Feasibility and efficacy of percutaneous nephrolithotomy, initial experience

Background: Renal stone disease is common in Iraqi population and percutaneous nephrolithoyomy present a minimal access for large stone a substitute for traditional open surgery

Objective: We are presenting our first experience in percutaneous nephrolithotomy [PCNL] in terms of renal access, stone free and to evaluate the other aspects such as the need of auxiliary procedures in a center without prior experience in this field

Materials and Methods: We evaluate all the PCNL performed in period of two year. A series of perioperative and post-operative details were recorded. All PCNL were performed in prone position

Results: The first 55 PCNL cases were included in the study. Out of 55 patients, 16 were women and 39 men. Their mean age was 35.5 years [range 11-65] and means stone diameter were 23.5 mm +/- 8.9. A successful renal access achieved in 87.3 % [48] cases with stone fragmentation. Procedures were performed over two year Dec.2013-Dec. 2015. Of fifty five patients 4 cases with single functioning kidney, and eleven cases with PCNL on same side of previous scar of pyelolithotomy. Stone free rate was 82%. Co morbidities included 8 hypertensive, 3 diabetics, one systemic lupus erythematosus and two with elevated blood urea. Morbidity and complications following PCNL are dominated by access failure in 12.7 % [n= 7]; intraoperative bleeding in 3.6 % [n=2], urinary leakage in one patient, ureteric colic in 5.4 % [n=3] hydrothorax 1.8 % [n=1]. None of these patients experienced post-operative bleeding, No mortality

Conclusion: PCNL can be learned by urologists who do not have the support of an experienced colleague without endangering patient safety

Semen quality of infertile couples-comparison between smokers and non-smokers

The effect of cigarette smoking on spermatogenesis is unclear. Previous studies suggest a deleterious effect of cigarette smoking on semen on semen quality, but their results have not been consistent. To compare the various semen parameters of infertile cigarette smokers with infertile non-smokers, to study the effect of cigarette smoking on semen quality. Semen samples of 66 cigarette smokers and 70 non-smokers infertile patients were included in the study. As far as possible; other factors which might influence semen quality were eliminated. Seminal parameters, when taken together, indicated the presence or absence of the three main semen variables: asthenospermia [A], oligospermia [O], an dnormospermia [N]. Smokers were categorized as light, moderate and heavy smokers. Semen samples were examined for Asthenospermia and oligospermia, according to World Health Organization guidelines. In our study, 25 smokers had normospermian [N] with their semen parameters falling within the normal ranges. In contrast, samples from 16 smokers qualified as N. this finding underscores the fact that smoking certainly has an adverse influence on the semen quality, as concluded in several other studies. Asthenospermian [A] was the most dominant semen variable contributing to the semen quality of smokers [n=34] as well as non-smokers [n=31]. Statistical analysis using Pearson chi-squared and t-test found no statistically significant effect of cigarette smoking on sperm density; motility or morphologic features of sperm were detected. Our study shows a limited effect of smoking on conventional sperm parameters

Ureteral injuries from gunshots and shells of explosive devices

Penetrating rather than blunt trauma is the most common cause of ureteral injuries. The approach to management differs from the far more common iatrogenic injury. The purpose of this series is to report our experience in ureteral trauma management, with attention to the diagnosis, repair, and outcome of these injuries. From April 2003 to October 2009, all abdominal trauma cases received alive, reviewed for penetrating ureteric injuries A total of twenty [fifteen male, five female] penetrating ureteral injuries were evaluated. All penetrating ureteric injuries were due to [9 gunshot and 11 shells from explosive devices]. Since the patients had a clear indication for surgery, no IVU or CT scan was done preoperatively, major intra-abdominal injuries were often associated. The diagnosis of ureteric injury was made intraoperatively in 8 cases [40%] While, twelve cases [60%] were diagnosed postoperatively. Eight ureteric injuries [40%] were proximal 1/3, 4 [20%] to middle 1/3 and 8 [40%] to the distal 1/3. Management was with stenting in 2 patients, ureteroureterostomy in 8, ureteroneocystostomy in 6, and nephrectomy in 4. In this study, a delay in diagnosis was a contributory factor in morbidity related to ureteral injury, the need for second operation in already compromised patients from associated injuries, The presence of shock on admission, delayed diagnosis, and colon injuries were associated with a high complication rate. Ureteral injuries must be considered early during the evaluation of penetrating abdominal injuries

Clinical and urodynamic evaluation of diabetic patients presented with voiding disorders

To ascertain the relationship between diabetic voiding dysfunction and vesico-sphincteric behavior, and try to point out any clinical prediction to bladder cystopathy in diabetic patients. Fifty-one diabetic patients complaining of voiding disorders were studied over two years [Oct/2000-Oct/2002], according to history, clinical examination and investigations especially full urodynamic assessment, patients were classified urodyriamiclly as either impaired detrusor contractility, detrusor hyperreflexia, detrusor areflexia, and normal. Mean bladder capacity was 479 +/- 123.9ml. with a mean first sensation of filling of 241.1 +/- 61.2ml. of the 55 patients 23[45.3%] impaired detrusor contractility], 18 [35.2%] had detrusor hyperreflexia, 4 [7.8%] had detrusor areflexia, and 6 [11.7%] were normal. The presence of sacral neurological signs and infection were found statistically significant in predicting an abnormal urodynamic pattern, while neither age, sex, nor the type and severity of diabetes were found related. These data suggest that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and voiding dysfunction, and in fact these patients present with variable pathophysiological findings. These findings demonstrate the importance of urodynamic studies in diagnosing voiding dysfunction in diabetics before initiation of therapy