Extracorporeal shock wave lithotripsy for lower pole nephrolithiasis: Efficacy and variables that influence treatment outcome

We evaluated the efficacy of Extracorporeal Shock Wave Lithotripsy [ESWL] for treatment of lower pole caliceal stones. The study attempts to identify the relationship between the radiographic anatomy of the lower pole and the outcome of ESWL treatment for a solitary lower pole caliceal stones to help in selecting patients that are likely to benefit from that treatment. A total of 100 patients with solitary lower pole calculi [less than 2 cm.] underwent ESWL monotherapy using the Dornier Lithotriptor S machine. Pretreatment intravenous urography [IVU] was done to determine the stone size and lower pole measurements which include; the lower pole infundibular length. The lower pole infundibular width and the lower pole infundibulopelvic angle. Clinical and radiographic follow-up was done every month for 6 months after ESWL treatment. Sixty-four patients [64%] were stone-free 6 months after starting ESWL treatment, eighteen patients [18%] showed improvement as decreased stone size and another eighteen patients [18%] failed ESWL treatment. Significant variables that influenced treatment outcome include, stone size and type: the number of ESWL sessions and the radiographic anatomy of the lower pole. A short and broad lower pole infundibulum were very important favorable factors that improved the stone clearance after ESWL. Also a wide infundibulopelvic angle significantly improves the stone free rate after ESWL.ESWL is the initial treatment of choice for lower pole calculi smaller than 2cm. The spatial anatomy of the lower pole as defined by the lower pole infundibulopelvic angle, infundibular length and infundibular width, has a significant role in stone free rates after ESWL

Nephron sparing surgery [partial nephrectomy] for small, localized renal tumors

Is nephron sparing surgery [partial nephrectomy] effective for small, localized renal cell carcinoma with durable long-term success? We present our results of partial nephrectomy for small localized renal tumors in a group of patients treated and followed up during the last 6 years at the Urology Department, Zagazig University Hospitals. Patients and .During the period between October 1995 and March 2001, nephron-sparing surgery [partial nephrectomy] was performed in 13 patients with small localized and peripherally located renal tumors. Patients were 10 men and 3 women and their ages ranged from 33 to 72 years [mean 50 years]. The patients were followed postoperatively by abdominal ultrasound, abdominal CT and chest X-ray every 3 to 6 months. The mean follow up interval was 27 months [range 6-65]. The histopathology revealed renal oncocytoma in one patient and renal angiomyolipoma in one patient. In the remaining 11 patients, the histopathology revealed renal cell carcinoma and the tumor stages were Tl in 5 patients T2 in 4 patients and T3a in 2 patients. Postoperative complications included, retroperitoneal hematoma which was managed conservatively in 2 patients and prolonged. Urine leakage from the wound which resolved after placement of double J-ureteral stent in 3 patients. After a mean follow up interval of 27 months [range 6-65], two patients developed local tumor recurrence and two patients developed metastatic renal cell carcinoma. The remaining 7 patients [with small localized renal cell carcinoina treated by partial nephrectomy] were free of disease and had no evidence of recurrence.Nephron sparing surgery [partial nephrectomy] is effective for small, localized and peripherally located renal cell carcinoma. It gives long-term tumor control with preservation of renal function, and the overall prognosis depends on the initial pathological tumor stage. Also benign tumors may be diagnosed and removed without loss of the kidney

effect of varicocelectomy on seminal parameters and serum hormones [follicle stimulating hormone [FSH], testosterone] in infertile men with varicocele

To assess the effects of varicocelectomy on testicular functions; semen quality and serum hormones [FSH, testosterone] in patients suffering from infertility and having clinical varicoceles. Fifty-three infertile patients, their ages ranged from 25-45 years and having clinical varicoceles [14 bilateral, 39 left side only], underwent inguinal varicocelectomy. Semen analysis [at least 3 times] was performed before varicocelectomy and 6 and 12 months after the operation. Also serum hormones [FSH, testosterone] were measured before and 6 months after surgery. Before varicocelectomy the patients were classified into 4 groups according to their total motile sperm counts [TMS]. After varicocelectomy the mean relative increases in TMS were calculated for each group. Also the mean increase or decrease in serum testosterone and FSH were calculated. The patients were followed for a mean follow up of 25 months [range 6-55] and all pregnancies that occurred during the follow up were reported.Patients with mild .and moderate oligoasthenospermia showed significantly better seminal improvement following varicocelectomy, than patients with severe oligoasthenospermia and patients with azoospermia, in whom the improvement in semen quality was little after the operation. Serum FSH decreased in about 35% of the patients, from a mean of 13.8 +/- 2.4 before varicocelectomy to a mean of 9.6 +/- 1.8 mIU/mL by 6 months after the operation. Also serum testosterone increased, in about 50% of the patients, from a mean of 5.2 +/- 1.5 before varicocelectomy to a mean of 8.5 +/- 1.6 ng/mL by 6 months after the operation.There were 13 pregnancies by natural conception during the follow up period.Most of these pregnancies occurred 6 months to 2 years after surgery and most were in postoperative group A [10 pregnancies] when the TMS improved> 30 million. Varicocelectomy is the most effective initial intervention in males with mild or moderate oligoasthenospermia with clinical varicoceles. Varicocelectomy improves testicular functions, with significant increase in serum testosterone and significant improvement in sperm concentration and motility