Extended pyelonephrolithotomy [modified resnick S technique] for the management of stagging renal stones

Seventeen patients with stagging renal stones extending mainly to lower calyces with or without multiple calyceal stones or extensions, 13 with intrarenal pelves were included in our study. We used a combination of Gil- vernet [s extended pyelolithotomy technique and Resnick[spyelo-nephrototomy technique. None of our cases needed blood Transfusion, none had serious post- operative bleeding and none developed hypertension during a follow- up period of 3 years. Only 1 patient had residual calyceal stone that was managed later by ESWL. We concluded that this is a safe operative technique for the management of some stanging renal stones, with low rate of complications.

subserosal extramural tunnel for uretral implantation in the Ileal-W bladder: an ideal antireflux Technique for dilated ureters

Anti reflux in ileal pouches could be a real challenge when the ureters are considerably dilated. We adopted in this work the technique of subserosal extra lumenal tunnel 1st presented by Abol-Enein and Ghoneim, which we applied with some modifications to suit the dilated ureters, both in augmentation ileo cystoplasty and after radical cystectomy. The technique was applied in 19 patients in two groups. Group I was 11 patients for bladder substitution after radical cystectomy and group II was 8 patients for augmentation after supra trigonal cystectomy for neurogenic or contracted bladder. Patients were followed for 6 to 36 months by routine lab, ultrasound, intravenous pyelography [renogram for some] ascending and voiding pouchography and urodynamics. In the 38 renal units done by the technique, all with considerably dilated ureters, non was refluxing throughout the follow up period. 2 units in one patient were obstructed and managed primarily endoscopicaly, but later, one ureter needed open surgical correction. We found this technique ideal for dilated ureters even in the Bilharzial thick walled, with no incidence of reflux and assuming the original anatomical appearance of the uretrovesical junction with easy endoscopical manipulation if needed

hemodynamics of sexual dysfunction following nerve sparing Radical cystoprostatectomy

Fourteen patients with invasive bladder cancer underwent penile duplex scanning and dynamic infusion cavemosometry preoperatively to assess arterial and venous hemodynamics. Nine of these patients were impotent after nerve sparing Radical cystoprostatectomy and had repeated duplex scanning and cavemosornetry six months postoperatively. On penile duplex all 9 patients had arterial insufficiency on at least one side in-spite of individual vesical arteries ligation. On dynamic cavernosometry. 2 patients had the criteria suggestive of corporoveno-occlusive dysfunction. We concluded that impotence following nerve sparing radical cystoprostatectomy is predominantly arterial in nature. The possible causes and points of technique are discussed

Management of neonatal pelvi-ureteric junction obstruction: a clinical study of 39 cases

The experience in the management of thirty nine newly borns [43 kidneys] with pelviureteric junction [PUJ] obstruction was reported. Twenty one patients [21 renal units] were surgically corrected by Andressen Hynes technique while the remaining 18 patients were conservatively managed. Follow up of all cases was available for 8 to 34 months. In the surgically corrected group, out of 21 renal units 19 [90.5%] were improved while 2 needed redo pyeloplasty after one year of follow up. In the 18 patients [22 kidneys] conservatively treated, 5 kidneys [22.7%] showed spontaneous relief of obstruction, 8 kidneys [36.4] deteriorated and needed surgical correction, while the remaining 9 kidneys [40.9%] had maintained function. It was concluded that surgical correction in neonatal PUJ obstruction yields excellent results while in those infants with partial obstruction and good renal function who are treated conservatively, deterioration is expected in almost 40% of them. Based upon the experience, spontaneous relief of obstruction usually occurs within the first 6 months of life, thus close follow up for patients was recommended with PUL obstruction who are treated conservatively and immediate surgical intervention for those who show no improvement within 6 months to avoid the high risk of renal function deterioration

Fracture of the penis: surgical management

Five cases of fracture penis have been treated. All cases were immediately explored with repair of the tunica albuginea. Follow-up for 2 to 17 months for all cases revealed excellent functional and morphological recovery. The different therapeutic modalities are discussed with a review of literature. Immediate surgical repair is the preference in these cases

Dorsal penile approach for insertion of Dynaflex penile prosthesis

32 patients have undergone implantation of Dynaflex penile prosthesis. In all cases, a transverse dorsal incision at the base of the penis was used. No single case of infection or postoperative prolonged edema was encountered. Two patients had inadequate deflation of prosthesis. Three had prolonged postoperative pain. Technique, results and long term follow-up data are discussed. It is recommended to use the dorsal penile approach in cases of Dynaflex prosthesis insertion. It offers a direct access with minimal tissue dissection and almost no bleeding. It gives excellent cosmetic results and carries a minimal risk of postoperative infection

Acute scrotal pain: diagnostic role of scintingraphy

A prospective randomized study of 103 cases of acute scrotal pain was designed in Hamad General Hospital, Qatar. All cases were clinically assessed by accident and emergency physician, then testicular scintigraphy was performed regardless of the primary diagnosis. US of the scrotum was additionally done in 11 cases. Out of the 64 cases, clinically diagnosed as torsion testis, only 24 were confirmed by scintigraphy [37.5%]. Among the 39 cases diagnosed as nontorsion, 9 [23.1%] cases were proved to be torsion by scanning. The total accuracy of clinical diagnosis in 103 cases of acute scrotal pain was 44.7%. It was concluded that clinical examination per se is not enough for accurate diagnosis in cases of acute scrotal pain and it should be supplemented with scintigraphy. 100% sensitivity and 97% specificity of scintigraphy in detection of testicular torsion was reported

Xanthogranulomatous pyelonephritis: a report of eleven cases and review of literature

A retrospective study of 11 patients with Xanthogranulomatous pyelonephritis who underwent nephrectomy at the hospital was done. Intravenous urography [IVU] and ultrasonography [US] were done in all cases while CT was done in 5 cases. Right kidney was dominantly affected [7 cases]. One case manifested as a right flank sinus. 2 cases had focal Xanthogranulomatous pyelonephritis and one of them was a 3-year old female child. Associated stones were found in 10 cases while ureteric stenosis was documented in 4 cases. Flank pain was the commonest complaint [81.8%]. Escherichia coli [54.4%] and Proteus mirabilis [18.2%] were the most common organisms isolated from the voided urine. The findings are demonstrated and compared to those in literature