Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial.

Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.

Ureteroscopy in infants and preschool age children: technique and preliminary results.

INTRODUCTION: We present our experience with the use of semirigid ureteroscopy for the treatment of ureteric stones in children less than or equal to 6 years of age. MATERIAL AND METHODS: The records of 21 children (12 female, 9 male) with an average age of 4.7 years (range 8 months to 6 years) treated with semirigid ureteroscopy between June 2006 and July 2010 were reviewed. In 13 ureteral units 7Fr semirigid ureteroscopy was carried out in a retrograde manner to treat stone disease, while an adult ureteroscope (9.5 fr) was used in the remaining patients. Stones were located in the upper ureter in 2 cases, middle ureter in 2 cases, and lower ureter in 17 cases. Ureteral dilation was not required in all patients. RESULTS: Stone size varied from 4 to 13 mm (mean 6 mm). The management of stones in 18 (90.7%) children was straightforward and a single ureteroscopy was required to clear the ureters. In 2 (6.2%) children, repeat ureteroscopy was undertaken to render the ureters stone free, and in 1 child (3.1%) it was not possible to remove the stone. Stones were fragmented with pneumatic lithotripsy in 12 cases and stones were removed mechanically without fragmentation in the remaining 9 cases. Intraoperative complications occurred in 2 (9.3%) children and included extravasation (1 patient), which was managed with ureteral stenting and stone upward migration (1 patient). Early postoperative complications included pyelonephritis (1 patient). Mean follow-up was 6.4 (3-36) months. Incidence of stricture at the site of stone impaction was not detected in any patients. None of the patients managed without a post-operative stent required subsequent intervention. CONCLUSIONS: In the hands of an experienced surgeon, ureteroscopy in young children can be a safe and efficient treatment for ureteral stones that can be performed without ureteral dilation. Routine ureteral stenting is not a requirement when the procedure is relatively atraumatic. Further studies and longer follow-up are necessary to determine the success of this technique.

Marzouk skin tag two-stage urethroplasty for the repair of complex cases of hypospadias.

BACKGROUND: Cases of hypospadias with severe chordee and deficient skin, as well as those for re-do hypospadias or fistula repair, are considered complex cases. Depending on the degree of complexity of the defect, a two-stage procedure may still be advisable. The present paper describes the so-called Marzouk skin tag urethroplasty as a new two-stage procedure advisable for use in such difficult cases. METHODS: The Marzouk skin tag urethroplasty procedure was performed on 16 complex cases. The first stage consists of urethral mobilization plus the double-buttonhole procedure (designed by the author) to form a midline ventral skin tag proximal to an advanced hypospadiac orifice. This skin tag is fashioned, 6 months later, by the author's special techniques (type I in 12 patients and type II in four patients) to form the neourethral tube and its coverage with minimal dissection. RESULTS: The operation resulted in a straight penis with neomeatus at the glans top in all 16 cases without significant complications. Both type I and II procedures give good functional results. The type I procedure has a superior cosmetic result. The follow-up period ranged from 4 to 8 months. CONCLUSIONS: The double-buttonhole modification can solve the problem of deficient skin and simplify a safe second-stage procedure. The Marzouk skin tag operation (types I and II) can be an additional option to be used when indicated.