EFFECTIVENESS OF ANTIMICROBIAL PROPHYLAXIS IN RECURRENT URINARY TRACT INFECTION (UTI) IN CHILDREN

ALSAYED S. ABDELAZEZ*, MAHMOUD M. ALI**, ABDELAZEZ A EMAI**  AND ABDELRAZAK MANSOUR M ALI***
* Department of urology, Al-Azhar University, Damietta, Egypt.
**Department of urology, Al-Azhar University, Cairo, Egypt.
***Department of Pediatrics, Al-Azhar University, Cairo, Egypt.

 

Objective: To evaluate the effectiveness of trimethoprim–sulfamethoxazole (TMP-SMX) as antimicrobial prophylaxis for recurrent UTI in children.

Materials and Methods: From June 1st 2010 to June 1st 2011, 360 children <12 years with proven UTI were treated and divided into two groups: Study group (n=180) who received daily low doses of TMP-SMX suspension (2 mg of trimethoprim + 10 mg of sulfamethoxazole /kg) as a prophylaxis and Control group (n=180) who received placebo and followed-up for 12 months.

Results: The median age at entry was 44± 7.23 months. UTI developed in 8.1% in study group (n=14/172) and 9.8% in placebo group (n=14/172) and the difference was statistically insignificant (P >0.05). The most serious adverse effect was the development of antibiotic resistance organism to TMP-SMX in antibiotic group in comparison to placebo group [71.4% (n=10/14) Vs 17.7% (n=3/17) respectively] (P <0.05).

Conclusion: Low-dose TMP-SMX was not associated with decreased recurrent UTI in predisposed risk children, whereas the risk for antimicrobial resistance was significantly increased.

Keywords: Children, recurrent UTI, antibiotic prophylaxis.

 

BIPEDICLED SCROTAL MYOCUTANEOUS FLAP: A NEW TECHNIQUE FOR AUGMENTATION PHALLOPLASTY

A. YOUSSEF, M. ESMAT AND M. WAEL
Department of Urology, Ain Shams University, Cairo, Egypt

Purpose: To assess efficiency and safety of our new technique of "bipedicled scrotal myocutaneous flap" in penile girth enhancement in cases of small penis syndrome.

Patients and methods: This study was conducted on 23 patients complaining of small penile size who did not respond to psychiatric treatment. Patients with ambiguous genitalia, hypospadias and epispadias were excluded from this study. All patients were subjected to penile augmentation using the new technique of bipedicled scrotal myocuanenous flap to increase penile circumference and division of suspensory ligament for penile lengthening. The change in penile dimensions was assessed by preoperative and postoperative measurement of stretched penile length (SPL) and mid penile girth. Follow up of the patients was done at 3 months and 9 months postoperatively.

Results: No intra-operative complications occurred. At 3 months postoperatively, the mean increase in penile dimensions was 2.3±0.2 (1.9-2.7) cm and 2.0±0.3 (1.6-3.1) cm in penile girth and penile length respectively. The patients' satisfaction rate was 65.2%. Only 3 cases experienced delayed scrotal wound healing that was managed conservatively without late sequelea. On follow up the penile girth enhancement was symmetrical and durable. No other postoperative complications reported. No affection of penile erection, significant scarring nor long term affection of penile sensation occurred.

Conclusion: The technique of bipedicled scrotal myocutanous flap is an easy and effective technique that provides a reasonable long term symmetrical increase in penile girth by using a well vascularised nearby flap. Moreover, it is a safe technique with no associated postoperative harmful sequelea.

 

DIAGNOSTIC AND THERAPEUTIC EFFICACY OF LAPAROSCOPY IN THE MANAGEMENT OF THE UNDESCENDED TESTIS

K. MURSI, I. SAAD, A. SALEM, M. EL-GHONIEMY AND A. ABDEL-HAKIM
Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Purpose: Twenty percent of undescended testes (UDT) are non-palpable. Imaging has shown suboptimal accuracy in locating non-palpable testis (NPT) with laparoscopy proving to be superior. We aim to evaluate the safety and efficacy of laparoscopy in diagnosis and management of NPT.

