Antegrade scrotal sclerotherapy for men with varicocele

Objective: applying antegrade scrotal sclerotherapy [ASS] for men with varicocele

Subjects and Methods: sixty male patients [mean age 25.6 years] with different grade of primary varicocele underwent ASS. Either due to primary infertility, scrotal pain or discovered accidentally in adolescent during examination for unrelated causes. All patients were evaluated with complete clinical examination, colour Doppler ultrasonography of the spermatic cord and determine the degree of reflux. Semen analysis was done for patients presenting for infertility. Azospermia patients, patients with bilateral subclinical varicoceles were excluded from this study. ASS were done in all patients under local anesthesia

Results: only 10 patients required intraoperative sedation and one patient needed spinal anesthesia. No intraoperative complications were recorded, no allergy to contrast or the sclerosant occurred. Difficulties in vein catheterization was occurred in [5] patients whom retreated again [2] weeks after first trial. Unilateral ASS was done in 17 patients and take average 18-30 minutes and required 6-24 hours to be discharged from the hospital and 3-5 days to start his normal activities. Bilateral ASS was done in 43 patients and take average 32-60 minutes and discharged from the hospital after average 8-30 hours and return to normal activity 7-12 days later on. Scrotal hematoma was occurred early in 7 cases [11.7%] and persistent scrotal pain in one case [1.6%]. As regard late complications no hydrocele, no testicular atrophy was occurred, but persistent reflux in 10 patients [16.7%] and occurred in high grade varicocele [26.6% in grade III and 17.6% in grade II]. Semen analysis [6] months after ASS was done in 40 patients and showed increased mean sperm count from an mean initial value of 16.5 x 10[6] to mean 22.8 x 10[6] ml [P = 0.05] while mean motility increased from 20% to 38% ml [P<0.001] and mean abnormal form decreased from 31% to 16% [P <0.001] with highly significant relationship

Conclusion: antegrade scrotal sclerotherapy can be done under local anesthesia so less preoperative investigation and low cost, can be done as outpatient procedure with short recovery time and also successful operation that improving sperm parameters occurred with few early and late complications

Testicular torsion: a perspective from the Middle East

Objective: to report our experience in the management of testicular torsion with emphasis on seasonal variation, salvage rate and the status of the torted testis 3-6 months after orchidopexy

Subjects and Methods: sixty patients with apresumptive diagnosis of testicular torsion, who presented to urology department in Armed Forces hospital in Kuwait between January 2000 and December 2003 were included in the study. Following scrota1 exploration, 52 patients were found to have testicular torsion. Of these patients, 8 with non viable testes underwent orchidectomy, while 44 with viable testes underwent orchidopexy. Both groups of patients had simultaneous contralateral orchidopexy. Patients who had orchidopexy were followed up monthly for 3-6 months by testicular ultrasound to assess the volume of the affected testis

Results: 52 patients were confirmed to have testicular torsion. The average number of new cases in the winter was [6.7] compared to [4] in the summer. Forty four patients underwent orchidopexy to give an operative salvage rate of [44/52] 84.6%. Of 44 patients in whom the duration of torsion was less than 24 hours, 1 [2.3%] had a non-viable testis, whereas of 8 patients in whom the duration of torsion was more than 24 hour, 7 [87.5%] had a non-viable testis. Patients who had orchidopexy were followed up monthly for 3-6 months after a minimum follow up of 3 months 6 patients [13.6%] developed testicular atrophy

Conclusion: the highest incidence of testicular torsion was during the cold season. The outcome of surgical management of testicular torsion was dependent on the duration of torsion and degree of spermatic cord torsion

Iintravesical instillation of bacillus calmette guerin versus intravesical instillation of hyaluronic acid in the treatment of interstitial cystitis

The study included thirty adult female patients with a mean age of [40-50y] with a interstitial cystitis. Patients were divided into two equal groups. First group was treated with intravesical installation of hyaluronic acid 40 my in 50-ml solution weekly repeated for 4 weeks then once monthly for 6 months. The second group was treated with intravesical installation of BCG [Tic strain] 40 my in 50-ml solution weekly repeated for 6 weeks. Evaluation was done according to symptom score. Improvemen occurred in both groups. With hyaluronic acid, maximum response reached by 24 weeks in which positive response occurred in 66.6% [complete response 13.3% and partial response 53.3%]. By the end of 48 weeks positive response decreased to 40% [complete response 6.6% and partial response 33.3%]. No reported complication in this group. With BCG, maximum response reached by 12 weeks in which positive response occurred in 73.3% [complete response 20% and partial response 53.3%]. However by the end of 48-week positive response decreased to 60% [complete response 13.3% and partial response 46.6%]. Microscopic haematuria occurred in 53.3% and symptoms of bladder irritability were increased in 20%, but disappeared spontaneously in 6 weeks. Both intravesical BCG and hyaluronic acid installation are effective in the treatment of interstitial cystitis. With BCG the maximum response started early, maintained for prolonged duration and persisted for the period of follow up of 48 3 weeks in 60%. But with intravesical hyaluronic acid the response persisted for the period of follow up of 48 weeks in 40% only

