Flexible ureterorenoscopy for upper urinary tract treatment using new 7.5 F 270 degree deflectable ureteroscope: Siriraj Hospital early experience.

Objective: To evaluate the efficacy and report our experience of using a flexible ureterorenoscopy in the diagnosis and therapy for upper urinary tract disease. Methods: Between September 2005 and June 2008, 21 upper urinary tract procedures were performed with 7.5 F actively deflectable, flexible ureteroscope. Of these 13 were for diagnostic reasons and eight for therapeutic purposes. A retrospective data of these procedures was collected. The indication, diagnostic or therapeutic procedure, operative time, success rate and postoperative course were analyzed. Results: The procedures were performed in 21 patients (mean age 66.71 years; range, 47-85 years; 11 procedures in males and 10 procedures in females). The indications were lateralizing essential hematuria (2), hematuria with upper tract radiolucent lesions (11), upper tract lesions without hematuria (3) and stones (5). In the diagnostic group, the mean operative time was 50 min (range 15-120). The procedure was completed successfully in all patients. The most common endoscopic finding was urothelial carcinoma in hematuria with upper tract lesions (9/11). In the therapeutic group (stone removal five, tumor fulguration three), the mean operative time was 83.12 min (range 30-160). The success rate of these therapeutic procedures was 62.5% (5/8). There was no intra and postoperative major complication. With an average follow up of 14 months (range 1-33), no patient had a late complication, such as ureteral stricture. The flexible ureteroscope did not need repair during this study. Conclusion: Flexible ureterorenoscopy is an effective and minimally invasive diagnostic and therapeutic tool for upper urinary tract disease.

Retroperitoneoscopic nephrectomy in dialysis dependent patients and comparison with open surgery.

OBJECTIVE: To evaluate the surgical outcomes and morbidity of retroperitoneoscopic nephrectomy compared with open nephrectomy for dialysis dependent patients. MATERIAL AND METHOD: Between November 2002 and August 2007, 14 hemo or peritoneal dialysis patients underwent nephrectomy or nephroureterectomy at Siriraj Hospital. Of the 14 patients, seven were treated with retroperitoneoscopic nephrectomy and seven with open nephrectomy. A retrospective review and data were carried out. The patient factors, type of surgery, perioperative outcomes and complications were analyzed. RESULTS: There was no conversion rate in the retroperitoneoscopic group. The mean estimated blood loss, analgesic requirement and time before starting oral intake were lower in the retroperitoneoscopic group (141.4 +/- 95 versus 292.8 +/- 226 ml, 5.0 +/- 4.5 versus 7.6 +/- 1.9 mg and 14.5 +/- 16.1 versus 23.1 +/- 23.3 hours, respectively). On the other hand, the mean operative time in the retroperitoneoscopic group was longer than the open group but with no significant difference (177.14 +/- 51 versus 160.71 +/- 84 min, p = 0.521). Two patients in the open group required intraoperative blood transfusion. There were two complications. One patient developed a large retroperitoneal hematoma after retroperitoneoscopic nephrectomy. Another had a perivesical collection in the open nephrectomy group. No mortality related to the procedures occurred. CONCLUSION: Retroperitoneoscopic nephrectomy should be considered as the procedure of choice for dialysis dependent patients. This has all the benefits of minimally invasive surgery such as reduced blood loss, minimal post operative pain leading to faster convalescence.

A role of intravesical capsaicin instillation in benign prostatic hyperplasia with overactive bladder symptoms: the first reported study in the literature.