Materials and Methods: Included patients were >1-year old with NPT. No imaging was done, and laparoscopy was performed all patients. Patients were classified according to diagnostic laparoscopy into 6 types, Type-I: no testes, vas or spermatic vessels, Type-II: a blind- ended vas, Type-III: vas and vessels entering the inguinal canal, Type-IV: testis at internal inguinal ring (IIR), Type-V: testis <1 one inch from IIR, and Type-VI: testis >1 inch from IIR. Stretching maneuver (SM) was added for Type-V. Follow-up included examination and Doppler US 2-months from surgery.

Results: Twenty-five NPT (15 unilateral and 5 bilateral patients) were included. Mean age 1.8 years. Four testes were Type-IV, 14 Type-V, and 7 Type-VI. Three testes were removed due to atrophy. In 8 (32%) testes, Laparoscopic Orchiopexy (LO) was performed (3 Type-IV and 5 Type-V with positive SM). In 14 (56%) testes, Fowler Stephens laparoscopic orchiopexy (FSLO) was done (6 testes Type-V with negative SM and 8 Type-VI). On follow-up, no significant difference in size, site and vascularity was found between FSLO and LO.

Conclusion: Laparoscopy has 100% accuracy in locating NPT. LO and FSLO can be considered treatments of choice for Type-IV and Type-VI NPT, respectively. SM evaluates mobility to contralateral IIR and detects appropriate surgery for Type-V NPT.

Keywords: Laparoscopy; management; undescended; testis.

IMPACT OF TAMSULOSIN ON CLEARANCE OF RENAL CALCULI AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

MOHAMED ABO EL-ENEN, MOHAMED GABER, * MOHAMED SAMY
 Urology and *Radiology Departments, Tanta University, Tanta, Egypt.

CONVENTIONAL AND VIRTUAL CYSTOSCOPIES FOR DIAGNOSIS OF URINARY BLADDER GROWTH LESIONS: A SUPPLEMENTARY RATHER THAN COMPETITIVE RULES

HOSSAM IBRAHIM, ABDUL NASER GHAREEB, MOKHTAR RAGAB  AND EMADELDEEN ALI SALAH*
Radiology and urology* Departments, Al-Azhar University Hospitals, Cairo and Assiut*.

Introduction and aim of the work: Recent CT scan technology allowed three dimensional image reconstructions to precisely and accurately show fine anatomical details. The goal of this study was to evaluate the usefulness of virtual cystoscopy (VC) in diagnosis of urinary bladder neoplasm in comparison with the gold standard conventional cystoscopy (CC).

Patients and Methods: Eighty three consecutive patients (mean age 54 years) clinically presenting for gross haematuria and positive urine cytology for malignancy, were prospectively evaluated with VC after bladder air insufflation or intravenous injection of contrast medium using multi-detector helical CT (1-mm section thickness). Afterwards, all patients had been subjected to CC and examination under anaesthesia.

Results: The findings of VCs were quite comparable with the findings from the CCs except in three patients were not detected by VC (two patients with tumor sizes < 3 mm and one with carcinoma in situ). The bladders of seven patients appeared normal on both CC and VC. The sensitivity and specificity of identification of bladder mass lesions using VC were 96% and 100% respectively, while, it’s positive and negative predictive values were 100%, and 70% respectively.

Conclusion: CT virtual cystoscopy is a minimally invasive technique that could be successfully used for detection of bladder tumors ≥3 mm especially for follow up after transurethral resection of bladder tumors (TURT) cases during daily routine abdominopelvic CT work. It is not a substitute but rather supplementary to CC.

DIFFERENTIAL TESTOSTERONE DEFICIENCY IN HYPOGONADAL MEN WITH ED

MAMDOUH MOHAMED * AND ALLEN D. SEFTEL.**

*Minia University Hospital, Minia Egypt.and **Dept of Urology Case western Reserve University, University hospiital Of Cleveland, Cleveland OH.
 

Aim of the study: The primary study end-point of this study was the determination of the prevalence of different types of serum testosterone deficiency in men presented for office evaluation of ED and low libido.

