Evaluation of post operative urinary bladder distention at prince Rashid Military Hospital

To assess and evaluate the occurrence of the post operative urinary distention using ultrasound technique. A total of 328 patients who underwent abdominal, neurosurgical, orthopedic and ENT surgical procedures at Prince Rashid Bin Al-Hassan Hospital between 1[st] April 2009 till 28[th] February 2010, were included in the study. Post operative urinary distention was assessed using ultrasound at the time of discharge from recovery room. The variables in the study were age, gender, type of anesthesia, type and duration of surgeries. Simple descriptive statistic [frequency and percentage] was used to describe the study variables. Of the 328 patients who were included in the study, 134 patients [40.9%] were noted to have bladder distention. Eighty-three patients [25.3%] who had bladder distention were unable to urinate within 30 minutes and underwent transient urinary catheterization. These patients were older than 55 years, experienced long surgical procedures for more than 125 minutes; the majority of them were males and received spinal anesthesia. For post operative urinary retention, it was concluded that spinal anesthesia, long duration of surgery and age of 55 years and above are at high risk of having urine retention. Ultrasound is considered a good and reliable technique to reveal bladder distention and urinary retention in these patients

Outcome of varicocele surgery and infertility at Prince Hussein Urology Center

To describe the outcome of surgical techniques for the treatment of testicular varicosity to improve fertility among infertile males at Prince Hussein Urology Center. This descriptive study was conducted on a total of 844 patients who underwent Varicocele surgery at Prince Hussein Urology Center, for infertility between the period of June 2003 and June 2008, surgery was performed for patients upon presenting to our clinic complaining of infertility for one year or more in the absence of female factor for infertility. Patients were non-randomly selected. Sperm concentration, motility and morphology was assessed by analysis of at least two different semen specimens each obtained after a 5 days period of sexual abstinence and separated by three weeks interval. Post surgery patients were classified as responders [more than 50% increases in sperm parameters] and non-responders. Simple descriptive statistical methods [frequency, mean and percentage] were used to describe the study variables. Surgical treatment of clinical palpable Varicocele successfully cured over 95% of Varicocele. Post surgery spermatogenesis was improved among 256 patients [30.3%]. Sperm concentration increased to variable degrees from 6.23 to 12.1 million among these patients with mean of 9.2 million, sperm motility improved from 5.2% to 18.7% with mean of 8.3%. Spontaneous pregnancy was achieved in 194[23%] couples within 12 months following surgery. Varicocelectomy is a safe, effective and associated with a rapid recovery and minimal morbidity. Varicocelectomy resulted in the induction or enhancement of spermatogenesis in several men with clinical Varicocele and abnormal semen parameters. Despite the absence of definitive studies on the infertility outcome of varicocele surgery, it is reasonable to be considered as an option in selective patients with semen abnormalities

Embolization of testicular vein for treatment of recurrent varicocele

To assess the efficacy of embolization of testicular vein for the treatment of recurrent varicocele. Between January 2002 and December 2005, a total of 64 patients with a mean age of 28 [18-40 years] were treated by embolization of testicular vein for management of recurrent varicocele at Prince Hussein Bin Abdullah II Center in King Hussein Medical Center. Indication for treatment was as either infertility or presence of dragging pain in the left testicle. Embolization was accomplished successfully in 53 patients [82.8%], whereas it was difficult in eleven patients because of venous spasm and anomalous collaterals which could not be cannulated. One patient required transfusion of blood due to bleeding from the internal spermatic vein. Embolization technique for internal spermatic vein for treatment of recurrent varicocele is a safe technique with low morbidity. It is also minimally invasive with high success rate

Tubeless percutaneous nephrolithotomy: our experience at Queen Rania urology center

