Urethrocut cutaneous fistula complicating hypospadias repair; Management and outcome

The outcome of the different surgical techniques used in our department for closure of urethrocutaneous fistulae [UCF complicating various types of hypospadias repair is evaluated. Simple, multi-layered closure and skin bridge operations were the commonest procedures used in this respect. The study comprised 120 patients undergoing UCF repair between 1998 and 2004. Out of the 120 patients, only 85 patients were available for postoperative follow up and evaluation. The median [range] age at primary fistula repair was 60 [30-180] months and the median follow up duration after the most recent repair was three years. Patients were categorized into 3 main groups; Group I included 28 patients [33.5% of the studied group] had simple closure of their UCF with successful outcome in 20 case [71%]. Group II involved 46 patients representing 54% of the studied group underwent multi-layered closure of their fistulae with successful results in 37 patients [82.5%]. Group III comprised 7 patients [8%] of the studied population for whom a skin bridge operation was done with successful outcome in 6 cases [85%]. The remaining 4 cases [4.5%] required repair of their fistulae using a Snodgrass technique with successful outcome. The overall success rate after primary fistula repair was reported in 63 cases [78%]. Fistulae larger than 2 mm [12 case] tended to re-fistulate in 50% of cases [6 cases]. Also multiple fistulae [14 case] showed greater tendency for recurrence as seen in 9 cases [65%]. After secondary repair for recurrent fistulae the success rate increased up to 22 case [78.5%] in Group I, up to 41 case [89%] in Group II and up to 7 patients [100%] in Group III. All failures, whether after primary or secondary repairs were caused by wound infection. From the above mentioned results it can be concluded that the overall success rate after multi-layer closure [89%] is much superior than the successful outcome after simple closure [78.5%] P < 0.05 while skin bridge oper

value of transrectal ultrasound guided needle biopsy in the diagnosis of non-malignant prostatec conditions

The majority of patients [60-65%] undergoing prostatic needle biopsies because of an elevated serum PSA levels and/or abnormal digital rectal examination will not have adenocarcinoma of their prostates upon pathological examination. Benign prostatic hyperplasia [BPH] and prostatitis are common causes of serum PSA elevation. We selected to evaluate the distribution of malignant and non-malignant conditions in patients undergoing prostatic needle biopsies. For this purpose 408 consecutive patients underwent 12 core transrectal ultrasound [TRUS] guided prostatic needle biopsies were evaluated. None of them had clinical prostatitis. Prostatic volume was estimated during the procedure. Pathologic examination focused on the presence of normal prostate, BPH, Prostatitis and cancer in every core. According to serum PSA levels, patients were classified into four different groups ranging between 0.1 to more than 20 ng/ml. Prostatic volume ranged between 10-178 ml. Prostate cancer was detected in 139 patients [34%] with average volume 36 ml, 89 patients [22%] showed pathologic evidence of chronic prostatitis with average volume 59 ml. BPH changes were elicited in 153 patients [37.5%] with average volume 42 ml while 27 patients [6.5%] were having normal prostates with average volume 51 ml. The incidence of prostate cancer, prostatitis, BPH and normal prostate was 25% 17%, 50% and 8% for group I [[PSA 0.1-4 ng/ml], [n = 94]] this incidence was 30%, 25%, 40 and 5% for group II [PSA 4.1-10 ng/,l], [n = 188]], it was 38%, 19%, 37% and 6% for group III [[PSA 10.1-20 ng/ml]], [n = 100] and it was 50%, 21%, 17% and 12% for group IV patients [[PSA > 20 ng/ml] [n = 22]1 respectively. From the above mentioned results we can conclude that the majority of patients suspected to harbour cancer in their prostates shows no malignancy upon pathologic examination of their biopsies, with BPH being the most common [37.5%] and prostatitis was a significant finding in 22% of patients. Prostate volume was not a crucial factor in predicting the pathologic entity. After excluding prostatitis, the higher the serum PSA level the higher the incidence of prostate cancer

Renal calculi treated by extra corporeal shock wave lithotripsy [ESWL] updated results at Al Azhar lithotripsy center

Al-Azhar lithotripsy center at El-Hussein University hospital is well known as a common pool in Cairo, treating all sorts of urinary calculi. In this respect and within the last two years, 376 patients [387 renal units] having renal calculi were evaluated and scheduled for extra corporeal] shock wave lithotripsy [ESWL], using Storz SLX lithotriptor. ESWL monotherapy was scheduled for 346 renal units, the remaining 41 renal units required pre-ESWL ureteral stenting. An overall fragmentation rate reached up to 91.7%, while a stone-free state was elicited only in 70.8%. Steinstrasse was noticed in 12 patients [3.1%], among them, only two patients required ureteroscopic manipulation to treat such conditions. From the collected data, we concluded that ESWL is a safe and efficient tool in the treatment of most renal calculi, and that stone size, site, density, multiplicity, urinary tract anatomy, as well as the type of lithotriptor, all play a significant role in the fragmentation and clearance rates

