Extra corporeal shock wave lithotripsy [ESWL] in paediatric urolithiasis: outcome and complications

Purpose: To evaluate the outcome of ESWL in paediatric group of patients

Patients and Methods: 70 children with 86 urinary calculi [79 stones in 66 renal units and 7 bladder stones] were treated by ESWL under general anaesthesia in 61 and sedo-analgesia in 9. The ages of patients ranged from 2 to 15.5 years [mean 12.9]. Of the 70 patients, 50 [71.4%] presented with pain and 11[15.7%] with haematuria. Stone size ranged from 5 to 30 mm; with an average of 11.4 mm. Stones were unilateral in 60 cases, bilateral in 3 patients and in the bladder in 7 cases. Except for 6 calculi sized 2-3 cm, all the stones measured <2 cm. Fifty-eight cases had single stone, 8 had 2 stones and 4 had multiple stones and most of the stones had poor density on plain X-ray films. Routine follow-up included renal ultrasound, blood pressure controls, laboratory tests and eventually plain X-ray film

Results: ESWL resulted in stone fragmentation in 71/79 stones in reno-ureteral units [89.9%] and 7/7[100%] in bladder stone. Fragmentation occurred after one session in 52 stones, after two sessions in 16 stones, and after multiple shock wave sessions in 10 stones. Auxiliary procedures were required in 15 children [21.4%]. After 3 months, 42 [63.6%] out of 66 reno-ureteral units were stone free. Non-surgical residual fragments [<4 mm] were present in 11 units [16.7%]. The procedure failed in 8 renal units [12.1 %], viz.3 in lower calyx, 2 in middle ureter, 1 in pelvis, 1 in middle calyx, and l in upper ureter. After 6 months follow-up, 51 [77 .2 %] out of 66 reno-ureteral units were stone-free and 6 units [9.1 %] had non-surgical residual fragments. The overall success rate for stone-free patients was 91.4% [64/70] after 6 months. The success rate for ESWL in stones located in reno-ureteral units was 86.4% [57/66]. Twenty children were lost to follow-up after 6 months

Conclusion: ESWL is an effective and the most suitable technique for the treatment of the paediatric calculi with low significant morbidity

Role of ultrasonography and colour doppler in diagnosis of scrotal disorders

Purpose: This study was preformed to evaluate the role of 2 D ultrasonography and colour Doppler ultrasonography in diagnosis of scrotal disorders

Patient and Methods: 50 patients with different scrotal disorders were studied. Their ages vary below 10 years and above 50 years. All patients were subjected to full history, clinical examination and 2 D and colour Doppler ultrasonography

Results: Epididymo-orchitis was the most common scrotal disorder encountered in our study [10 cases], both 2 D and colour Doppler ultrasonography easily diagnosed epididymo-orchitis and differentiated between epididymo-orchitis and tortion testis. Also, all grades of varicocele, hydrocele and complicated hydrocele can be easily diagnosed. The ultrasound can easily differentiate between intratesticular and extratesticular lesions with high accuracy in differentiation between cystic and solid lesions, but has a limited value in determining whether a focal testicular lesion is benign or malignant. The 2 D ultrasonography can easily diagnose undescended testis effectively up to the internal ring but not able to detect the undescended testis in the abdomen. Colour Doppler ultrasonography can diagnose abnormality of the testicular vascularity

Conclusion: Scrotal [2 D and colour Doppler] ultrasonography is an excellent tool in the diagnosis of scrotal disorders

Reliability of MRI versus CT in the evaluation of urinary bladder cancer

Purpose: This study was preformed to evaluate the role of MRI in staging of bladder cancer comparing the results with that of CT and pathological findings

Patients and Methods: Between September 2001 and December 2003, thirty cases with muscle invasive bladder cancer [28 males and 2 females] were studied. Their ages ranged between 27 and 72 years [mean 56.8] years. All patients were subjected to full history taking, complete clinical examination, routine laboratory investigations, urine cytology, abdominopelvic ultrasonography, CT, MRI and cystoscopy with biopsy. Clinically, 22 out of the 30 patients had palpable bladder mass. Twenty out of the 30 cases underwent radical cystectomy, pelvic lymphadenectomy and urinary diversion. The remaining cases were inoperable. The results of MRI and CT staging were compared with those of histopathological examinations

Results: Pathologically, there were transitional cell carcinomas in 18 cases [60%], squamous cell carcinomas in 11 cases [36.6%] and adenocarcinoma in I case [3.3%]. The tumour was involving the anterior wall in 4 cases, the posterior wall in 7 cases, the right lateral wall in 6 cases, the left lateral wall in 7 cases, the dome in 4 cases and the bladder neck in 2 cases. The accuracy of CT in determination of tumour site was 80%. MRI was better than CT in determination of tumour site with an accuracy of 100%. The pathological stage at diagnosis was pT[2], pT[3] and pT[4] in 13 patients [43.3%], 7 patients [23.3%] and 10 patients [33.4%] respectively. CT showed staging accuracy of 63.3% of tumours, under staged in 6.7% and over staged in 30% of patients. MRI was accurate in staging of 90% of bladder cancers, over staged in 10% of patients and under staged in 0%. The accuracy of CT in detection of pelvic lymphadenopathy was 80%, while the accuracy of MRI was 95%

Conclusion: MRI is better than CT for the evaluation of urinary bladder cancers

Neodymium: yag laser coagulation of the prostate in surgical risk patients

Transurethral Neodymium:YAG laser coagulation of the prostate gland was used to treat benign prostatic hyperplasia in 36 surgical risk patients, who had either significant lower urinary tract symptoms or urinary retention. The mean International Prostate Symptom Score [IPSS] decreased from 26.8 to 9.6, then increased to 14.2. The mean maximum flow rate [Qmax] increased from 8.3 to 15.1 ml/s and then decreased to 10.6 ml/s. The average residual urine volume [PVR] decreased from 139.3 to 65 ml, then increased to 87.5 ml at 12th and 60th months, respectively. Catheters were removed after seven days. Seven out of the 36 patients required re-catheterization within the first visit. Repeated interference was needed in 12 of the 36 patients. From the results obtained it was concluded that, aggressive Nd:YAG laser prostatectomy is safe and effective for high surgical risk patients with obstructive prostates and produces good results that are sustained for up to two years. On the contrary, the durability of this procedure is significantly decreased after three years with high incidence of re-treatment rate