To assess the outcome and safety of tubeless percutaneous nephrolithotomy in managing renal and upper ureteric stones in selected patients. Between June 2003 and July 2006, 85 patients with mean age of 35 years [range 17-67], were selected by simple random sampling method where two patients were chosen on weekly basis [2 patients every week] for the whole study period at Queen Rania Urology Center to undergo tubeless percutaneous nephrolithotomy for renal and upper ureteric stones. Of 85 patients, 50 cases were on the left side and 35 cases were on the right side, stone size was less then 3 cm in all cases. Nephrostomy tubes were not used in any patient. The incidence of complications, transfusion requirement, stone free rate and length of hospital stay were obtained. From 85 patients, 63 [74%] patients had solitary renal stone, 18 [21%] patients had multiple stones and 4 [5%] patients had upper ureteric stones. Average hospital stay postoperatively was 2 days [1-3]. The mean duration of percutaneous nephrolithotomy was 60 minutes [45-110], complete stone clearance was achieved in 77 patients [91%], 8 patients [9%] had small residual stones [<5mm] from which 3 patients [3.5%] required Extra Corporeal Shock Wave. Lithotripsy, while other patients required no further management. Blood transfusion was required in one patient because of postoperative hematuria which subsided spontaneously. Tubeless percutaneous nephrolithotomy is a safe, effective procedure for renal and upper ureteric stones in selected patients

Laparoscopic evaluation of non-palpable undescended testis

To evaluate the laparoscopic technique as a diagnostic and therapeutic tool in the management of patients with impalpable testis. During the period from January 2002 to September 2003, sixteen patients with mean age of years underwent laparoscopic to evaluate impalpable testis. Special attention was paid to the value of laparoscope in the diagnosis of these testis, in regards to their presence or absence, quality of the testis and the state of the spermatic vessels and character of the vas deferens. The laparoscope was also used in management after diagnosis. Laparoscopic orchidectomy was performed. Sixteen patients underwent laparoscopy to localize 19 impalpable testis, 13 patients had unilateral disease, while 3 patients had bilateral disease. Six testis were congenitally absent while 13 were atrophic. None were salvageable. All were removed laparoscopically. Histopathological report of the removed testis revealed atrophic testis in all cases. There was no perioperative or postoperative reported complication in all of our 16 patients. Laparoscopy is safe, minimally invasive procedure with low morbidity. It enable precise diagnosis and management of impalpable testis

Ureteroscopy as a day case procedure

To evaluate the efficacy and safety of ureteroscopy as a day case procedure. A retrospective analysis was performed of 256 patients who underwent ureteroscopy as an outpatient procedure at the Queen Rania Urology Center during the period between June 2003 and September 2004. The value of performing ureteroscopy as a day case procedure was assessed. Of the 256 patients involved, 181 were males and 75 were females, with a mean age of 32 years. The patients underwent ureteroscopy as a day case procedure for different ureteic pathologies. Most patients had uneventful ureteroscopy and were discharged on the same day. Only 18 patients were admitted post ureteroscopy because of intolerance of pain, fever, social factors, or for further management. Day case ureteroscopy should be considered in low risk patients scheduled for short and uncomplicated procedures. It is cost effective and safe

Steinstrasse development after extracorporeal shock wave lithotripsy

Objectives: To study the development of Steinstrasse, after Extracorporeal Shock Wave Lithotripsy [ESWL], and methods of prevention and treatment

Patients and Methods: Forty six patients diagnosed to have Steinstrasse, all of them treated conservatively initially. But when there was failure of conservative treatment, further management was used ranging from repeated ESWL, percutaneous nephrostomy [PCNL], endoscopic manipulation and then open surgery, depending on degree of obstruction, infection, renal function and response to each method of treatment

Results: Conservative management was successful in 22 patients [47.83%], repeated ESWL in 10 patients [21.74%], PCN in 7 patients [15.22%], ureteroscopy in 6 patients [13.04%] and open surgery in one Patient [2.17%]

Conclusion: Steinstrasse will be prevented by optimum selection of patients and accurate stone targeting. Active treatment [like ESWL, PCNL and ureteroscopy] is indicated when there is obstruction, infection and renal damage