OBJECTIVE: To study the treatment efficacy of capsaicin, in the cases of benign prostatic hyperplasia with overactive bladder symptoms. MATERIAL AND METHOD: A prospective study of 20 benign prostatic hyperplasia patients whose overactive bladder symptoms were not improved by alpha1 blockers. All of them underwent intravesical capsaicin instillation at the Faculty of Medicine Siriraj Hospital, Bangkok, between 2004 and 2006. Both clinical and urodynamic data were evaluated before and after treatment. RESULTS: Mean urgency decreased from 6.7 +/- 5.1 at baseline to 2.0 +/- 2.3 (p < 0.005), 1.4 +/- 2.4 (p < 0.005), and 1.3 +/- 2.2 (p < 0.005) at 1, 3, and 6 months. Mean urge incontinence decreaseD from 1.7 +/- 3.5 at baseline to 0.5 +/- 1.3 (p = 0.148), 0.4 +/- 1.2 (p = 0.114), and 0.3 +/- 1.1 (p = 0.085) at 1, 3, and 6 months. Mean urinary frequency decreased from 13.7 +/- 3.3 at baseline to 10.5 +/- 2.8 (p < 0.005), 9.6 +/- 2.0 (p < 0.005), and 9.5 +/- 2.6 (p < 0.005) at 1, 3, and 6 months. Mean nocturia decreased from 4.7 +/- 2.4 at baseline to 3.1 +/- 2.2 (p < 0.005), 2.7 +/- 1.2 (p < 0.005), and 2.9 +/- 1.6 (p < 0.005) at 1, 3, and 6 months. Mean first desire to void increased from 172.5 +/- 100.4 ml at baseline to 210.6 +/- 99.5 ml (p = 0.016) at 1 month. Mean maximal cystometric capacity increased from 350.3 +/- 165.9 ml at baseline to 397.4 +/- 165.7 ml (p = 0.012) at 1 month. Peak flow rate, detrusor pressure, and post void residual urine were not affected No serious adverse effect occurred in this study. CONCLUSION: Intravesical capsaicin instillation is an effective treatment for overactive bladder symptoms in benign prostatic hyperplasia patients.

A role of intravesical capsaicin instillation in benign prostatic hyperplasia with overactive bladder symptoms: the first reported study in the literature.

OBJECTIVE: To study the efficacy of capsaicin in treating overactive bladder symptoms in benign prostatic hyperplasia patients. MATERIAL AND METHOD: A prospective study of 20 benign prostatic hyperplasia patients whose overactive bladder symptoms were not improved by alpha1 blocker Alpha1 blocker was taken about 22.9 +/- 17.2 months before and continued throughout 6 months duration of the present study. All of them had undergone intravesical capsaicin instillation at the Faculty of Medicine Siriraj Hospital, Bangkok, from 2004 to 2006. Both clinical and urodynamic data were evaluated before and after treatment. RESULTS: Mean urgency decreased from 6.7 +/- 5.1 at baseline to 2.0 +/- 2.3 (p < 0.005), 1.4 +/- 2.4 (p < 0.005), 1.3 +/- 2.2 (p < 0.005) at 1, 3 and 6 months. Mean urge incontinence decreased from 1.7 +/- 3.5 at baseline to 0.5 +/- 1.3 (p = 0.148), 0.4 +/- 1.2 (p = 0.114), 0.3 + 1.1 (p = 0.085) at 1, 3 and 6 months. Mean urinary frequency decreased from 13.7 +/- 3.3 at baseline to 10.5 +/- 2.8 (p < 0.005), 9.6 +/- 2.0 (p < 0.005), 9.5 +/- 2.6 (p < 0.005) at 1, 3 and 6 months. Mean nocturia decreased from 4.7 +/- 2.4 at baseline to 3.1 +/- 2.2 (p < 0.005), 2.7 +/- 1.2 (p < 0.005), 2.9 +/- 1.6 (p < 0.005) at 1, 3 and 6 months. Mean first desire to void increased from 172.5 +/- 100.4 ml at baseline to 210.6 +/- 99.5 ml (p = 0.016) at 1 month. Mean maximal cystometric capacity increased from 350.3 +/- 165.9 ml at baseline to 397.4 +/- 165.7 ml (p = 0.012) at 1 month. Peak flow rate, detrusor pressure, and postvoid residual urine were not affected. No serious adverse effect occurred in the present study. CONCLUSION: Intravesical capsaicin instillation is an effective treatment for overactive bladder symptoms in benign prostatic hyperplasia patients.

