Laparoscopic decortication of symptomatic simple renal cysts

To investigate the technique and assess results of laparoscopic decortication of symptomatic simple renal cysts. Ten patients underwent trans-peritoneal laparoscopic decortication of symptomatic simple renal cysts. Complex renal cysts were excluded. Out of the 10 patients, 8 had undergone previous cyst aspiration with injection of sclerotic material for intended ablation. Out of these cysts, 8 were peripheral and 2 were peripelvic. The mean operative time was 116 +/- 37.7 minutes [range 90- 180] and blood loss was minimal. Symptomatic success was achieved in 9 patients with a mean follow up of 7 months [range 3-9], and radiologic success was achieved in 8 patients. Laparoscopic decortication of simple renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Peripelvic cyst location makes laparoscopic decortications more challenging in the term of technical dissection yet feasible for the clinical outcome

Detrusor blood flow as a measure of bladder outlet obstruction in patients with benign prostatic hyperplasia

In patients with benign prostatic hyperplasia [BPH], detrusor blood flow was evaluated by color Doppler ultrasonography [CDU] with the aim of revealing its possible usefulness as a measure of bladder outlet obstruction [BOO]. A total number of 30 men with lower urinary tract symptoms [LUTS] suggestive of BPH underwent pressure flow study [PFS] and detrusor CDU. Pulsatile blood flow was measured at three sites, the anterior bladder wall and the two lateral walls, and detrusor resistive index [DRI] was calculated. The findings were compared between patients with and without BOO. Between patients with and without BOO, there were significant differences for age [69.2 Vs. 62.1 years, p<0.005], PSA [3.9 Vs 2.6, p<0.05], prostate volume [45.5 Vs, 34.7, p<0.05], bladder wall thickness [5.6 Vs 3.2, p<0.001], blood flow detection [16/18 Vs 3/12, p<0.001] and DRI [0.82 by 0.65, p<0.005]. BOO was detected with a diagnostic accuracy of 83.3% [25/30] by CDU. Color Doppler ultrasonography has the promise to become a possible indicator for the diagnosis of BOO. To ascertain its clinical utility in terms of BOO predictability, a prospective study in a large cohort is needed

Ureteroscopy or extracorporeal shock wave lithotripsy for lower ureteric stone

The optimal treatment for distal ureteric stories still controversial. While most urologists offer extracorporeal shock wave lithotripsy [ESWL], others strongly prefer .ureteroscopy with or without mechanical fragmentation as the primary choice for treatment of lower ureteric stones. We present data from our department on these new modalities since 1998 to 2003. We treated 150 patients with distal ureteric calculi on Siemens modularis lithotriptor and 150 patients by ureteroscopy using forceps s, baskets or pneumatic lithoclast. Stone free rate three months post-ESWL was 90% with no complications. In ureteroscopic group of patients, the stone free rate was 95% with overall complications in 10 patients [6.7%] At our department, ureteroscopy with or without mechanical, fragmentation of lower ureteric stones is more efficacious method than ESWL, However the rarity of anaesthesia requirement and the absence of complications make ESWL as good as ureteroscopy. Our results may put ESWL as the second and in certain particular cases the first option in treatment of lower ureteric calculi

Suprapubic endoscopic procedures: a percutaneous approach

This study was carried out to assess whether suprapubic endoscopic surgery can be helpful in situations where trans urethral access is inadequate, difficult or likely to be associated with urethral damage. We have applied a new technique for percutaneous access to the bladder by using the self-retaining [locking] laparoscopic trocar. Forty male patients with lower urinary tract disorders were selected from the patients who attended the urology department at Benha University Hospitals during the period from June 1997 to October 1999. The patients ages ranged from 2 to 80 years old with a mean age of 48.1 years. According to the procedures done, 30 patients underwent percutaneous stone bladder clearance: 4 of them underwent a concomitant antegrade bladder neck incision. 6 patients treated with antegrade endoscopic dilatation [cut-to-the light of stricture posterior urethra] and 4 children underwent antegrade ablation of posterior urethral valve [PUV]. We concluded that, percutaneous access to the bladder by using the locking trocar is simple and safe technique. It avoids drawbacks of the other technique of creating and dilating the tract over a guide wire