Electrovaporization of bladder ulcer, A new approach for treatment of Bilharzial bladder ulcer

The aim of this work was to study the safety and efficacy of electrovaporization as a new modality of treatment of bilharzial bladder ulcers. Sixty-six patients with bilharzial bladder ulcers have been treated by the use of vaportrode or pencil tip electrocautery electrode at high cutting current to evaporate the ulcer bearing area, till the perivesical tissue was exposed. Indwelling urethral catheters were fixed for one week. Successful vaporization of the ulcer bearing area was recorded in 59 patients. Failure to get satisfactory vaporization was reported in seven patients due to extensive calcification in the ulcer bearing area, for whom even trial of excision was failed. The operative time ranged from 7 to 18 minutes. Some postoperative complications occurred in the form of deep hematuria in four patients, peritonism in five patients and secondary hemorrhage in two patients. Symptomatic relief was recorded in 52 patients immediately after the removal of the catheter. Persistence of symptoms was encountered in five patients and proved to be due to persistence of the ulcer, as proved by cystoscopy in two patients and incomplete healing in three patients. Vaporization of chronic bilharzial bladder ulcer is an effective, easy and safe modality of treatment without considerable complications

Resistive index changes after ESWL, the impact of age

In eighty-six patients, the resistive index using colored duplex sonography was measured for the arcuate and interlobar arteries before and after ESWL in the upper, middle and lower segment of the treated and the contralateral kidney. A statistically significant increase in post- therapeutic resistive index was found, but it remained within the physiologic range in the treated kidney and there was a statistically insignificant increase in the contralateral kidney. This increase is more pronounced in the young aged patients as well as in the elderly patients than the middle aged patients. All these changes returned to pre-ESWL level within two weeks and were maintained at the same level for eight weeks. It was concluded that shock wave lithotripsy caused reversible increase in the intrarenal vascular resistance. The extremes of age are more liable to such changes than middle aged patients. The second ESWL session must be postponed two weeks after the first one