ABSTRACT
OBJECTIVE: Renal transplantation from living related donor is the best treatment option for chronic renal failure with experience for more than 50 years. However, this procedure may expose the health and even the life of otherwise normal individuals to risk. In this prospective study we described the surgical complications of open donor nephrectomies by Clavien grading system. MATERIAL AND METHODS: Between May 2002 and December 2014, one hundred and seventy-two potentially healthy kidney donors were admitted to Althawrah General Hospital, Ibn-Sina Hospital and Military Hospital. The median age was 34 years (19-60 years) with male predominance in 64.5% of the cases. This prospective descriptive study reviews intra-, and post-operative surgical complications using Clavien grading system for surgical complications. RESULTS: The procedure was done via supracostal lumbotomy incision (above 12th rib) in 112 cases (65.1%) and transcostal incision with resection of 11th rib in 60 cases (34.9%). Left kidney was taken in most of the cases (68%) while right kidney in the remaining 42% with an average warm ischemia time of 31 seconds (range, 22-34 seconds). Surgical complications by Clavien grading system were observed in 18.6% of the cases (32 cases). Grade 1 in 28 (16.4%); Grade 2 in 2 (1.2%) and Grade 3 in 2 cases (1.2%) were detected. There was no grade 4 or 5 cases in our series. Median postoperative hospital stay was 3 days (range: 2-4 days). CONCLUSION: We found that most of the complications of open living donor nephrectomy are of grade I and higher grade complications are negligible compared to the advantages for the recipients.
ABSTRACT
OBJECTIVES: To describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm. PATIENTS AND METHODS: This study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia. RESULTS: The mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required. CONCLUSIONS: ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.
ABSTRACT
OBJECTIVE: To compare the efficacy of tubeless percutaneous nephrolithotomy (PCNL) using double-J stent and tubeless PCNL with external ureteral catheter in decreasing post-PCNL complications. METHODS: This prospective randomized comparative study includes 148 cases with kidney stones. They were operated by either tubeless PCNL with double-J stent (Group 1) or tubeless with ureteric catheter (Group 2). Group 1 consists of 72 cases (54 males and 18 females). Group 2 consists of 76 patients (56 males and 20 females). Both groups were compared from the point of post-PCNL complications without using tissue sealants or tract cauterization. The study was carried out in the Department of Urology, Al-Thawrah Modern General and Ibn-Seena Hospital, Sana'a, Yemen between January 2008 and January 2010. RESULTS: In Group 1, the post-PCNL complications were leakage of urine in 4 (5.6%), hematuria >48 hours in 6 (8.3%), fever in 2 (2.8%), and the length of hospital stay was 36-48 hours. In Group 2, the post-PCNL complications were leakage of urine in 13 (17.1%), hematuria in 9 (11.8%), 5 (6.6%) has fever, colonic injury in one, and fluid collections in 8 (10.5%). There was significant difference in urine leakage (p=0.028). CONCLUSION: Tubeless PCNL with double-J stent was the best method to decrease the complications and length of hospital stay.
