Urological complications of live related donor renal transplantation: 13 years' experience at a single center.

BACKGROUND: This study is a retrospective analysis of urological complications and their treatment in our series of live-donor renal transplantation. MATERIAL AND METHODS: The series comprised of 500 patients. All underwent extravesical ureteroneocystostomy and all except a few initial patients were stented. RESULTS: There were 92 complications in 82 patients (18.4%). Urinary leakage occurred in 1.2%. There were no intrinsic ureteric obstructions. Extrinsic ureteric obstruction occurred in 0.8% of cases. The incidence of UTI was 15.4% and of urethral strictures 1%. CONCLUSION: The technique of stented extravesical ureteroneocystomy has led to an extremely low rate of urological complications in our series, over a long time and in a substantial number of patients.

Placenta percreta invading the bladder causing exsanguinating hemorrhage.

We report a case of placenta percreta invading the urinary bladder that presented as gross hematuria. The patient had normal cystoscopic findings initially and other radiological investigations were reported as normal. However, she had catastrophic second hemorrhage and in spite of bilateral internal iliac artery ligation, hysterectomy and bladder closure with resuscitative measures, she could not be saved.

INITIAL EXPERIENCE WITH SHOCK WAVE LITHOTRIPSY AT ARMY HOSPITAL (R & R) DELHI CANTT.

Army Hospital (R & R) has acquired an Electrohydraulic Lithotripter (DIREX NOVA), the first of its kind in the Armed Forces for the treatment of stone diseases. The first 200 patients who underwent Extracorporeal Shock Wave Lithotripsy (ESWL) have been analysed in this study. This being a pilot study would serve as a beginning of an ongoing experience with this non-invasive procedure and its benefits for the stone population in the Armed Forces.

SILDENAFIL-ORAL MEDICATION FOR ERECTILE DYSFUNCTION-A REVIEW.

Problem of male erectile dysfunction has been better defined, recognised and being treated in the recent times. However, the intracavernosal injection of vaso-active materials and penile prosthesis implantation were only the viable options available. Sildenafil, which is a specific phosphodiesterase type V inhibitor, enhances erection on sexual arousal by increasing the quantity of cyclic guanosine monophosphate in the corpora cavernosa. This has revolutionized the treatment of erectile dysfunction. Though the drug appears very promising with little side effects, many questions regarding efficacy, safety, misuse and overuse need to be addressed.

IMPORTANCE OF PROSTATIC SPECIFIC ANTIGEN (PSA) IN CLINICAL PRACTICE : OUR EXPERIENCE.

A total of 89 patients in the age group of 50-92 years having different histopathologically proven prostatic conditions were analysed with prostate specific antigen (PSA) and clinical co-relation undertaken. PSA levels were found to be significantly higher (p < 0.05) in 48 carcinoma prostate cases (mean 93.16 ± 50.75 ng/ml) as compared to 32 benign prostatic hyperplasia (mean 4.66 ± 3.85 ng/ml). Similarly, levels were considerably reduced in 15 post-operative adenocarcinoma cases (mean 10.77 ± 9.65 ng/ml) as compared to their pre-operative samples (mean 93.16 ± 60.75 ng/ml). PSA levels were moderately higher in 9 cases of prostatitis (mean 13.28 ± 4.53 ng/ml). A very high degree of sensitivity, specificity and positive predictive value of PSA e.g. 95.8%, 75.6% and 82.2% respectively was found in adenocarcinoma cases, when levels of PSA were > 10 ng/ml. Thus it necessitates a detailed and thorough examination in such cases to come to final conclusion and early management of the cases.

Intracavernous papaverine for impotence in spinal cord injured patients.

The majority of the spinal cord injury patients in our centre are young healthy males aged between 20 and 40 years. Loss of erection and inability to have coitus and father children have been responsible for inadequate sociosexual rehabilitation. In 1985, under urologist supervision, intracavernosal papaverine injection treatment was started in 101 volunteers, 65 paraplegics and 36 tetraplegics. Satisfactory erection sufficient for coital penetration was possible in 98 patients. Three had prolonged erection lasting beyond 4 hours. Only one required irrigation of the corpus with saline to achieve detumscence. One patient developed cavernosal fibrosis necessitating discontinuing the injection. Administration was under medical supervision so that possible complications of priapism/systemic effects could be promptly managed.

A simple loop catheter for ureteric calculus retrieval.

The fabrication and use of a simple looped catheter for ureteric stone retrieval are reported. In a series of 46 patients the loop was passed successfully in 28 and the stone dislodged in 20 (71.4%). This device can be made by any urologist, using cheap, readily available materials. Complications are few and the success rate is high.