Author Archive

IS STONE RADIODENSITY A USEFUL PARAMETER FOR PREDICTING OUTCOME OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR LOWER CALYCEAL STONES < 15 MM?

ETAFY, M.1, ABDALMALEK, G.2, SALEH, F.1, GAWISH, M.1
1UCI, Dept. of Urology, Orange, United States of America,
2Alazhar University, Dept. of Urology, Assiut, Egypt.


Introduction & Objectives:
We examined the outcome of SWL for solitary stones less than or equal 15mm located within the Lower calyx, based on their radiographic criteria in KUB.

Material & Methods:
216 patients with solitary lower calyx stones measuring less than or equal 15mm were treated on a Simens lithotriptor. Patients were stratified into 3 groups based on radiographic appearance of the calculus in pre-operative KUB according to homogeneity, smoothness and density. The stone radiodensity was determined relative to the ipsilateral 12th rib. (SFR) were determined at 3 months by (KUB). Patients requiring re-treatment or auxiliary procedures were considered failures in SWL.

Results:
Follow-up information was available in all 216 patients, there was a correlation between stone radiographic criteria and stone composition. The calculi in the SF series were predominantly rough (75%) and had a density less than or equal bone (74%), whereas calculi in the NSF series were most often smooth (56%) and denser than bone (50%).

Conclusions:
Our study suggests that for stones less than or equal 15mm within lower calyx there is tendency for a worse SWL outcome for stones that have a smooth shape or radio-density greater than the 12th rib in KUB than those with rough shape and radio-density less than or equal to the 12th rib in KUB.

BALOON DILATOR FOR NEPHROSTOMY TRACT DILATATION: EXPERIENCE with 28 cases & comparison with alkan dilator system

Tarek M.A El-Gammal, M.D.
National Institute of Urology and Nephrology, Cairo, Egypt

Objective:
We present our initial experience with the high-pressure balloon dilator in nephrostomy tract dilation for percutaneous renal access & Compare our results retrospectively with a group of patients in whom metal Alkan dilators were used.

Patient and Methods:
Our study population consists of twenty eight patients, who had undergone percutaneous nephrolithotomy (PCNL)   between Jan. 2007 & Jan. 2008 using high-pressure dilating balloon catheter.  Insertion time, total operative time, blood loss, tract dilatation failure, pelvi-calyceal system perforation and the balloon cost were recorded &compared retrospectively with the results of the same procedure using metal alkan dilators.

Results:
Among the study patients who underwent balloon dilatation, the average insertion time was shorter (5min.), compared with the Alkan dilatation group (20-25min.), while the average total operative time was 90min.for balloon dilation &120-140min.
For alkan dilation a difference that is statistically significant. There was no renal hypermobility or collecting system injury or significant blood loss as we have clearly shown during the sequential alkan dilatation. The disadvantages reported were the high balloon cost & some difficulties in performing access in patients with prior renal surgery.

Conclusion:
Our study have shown that in spite of some downsides of balloon dilation system like high cost & some insertion difficulties among patients with prior renal surgery, it can be regarded as the most safest (atraumatic), Efficacious (high performance single-step technique) & Faster (short total operative & Fluoroscopic time) dilation system for renal access with improved haemostasis, compared to other kinds of mechanical dilators such as metal alkan dilators.  Although metal alkan dilators are cost-effective; there was a significant problems during the dilation procedure including kidney hypermobility, pelvi-calyceal system perforation, blood loss,
& time consumption.

Key Words:
Balloon dilation, metal alkan dilation, percutaneous nephro-lithotomy, renal calculi.

Evaluation of the results of Dornier Lithotripter S II system in the treatment of renal calculi

Mohamed Ramadan, Mohamed Mabrouk, Ismail El-Helaly, Ali Gomaa.
Department of Urology, Al-Azhar university hospital, Cairo, Egypt


Objective:
The aim of work is to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of renal calculi.

Patients and methods:
One hundred patients having renal stones who are candidates for  SWL treatment at Bab El-shaa’rya university Hospital, from Apr. 2010 to Mar. 2011, including 54 males and 46 females, ranging in age from 2.5 years to 67 years old (mean age: 40.2 years).

Results:
The initial fragmentation rate was 96%. The stone-free rate for stones of < 10 mm was 100%, for 11–20 mm was 87.6% and for > 20 mm was 75%. The overall stone-free rate 3 months after lithotripsy was 87%. After single session of lithotripsy, 48 patients (48%) became stone-free. Additional procedures to render patients stone-free after lithotripsy were needed in only 6 cases (6%). The stone-free rates for lower, upper, middle calyceal and renal pelvic calculi were 84%, 83.3%, 85.7% and 88.7%, respectively. Post SWL Complications, renal colic in (42%), Transient gross haematuria lasting 24 hours or less occurred in (33%) steinstrasse in (4%) of cases.

Conclusions:
The size, position, and number of calculi had a significant impact on the outcome after SWL, Significant stone clearance was achieved in patients with single, pelvic stone (10-20 mm), Dornier lithotripter S II system is one of the  effective and safe means of stone disintegration.

Evaluation of the Results of Laparoscopic pyeloplasty in The Treatment of Ureteropelvic Junction Obstruction

Etafy, M.1 ,   and  Abdalmalek, G.2
1UCI, Dept. of Urology, Orange, United States of America, 2Alazhar University, Dept. of Urology, Assiut, Egypt


OBJECTIVE:
In the treatment of ureteropelvic junction obstruction (UPJO), laparoscopic dismembered pyeloplasty and open pyeloplasty have been shown to have similar outcomes. We present our experience with laparoscopic dismembered pyeloplasty (LDP).

