Management of ureteral calculi with the use of transurethral ureteroscopy and electrohydraulic lithotripsy: 101 patients experience.

To evaluate the results of transurethral ureteroscopy and electrohydraulic lithotripsy for ureteral calculi needing surgical management. From 1993 to 1995, 101 patients with ureteral calculi were retrospectively analyzed. The locations and sizes of the calculi were examined and the success rate of the procedure was assessed. The overall success rate was 74%. The success rates of upper and lower ureteral calculi were 67% and 81%, respectively. The stone size did not affect the success rates. Among the failure patients, there were no serious complications and they could be subsequently treated with either ureterolithotomy or double J stent replacement. The median hospitalization was 4 days. Transurethral ureteroscopy and electrohydraulic lithotripsy is an effective and safe procedure for ureteral calculi treatment. This method is a minimally invasive procedure and involves a short hospital stay.

Scrotal flap penoplasty of the paraffinomas penis: 15 years of experience.

A two-stage scrotal flap penoplasty was carried out on a paraffinomas penis. In the first stage, total excision of the penile paraffin-containing skin was performed; The denuded penis was embeded in the subcutaneous tunnel of the scrotal sac. A scrotal skin flap for covering the penile shaft was separated after four months. During the past 15 years, a study was undertaken on 174 patients with an average age of 44 years (figure I). A satisfactory result was found in 148 patients, with 26 cases having required minor corrective surgery (table 1). Satisfactory sexual function was found in 168 patients, mildly painful intercourse in four patients and impotency in two cases (table 2). The post operative complications (table 3) were mild graft infection in 32 patients, partial graft necrosis in 11 cases redundant penile skin in 16 cases and tortious shape of the scrotum in 15 cases. All the patients presented to the hospital, complaining of abnormal penile shape and unsuccessful sexual intercourse.

Bladder cancer in Siriraj Hospital from 1991 to 1995.

A retrospective study was under taken of 284 patients with blander cancer seen at Siriraj Hospital from 1991 to 1995. Of the total 284 patients, new patients comprised 158 cases, while recurrent cases numbered 126. The average ages were 60-70 years. The male to female patients ratio was 235 to 59 (4:1), with the most common symptom being haematuria. Most of the patients (both new and recurrent cases) were in stage A, and the common histology was transitional cell carcinoma. A total of 39 patients in stages O and A were treated by TUR and adjuvant intravesical BCG therapy, while 62 patients with invasive bladder cancer underwent cystectomy.

The pattern of lymph node metastasis of penile cancer in Thais.

The prognosis of penile cancer is dependent on ilioinguinal lymph node metastasis. However, some controversy still exists concerning the management of those lymph nodes because the pattern of lymph node metastasis, especially in Thai males, is questionable e. Hence a prospective study of the pattern of lymph node metastasis was undertaken in 26 penile cancer patients from 1992 to 1995. All patients had the same pattern of lymph node metastasis. From primary lesion, tumour metastasized first to the inguinal lymph node, and then to the ipsilateral pelvic lymph node. There was no skip pattern. There was no correlation between Jackson staging, degree of cell differentiation, extension of primary lesion, palpability of clinical inguinal lymph node and pathological staging of lymph node metastasis after bilateral ilioinguinal lymphadenectomy. The primary lesion with poor differentiation was highly related to lymph node metastasis at the initial diagnosis. In patients with a clinically negative inguinal lymph node, 50 percent had inguinal lymph node metastasis and 12.5 percent had inguinal lymph node metastasis. In patients with a clinically positive inguinal lymph nod, 83.3 percent had inguinal lymph node metastasis and 38.8 percent had pelvic lymph node metastasis. In conclusion, lymph node metastasis in penile cancer is unpredictable by clinical evidence. Therefore prophylactic bilateral inguinal lymphadenectomy is recommended in all patients, and especially in cases with poor differentiation of the primary lesion, low education or low compliance with follow up. If there is inguinal lymph node metastasis, ipsilateral pelvic lymphadenectomy is recommended.

Current status of kidney transplantation in Thailand.

The first kidney transplantation in Thailand was done on March 3, 1972 at Chulalongkorn University Hospital in Bangkok. At present, twenty hospitals (both government and private) are performed this operation. The total number of transplant patients was reported (excluded 4 hospitals) for 750 patients up to September 1995. The average age was 38 years and the male to female ratio was 3:2 (450:300). The chronic glomerulonephritis is the leading cause of end stage renal diseases. Other causes were nephrosclerosis, stone, diabetes, polycystic kidney disease, IgA nephropathy and interstitial nephritis of unknown etiology. The replacement was CAPD and hemodialysis in an average ratio of 20:80. The donor were 86% cadaveric and 14% living related donors. The one year success rate was 95% with living donors and 87% with cadaveric donors; after five years was 82% with living and 64% with cadaveric donors. The major causes of graft loss were chronic rejection, infection and vascular complications (renal artery stenosis or renal vein thrombosis). The causes of death were studied in 122 patients. All of them survived more than five years. Forty percent (49 patients) died from infection; thirty nine percents (47) denied further dialysis treatments. The rest from other organ failure (11), heart diseases (3) and two were unknown cause. The sources of major infections were bacterial (23 patients), two of them were tuberculosis. The other were viral (HSV, HB and unknown) only two CMV were suspected and two were Cryptococcus infections. The urological complications were reported in 55 patients; forty percents (22) was urinary leakage. The immunosuppressive agents were prednisolone, cyclosporine A, azathioprine with occasionally ALG and OKT3. The double regimen of prednisolone + cyclosporine A accepted for more than 70%. The brain death criteria was submitted by the National Medical Board Meeting was accepted for our cadaveric donors.

Bladder augmentation: Siriraj experience.

Since 1987, 13 patients with low compliance bladder secondary to genitourinary tuberculosis, neuropathic bladder and contracted bladder from other causes underwent augmentation cystoplasty. Ileal segments were used in all of them and no serious complication was found. All eight patients with tuberculous cystitis and chronic scarring of the bladder from other causes, who had been suffering from frequent voiding, were free of these symptoms postoperatively. Three patients could void by themselves but the others required intermitted catheterization to remove residual urine. In five cases of neuropathic bladder, four patients with reflex incontinence were continent postoperatively and in one case with vesicoureteral reflux the symptoms subsided. All patients were satisfied with the outcome following surgery. Augmentation cystoplasty appears to offer a reliable procedure for low compliance bladder.