Comparative study of treating the obstructing ureteric stones by extracorporeal shock wave lithotripsy with or without preliminary drainage

In an attempt to assess the usefulness of a ureteral stent or percutaneous nephrostomy tube [PCN] in facilitating disintegration of obstructing ureteral stone with extracorporeal shock wave lithotripsy [ESWL]; a prospective randomized study on 98 patients with criteria of obstructing ureteric stones were allocated into three treatment groups: group 1: in situ ESWL without any stone manipulation; group 2: by pass stones with a stent followed by ESWL: group 3: PCN to relive the obstruction followed by ESWL. Group one 30 patients group two 22 patients and group three 18 patients. Number of patients available for follow up for a period of [3] months with sufficient data for analysis only 70 patients. The success rates [stone free or doesn t needed further intervention] were 83%, 81.8%, 77.8% in-group 1, 2 and 3 respectively. Forty one percent of patients in-group two needed two sessions or more. In-group one only 23.3% of patients needed two sessions or more, in-group three 33.3% of them needed two sessions or more. With proximal ureteric stones success rates were 92.3%, 93.3%. 87.8% in-group 1 and 2 and 3 [no significant difference]. With mid ureteric stones, success rates were 83.3%, 66.6%, 66.6% in-group 1, group 2, group3 [no significant difference]. With lower ureteric stones success rates were 60%, 50%, 71.4% in-group 1, 2, 3 [no significant difference.]. Ancillary procedures were needed in 20% of all cases, most of them treated by ureteroscopy and stone extraction with or without intracorporeal lithotripsy, most of the cases are lower ureteric stones. JJ stent or PCN do not increase the stone free rate over in situ ESWL alone. So treating ureteric stones with ESWL does not need any preliminary drainage

value of trnsrectal power doppler ultrasonography in cancer prostate

In attempt to assess the usefulness of transrectal power Doppler ultra-sonography [PDU] for improving the diagnoses of cancer prostate in-patients with abnormally elevated PSA, forty male patients with a mean age 65 years were assessed using a digital rectal examination [DRE], transrectal ultrasonography [TRUS] and [PDU]. All cases of prostatitis were excluded. The vascularity on PDU was graded on a scale of 0-3 where grade 0 negative and grade 1-3 was considered positive Transrectal needle prostatic biopsies were obtained from hypoechoic lesions or hyspervascular lesions under TRUS and PDU and systematic biopsy was taken in all cases. The results of PDU, DEE and TRUS were evaluated according to histopathological examination of needle biopsy. Prostatic biopsy confirmed prostate cancer in 11 patients out of 40 patients [27.5%], PDU was positive in 16 patients, of whom 10 had prostate cancer [62.5%], all those but one having prostate cancer were positive on PDU. Thus PDU had a higher sensitivity of 90.9% [10/11], than DRE [54.5%] and TRUS 72.7% and PDU had a higher negative predictive value in 95.8%, while 85% with TRUS and 80.7% for DRE. So, PDU increases the sensitivity and negative predictive value of TRUS in detection of cancer prostate if is it used as a routine investigation with conventional TRUS. This does not need any added manipulations. PDU is more useful for detecting prostate cancer in-patients with abnormally high serum PSA levels and if PDU is negative, needle biopsy may be avoided especially if PSA is not conclusively high

Comparing the effect of topical eutectic mixture of local anesthesia and lidocaine infiltration on pain response and analgesia requirement during extra corporeal lithotripsy procedure [using the storz modulith SL20]

Fifty adult male patients [mean age 35 +/- 15 ys.] with renal pelvic stones were selected for this study, all patients required 3 ESWL sessions. First session was performed without any form of preoperative analgesia or anaesthesia. Second session, patients received 25mg of EMLA cream applied locally to cover a skin area overlying the treated kidney, 90 minuets before ESWL session. Third session was started 10 minuets after subcutaneous infiltration to the area overlying the treated kidney with 20 ml, 1% lidocaine. Using EMLA cream and lidocaine subcutaneous infiltration lead to decrease the pain score perception when compared to without anaesthesia session. During the first 500 shock waves of ESWL, pain score of 2 or more was reported by 6%, 10% and 35% of patients using EMLA cream, lidocaine infiltration and without anaesthesia respectively, and 38%, 32% and 70% during the following 2500 shock waves. This decrease in pain score lead to less need for I.V. alfentanil analgesia to 38% in case of using EMLA cream, 32% in case of using lidocaine infiltration, while it was 70% when nothing was used. Local anesthesia is an effective means to reduce the pain score and analgesia requirement during extra corporeal lithotripsy procedure. Both EMLA and local infiltration are effective. However EMLA cream is easy to apply and has no complications. It is only drawback is its price