Is radical prostatectomy in thai men a high morbidity surgery for localized or locally advanced prostate cancer?

OBJECTIVE: To assess the morbidity of radical prostatectomy in Thai patients with localized or locally advanced prostate cancer MATERIAL AND METHOD: A total of 151 patients with prostate cancer underwent radical prostatectomy at Faculty of Medicine Siriraj Hospital, Bangkok, between 1994 to 2003. Operative complications and long term morbidity were evaluated with clinical stage T1, T2 and T3. RESULTS: Mean operative duration, blood loss and blood transfusion were 162 minutes (range 71-540), 1088 ml (range 200-4000) and 1.7 unit (range 0-12), respectively. Of 151 patients, 139 (92.6%) did not have perioperative complications and 42 (2 7.8%) did not have blood transfusion. Of 12 patients with morbidity, all patients were safely managed. There was no mortality. Of 140 patients with follow up results, 131 (93.7%) had no incontinence. Seven patients had mild stress incontinence. Only 2 patients had a significant incontinence. Eight patients had stricture of anatomosis. Strictures were simply managed with dilatation. There was no significant difference of operative time, blood loss, blood transfusion, incontinence and stricture parameters among clinical T stage (all p value > 0. 05). CONCLUSION: Radical prostatectomy in Thai men is not a high morbidity surgery in terms of immediate complications and long term morbidity. For clinical T3 prostate cancer, morbidity is not significantly higher than in patients with clinical localized disease.

Tension free vaginal tape (TVT) : Experience in Siriraj Hospital.

Early experience of a TVT operation in 39 patients was reported. Retrospective data was collected from patients’ files. All of the patients experienced symptoms of stress incontinence and 9 patients had stress incontinence and overactive bladder. Of 39 patients, 8 patients and 6 patients underwent A-P Repair and Anterior repair in the same setting of the TVT operation, respectively. Mean operative time was 51.41 minutes. Estimated blood loss was 65 mls. with average catheterization time of 3.1 days. Only minor complications were reported, including urge incontinence2, urinary retention 1, bladder perforation 1 and urethral injury 1. Stress incontinence was cured in 36 patients after 1 month follow up. The TVT operation was safe, simple and suitable for treatment of stress urinary incontinence.

The pattern of prostate-specific antigen responses following hormonal therapy in Thai men with bone metastatic prostate cancer.

OBJECTIVE: To study the pattern of prostate-specific antigen (PSA) responses and prognostic factors following hormonal therapy in Thai men with bone metastatic prostate cancer. MATERIAL AND METHOD: Forty-four patients with bone metastatic prostate cancer treated by bilateral orchiectomy were retrospectively studied for PSA responses during follow-up. The endpoint was time to PSA biochemical failure. PSA pattern and the prognostic factors were evaluated. RESULTS: PSA levels regressed to PSA nadir level in all patients. Time to 50 per cent PSA regression, time to PSA nadir level and time to biochemical failure were 2.1, 6.7 and 11.2 months, respectively. While biochemical failure was present, all patients were alive and had stable clinical conditions. Tumor grading was an important prognostic factor while age and pretreatment PSA level were not a significant indicator. Times to biochemical failure in the patients with well, moderate and poor differentiated tumors were 19.3, 10.0 and 9.3 months, respectively. CONCLUSION: Following bilateral orchiectomy in Thai men with bone metastatic prostate cancer, PSA level decreased continuously to the PSA nadir level in 6-7 months and stable for a period then it increased, known as biochemical failure. The patients with a well differentiated tumor had a significantly longer time to biochemical failure when compared to the patients with a moderate or poor differentiated tumor.

