Is there any role for alpha-blockers to treate lower urinary tract symptomatology after ureteral stenting?

Internal ureteral stents are associated with lower urinary tract symptomatology and can cause significant patient morbidity. This study aimed to evaluate the role of alpha-blockers as a treatment for stent-related symptoms. Sixty patients were scheduled for ureteral stenting after retrieval of lower ureteric stones. Thirty patients received Tamsulosin 0.4mg capsule daily postoperative and the other 30 patients did not received Tamsulosin. No significant difference was obtained between the groups with regard to age, sex, or postoperative haernaturea. Also, no statistically significant difference as regard suprapubic discomfort in the 2 groups on day 0, 1 and 6 [p 0.04], as well in urinary frequency, urgency or dysuria between the groups on the postoperative day-1. The irritative symptoms significantly reduced in both groups on day 6 [p<0.001]. Tamsulosin has no significant effect on stented patients in terms of bladder pain relief and irritative bladder symptoms

Urodynamic and clinical differences in BHP patients treated two different alpha blockers

There is controversy data about the indication of invasive urodynamic tests in patients with BPH. This study aimed is to evaluate and compare the effect of Doxazosin and Tamsulosin on international prostate symptom score [IPSS] and objective urodynamic results. A total of 90 patients were enrolled in our study, the inclusion criteria included: patients above 45 years of age, having no past history of prostatic surgery and with international prostate symptom score [IPSS] >/= 8. While the exclusion criteria included: patients with prostate cancer, and patients with bladder or urethral pathology. Pretreatment complete urodynamic tests were done for all patients, and then repeated 3 months after treatment with an alpha blocker [Doxazosin 1, 2 and 4mg or Tamsulosin 0.4mg]. Significant improvement in subjective parameters and quality of life revealed after treatment with Doxazosin and Tamsulosin. Although there was significant improvement of Qmax with both drugs, but none of they produced significant decrease of Schafer's grade of obstruction. None of the two drugs [Doxazosin and Tamsulosin] improved cystometric capacity and compliance nor decreased detrusor pressure at different voiding points. None of the drugs produced significant decrease of pressure flow grade of obstruction. The improvement of filling as well as voiding parameters was not manifested with both drugs. There is significant improvement of international prostate symptom score [IPSS] and quality of life score [QL] after treatment with both drugs and were associated with an increased of uroflows [Qmax]

Renal Cell Carcinoma: a clinico-pathological characteristics and evaluation of twenty four patients

To evaluate survival of patients with renal cell carcinoma postoperatively and the age of discovery. 24 patients were retrospectively included in our study during the last 3 years [2005-2007]. The full history including age, sex, geographic distribution, special habits, exposure to carcinogens and renal disease was assessed for all cases. Clinical examination was performed followed by laboratory and radiological evaluations and CT scan. Midline transperitoneal incision was done in 16 cases, thoraco-abdominal approach in 2 cases because of large upper pole renal mass and a classic fl ank lumber incision with rib resection in 4 cases. Radical nephrectomy was done in all cases except enuclation of a small renal mass less than 4cm in diameter was done for one case. All cases were localized at the time of presentation. All cases showed unilateral renal mass except one patient who had an asynchronous bilateral renal mass. The mean age was 48 years with 10 patients below 45 years. The male to female ratio was 2:1. laterality was equal between right and left sides while the lower pole was affected in 20 cases [83.4%] the upper pole in 4 other cases [16.6%]. The presenting symptoms were dull ache in 8 cases [33.3%] with presentation of gross haematuria in 6 cases [25%] and having a palpable fl ank mass in 6 of them [25%]. However two cases were presenting with paraneoplastic syndrome. Laboratory investigations done were normal apart from the 2 cases of paraneoplastic syndrome.The follow up, done every 3 month in the 1st year and every 6 months in the 2nd year where, 16 cases [66.7%] showed good prognosis for 2 years disease free survival. The other 8 cases showed local recurrence and one of them developed neooccurrence in the contra lateral side 6 months after surgery and died one year later.The Histopathological diagnosis was renal cell carcinoma: 18 conventional RCC, 4 cases were papillary renal cell carcinoma and 2 cases were chromophobe RCC. Renal cell carcinoma occurred in young age group in 41.9% of our patients [below 45 years] but with a good prognosis. Follow up is needed for the new occurrence of renal cell carcinoma in the contra lateral side

Outside-In transobturator tape as a minimally insasive method for treatment of female stress urinary incontinence

Evaluation of the safety and the efficacy of a suburethral, tension-free vaginal tape placed perennially between the obturator foramens [outside-in technique]. Twenty two female patients with clinical and urodynamic diagnosis of pure stress urinary incontinence [SUI] were included in this study. Patient's age ranged from 30-65 years [median age 48]. Exclusion criteria included: urge incontinence, Urodynamically proven detrusor overactivity, patients with vaginal prolapse [more than grade 1], and patients with residual urine > 20% of bladder capacity and/or weak flow [Q max < 15 ml/sec.]. The surgical procedure performed was the insertion of a tape coursed through the obturator membrane and the muscles over it via the lower segment of the obturator foramina to avoid the neurovascular bundles at the upper margin. The ends of the tape were tunneled percutanously with a tunneler. The retropubic space was not violated, and cystoscopy was not required. Patients were followed up for a mean of 18 months. Nineteen patients were cured with 86% success rate. Two were improved, while one patient showed no improvement. No signs of deterioration were recorded over the follow up period. No defects of healing or tape rejection or erosion were observed. All patients voided spontaneously post-operatively except in two patients who had reduced flow and detrusor hypotonia on pre-operative urodynamic study. De novo urge incontinence was recorded in one patient. Mean operative time was 25 minutes, and there was no report of intraoperative complications. Outside-in Transobturator vaginal tape is a minimally invasive procedure for treatment of female stress urinary incontinence with efficient, safe, and durable effect. The approach of the tape insertion minimizes the risk of trauma to internal organs, blood vessels, nerves, and urinary bladder. The retropubic space was not violated and Cystoscopy was not needed