Renal colic: pathophysiology, diagnosis and management

Renal colic not only leads to significant morbidity, but also imposes a financial burden on society in that it decreases productivity and increases healthcare costs. A review of medical literature regarding reno - urethral colic was performed using MEDLINE and on-line publications, like European Association of Urology [EAU] Guidelines. Clinical presentation of renal colic, mechanisms of urethral peristalsis and pathophysiology of renal colic were studied. An overview of available medical treatments was presented. The classic presentation of acute renal colic is sudden onset of severe pain in flank, primarily caused by acute urethral obstruction. The pain associated with urethral obstruction is caused by a rise in intra luminal pressure which produces an increase in urethral smooth muscle tension. The diagnosis is often made on clinical symptoms. The objectives of therapy at this stage are to eliminate pain, preserve renal function and eliminate the obstruction. Many drugs have been used in the treatment of renal colic, such as NSAIDs, opioid analgesics, and even loco-regional anesthesia and acupuncture. Nonetheless, the safest and most effective treatment has not yet been clearly defined. An accurate understanding of the pathophysiology of reno- urethral colic allows the physician to tailor the best treatment for each patient. Although many drugs have been suggested for treating renal colic, it seems that the first line medications should be NSAIDs, mostly in oral form. Fluid intake is encouraged and chemical analysis of stone should be performed whenever possible

Laparoscopic adrenalectomy: a report of the first experiment in Iran

To report the first experiment in laparoscopic adrenalectomy and study its success and immunity in treating different adrenal diseases. From March 1997 to July 2001, 11 patients underwent laparoscopic adrenalectomy through transperitoneal approach. Five of whom were males and 6 were females. Their mean age was 35.5 [range 28 to 52] years. Lesion was located at left in 6 patients and at right in 5. All necessary steps were preoperatively taken including CT scan, MRI, MIBG scan, and endocrine tests such as ACTH, cortisol, mineralocorticoid, 17-hydroxyprogesterone, and VMA. Three [5, 10, and 12 mm] trocars were used in left laparoscopic adrenalectomy and three or four [12, 10, 5, and 5 mm] trocars were applied in right laparoscopic adrenalectomy. All patients have been followed up for three months by physical examination and paraclinical tests. Mean operation time [including anesthesia and surgery] was 205 +/- 65.95 [range 130 to 310] minutes. No significant difference was seen between the operation time in the left and the right adrenalectomy [p=0.5]. Mean hospitalization was 5.54 +/- 3.4 [range 3 to15] days. Mean size of mass was 5.45 +/- 1.7 [range 2 to 8] cm. Blood transfusion was performed in 2 patients and open surgery was conducted for one because of high adhesion. No mortality was reported. During a 3-month follow-up, hormonal tests and blood pressure were normal for all patients, with no medical treatment. This experiment showed that transperitoneal laparoscopic adrenalectomy is an effective and safe approach in the treatment of adrenal masses with the least morbidity

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

Laparoscopic adrenalectomy: a report of the first experience in Iran

To report the first experience in laparoscopic adrenalectomy and to study its efficacy and safety in the treatment of different adrenal diseases. From March 1997 to July 2001, 11 patients underwent laparoscopic adrenalectomy through transperitoneal approach, five of whom were males and 6 were females. Their mean age was 35.5 [range 28 to52] years. Lesion was located on the left side in 6 patients and on the right side in 5. All necessary evaluations were done preoperatively including CT scan, MRI, MIBG scan, and endocrine tests such as ACTH, cortisol, mineralocorticoid, 17-hydroxyprogesterone, and urinary VMA. Three [5, 10, and 12 mm] trocars were used in left laparoscopic adrenalectomy and three or four [12, 10, 5, and 5 mm] trocars were applied in right laparoscopic adrenalectomy. All the patients were followed up for three months with physical examination and paraclinical tests. Mean operative time [including anesthesia and surgery] was 205 +/- 65.95 [range 130 to 310] minutes. No significant difference was seen between the operative time in the left side and the right side adrenalectomy [p=0.5]. Mean hospitalization was 5.54 +/- 3.4 [range 3 to15] days. Mean size of mass was 5.45 +/- 1.7 [range 2 to 8] cm. Blood transfusion was performed in 2 patients and open surgery was conducted for one because of extensive adhesions. No mortality was reported. During a 3-month follow- up, hormonal tests and blood pressure were normal for all the patients, with no medical treatment being required. Our study demonstrated that transperitoneal laparoscopic adrenalectomy is an effective and safe approach in the treatment of adrenal masses with the least morbidity