[Incidental perforation of peptic ulcer after trans-urethral resection of bladder tumor: a case report]

Peptic ulcer is relatively common and in 2% of patients may present with sudden perforation without previous history of peptic ulcer disease. Early diagnosis and management can save the patient. A 79-year-old man was presented to emergency room with gross hematuria and clot uninary retention. A 3-4 cm vegetative mass was in left lateral wall of bladder in cystoscopy. Under spinal anesthesia, transurethral resection was performed without any complication. The day after surgery, patient had developed generalized abdominal pain and guarding and hematuria with urinary retention. Emergency abdominal sonography revealed free fluid in pelvis with possible bladder perforation. Laparotomy was performed and there was no bladder perforation except a little extra and intra peritoneal clear fluid. With a cystectomy tube and two intra and extra peritoneal drains laparotomy was closed. Two days after the second surgery, liquid diet was started for patient, but it was associated with fecal oderous leakage from the drains. After consultation with general surgeons with diagnosis of trauma to rectum or lieum again laparotomy was performed. In re-exploration there was a perforation in stomach [anterior aspect of pylores], so it was repaired and a few days later with normal general condition patient was discharged. Although peptic ulcer disease is relatively common. Its perforation with association of other surgeries in these patients is very rare and can mimic the complication of T.U.R.B.T. So close observation of patients and proper management can save the patients

Endourology: a comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction

To compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction [UPJO] were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6% in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar [6.2 days] in the two groups. Mean follow-up was 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87% for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay is also not longer than that in open surgeries. Hence, laparoscopic pyeloplasty can be a substitute for skilled surgeons

PCNL in the management of lower pole caliceal calculi

Several therapeutic methods are used in the management of lower pole caliceal calculi. This survey has been conducted to evaluate the safety and efficacy of percutaneous nephrolithotomy in the management of lower pole calculi. Fifty-five patients, 43 males and 12 females with a mean age of 41.5 [range 11 to 75] years, who had suffered from lower pole caliceal calculi and treated by standard percutaneous nephrolithotomy [PCNL] between 1997 and 2001, were enrolled in this study. The stones were classified as follows: small [less than 25 mm], intermediate [25 to 34 mm] and large [more than 35 mm]. Mean follow-up was 6.2 months [range 2 weeks to 34 months]. The stones were completely extracted by one session PCNL in 43 patients [79%]. Repeat PCNL was needed in one patient and another method was used for stone extraction in another patient. Regarding the size of stone, 88%, 79%, and 74% of small, intermediate, and large stones were completely extracted, respectively. No major complication was noted. PCNL has high success rate in patients with stones larger than 2 cm and its morbidity would be low, provided that it is performed by skilled surgeons