Clinically insignificant residual fragments [CIRFs] after [ESWL]

To assess the significance of asymptomatic residual stone fragments of less than 4 mm [clinically insignificant residual fragments [CIRFs] after extracorporeal shock wave lithotripsy [ESWL]. Eighty-one patients were followed up for 6 to 60 months [mean 15] after ESWL to determine the fate of the CIRFs. -Of the 81 patients, 6 were lost to follow-up, leaving 75 patients. -During follow-up, fragments passed spontaneously in 18 patients, remained stable in 13 patients, and became clinically significant in 44 patients who developed one or more complications. For the latter patients, repeated ESWL was done in 16, percutaneous nephrolithotomy in 3, and ureteroscopic stone removal in 4 patients. The remaining 21 patients were treated conservatively with analgesics. -We found that: a]- 53% of the CIRFs located in the pelvis passed spontaneously, and most of the CIRFs in caliceal location became clinically significant. b]- as the stone burden and number of stone fragments increased, the risk of CIRFs becoming clinically significant increased. c]- The clearance rate was highest in the first 6 months. Finally, as the duration of follow-up increased, the rate of complications increased. Patients with residual stones after ESWL require close follow-up and timely adjuvant therapy. As the number and size of residual fragments increased, the risk of complications increased. A pelvic location was a favorable factor for spontaneous passage. Although the complete clearance rate of CIRFs with repeated ESWL was lower than for the operative interventions, most patients improved with this modality

Serum P.S.A level in clinical prostatitis

This work is an attempt to find out a practically applicable correlation between the changes of serum [P.S.A] in patients with symptomatic, clinical Prostatitis [acute and chronic] and the natural history of the disease. A total of 45 cases, age ranges 22-47 years and U/S prostate volume ranges 18-30 ml, 8 cases of acute prostatitis [A.P], 14 cases chronic bacterial prostatitis [C.B.P], and 23cases of chronic non-bacterial prostatitis [N.B.P]. Medical therapy for 6 weeks to all patients, and Serum [P.S.A] was measured at presentation then 3 and 6 weeks after starting medical therapy, and the degree of serum [P.S.A] elevation was assigned as mild [>the age-specific range but < 4 ng/ml], moderate [from 4 to 10 ng/ml] and significant [>10 ng/ml].All patients have attended follow-up for 9-12 months to evaluate for clinical relapse. Using the Age-Specific reference range; at presentation Serum [P.S.A] was elevated in 25 patients [55.6 percent of the total], it includes all cases of [A.P], 8 out of 14 cases of [C.B.P] and 9 out of 23 cases of [N.B.P]. The elevation was mild in 13 cases, moderate in 8 cases and significant in 4 cases. After 3-6 weeks of medical [antibiotics] treatment, serum [P.S.A] has decreased to the normal range in 21 out of the 25 cases [84 percent] and it was associated with significant clinical improvement during 9-12 months. Although clinical improvement and no growth cultures of the Expressed Prostatic Secretion [E.P.S] are achieved within 1-2 weeks of treatment, substantial reduction or normalization of [P.S.A] isn't achieved before 3-6 weeks of therapy; and it may be a better indicator regarding control of the inflammatory process and a hallmark of infrequent clinical relapse

Serum levels of total testosterone and the severity of erectile dysfunction

The aim of this study was to correlate the severity of erectile dysfunction [ED] with the total testosterone serum levels [TT], 208 men aged 40 to 80 years, were asked to answer the questionnaire of the Simplified International Index of Erectile Function [IIEF-5] as a method to diagnose and classify ED. The IIEF-5 scores ranged from 1 to 25 and the ED was classified into five groups according to the score: severe [1-7], moderate [8-11], mild - moderate [12-16], mild [17-21], and no ED [22-25]. Also, all subjects had their TT serum levels determined based on the blood sample obtained between 08:00 and 10:00. The analysis of the relationship between the different degrees of ED and TT levels were then studied. The prevalence of all degrees of ED was 49.0 percent. The degree of ED was mild in 15.38 percent, mild to moderate in 13.46 percent, moderate in 6.25 percent and severe in 13.94 percent. The variation of TT serum concentrations was similar [P > 0.05] in the different age groups. Furthermore, the TT serum levels were not different for individuals with and without ED [P > 0.05] and similar concentrations of TT was observed in different severity degrees of ED [P > 0.05]. ED presented a clear association with the subjects' aging, but neither correlation between TT levels and ED, nor with its severity, could be demonstrated in the present study

Resistance index [R.I] as a predicitive in the treatment of erectile dysfunction [E.D]

The aim of this work is to utilize the Pharmaco-Penile Duplex Ultrasonography [P.P.D.U] as a treatment-directed instead of an etiology-directed approach in cases of Erectile Dysfunction [E.D]. The intended treatment is Intra-Corporeal Injection [I.C.I] therapy using PEi; and the approach aims at 1- nullifying the most feared complication of prolonged erection; and 2- assessing the predictive value of the Resistance Index'[R.I] regarding an adequate erectile response with subsequent dose escalation. 68 cases of [E.D], all have started with a low dose [4mg of PEi] during the [P.P.D.U] and two parameters were traced in all cases 1- the patient's self report of erectile response. And 2- Resistance Index [R.I]: a] 8cases[41.8 percent] have achieved an adequate erectile response with this low dose [responders], all have adhered to self-injection therapy and within 4-7 months of follow-up, 75 percent of them experienced recovery of spontaneous erection. b] 40 cases [58.8 percent] failed to achieve an adequate erectile response with the low dose [non-responders], all have adhered to self-injection with dose escalation; 91.6 percent of the cases with R.I > 0.8 [during the initial P.P.D.U test] have achieved an adequate erectile response with dose escalation, while only 12.5 percent of the cases with R.I<0.8 have achieved an adequate erectile response with dose escalation [the maximum dose per injection did not exceed 20mg]. No cases of prolonged erection have been reported. The treatment-directed approach helps to: 4 Obviate the risk of prolonged erection. 4 Greatly simplify and nullify the limitation of operator dependency of the [P.P.D.U test] because; It doesn't require the measurement of pre- and post-injection diameters of the small cavernously arteries with its inherent inaccuracy. It relies on the measurement of [R.I], therefore; variations and/or possible errors in measurement of [P.S.V] and [E.D.V] are filtered out in the ratio R.I-P.S.V - E.D.V / P.S.V. R.I > 0.8 strongly predicts an adequate erectile response with subsequent dose escalation