Simple radiological indicators for staghorn calculi response to ESWL.

OBJECTIVE: To evaluate staghorn calculi response to ESWL using simple radiological indicators which are stone size, stone homogeneity, and stone density. PATIENTS AND METHODS: This is a prospective study of 60 patients with staghorn calculi where the majority had ESWL. The relationship between response and size, homogeneity and density is studied. RESULTS: Single staghorn calculus less than 4 cm, heterogeneous with stone density similar to bone or a little denser than bone has best response to ESWL. CONCLUSION: ESWL is useful as first line therapy for staghorn calculi less than 4 cm, heterogeneous with similar density to bone or a little denser than bone.

Urinary tract infections in adult and adolescent females of a developing community: pattern, bacteriology and genitourinary predisposing factors.

One hundred and twenty-seven consecutive adult and adolescent female patients with culture-proven urinary tract infections were analyzed to determine the pattern, bacteriology and the predisposing causes. Age ranged from 13 to 70 years (median 32, mean 35.7 years). Community acquired urinary tract infections occurred in 85%, while hospital acquired infections in 15% of cases. Urinary tract stones were the most frequently identified genitourinary predisposing causes, which occurred in 16 patients (15%). However, 52.3% of all patients had no identifiable predisposing cause. E. coli, the most frequently isolated organisms from patients with community acquired urinary tract infections, occurred in only 55.6%, while gram-positive cocci isolated from 28 patients (22%) are emerging as important hospital and community acquired urinary tract pathogens. The implications of these findings and a comparison with the reported literature are discussed.

The value of performing both IVU and DMSA scan in patients with urinary stone disease.

A study of 60 patients with stone disease was done, all patients had an IVU and DMSA scan. A DMSA scan helps to show clear cortical images, diagnose cortical scars and absence of cortical tissue. While the IVU allows gross evaluation of kidney function and morphological changes, the DMSA scan is an accurate measure of functioning renal mass. Anyhow, both studies are complementary to each other in patients with stones disease.

Orthotopic and ectopic ureteroceles in children.

In this work the embryology, clinical presentation, radiology and operative treatment of ureteroceles are presented. At the same time the author's experience with bilateral orthotopic and ectopic ureteroceles is discussed and compared with other authors' work.

Inadequate scrotal incision in testicular neoplasms: review of literature and report of three cases.

In a five years period (1983-1988) we were faced with three patients who had inadequate primary surgical management for their testicular tumours in the form of local testicular biopsy through a scrotal incision. Management of two of these patients by a high inguinal orchidectomy with wide local excision at the site of previous scrotal biopsy followed by a combination of chemotherapy and radiotherapy yielded good outcome.

Management of transitional cell carcinoma of the bladder.

A six years experience in the management of 33 Jordanian patients with transitional cell carcinoma of the urinary bladder is reported. They were treated by transurethral resection for superficial tumours, invasive tumours were treated by radiotherapy and resection, cystectomy was done for invasive cancer which did not respond to radiotherapy and resection, and urinary diversion was done for inoperable tumours. This treatment was suitable for these 33 patients medically and socially, and it gave similar results in comparison with other centres.

Etiology, treatment and recurrence of urethral strictures.

This is a study of urethral strictures in 50 Jordanian patients. The etiology, treatment and recurrence were discussed. The commonest causative agent was iatrogenic trauma and the commonest way of treatment was direct vision internal urethrotomy with an 80% non-recurrence rate.

Comparison of transurethral and transvesical prostatectomy.

This is a study of 32 transurethral (TURP) and 28 transvesical (TVP) prostatectomies which were done for 60 Jordanian patients. The weights of the prostates which were removed by TURP were less than those removed by TVP, while the amounts of blood transfusion which were given for the former group were less than those given for the latter one. Less postoperative complications were observed in the TURP group, except for urethral strictures. The non-urological complications were equal in both groups.

The place of abdominal safety line in the treatment of posterior urethral injury.

The simple traction by a balloon catheter splint technique is used in the treatment of posterior urethral disruption in this series. The abdominal safety line, which is a size 1 silk passed through the eyes of the urethral splint (Foley catheter) and rolled up on gauze with some tension on the anterior abdominal wall has been used in three cases. The value of this line is to anchor the urethral splint, to produce some countertractive effect, and to replace it if it failed; also, it could be used as a guide if it is decided to replace the urethral Foley catheter (splint) under vision with the help of the sheath of the optical urethrotome.

Renal injuries.

The present paper reports on solitary and associated renal injuries. Conservative and surgical treatments are discussed and compared with literary data.

Fate of urinary calculi in children and teenagers.

Urinary calculi are more common in children and teenagers in the Middle East than in other parts of the world. The fate of 45 cases is discussed in this work. Twenty-one passed their stones, three with renal calculi were kept under observation, and 21 cases had different types of surgical intervention. There were only two bladder stones treated by cystolithotomy and only one nephrectomy was done. The low incidence of bladder stones and the high percentage of radio-opaque stones, inspite of the relatively high incidence of stone disease in this age group, are probably due to the changing socio-economic conditions in Jordan.

Intravenous urography as a routine investigation in epididymitis.

One hundred and forty-two patients were admitted to the Jordan University Hospital with acute epididymitis between 1973 and 1983. Sixty-five had intravenous urograms which revealed renal tuberculosis in 1 patient, renal or ureteric stones in 10, bladder neck obstruction in 3, unrelated congenital anomalies in 10 and no abnormalities in 41. Twelve patients developed epididymal abscesses.