outcome of surgical interference in patients with acute obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of acute obstructive renal failure. Thirty six clinically diagnosed patients as having acute obstructive renal failure [22 men 61.1% and 14 women 38.9% ranging in age between 28 and 62 years, mean 45 years] in the period from October 2005 to October 2008. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 21[58.3%] patients, oliguria 12 [33.33%] patients, loin pain 16 [44.44%] patients, nausea and vomiting 23[63.9%] patients. 30 Patients underwent direct intervention and 6 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. There was a highly significant increase in the incidence of improvement among studied patients.100% [36 patients] out of 36 patients with acute obstructive renal failure showed improvement after surgical intervention. The syndrome of acute renal failure was reversed to a stable renal function that probably represents the preobstructive state of every patient. There was no morbidity or mortality rate in our series if compared with other series dealing with corrective surgery in obstructive renal failure. Surgical correction of acute obstructive renal failure show excellent results, so more efforts must be done for suspected obstruction in acute uremic patients to avoid the dialysis or kidney transplantation

outcome of surgical interference in patients with chronic obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of chronic obstructive renal failure. We will try to assess some of the factors that may predict favorable outcomes. Sixty four clinically diagnosed patients as having chronic obstructive renal failure [41 men 64.1% and 23 women 35.9% ranging in age between 25 and 69 years, mean 47 years] in the period from October 2005 to October 2008. The patients on this study were divided according to past history of renal impairment and/or regular dialysis into two groups as follow: Group [A]: Patients with chronic renal failure with no regular dialysis [36 patients] Males: 26 [72.22%] Females: 10[27.78%]. Group [B]: Patients with chronic renal failure with regular dialysis [28 patients] Males: 18 [64.29%] Females: 10 [35.71%]. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 17 [26.6%] patients [9 group A and 8 group B], oliguria 24 [37.5%] patients [14 group A and 10 group B], loin pain 42 [65.6%], patients [27 group A and 15 group B], nausea and vomiting 27 [42.2%] patients [8 group A and 19 group B]. 50 Patients underwent direct intervention and 14 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. In our series patients with chronic obstructive renal failure [group A], showed improvement in 31 patients [86.1%] and did not improve in 5 patients [13.9]. Out of the 5 patients who did not improve after management 1 patient [2.8%] remained unchanged and 4 patients [11.1%] continued to have progressive renal failure up to regular dialysis. In patients with chronic obstructive renal failure [group B], renal functions showed different degrees of improvement as follow: In 15 patients [53.6%] good improvement and subsequent complete weaning from dialysis occurred, while in 5 patients [17.8%] there was a decrease in weekly dialysis sessions from 3 to 2 sessions/week. In the remaining 8 patients [28.6%] there was no improvement and patients continued to have regular dialysis as preintervention. The overall complications in this series were [15.6%]. The incidence was much more in the chronic cases group B. The mortality rate in our series is [3.1%] which is not high if compared with other series dealing with corrective surgery in obstructive renal failure. The degree of improvement of renal function found to be correlated to preoperative residual parenchyma thickness, parenchymal echogenicity, corticomedullary differentiation, presenting hemoglobin value and radioisotope GFR. Finally there is evidence of reversibility of renal function after long standing obstruction which provides justification for efforts to identify and treat urinary tract obstruction even if a patient with an obstruction requires dialysis to avoid the dialysis or kidney transplantation or helping patients under dialysis for complete weaning form dialysis or decrease their number of weekly sessions

Safety and efficacy of supracosatal access for percutaneous nephrolithotomy: a 3-year experience

Successful removal of stones in percutaneous nephrolithotomy requires the accurate placement of a percutaneous track that provides direct access for stone manipulation. Supracostal approach is usually avoided be-cause of concerns about potential chest complications. We evaluated the hazard, safety and efficacy of supracostal approach for percutaneous nephrolithotomy. During the years 2003-2005 a total of 24 patients underwent PCNL through a supracostal track at Al-Hussain University Hospital. The indications for a supracostal approach were upper caliceal stone resistant to ESWL, upper caliceal stone with narrow neck, upper ureteric stone, Staghorn stone and sizable pelvic stone in a highly situated kidney. In 22 patients the punctures were performed just above the 12th rib; while in 2 cases the punctures were performed above the 11th rib. The data were analyzed for stone clearance, intra-operative and post-operative complications. Twenty one patients [87.5%] were rendered stone-free or had clinically insignificant residuals by PCNL alone. Overall complication was [20.8%]. Chest complications developed in only 2 patients [8.3%] in the form of hydro-pneumothorax and were managed successfully by intercostal chest tube drainage with an under water-seal connection. The study concluded that with proper choice of candidates, supracostal access for PCNL is safe and effective. The possible inadvertent pleural injury is rare and is easily manageable