METHODS:
A retrospective review of all adult LDP procedures was performed at our institution between November 2002 and July 2005. Preoperative evaluation included an abdominal CT angiogram to assess for crossing vessels and a diuretic renal scan to quantify the degree of obstruction. Follow-up with diuretic renal scan and patient pain analogue scale was performed at 3, 6, and 12 months after surgery. If the study is normal at 12 months then the patient is followed with ultrasonography of the kidneys and bladder looking for ureteral jets. The absence of ureteral jets, worsening of the hydronephrosis or patient complaint of pain then necessitates repeat diuretic renography.

RESULTS:
Eighteen LDP were performed on 7 men and 11 women .(Follow up was available for all patients) with an average age of 35  + 16 and average follow up of 11months. Mean operative time was 230 + 124 minutes and estimated blood loss was 61 + 40 ml. Average length of hospitalization and post­operative analgesia required was 2+1 days and 19+12 mg morphine sulfate equivalents. The overall success rate was 89% based on a normal diuretic renogram and lack of pain using a validated pain scale. There were no major complications.

CONCLUSION:
In this study, LP resulted in a durable success rate of 89% in patients with PUJO over a mean follow up of 11months. These results were comparable to those from open pyeloplasty, but with less morbidity. Based on our experience and that of others, LP is gaining acceptance as the new standard for patients with PUJO, especially if there are crossing vessels.

Key Words:
laparoscopy,  ureteral obstruction, ureteropelvic junction obstruction

LESS radical nephrectomy, a new born experience

Mahmoud M. Shalaby, Mohamad A. Zarzour, Amr H. Abofaddan and Fathy G. Elanany
Department of Urology, Assiut University Hospital


This video reports our initial experience with single incision laparoscopic radical nephrectomy.

A 56 y female presented by Rt loin pain and hematuria. CT revealed a multicentric renal tumor (T1 N0 M0).

Laparoscopic radical nephrectomy was done through single site, multiport approach
Operative time was 4 h 30 min. There was no intraoperative complications.
Tube drain was removed on post operative day 3 and patient was discharged 24 h later.
The specimen harbored a grade II clear cell RCC.

Conclusion:
LESS Radical nephrectomy is feasible. The operative time is longer compared to conventional laparoscopy but this is a very early point on the learning curve.

Laparoscopic radical cystectomy, the first report from Upper Egypt

Mahmoud M. Shalaby, Mohamad A. Zarzour, Amr H. Abofaddan and Fathy G. Elanany
Department of Urology, Assiut University Hospital


Radical cystectomy represents a considerable portion of the work load in every center in Egypt, it’s also a surgery with major toll on the patient.

This video describes the technique oflaparoscopic radical cystectomy. At the end of the procedure, the specimen is extracted through a 7cm Pfannenstiel incision, which is also used for creation of urinary diversion.

Operative time ranged from 3h 15min to 4h 30min. there were no intraoperative or postoperative complication.

Two patients completed 6months follow up, both had orthotopicilealneobladders. Both patients are disease free and continent.

Conclusion:
Laparoscopic Radical cystectomy should be considered as a standard procedure in our centers, it should have the same status as laparoscopic radical prostatectomy.

LESS URETEROLITHOTOMY

Ahmed Abdalla , Mahmoud Abdel Hakim, Amr Abdel Hakim.
Urology Department, Cairo University, Cairo, Egypt


INTRODUCTION
AS the laparoendoscopic single site surgery(LESS) using a transumbilical access represents the closest surgical technique to scarless surgery we assess the feasibility of LESS in management of ureteral stones .

PATIENTS AND METHODS
Four cases of LESS ureterolithotomy were performed by a single laparoscopic surgeon. The indications for LESS ureterolithotomy were a stone size of ≥20 mm, an impacted stone or failure of endourological management. All procedures were done using SILS port that was inserted through a 20-30-mm umbilical incision. Patients age range was 36 to 44, BMI was less than 25 kg/m2.Articulating instruments were used.

RESULTS
Mean operative time was 87 minutes. Blood loss was less than 50 cc. The mean stone size was 22.4 mm. The stones were located in the upper ureter in two patients and in the middle ureter in the other 2 patients.Ureteral stent were fixed in all patients after stone remval.Pain score was between 1 to 2 in all patients. Mean hospital stay was 2 days. Uretheral catheter were removed after 5 days. No intra or post operative complications were encountered. No analgesics were required. Ureteral stent were removed after 4 weeks.

CONCLUSION
LESS ureterolithotomy is technically feasible procedure however a large number of cases is needed to establish its efficiency as a line of management.

LESS RADICAL PROSTATECTOMY

Mahmoud Abdel Hakim, Ahmed Abdalla, Amr Abdel Hakim.
Urology Department, Cairo University, Cairo, Egypt.


INTRODUCTION
Our aim is to present our first case of pure laparoendoscopic single site radical prostatectomy

PATIENTS AND METHODS
One patient underwent LESS radical prostatectomy using SILS port that was inserted through a 20-30-mm umbilical incision. PSA was 8.7gm/dl.Gleason score was 3+3. The whole gland size was 57 gm.

RESULTS
Patients age was 63 years old. Operative time was 287 min. Blood loss was 350.Hospital stay was 2 days. Visual analogue pain score was 2/10. No need for analgesic use in the early post operative period. The procedure  was completed successfully without need for additional ports .Articulating instruments were used. Uretheral catheter was removed on tenth day. P.O pathology reveal prostate adenocarcinoma gleason 3+3 with negative surgical margin.P.S.A was 0.04 six weeks after the procedure.

CONCLUSION
LESS radical prostatectomy is a technically challenging procedure whoever a large number of cases is needed to point out its role in management of prostate cancer cases.


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