Management of complex urogenital fistulae in the female

To present our experience in the management of complex genitourinary fistulae in the female. Between 1995 and 2004, 12 female patients with a mean age of 30 [range 6 - 40] years were managed in our department for various types of complex genitourinary fistulae caused by difficult labor in 6 cases, abdominal hysterectomy in 5 cases and car accident in one case. All patients were subjected to clinical, radiological and endoscopic examination. The fistulae were managed by open surgery. The procedures were individualized according to the existing pathology and included bladder augmentation and construction of a bladder tube. The fistulae were repaired successfully and socially acceptable continence was achieved in all patients. Through urological evaluation of complex urinary fistulae is recommended. The treatment should be individualized based on the existing pathology and may include bladder augmentation and construction of a bladder tube

Finasteride [proscar] for the treatment of benign prostatic hyperplasia

Benign prostatic hyperplasia [BPH] is an and rogen dependent disease which requires dihydrotestosterone [DHT] for its development and progression. Finasteride [Proscar] is a drug that inhibits the transformation of testosterone to DHT inside the prostate through blockade of the enzyme 5 alpha reductase. It is assumed that this inhibition would result in regression of the hyperplastic process and, thereby, improvement of the associated outflow obstruction. In this study 20 patients with BPH received finasteride 5 mg tablets once daily for 2 months and 6 patients with BPH received placebo. Both groups of patients reported significant improvement of their symptoms after one month of treatment. Only those who received finasteride showed regression of the prostatic area on ultrasound [14% reduction at 2 months], decrease in serum prostate specific antigen [PSA, 76% reduction at 2 months] and increase in maximum urine flow rate [31.6% increase at 2 months]. No significant side effects related to and rogen blockade were reported. It is concluded that finasteride results in significant prostatic epithelial cell regression as evidenced by dramatic drop of serum PSA level with subsequent decrease in prostatic size and improvement of urine flow, the effects develop slowly over 2 months without significant side effects. Finasteride could offer an alternative for patients who are not c and idates for, or refuse TURP provided that they are fully compliant and not in need of urgent interference

Doppler wave analysis of prostaglandin-induced erection

Doppler wave length analysis was used to assess penile blood flow in 50 important patients both in the flaccid state and after induction of erection with 25 ug/ml prostaglandin E1, intracavernous injection. Nine volunteers served as controls. Maximum velocity was slightly lower in patients in the flaccid state but was not different from controls after induction of erection. Prostaglandin E1, induced good erection which lasted for an average of 2.6 hours in 100% of controls and 80% of patients. In 9 patients whose main complain was rapid loss and weakness of erection, the end diastolic velocity was above the zero base line, after prostaglandin injection they developed tumescence without rigidity and the end diastolic velocity increased to more then 5 cm/sec. Cavernosography proved venous leak in 8 of those patients [88.8%]. There was a good correlation between a normal Doppler analysis and a positive response to prostaglandin injection. Elevated end diastolic velocity especially after prostaglandin was predictive of venous leak. No complications resulted from the use of prostaglandin E1 injections. The combined use of Doppler and prostaglandin E1 intracavernous injection enhanced the diagnostic yield of both of them and allowed selection of candidates for cavernosography

Management of lower ureteric calculi: experience with ureteroscopy

The choice of management of lower ureteral calculi remains a challenge to the urologist. Endoscopic removal of ureteric stones is being increasingly attempted by urologists. This report aims at identifying some of the factors that may affect the outcome of the procedure, providing guidelines to improve the results and to reduce complications. The present study included 30 patients with lower ureteral stones on whom ureteroscopic extraction was attempted. The stone size was 7 mm X 5 mm on the average. The overall success rate was 80%. No major complications resulted from the procedure. Surgical removal of the stone was done in 3 [10%] who had impacted stones. Careful attention to the details of ureteral dilation, prior to introduction of the ureteroscope, is essential in order to avoid complications