Outcome of bilateral ureteroscopic retrieval of stones in a single session.

AIM: Evaluation of bilateral ureteroscopic retrieval of stones as a single-stage procedure in terms of clearance of the stones, complications of the procedure and duration of hospital stay. A successful outcome was considered when both ureters were free of stones without any major complications. MATERIALS AND METHODS: A total of 60 patients with bilateral ureteric stones were treated ureteroscopically from March 2006 to September 2009 in the department of Surgery (Urology unit). Majority of the patients were in their third and fourth decade of life with 38 males and 22 females. A single session bilateral ureteroscopic retrieval of stones was done using a 7.8 Fr semirigid ureteroscope. A 0.038-inch guide wire was used and advanced under direct vision, and monitored by C-arm X-ray image intensifier. Balloon dilatation of the intramural ureters was required in 82 renal units. The stones were either extracted directly or disintegrated into small pieces by lithotripsy (pneumatic) before extraction. Ureteric stenting was required in 39 patients. Patients were followed for a period of 3-12 months. RESULTS: A total of 60 patients (120 renal units) with bilateral ureteric stones were treated ureteroscopically. The stone size in the treated patients was in the range 6-20 mm. The stones were radio-opaque in 47 patients and radiolucent in 13 patients. Single stone was present in all except two patients. Operative time ranged between 40 and 120 minutes. Stones were completely removed in 51 (85%) patients following single-session procedure of which 39 (76.4%) were stonefree intraoperatively and another 12 (23.5%) were cleared of the stones in 4 weeks follow-up. Six patients were stonefree unilaterally. Failed procedures were managed with repeated ureteroscopy, DJ stenting and ESWL or open ureterolithotomy. Intraoperatively false passage or minor ureteric perforations were seen in six patients. Postoperative complications included abdominal pain in 10, persistent fever in 4 and hematuria in 2 patients. No long-term complications were observed. Most of the patients were discharged in 2 days. CONCLUSION: Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. The results are comparable to unilateral or staged bilateral procedures.

PCNL - a comparative study in nonoperated and in previously operated (open nephrolithotomy/pyelolithotomy) patients - a single-surgeon experience

PURPOSE: Re-procedure in patients with history of open stone surgery is usually challenging due to the alteration in the retroperitoneal anatomy. The aim of this study was to determine the possible impact of open renal surgery on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: From March 2009 until September 2010, 120 patients underwent PCNL. Of these, 20 patients were excluded (tubeless or bilateral simultaneous PCNL). Of the remaining 100, 55 primary patients were categorized as Group 1 and the remaining (previous open nephrolithotomy) as Group 2. Standard preoperative evaluation was carried out prior to intervention, Statistical analysis was performed using SPSS v. 11 with the chi-square test, independent samples t-test, and Mann-Whitney U test. A p-value < 0.05 was taken as statistically significant. RESULTS: Both groups were similar in demographic profile and stone burden. Attempts to access the PCS was less in Group 1 compared to Group 2 (1.2 + 1 2 vs 3 + 1.3 respectively) and this was statistically significant (p < 0.04). However, the mean operative time between the two groups was not statistically significant (p = 0.44). Blood transfusion rate was comparable in the two groups (p = 0.24). One patient in Group 2 developed hemothorax following a supra-11th puncture. Remaining complications were comparable in both groups. CONCLUSION: Patients with past history of renal stone surgery may need more attempts to access the pelvicaliceal system and have difficulty in tract dilation secondary to retroperitoneal scarring. But overall morbidity and efficacy is same in both groups.

PCNL--A comparative study in nonoperated and in previously operated (open nephrolithotomy/pyelolithotomy) patients--a single-surgeon experience.

PURPOSE: Re-procedure in patients with history of open stone surgery is usually challenging due to the alteration in the retroperitoneal anatomy. The aim of this study was to determine the possible impact of open renal surgery on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: From March 2009 until September 2010, 120 patients underwent PCNL. Of these, 20 patients were excluded (tubeless or bilateral simultaneous PCNL). Of the remaining 100, 55 primary patients were categorized as Group 1 and the remaining (previous open nephrolithotomy) as Group 2. Standard preoperative evaluation was carried out prior to intervention, Statistical analysis was performed using SPSS v. 11 with the chi-square test, independent samples t-test, and Mann-Whitney U test. A p-value < 0.05 was taken as statistically significant. RESULTS: Both groups were similar in demographic profile and stone burden. Attempts to access the PCS was less in Group 1 compared to Group 2 (1.2 + 1 2 vs. 3 + 1.3 respectively) and this was statistically significant (p < 0.04). However, the mean operative time between the two groups was not statistically significant (p = 0.44). Blood transfusion rate was comparable in the two groups (p = 0.24). One patient in Group 2 developed hemothorax following a supra-11th puncture. Remaining complications were comparable in both groups. CONCLUSION: Patients with past history of renal stone surgery may need more attempts to access the pelvicaliceal system and have difficulty in tract dilation secondary to retroperitoneal scarring. But overall morbidity and efficacy is same in both groups.

Effects of Danazol on the epididymal function in male langurs (Presbytis entellus entellus Dufresne).

