Introduction: Besides being a risk factor for urolithiasis, obesity is a challenge in the treatment of urolithiasis from the perspective of both the surgeon and the anesthetist. In this study, we ...tried to assess the feasibility and safety of supine percutaneous nephrolithotomy (PCNL) under regional anesthesia in obese patients with a body mass index (BMI) ≥30.
Methods: This was a prospective observational study and included 51 obese patients (BMI ≥30 kg/m2) with renal stones planned for PCNL. All patients underwent supine PCNL under regional anesthesia with the standard technique. A decision for totally tubeless or a tubeless PCNL was made at the end of the procedure and the intraoperative and postoperative data were recorded. All patients underwent computed tomography (CT) imaging at 1 month after surgery to assess the stone-free status and the need for additional treatment.
Results: The mean age of the patients was 53.2 ± 8.09 years, and the mean BMI was 34.4 ± 2.369 kg/m2. The mean operative time was 73.3 ± 26.2 min, the mean hospital stay was 58.3 ± 22.1 h, and the mean postoperative Visual Analog Score (VAS) for pain was 3.8 ± 1.4. The stone-free rate was 68.6% on the follow-up CT performed after 1 month, and 31.4% of the patients had significant residual fragments which required re-treatment either by retrograde intrarenal surgery (RIRS) in 19.6% (either as primary RIRS for the residual calculi in one patient 1.9% or as RIRS for post shock wave lithotripsy (SWL) or alkalinization failure in 9 patients), SWL in 21.6%, or urine alkalinization in 7.8%.
Conclusion: Supine PCNL under regional anesthesia, in this subgroup of obese patients, was found to be feasible and safe with satisfactory stone-free rates and minimal postoperative pain.
Background
Acute or chronic obstruction of the urinary tract can be due to a lot of different causes. Patients with pyonephrosis usually complain of a triad of fever, loin pain and elevated white ...blood cell count in cases of acute obstruction; and they may also have hypotension in severe cases of the disease. These patients have to be treated with appropriate decompression, or they may develop septic shock. The urgency of the need for treatment greatly depends on the differentiation between hydronephrosis and pyonephrosis.
There is a lack of reliable clinical prognosticators of pyonephrosis in patients with obstructive hydronephrosis. Hounsfield unit (HU) measurement is considered as an adequate predictor of pyonephrosis and may aid in the diagnosis and management of this disease that may be fatal.
The use of HU values in differentiation between pyonephrosis from hydronephrosis depends on the fact that the pyonephrotic fluid contains infected material, urine, cellular particles and microorganisms, which when combined can increase the HU values on a computed tomography (CT) study.
This study was done to assess the diagnostic value of the HU measured CT in differentiation between hydronephrosis and pyonephrosis.
Results
Thirty-nine patients were included in this study. All patients had loin pain and were diagnosed with pelvicalyceal dilatation by ultrasonographic examination. They then underwent non-contrast CT examination.
Using CT scan, the degree of PC dilatation was significantly higher among hydronephrosis group as hydronephrosis group had 63.1% severe dilatation of PCs versus 30.8% in pyonephrosis group with p value 0.0001.
Pelvic wall thickness > 2 mm was reported in 10 (76.9%) patients of pyonephrosis group versus in three (7.9%) patients among hydronephrosis group with p value 0.0001.
The mean Hounsfield units were significantly higher among pyonephrosis group compared to hydronephrosis group (16 ± 5.2 versus 1.7 ± 5.5) with p value 0.0001.
Sensitivity analysis showed that Hounsfield units can significantly diagnose pyonephrosis using the cutoff point 6.2 units, with sensitivity 92.3%, specificity 93.3%, area under the curve (AUC) 96.9% and p value 0.0001.
Conclusions
Measuring HU in a NCECT scan of the kidney might be helpful for differentiating between hydronephrosis and pyonephrosis especially upon considering 6.2 HU as a cutoff point.
