ureteric stones w ith a low complication rate

Transurethral microwave thermotherapy; a single center study

Objective: To assess the efficacy of Transurethral Microwave Thermotherapy [TUMT] as a treatment modality of Benign Prostate Hyperplasia [BPH]

Patients and Methods: During the period between September 1999 to May 2002 inclusive, sixty six patients were treated with Transurethral Microwave Thermotherapy at KHMC using Prostasoft 2.5 on outpatient basis. Their ages ranged between 55 and 80 years, with a mean of 63 years. The treated prostate weight averaged 60 grams. No anaesthesia was needed, and the patients were discharged home with a Foley's catheter 2-3 hours after the treatment session. The patients were followed in a preassigned schedule for up to 6 months. Madsen scoring system was used to assess the subjective improvement

Results: The Prostate Specific Antigen [PSA] showed a mean reduction of 0.17 ng/ml from the baseline readings. The maximum symptomatic improvement was achieved 3 months after the treatment

Conclusion: TUMT is a safe and effective outpatient form of treating symptomatic BPH, and it is a quite accepted option for patients unfit for a major surgery such as TURP

Managment of chronic infection of the midshaft of the penis due to a metallic ring

This is a case of a 19 year old male patient, who presented to the urology clinic with chronic circumferential infection of the midshaft of the penis due to a metallic ring, which was used by the patient to control nocturnal enuresis. The ring was removed and primary closure was performed with good results