The efficacy of Thai capsaicin in management of overactive bladder and hypersensitive bladder.

This paper has been generated to provide information on the effectiveness of capsaicin treatment among patients with overactive or hypersensitive bladder. The evaluation process required approximately 14 (overactive bladder) and 11 (hypersensitive bladder and primary detrusor instability) participants who received capsaicin intravesically. The solution consisted of capsaicin (concentration = 1 mM/L) diluted in 30 per cent ethanol solution 100 ml. All participants went through at least 1 urodynamic test 1 month before and after receiving capsaicin intravesical instillation. The capsaicin treatment for overactive and hypersensitive bladders was very effective. On the average, (overactive bladder) participants' voiding needs decreased from 16.5 +/- 4.8 times/day to 8.6 +/- 2.5 times/day, leakage from 9.7 +/- 8.1 times/day to 2.4 +/- 4.3 times/day, bladder capacity from 160.1 +/- 123.3 ml to 236.9 +/- 146.1 ml, and detrusor contraction from 71.1 +/- 29.2 cm/H2O to 57.3 +/- 27.2 cm/H2O. On average, (hypersensitive bladder and primary detrusor instability) participants' voiding needs decreased from (Day time) 19.45 +/- 17.99 times to 12.00 +/- 8.91 times/day, (Night time) 7.09 +/- 6.03 times to 4.09 +/- 3.8 times, bladder capacity from 197.40 +/- 156.06 ml to 323.45 +/- 129.46 ml, and detrusor contraction from 32.64 +/- 22.77 cm/H2O to 36.64 +/- 19.22 cm/H2O. Capsaicin efficiency was rated very high for both overactive and hypersensitive bladder and primary detrusor instability. In Thailand, it has been possible to produce capsaicin using local chili supplies, thus the price of the drug itself is very economical. When considering the efficiency and the inexpensive cost of capsaicin, this treatment would be another great alternative for overactive and hypersensitive bladder cure.

Uroflowmetry in normal Thai subjects.

BACKGROUND AND OBJECTIVES: Uroflowmetric parameters of urination may be influenced by many factors including age, sex, voiding position, technique used and also anatomical and physiological variations. A cross-sectional study was carried out to measure uroflowmetric parameters in normal Thai subjects and to compare these parameters among different ages and genders. Correlations between peak flow rate and other parameters were also studied. METHOD: One hundred and forty healthy Thai subjects were studied. They were classified into two groups. Group I comprised of 50 male and 50 female young adults aged 18-30 years. Group II comprised of 20 male and 20 female pre-elderly aged 50-60 years. A Dantec Urodyn 1,000 uroflowmeter was used. The residual urine measurement was performed using an ultrasonograph. RESULT: The techniques revealed the following uroflowmetric parameters. In the young adults, the mean with standard deviation of the peak flow rate was 31.2 +/- 9.0 ml/sec, mean flow rate 22.6 +/- 7.4 ml/sec, voiding time 24.7 +/- 10.6 sec, and voided volume 376.9 +/- 147.5 ml. In the pre-elderly group, the peak flow rate was 27.5 +/- 9.2 ml/sec, mean flow rate 19.1 +/- 6.2 ml/sec, voiding time 24.4 +/- 8.5 sec, and voided volume 310.3 +/- 107.8 ml. The peak flow and mean flow rates were significantly higher in the young adults (p < 0.05). The voided volume in the young was higher with similar voiding time. The peak flow and mean flow rates in females were significantly higher than the males (32.5 +/- 10.0 vs 27.8 +/- 8.0 ml/sec, p < 0.05 and 23.5 +/- 8.1 vs 19.8 +/- 5.8 ml/sec, p < 0.05 respectively). Voided volume and voiding time did not differ among both genders. The correlation between peak flow rate and voided volume was significant (r = 0.382, p < 0.01) indicating that the higher the voided volume the higher the peak flow rate. Residual urine was less than 50 ml in all subjects indicating that these subjects could void completely well. This study yielded normal uroflowmetric parameters in Thai young adult and pre-elderly subjects without urological symptoms. These parameters vary with age and gender, and are useful for the investigations of bladder function in a urological clinic.