Bladder and urodynamic changes in multiple sclerosis Torad, Hesham; Shalaby, Nevin; Hussein, Hussein Aly ...
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery,
05/2020, Volume:
56, Issue:
1
Journal Article
Peer reviewed
Open access
Background
Urinary dysfunction is a common symptom during the course of multiple sclerosis (MS). Long-term follow-up of the natural history of bladder dysfunction in MS has been seldom addressed.
...Objective
To identify the type and the course of voiding dysfunction in MS patients in relation to the urodynamic changes of the lower urinary tract (LUT)
Subjects and methods
An observational prospective study including 120 MS patients with urinary dysfunction rated by the American Urological Association (AUA) symptoms questionnaire and assessed by urodynamic studies and followed for 1 year.
Results
Irritative symptoms were the most frequently encountered symptoms (90%), whereas overactive bladder was recorded by urodynamic studies in 35% of subjects. Urinary symptoms severity score was higher in patients with initial urodynamic abnormalities by the end of the 1-year follow-up period (
P
< 0.001). A statistically significant relationship was found between urinary symptoms severity score and each of expanded disability status scale (EDSS) and urodynamic pattern of abnormalities (
P
< 0.01).
Conclusion
Irritative symptoms and overactive bladder seem to be the most frequent urinary dysfunction in MS patients. Urinary symptoms are related to the degree of disability. The initial urodynamic abnormalities are associated with worse urinary dysfunction outcome after 1 year.
Background
Comparison between the clinical outcomes of mid-urethral sling procedure for stress incontinence with and without repair of asymptomatic stage II cystocele is made.
Methods
This is a ...prospective randomized study of 72 female patients with stress urinary incontinence and asymptomatic stage II cystocele. The patients were divided into two groups: group 1 treated with trans-obturator tape only and group 2 with repair of cystocele by anterior colporrhaphy in the same session. We compared between both groups in cure rate and voiding function after 1 year.
Results
The cure rate of group 1 was 66.7%, while for group 2 it was 90% after 12 months (
p
< 0.05). Six patients (17%) with asymptomatic stage II cystocele in group 1 became symptomatic or developed higher stage after 12 months that required surgical repair. The incidence of postoperative irritative urinary symptoms was also significantly higher in group 1. There were no significant differences in the change in maximum flow rate or postvoiding residual urine between the two groups postoperatively.
Conclusion
Concomitant repair of stage II asymptomatic cystocele with mid-urethral sling improves the cure rate of stress urinary insentience and reduces the incidence of irritative urinary symptoms.
Introduction and objectives
To compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume ...benign prostatic hyperplasia (BPH) (> 80 ml).
Patients and methods
A prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP.
All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system.
Results
The mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups (
p
= 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups.
Conclusion
Low-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.
Introduction The aim of this study was to assess the effectiveness of low-power thulium (30 W) and the duration necessary to eliminate adenomas at the level of the surgical capsule, as well as its ...impact on postoperative urinary and sexual function. Laser prostate enucleation (HoLEP) has been shown to be a safe procedure with a reduced risk of bleeding 3, shorter hospital stays 4, and a quicker features time 5 when compared to other BPH treatment options, i.e. open prostatectomy and transurethral resection of the prostate (TURP), which have some minimal and key adverse impacts such as dysuria, urinary frequency, sexual dysfunction, and sepsis 6. The premise behind adopting low-power laser enucleation is to give less energy to the surrounding structures but with similar outcomes to high-power ThuLEP and a lower incidence of postoperative dysuria, decreased storage LUTs, and improved erectile function. The history, digital rectal exam, international prostate symptom score (IPSS), urine analysis and culture, haemoglobin concentration (Hb), serum prostate-specific antigen (PSA) (preoperative and at 6 months), transrectal ultrasonography (TRUS), Urofiow, and post-void residual urine PVR were all performed on eligible individuals (after voiding residual urine).
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