Peri- anal and peri- prostatic local infilterating aneasthesia before transrectal ultrasound [TRUS] guided biopsy in patients with or without painful anal disorders

TRUS guided biopsies is painfull and uncomfortable procedure; which could cause many complications up-to vasovagal attacks. Some patients can not sustain the procedure to complete his required biopsies either due to presence of anal disorders [fissures, piles. stenosis .. ] or untolerable pain during biopsy. The objective of this study was to evaluate the use of peri-anal and peri-prostatiic local infilterating aneasthesia prior to TRUS biopsy in patients with or without painful anal conditions. Five hundred patients who are subjected for TRUS biopsy were included in this study of them 150 patients were found to have painful anal problems [fissure, piles. tight anal canal]. Peri-anal infilterating aneasthesi were used only in [n=150] patients who complaining of anal problems while. periprostatic aneasthesia were performed in all included patients [n=500] of this study. DRE was routinly performed prior to TRUS 10 assess the presence of anal disorders and to evaluate the prostate. Local injection of xylocain 0.5% in perianal rectal muscle before the introduction or TRUS probe followed by peri-prostatic injection of the same anesthetic material which were injected in sagital axis started from the seminal vesicle base of each side or the prostate till the prostatic apex. Then TRUS evaluation of the prostate and its measures, presence of focal lesion and capsular integrity were done to give the proper time for aneasthia. Biopises were taken according to TRUS finding using the standard sixtant or the extended biopsy technique+/- lesion directed. Most of the patients [90%] were comfortable using this procedure without significant pain during TRUS guided biopsies. Only 3% of the patient feel mild pain during mid-zonal biopsy because of repeat biopsy. Patients with painful anal problems were comfortable without prior treatment or delay in the procedure. Some of this painful anal problems improved after the procedure [anal dilatation]

On conclusion: Peri-anal local infilterating aneasthesia solve the problem of TRUS biobsy in patients with painful anal problems without delay or the procedure. Peri-prostatic local infiltrating aneasthesia was safe and effective prior to TRUS guided biopsies for all patients

Cytokeratins as useful serum markers in the diagnosis and monitoring of Egyptian bladder cancer. A comparative study between TPA and TPS

Cytokeratins [CKs] have been shown to he over expressed in bladder cancer and to be valuable as tumor markers in urology. The present study was designed to evaluate the diagnostic value of Tissue Polypeptide Antigen [TPA] and tissue Polypeptide Specific Antigen [TPS], as serum markers exploring some specific CKS, in the diagnosis and monitoring of bladder cancer. For this purpose, a cohort of 174 case were allocated into three groups; group 1 included 64 histologically confirmed primary bladder cancer patients scheduled for different treatment modalities, group 2 comprised 75 cases with benign urologic conditions and group 3 were 35 healthy volunteers. Serum TPA and TPS were estimated in all cases after initial evaluation as well as postoperatively in group 1 using an Enzyme Limbed Immuno Sorbant Assay[ELISA] technique. Results showed that serum TPA and TPS levels were significantly higher in group 1 as compared to the other groups, P<0.01. Evaluation by histologic findings declared a higher sensitivity of TPA [55.7%] at a specificity 95% in transitional cell carcinoma [TCC] as compared to 39% for TPS. A high percentage of Egyptian bladder cancer [+30%] is represented by- squamous cell carcinoma [SCC]; in this population TPS showed the highest sensitivity reaching up to 66% followed by TPA [48%]. The sensitivity of either marker increased with advancing tumor stage and grade in all histologic types as well as with nodal stage and metastases, p< 0.01. In all treated malignant conditions there was no statistically significant difference between serum TPA and TPS levels in free disease states. Cases showing tumor relapse exhibited a steady rise in both serum TPA and TPS levels before any detectable clinical recurrence with no statistically significant difference between either marker. In conclusion, serum levels of TPA and TPS in bladder cancer patients correlated well with initial tumor stage and grade and served for detecting and monitoring tumor relapse

Neodymium: yag laser coagulation of the prostate in surgical risk patients

Transurethral Neodymium:YAG laser coagulation of the prostate gland was used to treat benign prostatic hyperplasia in 36 surgical risk patients, who had either significant lower urinary tract symptoms or urinary retention. The mean International Prostate Symptom Score [IPSS] decreased from 26.8 to 9.6, then increased to 14.2. The mean maximum flow rate [Qmax] increased from 8.3 to 15.1 ml/s and then decreased to 10.6 ml/s. The average residual urine volume [PVR] decreased from 139.3 to 65 ml, then increased to 87.5 ml at 12th and 60th months, respectively. Catheters were removed after seven days. Seven out of the 36 patients required re-catheterization within the first visit. Repeated interference was needed in 12 of the 36 patients. From the results obtained it was concluded that, aggressive Nd:YAG laser prostatectomy is safe and effective for high surgical risk patients with obstructive prostates and produces good results that are sustained for up to two years. On the contrary, the durability of this procedure is significantly decreased after three years with high incidence of re-treatment rate