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

Multimodal management of urolithiasis for forgotten severely calcified ureteral JJ stent: our experience at King Hussein Medical Center

To evaluate the management of forgotten ureteral JJ stent with sever encrustation and stone formation. This is a retrospective study which was conducted at King Hussein Medical Center during the period January 2005- April 2009, fifteen patients [10 male and 5 female] aged between 25- 60 years, with severe JJ stent encrustations were incorporated in this study. Three with severe encrustation of the whole stent, 5 with severe encrustation of both ends, 5 with ureteric part and bladder end encrustation, and 2 with bladder end encrustation only. The duration of forgotten JJ range from 6 months -12 years. Multimodal therapies were used for the management. All patients were stents and stone free after 1-4 approach [ureteroscopy, percutaneous nephrolithotomy, cystoliholapaxy and open surgery] in multisessions. All patients were treated by minimally invasive endourological procedure in all sessions except one which required open ureterolithotomy. One major complication was encountered, small bowel injury which was managed without events. Severe encrustation of the JJ stents requires multimodal therapy for managing this complex problem; each patient may need multiple approaches in one or multiple sessions. Open surgery may be indicated when minimally invasive procedures fail

Large calculi within malpositioned and malformed kidneys, is percutaneous nephrolithotomy [PCNL] feasible? a single center's experience over 10 years

Percutaneous nephrolithotomy [PCNL] for large calculi within malpositioned and malformed kidneys is a challenging problem for urologist because of the abnormal anatomy. The aim of this study was to evaluate and to review our experience with PCNL in malpositioned and malformed kidneys with large calculi. Between January 2000 and December 2009, we performed PCNL in 36 patients with large calculi in malpositioned and malformed kidneys, including 16 patients with horseshoe kidneys, 11 patients with rotational anomalous, three patients with transplanted kidney and six patients with ectopic pelvic kidneys. After appropriate preoperative evaluation, the procedure was performed by choosing anterior, posterior or laparoscopic assisted approaches under fluoroscopic and ultrasound guidance. PCNL access was made in the upper pole of the kidney in 21 [58.3%] patients, in the midpole in 14 [38.9%] patients, and in the lower pole in one patient [2.8%]. The mean age of the patients was 37.5 years [range 21-57] with male: female ratio 2.7: 1, the mean stone size was 2.9 cm [range 2.1-4.9]. Complete stone removal was achieved in 26 [72.2%] patients. A second-look procedure for residual stone removal was required in nine patients [25%], five of them via the same tract and three patients required another access, four of them became stone free, four patients required adjuvant ESWL sessions for the residual stones, and one patient converted to open surgery due to difficulty in creating an access. The mean operating time for PCNL was 95 minutes [range 45-120], and the mean hospital stay was 3.7 days [range 3-8 days]. Blood transfusion was required for three [8.3%] patients, transient postoperative pyrexia encountered in six [16.7%] patients and one patient had persistent urine leak [2.8%]. Serious complications were encountered, small bowel perforation was occurred in two [5.6%] patients, and both were treated by laparatomy with primary repair of injury with uneventful outcome. Patients with malposition and malformed kidneys and large calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation. Stone management in malformed and malposition kidneys is challenging, and establishing percutaneous renal access is the most crucial step in the procedure

Percutaneous nephrolithotomy for management of large renal stones. Experience at Prince Hussein Bin Ab dull ah Urology Center

The aim of this study was to evaluate and to review our experience with percutaneous nephrolithotomy [PCNL] in management of large renal stones. Between January 2005 and December 2009, 786 patients underwent PCNL for treatment of renal stones at our center, 108 renal units were with big stone burden. All procedures were performed in prone position after retrograde insertion of ureteral catheter under fluoroscopic guidance for creating the PCNL tract. 27F rigid nephroscope was used to identify the stones, fragmentation was done using electrohydrulic or pneumatic lithoclast. Stones fragments were removed by forceps and suction. 20F foley catheter inserted in all cases as nephrostomy, and postoperative stone clearance was documented by plain abdominal X-ray KUB. 108 renal units of 92 patients were treated [67 men and 25 women] with mean age of 41 years [range 17- 74 years]; the average stone size was 4.9cm [range 3.0-6.8cm]. 83 renal units were treated with PCNL monotherapy [76.9%], with mean operative time of 75 minutes [range 55-100 minutes]. 18 renal units required a second look for significant residual stones through the same tract after 72 hours [16.7%], 7 renal units required a second look through a different calyx [6.5%]. Complete stone removal achieved by PCNL alone in 89 renal units [82.4%], with ESWL for the residual small stones we achieved 91.7% stone clearance rate. The mean hospital stay was 3.7 days [mean 3-8 days]. No Serious complications were encountered, 9 patients required blood transfusion [8.3%], 18 patients developed transient post operative pyrexia [16.7%] and three patient had persistent urine leak [2.8%]. PCNL is the first line treatment option for management of large renal stones. Selection of the patient, establishing percutaneous renal access, a well standardized technique and post-operative follow up are mandatory for early detection of complication and achieving a high stone free clearance rate. With significant residual stones in PCNL procedure, a second look at 48-72 hours interval is preferable in centers where flexible instruments and laser therapy are not available

Embolization of testicular vein for treatment of recurrent varicocele

To assess the efficacy of embolization of testicular vein for the treatment of recurrent varicocele. Between January 2002 and December 2005, a total of 64 patients with a mean age of 28 [18-40 years] were treated by embolization of testicular vein for management of recurrent varicocele at Prince Hussein Bin Abdullah II Center in King Hussein Medical Center. Indication for treatment was as either infertility or presence of dragging pain in the left testicle. Embolization was accomplished successfully in 53 patients [82.8%], whereas it was difficult in eleven patients because of venous spasm and anomalous collaterals which could not be cannulated. One patient required transfusion of blood due to bleeding from the internal spermatic vein. Embolization technique for internal spermatic vein for treatment of recurrent varicocele is a safe technique with low morbidity. It is also minimally invasive with high success rate

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

Ureteroscopy as a day case procedure

To evaluate the efficacy and safety of ureteroscopy as a day case procedure. A retrospective analysis was performed of 256 patients who underwent ureteroscopy as an outpatient procedure at the Queen Rania Urology Center during the period between June 2003 and September 2004. The value of performing ureteroscopy as a day case procedure was assessed. Of the 256 patients involved, 181 were males and 75 were females, with a mean age of 32 years. The patients underwent ureteroscopy as a day case procedure for different ureteic pathologies. Most patients had uneventful ureteroscopy and were discharged on the same day. Only 18 patients were admitted post ureteroscopy because of intolerance of pain, fever, social factors, or for further management. Day case ureteroscopy should be considered in low risk patients scheduled for short and uncomplicated procedures. It is cost effective and safe