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We are reporting, a case of 52 year old male, with obstructive uropathy who underwent cystolithotripsy surgery associated with chronic kidney disease presented with respiratory distress, tachypnea and hypoxia on 3rd post-operative day. He was on maintenance hemodialysis. Examination revealed absent air-entry on right side, dull percussion note on right side and positive trail sign. Chest X-ray and HRCT showed complete collapse of right lung with ipsilateral shift of trachea with mediastinum. Conventional physiotherapy postural drainage, breathing exercises, active cycle of breathing technique, forced expiratory techniques, spirometry, nebulization given for a day, no improvement seen because patient had strong cough reflex but unable to expectorate; any effort to cough caused more distress and breathing difficulty. Mechanical insufflation-exsufflation, a therapy in which the device which inflates the lungs(Insufflation pressure start at 15-20 cmH2O and increase to give an inspiration to total lung capacity, last for 2 second) followed by an immediate and abrupt change to negative pressure (exsufflation pressure same as the insufflation, then increase up to 10–20cmH2O, held for 3-6 second), which produces rapid exhalation, simulates cough and thus moves secretions cephaladly. Thus device helps patient cough out effectively. Lung collapse resolved within 1 day, regular physiotherapy was given to prevent recurrent lung collapse until discharge, X-ray and auscultation findings and oxygen saturation improved. It concludes, successful utilization of chest physiotherapy and mechanical insufflators-exsufflators aids in the resolution of lung collapse in an urgent situation.
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Background: aim of the study was to present the experience in managing forgotten/encrusted Double J (DJ) ureteral stents and to review the literature on the subject.Methods: Author retrospectively studied patients presenting to the Outpatient Department from January 2016 to January 2019 with forgotten DJ stent(s) (six or more than six months after the insertion). Data was collected for age, gender, indication for DJ stenting, clinical features at presentation, radiological imaging and surgical procedure performed to extract the DJ stents. The post-operative stay, complications of the procedures and morbidity was also studied.Results: During the study period, a total 32 patients reported to the department with history of forgotten DJ stents. Most common age group involved was 41-60 years. Most common presenting symptoms were lower urinary tract symptoms (LUTS) or dysuria. Duration of stent in-situ ranged from 6 month to 15 years. Most common sites of encrustations along the forgotten DJ stent were ureter and kidney followed by urinary blabber. Fluoroscopic guided DJ stent removal was done in 8 patients. A combination of Cystolithotripsy, URSL and PCNL was needed to clear the stone and extract the DJ stent in remaining patients.Conclusions: Forgotten/encrusted DJ stent may lead to complications ranging from urinary tract infections to loss of renal function. They can be safely and successfully removed, and the renal function can be preserved. Endo-urological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.
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Objective The main objective of this paper is to evaluate the feasibility and clinical efficiency of the man-agement of male children with bladder stones by percutaneous suprapubic cystolithotripsy(PCCL). Methods From Au-gust 2008 to September 2012,40 cases of male children with bladder stones were undergone by percutaneous suprapu-bic cystolithotripsy(PCCL). The age of patients was ranged from 1 to 9 years. The size of stones was ranged from 10 to 35 mm. Results All the patients were operated successfully only once by percutaneous suprapubic cystolithotripsy(PC-CL). All the stones were eliminated at a rate of 100%and there were no over bleeding,infection,perforation,urine fis-tula and other complications. During a follow-up period of 1 to 10 months there was no stone recurrence and urethral stenosis. Conclusion Percutaneous suprapubic cystolithotripsy (PCCL)is a safe,high-effect and accurate lithotripsy method for the treatment of male children with bladder stones,and it is worthy of wide application.
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Objectives: to investigate the effectiveness and reliability of the combination of optical cystolithotripsy (OC) and transurethral prostatectomy (TURP) for the treatment of bladder calculi and obstructive benign prostates enlargement (BPE). Patients and methods: from September 1999 to December 2003, 63 patients who had bladder stones and BPE were treated with combined OC and TURP; 45 patients who had bladder stones with no infravesical obstruction were treated with OC alone. In the same period, the records of random selection of 561 patients with BPE were treated by TURP. The operative duration time, the length of hospital stay, the duration of urethral catheterization, outcome and complication of the procedures for each patient were reviewed. Results: The mean duration of surgery were significantly longer with combined OC and TURP than with OC or TURP alone (p<0.05), but not of hospital stay and urethral catheterization. Stones free rates were 100% after OC alone and combined OC and TURP. The postoperative average mean peak flow rates were 13.2 ml/s in the combined OC and TURP group and were 13.7 in the TURP alone group. The complication rates were 13.6% for the TURP procedure, 5% for the OC alone and 21% for the combined OC and TURP (p<0.05). Conclusion: Simultaneous treatment with OC and TURP did not change the effectiveness of these procedures, but caused additional morbidity.