Diagnosis of unilateral single system ectopic ureter in girls in the era of magnetic resonance urography (MRU)

Objective: The ectopic ureter frequently drains an ectopic dysplastic or hypoplastic kidney. The present study aims at defining the role of MRU in establishing the diagnosis of this anomaly. Patients and Methods: Between February 1996 and March 2000; 11 girls presented or were referred to our department for management of urinary incontinence. Their age at presentation ranged from 4-9 years (mean 6.5 years). Radiological work up included abdominal ultrasound (US); excretory urogram (IVU); voiding cystourethrography (VCUG); 99 m technetium-dimercaptosuccinic acid (99m Tc-DMSA) renal scan; enhanced spiral computed tomography (CT) and magnetic resonance urography (MRU). Results: Ultrasound showed evidence of a solitary kidney with failure to visualize a contralateral kidney in 7/11 patients. In the remaining 4 patients (36.4); US revealed a pelvic kidney in two and a pelvic cystic mass in another two patients. IVU revealed only one functioning renal unit in all cases. None of the patients showed vesicoureteral reflux on VCUG. On 99m Tc-DMSA ; a single kidney was seen in 9/11 patients and ectopic pelvic kidneys with normal contralateral kidneys in 2/11 patients. The 7 patients; in whom US and 99m Tc-DMSA scan had failed to localize the kidney; underwent CT scanning which visualized a pelvic hypoplastic kidney with a normal contralateral kidney in 2/7 patients. The remaining 5 patients underwent MRU that disclosed a normal kidney with a contralateral lumbar hypoplastic kidney in one and a pelvic ectopic kidney in four. The patients were managed by nephrectomy (n=9) and ureteroneocystostomy (n=2). Conclusions: A single system ectopic ureter should be suspected in all girls with continuous urinary dribbling after the age of successful toilet training. With the inclusion of MRU into radiological workup; dysplastic or hypoplastic kidneys can be accurately localized. MRU is indicated for the diagnosis and for therapeutic planning in such cases

Charleston Pouch with in-situ appendix and concealed umbilical stoma

Objectives : To evaluate the functional outcome of the Charleston pouch procedure as a continent catheterizable urinary reservoir using an unaltered in-situ appendix with a triangular skin flap at its umbilical stoma with few modifications to the original technique. Patients and Methods: Between February 1999 and October 2002; 34 patients (31 males and 3 females) were studied at the Urology Department; Assiut University Hospital; Assiut; Egypt. The indications for urinary diversion were radical cystectomy for invasive carcinoma of the bilharzial bladder in 27 males and three females; and incontinent epispadias in four male patients. The age of the patients ranged between 18 and 60 years (mean 48.1 6.1 years). Mean follow up was 30 4.2 months (range 11-40 months). The evaluation during the follow-up period included clinical; laboratory; imaging and urodynamic studies to evaluate the functional outcome. Results: All patients are continent (day and night). No stomal stenosis was recorded. Laboratory investigations were within normal. The upper urinary tract remained unchanged in all patients. Pouchometry revealed that the Charleston pouch is a low-pressure (4 -21 cm H2O) reservoir with a good capacity (average 750 ml). Cancer recurrence was recorded in 3 patients at 12; 27 and 32 months. Conclusions: The Charleston pouch with in-situ appendix is an efficient versatile technique for the creation of a catheterizable continent cutaneous urinary reservoir. The umbilical stoma with triangular skin flap provides excellent cosmetic results

Endoscopic transurethral resection of bilharzial ulcers in the urinary bladder. Single-center experience with 1000 patients

Objective To report on the results of endoscopic transurethral resection of chonic bilharzial ulcers of the urinary bladder at the Assiut University Hospital; Assiut; Egypt. Patients and Methods Between June 1995 and April 2001; 1000 patients (87.3males and 12.7females) with chronic bilharzial ulcers (78de novo and 22recurrent ulcers after previous open partial cystectomy) were treated by endoscopic transurethral electroresection (TUR) at our department. Single ulcers were diagnosed in 612 (61.2); double ulcers in 261 (26.1) and multiple ulcers in 127 (12.7) patients. Ulcers of a moderate diameter (1-2 cm) were present in 505 (50.5) patients. Electroresection was done until healthy fibers of the detrusor muscle or even the prevesical fat was reached. Results The mean duration of the resection was 19.8 minutes. Extraperitoneal bladder perforation was recorded in 11 patients (1.1). In all these patients conservation was successful. Intraperitoneal bladder perforation was recorded in 16 patients (1.6). In six out of these patients conservation was successful; while peritoneal drainage was necessary in the remaining cases. Conservative management was successful in 5 cases (0.5) of secondary haemorrhage. Hospitalization was one day in 920 patients (92). After six months 862 patients (86.2) were available for follow up. 745 (86.4) were symptom-free and 794 (92.1) reported complete healing of the resected ulcer at follow-up cystoscopy. Conclusion Endoscopic transurethral electroresection is a satisfactory modality for the treatment of bilharzial ulcers of the urinary bladder

Role of transferrin and ceruloplasmin as endogenous antioxidant in the pathogenesis and promoton of late diabetic complications

The serum antioxidant, ceruloplasmin and transferrin were estimated in forty diabetic patients that either suffer only from hyperglycemia [n = 20] or from hyperglycemia and late diabetic complications [n = 20]. Glycohemoglobin percentage was determined to test the degree of control of diabetic state. It was found that serum ceruloplasmin was significantly higher in diabetics with late complications than in diabetic without it. On the other hand, serum transferrin was significantly lower in diabetic with late complications than in diabetic without. Glycohemoglobin percentage was comparable in both groups of patients although it was still higher than that recommended percentage for good controlled diabetes