Tamsulosin in the expulsion of distal ureteral calculi

The purpose of the work is to evaluate the effectiveness of Tamsulosin for patients with distal ureteral calculi with respect to its effect on stone expulsion and time to stone expulsion. This prospective randomized controlled study included a total of 70 patients with distal ureteral calculi, who presented to the outpatient clinic of El-Sahel Teaching Hospital between March 2009 and May 2011. Their age range was between 19-65 years in the Tamsulosin group and 20 - 68 years in the control group. Selection criteria included a ureteral calculus located in the distal ureter [Juxtavesical or Intramural], single, size less than 1 cm with no or minimal ipsilateral hydronephrosis and normal contralateral kidney. Patients with solitary kidney, renal insufficiency and high grade obstruction, were excluded. All patients were initially assessed by appropriate physical examination followed by plain UT and I.V.U to locate site and size of the calculus. Urinary tract ultrasound was done to exclude solitary kidney or high grade obstruction and for follow up of patients during the study. Renal functions in the form of blood urea and serum creatinine, were done. Patients with ipsilateral ureteral surgical manipulation, serious medical conditions,pregnancy and those receiving calcium channel blockers or corticosteroids, were excluded. A written informed consent was signed by all patients included in the study. The patients were randomlly categorized into 2 groups, each group consists of 35 patients: Group I [Control Group] included 35 patients who were given oral sodium diclofenac 50 mg twice/day for 10 days. Group II [Tamsulosin group] included 35 patients, who were given Tamsulosin 0.4 mg once/day for 28 days or until stone expulsion [whoever is nearer] in addition to oral sodium diclofenac 50 mg twice/day for 10 days. All patients in both groups were instructed to drink a minimum of 2 liters of water every day and for follow up including number of pain episodes, serum creatinine, KUB and urinary ultrasound. The primary endpoint of the study was the determination of the stone passage time, episodes of renal colic, need for analgesia, drug adverse effects, stone size and distal ureteral stone site whether Juxtavesical or Intramural. Sex distribution was 24 males and 11 females in group 1 [control group] compared to 22 males and 13 females in group 2 [Tamsulosin group]. Age ranges were 20 - 68 years [mean 41.2 +/- 10.55 years] and 19 - 65 years [mean 39.3 +/- 10.67years] for groups 1 and 2 respectively. Stone sizes ranged bet ween 4-10 mm in both groups [mean of 5.3 +/- 1.24 and 5.8 +/- 1.58 mm in groups 1 and 2 respectively].In both groups, no significant statistical differences,were noted as regards patients age,sex distribution or laterality [P= 0.453, P= 0.615 and P= 0.461 respectively]. The overall stone expulsion rate was 60% and 94.3% in groups 1 and 2 respectively. For stones < 6 mm, expulsion rates were 76.2% and 95.7% in groups 1 and 2 respectively. For stones 7-10 mm, the expulsion rates were 35.7% and 91.7% in groups 1 and 2 respectively.The improvements percentages in stone expulsion attained were 37.5% and 120% for stones < 6mm and 7-10 mm respectively. Episodes of renal colic were reported in 26 patients [74.3%] in the control group versus 8 patients [22.9%] in the Tamsulosin group [P< 0.001]. Tamsulosin is an effective and safe therapy for uncomplicated distal ureteral calculi as it improves stone passage rates,shortens passage time,decreases analgesia requirements and decreases the need for intervention. Moreover, these results allowed home management without hospitalization and allowed the patient to almost regularly perform everyday activities. Tamsulosin augments stone passage rates for all stone sizes especially for larger stones than smaller ones.Moreover,Tamsulosin shortens the time of stone passage especially for smaller stones than larger ones

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