Extracorporeal shock-wave lithotripsy success rate and complications: initial experience at Sultan Qaboos university hospital

To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones. Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance. Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 [85%] had renal stones and 33 [15%] had ureteric stones. The mean +/- SD stone size was 11.3 +/- 4.5 mm, while the mean age of the patients was 39.9 +/- 12.8 years with 68.5% males. The mean renal stone size was 11.6 +/- 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 +/- 3 mm; and a mean of 1.3 sessions was required. Treatment success [defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones] was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients [38.5%] with renal stones and 13 patients [39.4%] with uretetric stones. The most common complication was loin pain [experienced by 16.7% with renal stones and 21% with ureteric stones]. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine [p=0.004] and the number of shockwaves [p=0.021]. Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones

Comparison of the demographics, semen parameters and hormone profiles in men with primary and secondary infertility

The objectives of this study were to compare the demographics, semen parameters and hormone profiles in men with primary and secondary infertility. The study was designed as a retrospective analysis of data collected from men attending a combined infertility clinic [seen together by urologist and gynaecologist] from January 2005 to December 2008 at Sultan Qaboos University Hospital, a tertiary care hospital in Oman. Ninety-eight consecutive male patients with one or more abnormalities in semen analysis were referred to the combined infertility clinic. A complete physical examination was carried out by a urologist followed by hormone evaluation of follicle stimulating hormone [FSH], luteinizing hormone [LH], testosterone [T] and prolactin [PRL]. The semen parameters and the sex hormone evaluation were not significantly different between the men with primary and secondary infertility. The men with primary infertility were younger than the men with secondary infertility. A total of 24% of the men in the primary group and 16% in the secondary group were azoospermic with normal gonadotropin values in 9 men and 1 man in the primary and secondary group respectively. Azoospermia was more common in the primary infertile group and, based on gonadotropin levels, obstructive causes seemed more prevalent in the primary group compared to secondary group

Keyhole surgery of the kidney at Sultan Qaboos University Hospital, Oman

Percutaneous access surgery of the kidneys was introduced in Sultan Qaboos University Hospital [SQUH] in 1998. We are presenting our early experience in the first 31 patients operated on over an eight year period using the percutaneous approach. A retrospective review of 25 patients, who underwent percutaneous nephrolithotomy [PCNL] for the treatment of large renal stones and 6 patients who underwent endopyelotomy for the treatment of pelviureteric junction [PUJ] obstruction. In the PCNL group complete stone clearance was achieved in 68% [17/25] patients and the complication rate was 28% [7/25]. In the endopyelotomy group the success rate of relief of obstruction of PUJ measured by renogram and relief of symptoms was 83% [5/6 patients]. Our early results of PCNL are promising and comparable to international results

Laparoscopic deroofing of larfe renal simple cysts causing gastric symptoms

Widespread use of ultrasonography and computerized tomography of the abdomen result in the detection of a large number of renal mass lesions. Most of these are simple renal cysts, which do not need any further evaluation or follow up unless symptomatic. Simple renal cysts can be diagnosed with certainty if the treating physician or surgeon is aware of these features and can avoid unnecessary urology referral, patient anxiety, inconvenience and expense. Symptomatic cysts and complex renal cysts need further evaluation and intervention. We present the case of large symptomatic renal cysts persisting after aspiration sclerotherapy, which were managed by deroofing the cyst laparoscopically. Laparoscopic deroofing is rapidly becoming accepted as the surgical intervention of choice for symptomatic renal cysts persisting after aspiration sclerotherapy