Color Doppler Ultrasonography in Evaluating the Outcomes of Pyeloplasty in Ureteropelvic Junction Obstruction.

PURPOSE: To evaluate the accuracy of Color Doppler ultrasonography for diagnosing post pyeloplasty elimination of obstruction in Ureteropelvic Junction Obstruction patients. METHODOLOGY: Patients with the diagnosis of UPJO enrolled in the study and underwent open pyeloplasty. Three to 6 months after the operation, patients were recalled and underwent isotope scan as the gold standard test and renal color Doppler ultrasonography to assess the success rate of pyeloplasty. RESULTS: A total of 39 patients were evaluated and analyzed. The average follow-up time for patients was 9.1 months. The success rate of surgery in the study population was 100%. The mean RI of the affected side before the operation was 0.69 ± 0.01 and after the pyeloplasty, it reached to 0.65 ± 0.01. The difference between the mean RI of the affected side before and after the operation is 0.04 (P < 0.001). Age, type and severity of obstruction and the technique of surgery did not have any impact on these parameters. The difference between the RI of the affected and healthy side was termed ΔRI. ΔRI before and after the operation was 0.084 and 0.014, respectively. The decrease of ΔRI in the case of pyeloplasty is 0.07 on average (P < 0.001), which can be predicted for pyeloplasty success. DISCUSSION: Color Doppler ultrasonography can be used as a non-invasive, fast, non-expensive, and available modality for evaluating the outcome of pyeloplasty instead of the nuclear scan or IVP.

A New Touchless Technique for Suturing in Transperitoneal Laparoscopic Pyeloplasty.

BACKGROUND: The most difficult, time-consuming, and critical steps of laparoscopic pyeloplasty (LPP) are ureteral spatulation, apical ureteral stitch placement, and ureteropelvic anastomosis. To simplify these critical steps, avoid the risk of ureteral shortening, and also minimize ureteral manipulation, we present a modified dismembered technique for suturing with the outcome of patients who underwent LPP using this technique. MATERIALS AND METHODS: This study included 23 patients who were candidates for transperitoneal dismembered Anderson-Hynes LPP. The ureter was partially cut just below the ureteropelvic junction. The ureter was spatulated at its lateral aspect to cross the obstruction site and reach the normal ureter. The renal pelvis was obliquely cut equal to the size of ureteral spatulation. The ureter and pelvis were still connected partially. At this point, the first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis. Anastomosis was performed by running sutures. RESULTS: No cases of internal organ injury and no cases of open surgery conversion were encountered. The radiologic success rate was 96%. After operation, in 1 patient, obstruction still existed and the patient underwent nephrectomy due to a nonfunctional obstructive kidney. CONCLUSIONS: This modification preserves total ureteral length and facilitates spatulation and suturing in transperitoneal laparoscopic dismembered pyeloplasty. The results showed that it is a useful method, especially for less-experienced surgeons.

Laparoscopic Pyelolithotomy for Management of Complete Staghorn Stone of An Ectopic Pelvic Kidney.

A 40-year-old man was referred to our urology clinic due to vague abdominal pain and hematuria. Computed tomography (CT) without contrast material visualized an ectopic kidney in the left iliac fossa with a complete staghorn stone. Under general anesthesia, operation was done in supine position with a gentle lateral elevation on the right side. The surgeon stands on the right side of the patient. First, a 12 mm port was inserted at the umbilicus using the Hasson technique. After creation of pneumoperitoneum, operation was done by three 5 mm trocars were arranges as paraumbilical, the point between umbilicus and inguinal canal at left and right side.A vertical pyelotomy incision was made over the anterior pelvic wall and then extended to a cross figure. The stone extracted intact with a laparoscopic stone grasper and placed in endobag. A short double J stent was placed via the pyelotomy incision and renal pelvis was closed using continuous 4.0 vicryl sutures. He was discharged from hospital after 3 days without any complication.

Serum Sodium and Potassium Levels in Cerebro-vascular Accident Patients.

BACKGROUND: We aim to assess serum sodium and potassium levels in patients with different types of cerebro-vascular accidents (CVA) in comparison to control group. METHODS: A comparative cross-sectional study conducted on patients admitted to the emergency department from January to August 2012. Control group consisted of patients admitted to emergency department due to common cold, urinary tract infection, low back pain, cluster, and tension headache or migraine. Serum sodium and potassium levels were measured via standard laboratory methods. RESULTS: There were 77 patients in control group and 78 in CVA group. Forty nine patients from the CVA group had ischemic CVA, 11 had hemorrhagic CVA and 18 suffered a transient ischemic attack (TIA). Serum sodium level in control group was significantly lower than in patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). Serum potassium level in control group was higher than patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). Patients with hemorrhagic CVA showed significantly lower serum potassium level than patients with TIA and ischemic CVA (P < 0.001). Correspondingly, it was observed that serum sodium to potassium ratio was higher in patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). In patients with hemorrhagic CVA serum sodium to potassium ratio was higher when compared to patients with TIA and ischemic CVA (P < 0.001). CONCLUSION: This study shows that higher serum sodium and lower serum potassium level may be associated with higher incidence of CVA. Further studies are paramount to elucidate the role of serum electrolyte levels in vascular events.

Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study.