Danazol (28 mg/kg body weight) was administered intramuscularly (i.m.) to intact langurs for a period of 48 days. Epididymides weight showed no significant change but tubular lumina were devoid of spermatozoa. These effects were reversible after 180 days of recovery period. Possible antiandrogenic action of the drug was evaluated by administering Danazol in conjunction with testosterone propionate (TP) (0.7 mg/kg body weight) to castrated langurs. Biochemical estimations for total protein and sialic acid contents showed a significant fall in all the treated groups. Whereas, alkaline phosphatase activity was increased in Danazol treated langurs and a decrease was noticed in castrates, which returned to near normal level after recovery period in intact and TP treatment in castrates. In conclusion, the present findings demonstrate that Danazol effectively suppressed the action of testosterone propionate in castrates. The inhibitory effects of Danazol on steroidogenesis in intact langurs might be due to biochemical interaction at subcellular system.

Ureterocalycostomy for postpyelolithotomy stenosis after failure of intubated infundibuloplasty.

Extended pyelolithotomy for staghorn calculus in a uremic patient with solitary functioning kidney was followed by development of stenosis of the infundibulum draining the superior and middle calyces. Drainage of the lower calyx down the ureter remained intact. Intubated infundibuloplasty proved unsuccessful since scarring and occlusion promptly recurred. Anastomosis of the middle calyx to the ureter was then performed with good results. We believe this is the first reported case of ureterocalycostomy for providing drainage to the middle calyx without lower polar nephrectomy.

Urethro-caverno-cutaneous fistula with distal urethral stricture and aberrant voiding into corpora cavernosa.

Following emergency cavernospongiosum shunt performed for priapism occurring in a psychiatric patient on chlorpromazine therapy, a urethro-caverno-cutaneous fistula with distal urethral stricture developed, resulting in aberrant voiding into the corpora cavernosa. The causation, management, and prevention of this hitherto unreported combination are discussed.

Pedicled omental graft in repair of large, difficult vesicovaginal fistulae.

Large vesicovaginal fistulae, particularly those associated with urethral loss, present formidable repair problems. Omentum, recognized for its role in resolving abdominal infection, is successfully used for pedicle grafts in these complex situations. The authors present their experience in 25 cases, describing modifications of an earlier procedure.

Giant fibrous polyp of the lower end of the ureter: case report and review of the literature.

Primary benign mesodermal tumours of the ureter mostly occur in the proximal part of the ureter. A case of a large fibrous polyp of the lower end of the ureter is described. The clinical presentation, radiological findings and treatment are discussed.

Fatal complication of intravesical formalin during control of intractable hemorrhage from radiation cystitis.

Fatal acute tubular necrosis occurred in 1 patient in whom intravesical formalin was used to control massive persistent hemorrhage from radiation cystitis. A suggestion is made to monitor blood formic acid levels and institute prompt dialysis whenever these exceed 80 mg. per 100 ml. to avert such a catastrophe. Intravenous sodium bicarbonate appears to be indicated prophylactically in combating the associated metabolic acidosis due to absorbed formic acid.

Topical or no anaesthesia for external urethral sphincterotomy in neurogenic vesical dysfunction due to spinal injury.

Considerable controversy exists regarding the ideal anaesthetic coverage for external urethral sphincterotomy in spinal injury patients with detrusor-sphincter dyssynergia. From this preliminary experience on 34 patients in whom this procedure was indicated and then attempted under topical (urethral instillation of 20 ml of 2 per cent Lignocaine jelly) or no anaesthesia, we are encouraged into believing that these patients may not require general or regional anaesthesia for this operation.

Blow out of a colocystoplasty loop owing to bladder neck obstruction.

A case of blowout of the colonic segment of a colocystoplasty at its free end owing to late development of bladder neck obstruction is described. Prostatitis and secondary bladder neck contracture provided further hindrance to the already inefficient voiding mechanism and predisposed to the rupture of the decompensated bowel loop. This is an extreme example of proof that the colonic loop, except as an improved substitute for an ileal segment, cannot withstand high intraluminal pressures generated in the presence of bladder outlet obstruction.

Testicular degeneration and necrosis induced by chronic administration of cannabis extract in dogs.

UNLABELLED: 1. Daily administration of cannabis extract (12.5 mg/kg body wt. for 30 days) produced a complete arrest of spermatogenesis in dogs. Distinct degenerative effects were produced in the form of extensive fibrosis and exfoliation of the seminiferous elements. 2. RNA, protein and sialic acid contents of the testis and epididymides were reduced after cannabis extract administration, whereas, testicular cholesterol and enzyme phosphatase were elevated. 3. Serum transaminases were slightly elevated, whereas the alkaline phosphatase and haemoglobin/haematocrit values were in normal range. 4. Histophysiological examination of the liver did not show any damage. 5. Reduced androgen production was reflected in low levels of sialic acid in the testis and epididymides, and shrunken Leydig cell nuclei and luminal epididymal epithelium. 6. IN CONCLUSION: Cannabis extract at 12.5 mg/kg body wt. dose level did not cause severe damage to the vital organs but it produced an effective inhibition of spermatogenesis in male dogs in 30 days and thus induces an antifertility state. The possibility of an adverse effect of frequent marihuana use on male reproductive organ functioning in man is alarming.

Uretero-diverticulostomy to provide efficient drainage of pyelocaliceal diverticlum without sacrificing functional renal parenchyma.

Dependent drainage of a lower pole pyelocaliceal diverticulum was achieved by uretero-diverticulostomy in eight patients who already had compromised renal function due to bilateral megaureters or posterior urethral valves. This procedure preserves all functional renal parenchyma and the ureteropelvic junction is left undisturbed. This is the first description of such a procedure for the treatment of lower polar pyelocaliceal diverticulum.

Optical working of infrared materials.

The techniques of optical working of various ir materials, namely, cutting, grinding, polishing, protective coatings, and testing, are described in detail.