Shock wave lithotripsy in patients with renal calculi

To demonstrate the efficacy of shock wave lithotripsy [SWL] in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter. One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation [Pethidine 1mg/kg and Midazolam 5-10mg] for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months. Complete clearance of the stones occurred in 2154 kidneys [89.5%]. At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 [23.5%] for Group I, 254 [36.1%] for Gourp II, 473 [85.5%] for Group III, 278 [100%] for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction. Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys

Fournier's gangrene in diabetic and renal failure patients

To report our experience in the management of 9 patients with Foumier's gangrene seen in our institute, to identify the most common prognostic variables in our patients, and to evaluate the outcome of aggressive management in patients with Fournier's gangrene. We reviewed the medical records of 9 patients admitted to King Abdul-Aziz University Hospital [KAUH] in Jeddah, Kingdom of Saudi Arabia from November 1999 until November 2002. Their age, sex, clinical presentation, predisposing factors, microbiology testing, management and prognosis were studied. Nine male patients were diagnosed and treated. The mean age was 68 years, 6 patients [66.6%] were diabetics and one of them had renal insufficiency not requiring dialysis, while 3 patients were on regular hemodialysis. Bacterial culture results revealed a single organism in 44.4%, and more than one organism in 55.6% of the cases. No anaerobes could be cultured, and one patient had C and ida albicans. All patients had temporary suprapubic catheter diversion while stool diversion by colostomy was required in only one patient. In 7 patients, aggressive debridement and parental antimicrobial were successful to eradicate the infection, whereas 2 patients [22.2% of the cases] died of uncontrolled sepsis. Foumier's gangrene is a very serious disease, underst and ing the criteria of early recognition of the disease, referral to the specialist, and aggressive debridement with the use of appropriate antimicrobial therapy will improve the outcome of the patients and decrease the mortality rate

Extra corporeal shock wave lithotripsy using the domier MPL 9000 in treatment of nephrolithiasis

After the installation of the third generation Dornier MPL 9000 multipurpose lithotripter in Assiut University Hospital and within one year 460 patients suffering from renal calculi were treated using a modified ellipsoid with a larger skin to focus distance with increased coupling surface area. Single stone was encountered in [214 patients], two stones [91 patients], branched stones [39 patients], multiple stones [116 patients] Succesful disintegration was achieved in 94% with an average number of sessions 2.28. The great majority of cases were premedicated by morphia or pithidine and one of the non steroidal anti-inflammatory drugs [NSAID]. Our preliminary reports concerning the use of Dornier MPL 9000 for treatment of nephrolithiasis indicated that the technique was easy, safe, effective and provided a maximal range of indications

Ureteral stone manipulation: which modality is suitable for a given situation

Four different modalities were tried for ureteral stones extraction or fragmentation in 228 patients harbouring single or multiple ureteral stones at different levels. Mechanical extraction was tried in 46 patients, ultrasonic disintegration in 80 patients, lasertripsy in 82 patients while ESWL was tried in 20 patients with ureteral calculi. Mechanical extraction was found to be suitable for stones less than 1 cm in healthy ureter in adult patients while ultrasonic disintegration was successfully tried in relatively big stones with rough surface and dilatable middle and lower third in adult patients. Lasertripsy had been successfully used to fragment stones in bilharzial ureters, impacted stones and in children. ESWL was found to be successful both in upper, lower and intramural calculi

Urodynamic evaluation of bladder function in intravesical obstruction

The purpose of diagnostic evaluation in bladder outlet, obstruction is to identify precisely the pathophysiology underlying the patient's symptoms so that rational therapy directed at relieving the most related cause of the symptoms can be initiated. One hundred, patients diagnosed by clinical, radiological and endoscopic means as having bladder outflow obstruction were evaluated by 1] Detailed symptom score, 2] Uroflowmetry, 3] Cystometry 4] EMG of perianal muscles and 5] Pressure-Flow. The pressure-flow data were applied the pressure and flow diagram constructed by Schafer [1990]. Another twenty non obstructed controls were evaluated by the same procedures. Symptom score was higher in the OBS group, but no correlation was found between symptom score and urethral resistance in the OBS group. Detrusor instability [DI] was found in 43% of patients. Significantly higher opening pressure [56.83 +/- 40.01] and residual urine [170.26 +/- 129.94] were found in the OBS group versus those of controls, [3l.65 +/- 95.2] and [23.5 +/- 14.06] successively. We concluded that the pressure flow study remains to be the corner-stone for diagnosis of outflow obstruction, and that symptoms of prostatism are not totally related to simple outlet obstruction as they may be caused by weak detrusor and DI in addition

Ultrasonography for diagnosis of obstructive uropathy in children

This study included 34 children, 30 males and 4 females, their ages ranged from 3 months to 3 years. They were suffering from obstructive uropathy. After routine investigations, abdominal ultrasonography was done for them. They were divided into 3 groups according to their presentation and clinical examination, the first group [7 cases] was diagnosed by sonography as pelvic hydronephrosis, while plain X-ray and IVPs were not confirmative. The second group [12 patients] was diagnosed by ultrasonography as radiolucent stones in pelviureteric junctions or upper ureter that were unilateral in 3 cases and bilateral in 9 cases, while plain X-ray and IVU were not diagnostic. The third group [15 cases] was diagnosed by ultrasonography as infravesical obstruction and confirmed by cystourethrography and urethrocystoscopy. It could be concluded that ultrasonography is the best way for rapid and safe diagnosis of obstructive uropathy in infants and young children when compared to other methods of diagnosis