Prospective randomized study of transurethral vaporization resection of the prostate using the thick loop and standard transurethral prostatectomy.

OBJECTIVES: Transurethral vaporization resection of the prostate (TUVRP) is a recent modification of the standard transurethral prostatectomy (TURP). The procedure uses one of the novel, thick resection loops coupled to augmented electrocutting energy. We evaluated the safety and efficacy of TUVRP in comparison with TURP. METHODS: Sixty-eight patients with prostatic outflow obstruction were prospectively randomized between equal TUVRP and TURP treatment groups. Safety parameters evaluated included changes in serum hemoglobin, hematocrit, and sodium 1 and 24 hours after resection. Operative time, catheterization time, and incidence of complications were noted. Efficacy parameters included evaluation by the International Prostate Symptom Score and maximum flow rate. RESULTS: Patients of both groups were balanced for the different baseline variables. One hour after TURP, patients had significantly lower levels of hemoglobin, hematocrit, and sodium (P = 0.03, 0.03, and 0. 01, respectively). The prostate resection weight was similar in both groups; however, the difference in the mean operative time was significant (TUVRP group 42.4 minutes and TURP group 35.9 minutes, P = 0.02). The postoperative catheterization time was significantly shorter for the TUVRP group (23.1 +/- 10.3 versus 36 +/- 17.3 hours, P <0.0001). All patients were followed up for an average of 9 months. The International Prostate Symptom Score was 4 +/- 3.4 and 5.6 +/- 3.1 and the maximum flow rate was 19 +/- 6.5 and 15.2 +/- 10 mL/s for the TUVRP and TURP groups, respectively; these differences were statistically significant (P = 0.03 and 0.01, respectively). Complications included urethral strictures (6 patients) and delayed hemorrhage with clot retention (2 patients); no differences in the incidence of complications were noted between the two groups. CONCLUSIONS: The results of the present study have demonstrated that TUVRP is as safe and efficacious as TURP in the treatment of men with prostatic outflow obstruction. The shorter catheterization time observed after TUVRP may be clinically significant, considering the demand for lower morbidity profiles by patients. The longer operative time in TUVRP was related to the slower motion of the Wing electrode needed to add the advantages of electrovaporization.

Extracorporeal shockwave lithotripsy for ureterolithiasis in patients with urinary bilharziasis: efficacy and variables that influence treatment outcome.

OBJECTIVES: Schistosomiasis affecting the ureter is commonly accompanied by ureteric dilatation with or without ureteric stricture and altered ureteric wall motility that can influence extracorporeal shockwave lithotripsy (ESWL) results. This study attempts to identify variables that may influence the outcome of ESWL in the treatment of ureterolithiasis in patients with urinary bilharziasis. PATIENTS AND METHODS: Forty-three patients with urinary schistosomiasis and ureterolithiasis treated with ESWL were reviewed. The study data include characteristics of patients, stones, urinary tract treated and details of ESWL treatment. RESULTS: Thirty-five patients (81.3%) were stone-free at 3 months. Multivariate analysis with logistic regression identified two significant variables that influenced treatment outcome, namely the presence of ureteric stricture (p = 0.004) and the ESWL voltage (p = 0.003). Ten ureteric strictures were encountered in 9 patients (21%), the majority of these were diagnosed post-ESWL when patients failed to pass well-fragmented stones in spite of pre-ESWL evaluation. CONCLUSIONS: In situ ESWL is a safe and effective first line of treatment for urinary stones in bilharzial ureters. The presence of concomitant bilharzial stricture is a significant variable which affects the treatment outcome. Every effort should be made to rule out and deal with possible complicating factors such as ureteric strictures in the pretreatment period.

Classification of urinary stones by cluster analysis of ionic composition data.

The cluster analysis technique is considered for classifying kidney stones based on data for nine chemical analysis parameters. A set of 214 stones is used, which has been previously classified using empirical classification rules into three stone types using the percentage concentrations of the urate, oxalate, and phosphate radicals. We investigate whether cluster analysis utilising data on all parameters leads to different classifications and explore the possibility of other effective classifiers. We also compare the performance of various clustering techniques, distance and similarity measures and data standardisation methods. Results indicate that inclusion of the additional six parameters does not improve the classification accuracy. Best matching with the empirical classification (6% error) is achieved using the average linkage (between groups) clustering method and the squared Eculidean distance measure without data standardisation. Excluding these three main radicals causes a 63% matching error. Cluster analysis results suggest that carbon ions alone provide a single classifier for the three stone types, giving a matching error of approximately 10% with the empirical classification.

The structure of large lamellar urinary stones. A quantitative chemical analytic study applying a new classification scheme.

To study the structural composition of 61 renal and 9 vesical large lamellated non-infection urinary tract stones, samples from successive layers were quantitatively analyzed with standard chemical techniques, but with a new classification based on percentage composition of ions rather than compounds. The commonest pattern of composition (n = 41) was that of the lamellar stones of one stone type (uric acid, oxalate, or phosphate) and group (according to % of indicating ion), followed by bilamellar stones of different stone types (17) or of one stone type but different groups (8). The other stones were trilamellar (3) or quadrilamellar (1) of different stone types. In the 29 stones with lamellae of different type and/or group, the chemical composition of successive layers seemed to confirm the correlation between uric acid and oxalate, rather than phosphate, ions and between oxalate and both uric acid and phosphate ions. An influence on these correlations either positive or negative, may be the responsible factor for specifying the type and group of a forming stone or layer of a stone. The observed ionic correlations within the stones seem to support the choice of the oxalate ion, in the uric acid or phosphate stones, and both of the uric acid and phosphate ions, in the oxalate stones, as indicating ions for grouping in our proposed classification of urinary stones.

Crystalluria and its possible significance. A patient-control study.

The significance of crystalluria in the diagnosis and prognosis of urolithiasis remains a controversial subject in the current urological literature. In this study, in addition to the standard urolithiasis clinical and biochemical work-up, routine urine microscopy was performed to study crystals in 1 fresh and 2 stored morning urine samples from 140 urinary stone patients and 42 controls. Crystalluria was more frequently detected in patients (9.3% of the fresh samples) than in controls (2%). Storing the samples for 6 hours did not increase the frequency percent of detected crystalluria either in patients or controls. However, in the samples stored for 24 hours, the frequency of crystalluria increased to 27.1% in patients and only to 12% in controls, though the pH did not change from that of the fresh sample. In addition, while calcium oxalate crystals in patients formed aggregates whether in fresh or 24 hour samples, those of controls did not. This denotes a characteristic change in the physico-chemical properties of the urine of stone formers from that of controls. Accordingly, the study of crystalluria in patients with urolithiasis seems to help in the proper evaluation and, maybe, treatment of the disease.

Ionic associations within 460 non-infection urinary stones. A quantitative chemical analytical study applying a new classification.

In addition to standard quantitative wet chemical and inductively coupled plasma atomic-emission spectrometric stone analytic techniques, elemental analysis for the determination of nitrogen, carbon and hydrogen was utilized in this study of 460 category I (non-infection) urinary stone samples from western Saudi Arabia. They were classified according to the percentage composition of detected ions, including trace or minimum amounts. The incidence of uric acid stones (24%) is higher than that reported from western countries but similar to those reported from eastern Europe and other parts of the middle east and most are in the group with the highest uric acid content (UrI4). Oxalate stones are the most common type (61%) and phosphate stones (15%) the least common. The results confirm the reliability of elemental microanalysis and support its use for the quick identification of stones especially those that weigh < 1 mg and are too small for wet chemical analysis. Within the various stone types, however, the ionic associations shown by wet chemical analysis denoted the presence of mutual indirect associations between the characterising ion oxalate and both uric acid and phosphate ions, but no association between the characterizing ion uric acid and phosphate ions. Factors that affect these ionic correlations may influence the processes of stone initiation and type of stone formed.

Paediatric urology 1000 years ago.

In this paper we present a commentary on four books from the paediatric urology point of view; al-Hawi (Continens), R. fi Siyasat as-Sibyan wa tadbirihim, at-Tasrif and al-Qanun by the Moslem scholars ar-Razi, Ibn al-Jazzar, al Zahrawi and Ibn Sina who lived within the period of the ninth to the eleventh centuries. In these books the supreme abilities of the authors as clinicians and their role in the creation of clinical medicine are shown by: The presentation of the various pathological conditions usually starting with the complaint then describing the origin of the disease and enumerating the accurate signs necessary for diagnosis. Differential diagnosis between various conditions which produce similar complaints is precisely described. For example, retention of urine and different types of anuria, types of renal haematuria, dormant and moving renal stones and their precise localisation, renal or vesical pain and pain due to colitis. Finally, the methodical classification of the diseases according to the organs affected is discussed. The description of the pathology and the knowledge of new diseases was an important advance made by these scholars. From the urological point of view, spina bifida and its relation to incontinence was first described by ar-Razi and most of the diseases of the kidney and bladder can be recognized in the systemic classification of the diseases of these organs given by Ibn Sina who pointed out the psychological role in some cases of nocturnal enuresis.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluoroscopic assessment of bilharzial ureteropathy.

This paper reports a fluoroscopic study of ureteric peristalsis during intravenous pyelography in 32 patients with urinary bilharziasis and 13 non-bilharzial controls with normal intravenous pyelograms. Ureteric peristalsis is reduced in parallel with urographic signs of involvement. The role of fluoroscopic examination of the ureters in staging bilharzial ureteropathy is discussed.

Bilharzial uropathies and a scheme for primary medical care.

Fifty patients suffering from the late effects of urinary bilharziasis were studied. A preliminary idea about the incidence of bilharzial cancer in the endemic area of Jeezan is presented. The role of ileal loop ureteric replacement in extensive ureteropathy is emphasized. A scheme is proposed for the categorisation of bilharzial patients on the basis of their symptoms in order to detect complicated cases at the primary medical care level.

Ileal loop replacement and restoration of kidney function in extensive bilharziasis of the ureter.

Ileal loop replacement is often the only possible treatment of extensive bilharziasis of the ureter. Experience with 5 such cases is presented and the special problems arising from the nature and extent of the lesion are discussed. In bilateral cases, attempts should be made to preserve as much renal tissue as possible. Non-functioning kidneys in 3 cases were not removed and a degree of function was restored following the relief of obstruction by also connecting these kidneys to the ileal loop.