The risk and effectiveness of transurethral resection of prostate.

BACKGROUND: To advise a patient to have transurethral resection of prostate (TURP) needs information on the benefit and complications of the procedure. Quality assurance also needs present results to be compared with future ones. OBJECTIVES: The authors wanted to know: 1. Whether TURP can decrease theInternational prostate symptom score (IPSS) and improve the Quality of Life (QOL) scores concerning urination at 1.5 months post-operatively for at least 25 per cent of the pre-operative scores?; 2. What are the common medical diseases in this type of patient?; and 3. What are the mortality and immediate complications of TURPF? METHOD: This was a prospective, before-after design trial. All patients who came to have TURP at a tertiary care hospital were studied. IPSS and QOL scores were recorded before surgery and again when the patients came back to follow up at 1.5 months after discharge. Patients were evaluated for cardiopulmonary reserve and congestive heart failure. Anesthetic technique of choice was spinal anesthesia with 0.5 per cent bupivacaine. Anesthetic and surgical complications were recorded if the definitions were met. ANALYSIS: Pre-operative and 1.5 months post-operative scores were compared using paired t-test and 95 per cent confidence interval. RESULTS: During the 13 months there were 269 consecutive males who received TURP. The mean +/- SD age was 70.4 +/- 8.8 years (range 35-97). The mean difference between pre- and post-operative IPSS was 6.7 +/- 9.1 (95% CI 5.2-7.8). Quality of Life also improved, the mean difference between pre- and post-operative QOL was 3.2 +/- 1.6 (95% CI 2.9-3.5). Most patients had ASA class 2. Common pre-operative existing diseases were hypertension (31.6%), ischemic heart disease (18.2%), diabetes (15.6%), and COPD (7.1%). Anesthetic techniques were spinal block (77.3%), epidural block (5.9%), continuous epidural (11.2%), and general anesthesia (5.6%). Intra-operative complications were reported and T URsyndrome occurred in 1 patient (0.37%). There was one surgical death 3 days post-operation, due to septic shock probably from bowel perforation. CONCLUSION: The patients' symptoms and quality of life significantly improved, but there was 1 surgical death and 1 TUR syndrome among 269.

The prevalence of prostate cancer screening in Thai elderly.

PROBLEM: Prostate cancer is the most common cancer in elderly men in Western countries. In the future, it may be an important problem in Thailand. At present, there is no evidence about the prevalence and the outcome of screening in this disease. OBJECTIVES: To determine the prevalence of prostate cancer in elderly Thai men and to identify the most appropriate screening method for detection of prostate cancer in Thailand. MATERIAL AND METHOD: 928 elderly men from communities around Siriraj Hospital were evaluated for prostate cancer by Digital Rectal Examination (DRE) and/or Prostate Specific Antigen (PSA). Transrectal ultrasound guided biopsy (TRUS-Bx) which is the gold standard for definitive diagnosis was performed in cases with an abnormal DRE and/or PSA. If biopsy could not be performed, intermittent follow-up with DRE and/or PSA were recommended. RESULT: The prevalence of prostate cancer in Thai elderly men in the urban community was more than 0.75 per cent and the prevalence of abnormal DRE and PSA was 8.7 and 17.3 per cent respectively. The Positive Predictive Value (PPV) of both tests was 60 per cent and higher than the PPV of an individual test. A screening program for prostate cancer starting with DRE may be more cost effective. CONCLUSION: The prevalence of prostate cancer, abnormal DRE and abnormal PSA in Thai elderly men were more than 0.75, 8.7 and 17.3 per cent respectively which are comparable to the prevalence in Western countries. It is important that we take an interest in this disease.

