Extra corporeal shock wave lithotripsy for the management of paediatric urolithiasis

Between 1992 and 1994, 33 children with urinary calculi [renal, ureters, bladder] were treated in Al-Nour Specialized Hospital and King Fahad Hospital in Holy Makkah and Jeddah [K.S.A.] using lithostar plus 2 for extra corporeal shock wave lithotripsy. Lithotripsy was performed on 28 renal cases; 8 ureteral and 2 bladder stones. The success rate [stone free and fragments 3 mm or less] for renal stones was 81.3% within 3 months and the stone free rate 95.4% after 3 months and auxilliary procedures were performed in 25% of the renal calculi. The success rate for ureteral calculi was 85% within 3 months, the stone free rate was 90.3% after 3 months and auxilliarv procedure were performed in 10% of the ureteral calculi. The over all success rate was 87% within 3 months, stone free rate 95.2% after 3 months, the retreatment 37% and auxilliary procedure were 39%, while 2 children with stone bladder the clearance rate after 3 weeks 100%. Ureterolithotomy was performed in 2 cases while one patient underwent percutaneous nephrostomy to obviate urinary obstruction, 10 patients out 33 children underwent ESWL have developed complications, [Colic 13%, fever 3%, perirenal hematoma 3% and mild hematuria in 6%]

role of an urgent urethrography in the diagnosis and optimal management of anterior urethral injury

Twenty one patients with straddle injuries [thier age ranged from 20- 45 years] underwent urgent urethrography for evaluation of urethral integrity, complete rupture bulbous urethra in 15 patients and simple urethral contusion in other 6 patients. 10 patients were managed by primary urethral reconstruction with supra pubic diversion and the other 5 patients by supra pubic cystostomy as the primary repair for rupture bulbous urethra. Two out of ten patients were managed by primary urethral reconstruction requires further procedure of urethral dilatation, while 3 patients were managed primarily by suprapubic cystostomy required gradual urethral dilatation, two of them visualised internal uretherotomy and only one patient needs surgical excision of strictured part with urethroplasty [end to end anastomosis]. Therefore urgernt urethrography provides, non invasive, simple and accurate diagnostic procedure for the extent of urethral injury, that is necessary for optimal management with the best successful outcome and least morbidity, as well it can eliminate the controversy existed about the result of primary urethral repair in comparison to suprapubic cystostomy as preliminary procedure as it clarifies the extent of urethral injury

Evaluation of bladder functions in chronic spinal injuries

Fifty patients with spinal cord injuries of two years duration were submitted to clinical, neurological and urodynamic evaluation. Neurogenic incontinence was the main presenting feature in most of cases 45 [90%]. However, difficulty and retention of urine were found in only 5 cases [10%]. The eventual picture of spinal cord injury depends on the level, duration and the extent of the lesion. These consecutively studied cases were having chronic and established lesions in most of the cases. From the clinical point of view, 30 cases out of 50 were clinically categorized as either having UMNL [16 cases], or LMNL [14 cases]. The remaining 20 cases, showed clinically a picture of mixed upper and LMNL. Therefore, urodynamic assessment was mandatory to clarify the eventual effect on the bladder function. By the virtue of urodynamis, it was possible to categorize the patients into hyperreflexic [30 cases] and areflexic [20 cases]. Urographic evaluation of these cases enabled us to study the state of the bladder which was decompensated in more than 50% of cases of areflexia and only in 10% of hyperreflexic cases. Again; refluxing ureter and deterioration of renal function were also detected. The incidence of reflux was more in the group of hyperreflexia [33%] compaired to - 20% in the areflexic group. The presence of high pressure reflux in cases of hyperreflexia was supported by presence of U.D.C and high urethral closing pressure in this group, detected by UPP