Evaluation of Upper Urinary Tract Integrity After Radical Cystectomy and Orthotopic Diversion with Ileal and Sigmoid Neobladder.

The study aims to evaluate the effects of orthotopic urinary diversion using ileal and sigmoid segments after radical cystectomy on upper urinary tract function and morphology. A retrospective study included 60 patients divided into 2 equal groups (W-ileal pouch group and sigmoid pouch group). We assessed renal function and morphology post-operative after 6 months and after 1 year by serum creatinine, ultrasound, IVP, pouchogram, and renal scan study. After 6 months post-operatively, in the W-ileal group, there were 16 renal units (26.6%) deteriorated in morphology and 11 renal units (18.4%) deteriorated in function. After 1 year, further deterioration in morphology was noted in 17 renal units (28.3%) and in function in 16 renal units (26.7%). In the sigmoid group, after 6 months post-operatively, there were 14 renal units (23.3%) deteriorated in morphology and 14 renal units (23.4%) deteriorated in function. After 1 year, further deterioration in morphology was noted in 47 renal units (24.4%) and in function in 18 renal units (30%). Incorporating the bowel into the urinary tract is potentially dangerous to the upper urinary tract's integrity, and the leading cause of renal impairment is uretero-pouch obstruction.

Urologic complications of genitourinary schistosomiasis.

OBJECTIVES: To provide systematic review of the literature on the long-standing complications of genitourinary schistosomiasis. MATERIALS AND METHODS: The PubMed literature database was searched from inception to December 2010. The following keywords were used: schistosomiasis, bilharziasis, and genitourinary. Only English language publications were utilized. RESULTS: Variable tissue reactions to bilharzial eggs with subsequent healing or progression and complications in the urinary tract mainly affect the urinary bladder and pelvic segments of the ureters. These lesions may assume an atrophic, proliferative, or neoplastic pattern. Although the pathology is usually extensive in the submucosal, all layers from the mucous membrane through deep to the perivesical or periureteral tissues may be involved. Main fixed bilharzial urologic sequelae include chronic bladder ulcers, leucoplakia, vesical granuloma, contracted bladder, bladder neck contracture, stricture ureters, and bladder carcinoma. These sequelae may lead to marked morphologic and functional changes of the urinary tract, and ultimately, mortality can follow from renal failure or bladder cancer. CONCLUSIONS: Urinary schistosomiasis is a preventable disease through nationwide snail control and mass therapy with oral antibilharzial drugs. If not properly treated, long-standing urinary complications may result in serious sequelae that may lead to mortality from renal failure or bladder cancer.

Holmium laser ablation of the prostate versus photoselective vaporization of prostate 60 cc or less: short-term results of a prospective randomized trial.

PURPOSE: We report on the first randomized trial to our knowledge comparing holmium laser ablation and photoselective vaporization of the prostate in patients with a small to moderate size prostate. MATERIALS AND METHODS: Between March 2005 and April 2007, 109 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and prostate size 60 cc or smaller were randomized to photoselective vaporization of the prostate (52) or holmium laser ablation of the prostate (57). All patients were evaluated by preoperative and postoperative International Prostate Symptom Score, peak flow rate and post-void residual urine volume, measurement of prostate specific antigen and transrectal ultrasound prostate volume. Followup evaluations were performed during visits at 1, 3, 6 and 12 months. RESULTS: Mean +/- SD preoperative prostate volume was 33.1 +/- 14.5 and 37.3 +/- 13.6 cc in the holmium laser ablation group and the photoselective vaporization group, respectively. Holmium laser ablation of the prostate required more operating time than photoselective vaporization (69.8 vs 55.5 minutes, p = 0.008). In the holmium laser ablation group the International Prostate Symptom Score improved from 20 +/- 6.8 to 6.2 +/- 3.9 and peak urinary flow rate increased from 6.7 +/- 3.9 to 17.2 +/- 8 ml per second. In the photoselective vaporization group the International Prostate Symptom Score improved from 18.4 +/- 6.6 to 8.2 +/- 6.2 and peak urinary flow rate increased from 6.4 +/- 3.9 to 18.4 +/- 8.4 ml per second. Urethral stricture rates were 1.7% vs 5.7%, bladder neck contractures were 3.5% vs 7.7% and revaporization rates were 3.5% vs 1.9% in the holmium laser ablation and photoselective vaporization groups, respectively. CONCLUSIONS: Holmium laser ablation and photoselective vaporization of the prostate are safe and effective in patients with benign prostatic hyperplasia with a small to moderate size prostate. Both procedures are easy to learn but holmium laser ablation of the prostate requires a longer operating time.

Holmium laser enucleation of prostate in patients with prostate size

OBJECTIVES: To evaluate the safety and efficacy of holmium laser enucleation of the prostate in patients with small to moderate size prostate. METHODS: We retrospectively reviewed the data of 224 patients with a preoperative prostate size

Recoverability of renal function after treatment of adult patients with unilateral obstructive uropathy and normal contralateral kidney: a prospective study.

OBJECTIVES: To study the methods of prediction of recoverability of renal function after the treatment of adult patients with unilateral obstructive uropathy and a normal contralateral kidney. METHODS: This prospective study included 91 consecutive adult patients with the diagnosis of unilateral obstructive uropathy and a normal contralateral kidney. All patients had a nonequivocal cause of obstruction that was successfully relieved after treatment. All patients underwent plain abdominal x-ray, gray-scale ultrasonography, Doppler ultrasonography, excretory urography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope renography before and after treatment. Patients were seen regularly at 3, 6, and 12 months for a mean duration of 13 +/- 6 months (range 6 to 36). At each visit, ultrasonography and renography were performed, and excretory urography was performed at least once during follow-up. Several renographic and ultrasound parameters were studied before and after treatment to evaluate their value in predicting the recoverability of renal function. The difference between the selective renographic glomerular filtration rate (GFR) of the ipsilateral kidney before treatment and its mean value after treatment was considered as the reference variable to which all other variables were compared. All prognostic parameters were evaluated by both univariate and multivariate analyses. RESULTS: On univariate analysis, the factors that significantly affected the recoverability of renal function after the relief of obstruction included preoperative renographic GFR, renal perfusion, parenchymal thickness, parenchymal echogenicity, corticomedullary differentiation, reduction of the renal resistive index of the corresponding kidney, and compensatory hypertrophy of the contralateral normal kidney. However, using multivariate analysis, only the preoperative selective renographic GFR and renal perfusion of the corresponding kidney sustained their statistical significance as independent factors affecting renal functional recovery. A preoperative GFR value of 10 mL/min/1.73 m2 was estimated as the cutoff point that can determine the best prediction of stabilization or improvement of renal function after the relief of obstruction. CONCLUSIONS: Preoperative renographic clearance and perfusion of the corresponding kidney were the only predictors of recoverability of unilateral renal obstruction. Kidneys with a renographic GFR of less than 10 mL/min/1.73 m2 were irreversibly damaged. Improvement or stabilization of function can be expected after relief of obstruction of kidneys with a renographic GFR of 10 mL/min/1.73 m2 or greater.