The efficacy of Thai capsaicin in the treatment of primary detrusor instability and hypersensitive bladder.

Our an objective was to study the efficacy of Capsaicin extracted from Capsaicin frutescen in treating the patients with hypersensitive bladder and primary detrusor instability. Eleven patients, 3 males and 8 females, with average age of 60.3ฑ14.3 years were treated by intravesical instillation 1 mM/L Capsaicin in 30% ethanol in an amount half of the bladder capacity for 30 minutes after instillation 2% xylocaine without adrenaline for 15 minutes three out of the 11 patients who could not tolerate the pain by this method were anesthesized with regional or general anesthesia. The results were as follow :- 1. Clinical symptoms were improved significantly, i e. the frequency was reduced from day : night = 19.45ฑ17.99 : 7.09ฑ6.30 to 12.00ฑ8.91 : 4.09ฑ3.8 at p < 0.05 and leakage almost disappeared. 2. Maximal bladder capacity increased from 197.45ฑ156.06 ml to 323.45ฑ129.46 ml which was statistically significant (p=0.009). 3. Detrusor pressure at maximal bladder capacity increased from 32.63ฑ22.76 cmH2O to 36.63ฑ19.21 cmH2O but was not statistically significant (P=0.823). 4. Voiding pressure nonsignificantly increased from 47.1ฑ6.4 cmH2O to 48.1ฑ6.6 cmH2O (p=0.959). The adverse effects found were burning pain at suprapubic area, sweating and hematuria.

Anesthesia for cystectomy.

Objectives : To determine the common pre-existing medical condition, the anesthetic technique used, monitoring, complication, the duration of stay in postoperative ICU, and mortality of cystectomy. Methods: Between February 1998 and July 1999, 61 patients underwent cystectomy for bladder carcinoma. Their medical conditions, anesthetic technique, monitoring, complication, and perioperative mortality were recorded. Result: The common associated diseases were hypertension (18%), renal insufficiency (16.4%), and diabetes (13.1%). Combined general and epidural anesthesia was chosen in 80.3% of cases. Besides standard monitoring, 80.3% of patients had central venous pressure monitoring. Complications that occurred were hypotension, hypothermia and massive transfusion. There was one intraoperative death from massive bleeding. Postoperatively, 82.0% of patients were admitted in the ICU and the mean duration of admission in ICU was 1.1 (S.D. 0.63) days. Conclusion: Anesthesia for cystectomy needs vigilance and combined general and regional anesthesia is the technique of choice. Because of the long operative time and invasive surgery, patients often experienced intraoperative hypotension and hypothermia. Central venous pressure monitoring was useful and commonly used. Postoperatively, most patients were admitted to the ICU but mostly for only 1 day, therefore ICU admission may not always be necessary.

Epidemiology of genitourinary tract carcinoma in Siriraj Hospital During 1990-1995.

In Thailand genitourinary tract cancers are not as common as cancers of the liver and lung; but they affect the quality of life, well-being and mortality rate. If detected early, they can be cured by surgery. From the Thai cancer statistics, the incidence of genitourinary cancer ranked the fifth and bladder cancer was the most common. This report is a retrospective study of genitourinary tract cancers in Siriraj Hospital between 1990 to 1995. The total number of patients with genitourinary tract cancer was 638 with an average of 127.6 patients per year and bladder cancer was the most common (284 patients, 44.5%). The second most common was prostate cancer (191 patients, 29.9%), followed by renal cancer 68 patients (10.6%), penile cancer 50 patients (7.8%), and upper urinary tract cancer 45 patients (7%). Most of the patients were over 60.

Bladder perforation from capsaicin infusion : A case report.

