Subcutaneous nephrovesical bypass in kidney transplanted patients

Renal transplant ureteral stricture or obstruction is a rare but devastating complication after renal transplantation. To determine the efficacy and complications of subcutaneous prosthetic ureters as a salvage procedure in transplanted kidneys with recurrent ureteral obstruction. 5 subcutaneous prosthetic ureters were inserted in 5 kidney recipients who had recurrent ureteral stenosis and failed endoscopic and open reconstructive surgeries. The prosthetic ureter consisted of an internal silicone tube covered by a coiled PTFE tube. The proximal end of the tube was passed through a subcutaneous tunnel, and the distal end was inserted in the bladder through a small suprapubic incision. The mean follow-up of patients was 11.3 months. One of the patients re-operated two days after the procedure because of urinary leakage from the distal end of the prosthetic ureter. No infection or tube encrustation was encountered. Subcutaneous prosthetic ureter is a safe alternative for permanent percutaneous nephrostomy in transplanted kidneys with obstructed ureter and failed endoscopic and open procedures

[Seven-year tolerance of intrauterine device in bladder]

Spontaneous migration of an intrauterine device into the bladder is very rare. Foreign bodies of the urinary bladder may occur by self-insertion or migration from neighbor organs. When ignored for a long time, foreign bodies act as a core for calculus formation. The patient usually present with dysuria and intermittent urinary tract infections. A 42-year-old woman is reported in whom an intrauterine device had been placed 7 years before this report, and complained of chronic pelvic pain, recurrent urinary tract infections and irritative urinany tract symptoms. After observation of stone in the bladder, the intrauterine device and the surrounded stone was removed by suprapubic cystolithotomy

innovative technique: ureteral stent removal by vaginal examination

Finding manual skills for special circumstances would be important both for the urologist and the patient. In this study a simple technique was examined to facilitate the removal of ureteral stent by vaginal examination in some female patients under special condition. Overall, 32 female patients [37 ureteral stent] underwent Stent Removal by Vaginal [SVR] examination technique. The patient was positioned in lithotomic position and was asked to keep her bladder semi-full. The ureteral stent in the ureteral orifice was touched by the index finger between the anterior vaginal wall and the bladder trigone; then the grasping forceps held by the other hand entered the bladder through the urethra to reach the end of the stent and pull it gently and completely. The technique was done successfully in stents. No significant side effect was observed after using SRV technique, but gross hematuria was seen in eight patients [23%]. S.R.V. technique is a simple and effective procedure that dose not require additional equipments or personnel. was more useful in elderly women with atrophic vaginitis and without cystocele

role of urine polymerase chain reaction test in diagnosis of genitourinary tuberculosis

The genitourinary system is one of he most common sites of infection in non-pulmonary tuberculosis [TB]. The clinical symptoms and radiologic findings of urinary TB are nonspecific. Current diagnostic tests are of low sensitivity and labor-intensive. Therefore, this study was aimed to evaluate diagnostic value of urine PCR in genitourinary tuberculosis [GNTB]. This was a descriptive study on 33 patients with confirmed genitourinary TB. Demographic data, clinical symptoms, laboratory and radiologic findings were collected. For each patient, three consecutive early morning urine specimens were examined by PCR. The diagnostic value of PCR in mycobacterium tuberculosis [MTB] in comparison with standard microbiological methods was assessed.There were 33 patients with a mean age of 47.27 16.1 years. The most common presenting symptoms were irritative voiding symptoms [51.5%], flanks pain [27.2%], gross hematuria [9%] and suprapubic pain [9%]. Laboratory findings in U/A were hematuria [75.8%] and pyuria [60.6%]. IVU was abnormal in 61.5% of patients. Most common abnormalities were pyelocalyceal dilation [44%], ureteral stricture and hydroureter [37%] and multiple small calyceal deformities [25%]. Of the 33 patients PCR for MTB was positive in 16 cases [48.5%]. In patients with abnormal IVU, PCR was positive in 62.5%. A high index of clinical suspicion is necessary for diagnosis of GUTB. PCR is recommended for instant diagnosis and screening before further examination, it cannot be the only method in identification of GUTB