Patients and Methods: To determine the prevalence of differrent testosterone deficiency in men presented for office evaluation of their erectile dysfunction[ ED] ,total,free and % free serum testosterone levels were obtained from 69 patients presenting to out patients urology clinics at Urology Dept. Minia Uinversity Hospital Mini Egypt with a chief complaint of ED in the period between June 2008 and May 2010. Samples were drawn between 8-11 Hs in all patients. All men in this study had ED and low sex drive (libido), several validated questionnaires (SHIM and ADAM) were I filled in the office prior to the examination. Sixty nine men were included in this study with average age 63 (mean 56 ± 12) were evaluated over a 12 month period met criteria for inclusion. The patients completed these questionnaires in the office, prior to physician interview. All men had serum testosterone levels drawn. [total, free and % free testosterone]. Hypogonadism, defined as total serum T<300 mg/dl, free T<2.5 ng/dl or r < 4.50 ng /dl depending on the laboratory kits), and %free T <0.62ng/dl or < 4ng/dl).

Results: All 69 men had ED, with an average SHIM score of 11+, Low serum testosterone level (Hypogonadism) was seen in 28 patients out of 69 patients (40.57%); of those 28 men ,13 patients had low total testosterone (18.45%), 17 patients had low free testosterone (24.63%), and 11 patients had low % free testosterone level (15.94%). 6. While low libido was noted in 97% of men using ADAM questionnaire for the detection of men with low sex drive.

Conclusion: These data support the concept that male erectile dysfunction now must be considered in the office evaluation of male erectile dysfunction, all types of serum testosterone either total, free and % free shoud be put in mind for diagnosis of men with ED and low libido.

 

RENAL STONES “BIOEFFECTS AND FREQUENCIES OF SHOCK WAVE LITHOTRIPSY (SWL)”

MAMDOUH AB. AB.MOHAMID AND ALAYMAN F. HASSEIN
 Urology Department, Minia University Hospital, Minia Egypt

Aim Of The Work: Our primary end point of this prospective study was to evaluate the bioeffects of SWL for treatment of renal stones using different frequencies of shock wave lithotripsy to determine the optimal frequency required, not only for stone fragmentation, but also for safety concerning its bioeffects.

 

Patients And Methods: This prospective study was conducted upon 100 patients (64 male and 36 female) aged 17- 60 years with mean age 35.92 years. All patients had symptomatic renal calculi at the SWL unit, Urology Depart, Minia University Hospital, in the period between July 2008 and Aug. 2009. Extracorporeal shock wave lithotripsy (SWL) was used as primary treatment option for all patients. All patients subjected to complete history taking, clinical examination, laboratory and imaging studies. Patients were randomly classified into 3 groups according to the frequency of shock waves used: Group 1 included 30 patients in whom we used 60 shock waves per minute. Group 2: included forty patients in whom we used 90 shock waves per minute. Group 3: included thirty patients using shock waves 120 shock per minute. All patients were followed up within the first week, 3 months after SWL for the above mentioned laboratory and imaging study to assess the bioeffects of SWL in this group of patients.

 

Results: This study included 100 patients presented with symptomatic renal stones, in those group of patients in this work we noticed some degree of transient renal damage had occurred as a result of stone disintegration by SWL in the first week in the form of a varying degree of intra and peri-renal edema and hemorrhage as well as some degree of impaired renal function,also,there is a decreased in the intra renal blood flow within the first 24 hours after SWL which evidenced by increased renal vascular resistive index. Shock wave lithotripsy (SWL), not only produce renal damage but also has extra renal damaging effects to other organs such as liver (transient rise in the liver enzymes as well as bilirubin), pancreas (rise in the blood glucose level in the first 24 hours following SWL) and cardiovascular system (decrease pulse rate in the first 24 hours after SWL).These bioeffects of ESL not affected by the change in the frequency of shock waves between 60, 90, 120 shock/min except for hematuria which is markedly significant using high frequency shock waves? All of these bio effects produced by SWL disappeared three month after SWL.

 

Conclusion: All the bioeffects produced by SWL either physical and/or chemical are not influenced by changing the frequency of shock waves used for disintegration of renal calculi between 60, 90, 120 shock/min except for heamaturia which was markedly significant with the use of higher frequency shock waves. All the bioeffects produced by SWL disappeared three months after SWL.

 

Key Words: Extracorporeal, Shock waves lithotripsy, bioeffects, frequency, renal calculi, resistive index.


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