We reported a 36 year old patient, with a spinal cord lesion who had bladder perforation during an infusion of 400 mls of Capsaicin (1mMol in 30% alcohol) for treatment of detrusor hyperreflexia. Under spinal anesthesia during the procedure he was restless and complained of chest discomfort. The operation was therefore terminated and a cystogram was carried out. Cystography showed extraperitoneal leakage of contrast media. He was treated conservatively and had an uneventful post-operative period. To prevent this complication, we therefore recommend an infusion volume of Capsaicin of between half to two-thirds of the patients bladder capacity together with pressure monitoring during the procedure.

The efficiency of capsaicin in overactive bladder.

Our objective was to treat the overactive bladder caused by Detrusor hyperreflexia (in suprasacral cord neuropathic bladder) and Detrusor instability (idiopathic) by Capsaicin that was extracted from Capsicum Frutes Cens. Eleven with patients neuropathic bladder and three patients with idiopathic Detrusor instability were enrolled. They were treated by intravesical Capsiacin at a concentration of 1 mM/L in 30% ethanol to half of the bladder capacity for 30 minutes after 2% Xylocaine without adrenaline up to half of the bladder capacity for 15 minutes. The results showed significant improvement ie. Average frequency reduced from 16.5 + 4.8 time/day to 8.6 + 2.5 time/ day Average leakage reduced from 9.7 + 8.1 time/day to 2.4 + 4.3 time/day Urodynamic results Pressure at maximal bladder capacity reduced from 71.1 + 29.2 cmH2O to 57.3 + 27.2 cmH2O Voiding pressure reduced from 74.8 + 35.3 cmH2O to 65.1 + 35.0 cmH2O

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.

Percutaneous nephrolithotomy vs open pyelolithotomy for renal pelvis calculi.

Objective: To compare the stone free rate and morbidity of percutaneous nephrolithotomy (PCNL) and open pyelolithotomy for a single renal pelvis stone. Patients and methods: A retrospective study was performed by reviewing case records of patients who underwent stone removal surgery between August 1994 and March 1999. The inclusion criteria was a single renal pelvis stone which was not smaller than 3 cm2 in surface area. Patients in the open pyelolithotomy group who had concurrent nephrotomies were excluded. There were a total of 46 patients of which 25 had undergone PCNL and 21 had undergone pyelolithotomy. Both groups were compared in terms of age, sex, stone surface area, haematocrit, blood urea nitrogen, serum creatinine, operative time, complications, stone free rate, adjunctive procedures, doses of postoperative analgesic injection, length of hospital stay, and time to return to normal work. Statistical analysis was performed by Chi-square test and t-test. Results: Preoperative status of the two groups were similar. The operative time was comparable between the two groups. The stone free rate of the PCNL group and the pyelolithotomy group were 92% and 95% respectively which was not statistically different. Five patients in the PCNL group needed ancillary procedures while only one patient in pyelolithotomy group did. Overall complications of the PCNL group and the pyelolithotomy group were 28.6% and 28% respectively which were comparable. Severe bleeding due to arterio-venous fistula occurred in 2 patients of the PCNL group. However, the complication could be managed successfully by selective embolisation. Disruption of uretero-pelvic junction occurred in one patient of the pyelolithotomy group and was repaired successfully. The number of doses of postoperative pethidine injection to lessen pain was lower in the PCNL group when compared with the pyelolithotomy group (mean 0.96 dose vs 1.95 doses, p<0.003). Length of hospital stay was comparable between the two groups. Time to return to normal work was shorter in the PCNL group when compared with the pyelolithotomy group (mean 13.7 days vs 36.3 days, p<0.001). Conclusions: PCNL is a safe and effective method to treat renal pelvis stones compared to open pyelolithotomy and offers less postoperative discomfort and shorter recovery period.

Treatment of penile incarceration: A case report (string method).

Cases of penile incarceration with constrictive band are occasionally seen in the emergeney room, and treatment is to remove the constrictive band. We report a case of penile incarceration in a 50-year-old man, the penis was encircled by a metallic nut. This paper describes a simple method to deal with such an emergency in which no special skill is required and no immediate or long term morbidity related to the treatment.

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.