Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave lithotripsy - the controversy continues.

BACKGROUND: To determine factors influencing the clearance of fragments after extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC) stones. METHODS: In the period between July 1998 and Oct 2001, 100 patients with isolated lower polar calyceal calculi or= 14 years, were included in the study. Intravenous urograms (IVU) were reviewed to define the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end points i.e. stone free status; number of shock waves used and number of sessions were correlated with variables like LPC anatomy, body mass index and stone size. RESULTS: At three months follow up the clearance for stone size 90 degrees ) had stone clearance of 94 and 100% respectively. For the infundibular width of < 4 mm, the stone clearance was 93% were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30 kg/m2, the stone clearance was 92 and 95% respectively. CONCLUSIONS: There is a trend towards more ESWL sessions and shock wave requirement in patients with acute pelvi-calyceal angle and narrow infundibulum but it is not statistically significant. Size (

Is there a difference in early perioperative morbidity in transurethral resection of prostate (TURP) versus TURP with cystolitholapaxy and TURP with inguinal herniorrhaphy?

Objective of this study is to determine the difference in early peri-operative morbidity of transurethral resection of prostate (TURP) and if it is combined with inguinal hernia repair and mechanical and/or pneumatic fragmentation of bladder calculus. All patients undergoing TURP, cystolitholapaxy (CLL), inguinal hernia repair (IHR) or any combination between January 1997 and December 1999 were identified using ICD 9CM coding and indexing system. Overall 1273 patients were identified, charts were reviewed for demographics, pre-operative parameter, intra-operative data and early peri-operative morbidity. In the three year period, 19 patients had TURP and inguinal herniorrhapy (IHR), 17 patients had TURP and cystolitholapaxy (CLL), 2 patients had TURP+IHR+CLL performed simultaneously; in the same period 346, 815, 74 patients had TURP, IHR, and CLL alone respectively. All the groups were matched for age, presentation and Co-morbidities. There was significant difference in the operating time between the different groups. Complications were not significantly different in the TURP, IHR, CLL, TURP+IHR, and TURP+CLL. In conclusion, mean operative time for TURP+IHR is increased by a fraction of 168.3 for TURP+CLL by 109.8 and TURP+IHR+CLL is 202.1 over TURP alone, with no significant difference in morbidity between TURP and TURP+IHR and TURP+CLL.