PURPOSE: This article reports a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) versus retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with medium-term follow-up. SUBJECTS AND METHODS: Between September 2008 and November 2011, 24 patients with surgical adrenal diseases were prospectively randomized to undergo TLA (Group 1, 11 patients) or RLA (Group 2, 13 patients). Study exclusion criteria were patients with a body mass index of >40 kg/m(2), significant prior abdominal surgery, and bilateral adrenalectomy. Mean follow-up was 9 months in both groups. RESULTS: The groups were matched in regard to patients' age (P=.80), sex (P=.72), body mass index (P=.62), and laterality (P=.72). Median adrenal mass size was 2.92 cm (range, 2-5 cm) in the TLA group and 2.63 cm (range, 2-5 cm) in the RLA group (P=.55). TLA was comparable to RLA in terms of operative time (P=.22), estimated blood loss (P=.83), time to ambulation (P=.21), hospital stay (P=.25), analgesic requirement (P=.40), and postoperative pain (P=.40), whereas time to oral intake resumption (P=.001) and convalescence period (P=.002) were significantly shorter in the RLA group. One case from the RLA group was electively converted to open surgery. During a mean follow-up of 9 months, there were no late complications, and no deaths occurred in any group. CONCLUSIONS: Laparoscopic adrenalectomy is a viable treatment option for removal of benign adrenal lesions that can be performed safely and effectively by either the transperitoneal or retroperitoneal approach. All operative parameters are similar in the two approaches, except that the convalescence period and time to oral intake resumptions that are significantly shorter with retroperitoneal surgery.

Preventive effect of tamsulosin on postoperative urinary retention.

PURPOSE: To investigate the prophylactic effect of Tamsulosin, a super-selective alpha-1a adrenergic blocking agent, on the development of urinary retention in men undergoing elective inguinal herniorrhaphy. MATERIALS AND METHODS: From May 2010 through November 2011, a total of 80 males who underwent elective inguinal herniorrhaphy in a university hospital were included in this study. Patients were randomly assigned to one of two groups. In group one (control), the patients were given two doses of placebo orally, 6 hours before surgery and 6 to 12 hours after surgery. Patients in group two were given 0.4 mg of Tamsulosin orally in the same manner as the placebo. All patients were closely followed for 24 hours post-operatively, and any voiding difficulties or urinary retention was recorded. RESULTS: There were 40 patients in group one (control group) and 40 patients in group two (Tamsulosin group). The patients' mean age was 64 years. In group one, 6 patients and in group two, 1 patient required catheterization. Thus, 15% of patients in group I and 2.5% of patients in group II had urinary retention. The difference in the requirement for catheterization was statistically significant (p=0.04). The technique of herniorrhaphy, the side of the body in which the hernia was located, the type of anesthesia, the duration of the surgery, and the severity of pre-operative urinary symptoms had no significant effect on the incidence of urinary retention. CONCLUSIONS: The use of perioperative Tamsulosin represents an effective strategy to reduce the risk of post-operative urinary retention following inguinal herniorrhaphy.

Percutaneous decortication of cystic renal disease.

PURPOSE: To assess the efficacy of percutaneous unroofing in the treatment of simple renal cysts instead of laparoscopic decortication and open surgeries. MATERIALS AND METHODS: From November 2009 to October 2010 at our department, 11 patients with 12 simple cyst units were managed by percutaneous unroofing. All cysts were evaluated with ultrasonography and abdominal computed tomography. If there were no contraindications, cyst wall resection was performed. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterized. The drain was left in place for 2 days. RESULTS: At the 5-month follow-up, patients were asked about their symptoms and ultrasonography was performed. From 12 cyst units, 8 were completely resolved, 3 were reduced to less than 50%, and 1 was persistent to near its original size. Success was defined as a more than 50% reduction in cyst volume. CONCLUSIONS: Simple renal cysts can be safely managed by percutaneous unroofing with a success rate of more than 90%. This technique can offer several advantages over open surgery, such as decreased length of hospital stay, improved convalescence, and reduced risk of complications. Percutaneous resection also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy.

Megacystis secondary to congenital urethral stricture.

Functional bladder capacity at a certain age can be accurately estimated and expressed as a function of age. We present a 13-year-old boy with abdominal distention who was presumed to have ascites. Abdominal ultrasound revealed that the bladder was severely distended, and cystoscopy showed a short stricture in the bulbar urethra followed by a large bladder without obvious borders. Under general anesthesia, bladder capacity was 9250 cc. Reduction cystoplasty was performed. At the 2-year follow-up, he voided spontaneously with 20 cc post-void residual urine.

Percutaneous unroofing of renal simple cysts: Experience from one centre.

OBJECTIVE: To assess the efficacy of percutaneous unroofing (PU) for treating simple renal cysts, compared with laparoscopic decortication and open surgery. PATIENTS AND METHODS: From November 2009 to October 2010, 11 patients with 12 simple cysts in renal units were managed by PU. All cysts were evaluated with ultrasonography and abdominal computed tomography. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterised. A drain was left in place for 2 days. Success was defined as a >50% reduction in cyst diameter. RESULTS: At the 5-month follow-up, patients were asked about their symptoms and assessed by ultrasonography. Of the 12 cyst units, eight were completely resolved, three were reduced to <50% in diameter and one was persistent, close to the original size. CONCLUSION: Simple renal cysts can be managed safely by PU, with a success rate of >90%. This technique offers several advantages over open surgery, with a shorter hospital stay, improved convalescence and reduced risk of complications. PU also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy.