The role of ultrasonography in detecting urinary tract calculi compared to CT scan.

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) in measuring the urinary tract stone using non-contrast computed tomography (NCCT) as the standard reference. PATIENTS AND METHODS: A total of 184 patients suspected with urolithiasis who had undergone NCCT and US radiologic investigation from 2015 to 2017 were enrolled in this study. The sensitivity, specificity, and stone size measured in US were validated by NCCT. Data of the stone size in US were classified into four groups (0-3.5, 3.6-5, 5.1-10, >10 mm) and then compared with NCCT data. RESULTS: In 184 patients, NCCT detected 276 (97.2%) stones, while US could identify 213 (75.5%) stones. Overall sensitivity and specificity of US were 75.4% and 16.7%, respectively. Detection rate of mid and distal ureteral stone was lower than that at other locations. The detection rate increased with the stone size. About 73% concordance was obtained for the stone size measured by US and NCCT (Pearson's correlation coefficient was 0.841). Factors such as the stone size, amount of hydronephrosis, and weight affected the detection rate of the urinary tract stone using US (P<0.001, P=0.02, and P=0.01, respectively). CONCLUSION: The stone size obtained by US was almost the same as that detected by NCCT; however, US is a limited imaging modality in detecting urinary tract stone, especially when used by an inexperienced radiologist, and in the case of smaller stone size, increased weight, and low grade of hydronephrosis.

Spontaneous Rupture of Renal Cell Carcinoma in Pregnancy, Surgical Management With Fetal Preservation:A Case Report.

Spontaneous Retroperitoneal hemorrhage in pregnancy is a rare condition. Renal angiomyolipoma (RA) is the most common cause of this hemorrhage. To the best of our knowledge, this is the first reported case of Wunderlich syndrome (WS) due to renal cell carcinoma (RCC) diagnosed in the second trimester of pregnancy.

Percutaneous Nephrolithotomy During Early Pregnancy in Urgent Situations: Is It Feasible and Safe?

PURPOSE: Urolithiasis during pregnancy poses risks for mother and the fetus with specific challenges in diagnosis and management. We report our experience with urgent percutaneous nephrolithotomy (PCNL) in seven pregnant patients with symptomatic renal stone in early pregnancy. MATERIALS AND METHODS: Seven pregnant patients with symptomatic renal stones were reviewed. The technique comprised PCNL with complete access under guide of ultrasonography in prone position under general anesthesiausing pneumatic lithoclast for stone fragmentation. RESULTS: There was no significant residual fragment of stone in the operated kidneys. The patients discharged without complications and delivered their babies healthy. CONCLUSION: PCNL should not be considered as the first therapeutic method in the first trimester of pregnancy, unless in urgent situations such as symptomatic renal pelvic stone with moderate to severe hydronephrosis in patients who do not tolerate or are complicated by nephrostomy or internal stent. However, this procedure could be technically demanding and should be done in centers with enough experience and equipment in percutaneousnephrolithotomy.

Cystostomy-free open suprapubic transvesical prostatectomy: Is it a safe method?

AIM: To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss. RESULTS: Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98). CONCLUSION: OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications.

Percutaneous nephrolithotomy in solitary kidneys: experience with 412 cases from Southern Iran.

Some patients with nephrolithiasis who become candidates for percutaneous nephrolithotomy (PCNL) have a single kidney. This poses a challenge for the physician regarding the safety and efficacy of this procedure for these patients. This study has aimed to evaluate the safety and efficacy of PCNL in these patients. Between 2002 and 2014, out of 10,800 cases who underwent PCNL in our centres, 412 had a single kidney. We recorded the results and complications in these patients. Out of 412 patients, 279 were men and 133 women. Their mean age was 46.4 years (range 19-71) and mean stone size was 26.5 mm (range 21-55); 161 of them had a functional single kidney, 36 were congenital, and the remaining 215 had undergone contralateral nephrectomy because of stones, trauma, infection or tumour. Comorbidities included 104 hypertensive, 66 diabetic, 65 morbidly obese, 56 uremic and 47 ischemic heart disease cases. The stone-free rate was 91.3% (376/412) on postoperative X-ray/sonography. However, 42 patients required ancillary measures. Complications include fever (T > 38.3 °C) in 34 cases (8.2%), bleeding requiring transfusion 19 cases (4.6%), UTI nine cases (2%), sepsis one case (0.2%), perinephric collection three cases (0.7%), hydro/pneumothorax two cases (0.4%), access failure in five morbidly obese cases (1.2%), pyonephrosis two cases (0.4%), myocardial infarction four cases (1%), transient increasing of blood urea nitrogen (BUN) and serum creatinine (Scr.) in four normal functioning kidney (1%) and eight uremic cases (1.9%), and two cases resulted in death (0.4%). PCNL seems a safe and effective option in cases of a single kidney, but it needs more attention in order to prevent even minor complications that can result in an anephric state.

Percutaneous nephrolithotomy: is distilled water as safe as saline for irrigation?

PURPOSE: To compare dilutional effect of distilled water with saline solution as an irrigation fluid in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Three hundred twenty eight adult patients (191 men, 137 women) who were candidates for PCNL were randomly assigned into two groups (distilled water, n = 158, group 1; saline solution, n = 162, group 2). Stone size, operation time, irrigation fluid volume, blood hemoglobin level, urea nitrogen, creatinine, sodium and potassium levels were checked before and at 6 and 12 hours after operation. RESULTS: The mean age of the patients was 37.8 years, and the mean stone diameter was 31.5 mm. There was no clinical case of transurethral resection (TUR) syndrome. Serum sodium depletion was significantly more in group 1 than group 2 (P < .0001). Group 1 had significant decreased post-operative serum sodium levels (P < .0003). Similarly in group 2, postoperative serum sodium levels were significantly lower than the preoperative concentration (P < .01), but it was not the same 6 hours after the operation (P = .23). Serum sodium concentrations remained within normal limits in all cases, without causing clinical signs and symptoms of hyponatremia. CONCLUSION: We found that distilled water is safe irrigation fluid for PCNL in adults. In addition, it is more available and cost effective.

Urethral catheter traction reduces bleeding compared with suturing of prostatic vesical junction during suprapubic prostatectomy: a randomized clinical trial study.

OBJECTIVES: To determine whether catheter traction during suprapubic prostatectomy can be beneficial in reducing intraoperative and postoperative bleeding. METHODS: A total of 156 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from September 2004 to January 2006. Of the patients, 78 underwent open prostatectomy with suturing at the prostatic vesical junction (group 1) and 78 were treated with urethral catheter traction to control bleeding (group 2). The duration of operation, duration of hospital stay, intraoperative blood loss, hemoglobin decrease, and weight of resected prostate were recorded in both groups. Three months later, we followed up patients with the International Prostate Symptom Score questionnaire, maximal flow rate measurement, and cystoscopic examination. RESULTS: The mean operative time was 59 +/- 7 minutes and 40 +/- 9 minutes (P = .015) and the mean hospital stay was 3.7 +/- 0.24 days and 4.4 +/- 0.46 days (P = .09) in groups 1 and 2, respectively. The mean blood loss during surgery was 279 +/- 155 mL and 219 +/- 139 mL (P = .04) and the mean hemoglobin decrease was 2.3 +/- 1.4 g/dL and 1.6 +/- 1.5g/dL (P = .04) in groups 1 and 2, respectively. The mean weight of the prostate was not significantly different statistically between the 2 groups at 63 +/- 23 g and 64 +/- 19 g in groups 1 and 2, respectively (P = .8). The urethrocystoscopy examination at 3 months postoperatively revealed bladder neck contractures in 6.41% of the patients in group 1 and 3.85% in group 2. CONCLUSIONS: The results of our study have shown that urethral catheter traction diminishes bleeding compared with suturing at the prostatic vesical junction during suprapubic prostatectomy.

Ultrasonography-guided percutaneous nephrolithotomy.

PURPOSE: To evaluate the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between August 2003 and December 2007, 47 patients were treated, 29 men and 18 women, with a mean age of 33.4 years (range 21-67 yrs) and a mean stone size of 31.5 mm (range 24-46 mm). All stones were located in the renal pelvis with mild to moderate hydronephrosis seen on intravenous urography. A ureteral stent was inserted cystoscopically, and saline was injected for more localization of the pelvicaliceal system (PCS), if needed. Puncture of the PCS was performed with an 18-gauge nephrostomy needle through the lower pole calyx, and all the stages, including dilatation, were performed under ultrasonography guidance. RESULTS: Thirty-nine patients were stone free in the kidneys, ureters, and bladder the day after the operation. Five patients had multiple fragments that measured about 4 to 5 mm, which passed in 4 weeks (total stone-free rate: 93.61%); failure occurred in two patients, and fluoroscopy was needed; two patients who had residual fragments that measured 10 and 12 mm underwent shockwave lithotripsy; and in one patient, a fragment that measured 7 to 8 mm migrated into the ureter--it fragmented and was removed with a ureteroscope 2 days after the operation. CONCLUSION: PCNL using sonography is a good alternative to the fluoroscopic method. It is performed without radiation exposure to the surgeon and patient; however, more experience is needed.

Effect of intraurethral captopril gel on the recurrence of urethral stricture after direct vision internal urethrotomy: Phase II clinical trial.

OBJECTIVE: The purpose of this study is to evaluate the effect of intraurethral captopril gel as an antifibrotic agent on patients with urethral stricture. MATERIALS AND METHODS: In the first phase of clinical trial, 13 rabbits were included and local side-effects of captopril gel were evaluated. In the second phase, 56 patients were enrolled from April 2004 to January 2006. After internal urethrotomy the patients were classified into three patient groups: (i) received placebo gel (group I); (ii) received 0.1% captopril gel (group II); and (iii) instilled 0.5% captopril gel intraurethrally (group III). RESULTS: In phase I, no significant local side-effects were seen in the urethra of rabbits. In phase II, the mean age of the patients was 39.5 and the mean follow-up duration was 16 months. The most common etiology of the urethral stricture in the patients was iatrogenic (35.7%), most of their strictures had a depth of 0.5 cm or less (67.8%), and the length of most strictures was between 1 and 2 cm (41.1%). The patients' maximum urine flow increased more in groups II and III, than in group I (P < 0.04, P < 0.05, respectively). The recurrence rate was less in groups II and III than in group I (P < 0.05). In terms of the maximal urine flow and recurrence rate, no significant difference was seen between group II and group III (P = 0.13, P = 0.21, respectively). CONCLUSION: Captopril gel is a safe, effective and non-toxic agent for decreasing the recurrence rate of the urethral stricture after internal urethrotomy. However, more studies, including more cases and a longer follow up, are needed to prove the effect of captopril gel on patients' urethra.