ABSTRACT

Introduction: Complete duplication of the collecting system is one of the most common congenital urologic anomalies that should be oriented with nephroureterectomy when symptomatic with urinary tract infection or flank pain. Until recently, nephroureterectomy involved a flank incision with significant morbidity and prolonged recovery time. In the last few years, there have been a few reports of partial nephroureterectomy, particularly in the pediatric population.

Case Presentation: A 25-year-old woman presented to our consult with a history of recurrent right pyelonephritis and a right duplicated kidney and ureter associated with atrophy of the hydronephrotic upper-pole and dilation of the entire respective ureter. Voiding Cystourethrography showed no vesicoureteral reflux. She elected to undergo laparoscopic transperitoneal upper-pole nephroureterectomy. There were no postoperative complications, and the cosmetic result was excellent.

Conclusion: To our knowledge this is one of the few reports of laparoscopic partial nephroureterectomy done in adults. This seems to be a safe and effective technique to be performed in adults, with admirable cosmetic and functional results.

Keywords: Laparoscopic, Partial nephroureterectomy, Duplex kidney, Megaureter

Correspondence: Francisco Botelho, Department of Urology, Hospital S. João, R. Igreja da Areosa nº34 4ºDto, 4200-323, Porto, Portugal, francisco.botelho@sapo.pt

ABSTRACT

Introduction: Diabetes mellitus is a common public health problem due to the seriousness of its complications. Because of the potential harm to the kidneys of diabetic patients, preventive and therapeutic measures should be taken against the various types of lithiasis.

Materials and Methods: This survey included 116 type 1 diabetics. First morning urine samples were examined with a polarized light microscope for qualitative and quantitative analysis of crystalluria.

Results: The calcium oxalates were more abundant in both genders compared to the other crystalline species, with a frequency of 76.7% at direct examination and 82.4% at +4°C. The total frequency of purine crystalluria was 22.0% at direct examination.

Conclusion:The crystalluria observed in type 1 diabetics showed the predominate prevalence of the oxalocalcic type (Weddellite) crystals with a frequency of 64.5%, followed by Whewellite with a frequency of 15.0%. The high percentage of the purine crystalluria in diabetics gives information about dangers to clinicians and experts.

Keywords: Diabetics, Lithiasics, Crystalluria, Uric acid, Purine, Calcium oxalate

Correspondence: Brahim Kacem, Department of Biology, Faculty of Sciences, University of Mostaganem, City 152 logts Bloc B 16, Mostaganem 27000, Algeria, kacem1b@voila.fr

ABSTRACT

Background: The use of minimally invasive techniques in the treatment of staghorn and multiple renal stones has overshadowed the open techniques in the past two to three decades. In this study, we reevaluate the role of open techniques in the management of these conditions.

Objective: To compare the role of open techniques versus combined percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in the management of staghorn and multiple renal stones.

Methods: Between 1999 and early 2005, a total of 208 patients were operated upon: 111 patients with 118 renal units underwent open-technique surgery, and 97 patients with 106 renal units underwent combined PCNL and ESWL. Operative time, operative cost, blood loss, stone-free rate, use of single or multiple sessions, hospital stay, complications, total cost, and time to return to ordinary activities were calculated and plotted in a database, analyzed, and compared for the two groups of patients.

Results: Operative time for the open group was significantly less than the PCNL group, as most of the latter needed multiple sessions of PCNL and ESWL, raising the hospital stay, the operative cost, and the total hospital cost. In the open group, 106 (89.8%) patients were stone free in a single session, and only 12 (10.2%) needed ESWL sessions. In the PCNL group, 88 (83%) patients were stone free after the first session, a statistically significant difference. However, the time needed for convalescence was significantly less for the PCNL group.

Comparing the complication rate for both groups, we found that the open group had less incidence of colonic injury, AV fistula, and urinary leakage, which reflected on the length of hospital stay and cost. However, the open group had more incidence of blood loss and pneumothorax, comparable incidence of sepsis, and needed more time to return to ordinary activity compared to the PCNL group.

Conclusion: Open techniques are still a viable option that should be considered when treating patients with complex multiple and staghorn renal stones, especially regarding their cost-effectiveness in the face of limited resources in developing countries.

Keywords: Stone, Renal, Staghorn, PCNL, Open

Correspondence: Mohamed Ali A Ismail, Urology Department, Theodore Bilharz Research Institute, Giza, Egypt, mohadali@hotmail.com

ABSTRACT

Objective: A randomized prospective comparison of two synthetic mid-urethral tension-free slings was undertaken at a university hospital to evaluate clinical efficacy, complication rates, and ease of procedure and training residents.

Methods: Between January 2004 and September 2005, 96 women with stress urinary incontinence were consecutively assigned to Gynecare TVT^® or Boston Scientific Lynx^® mid-urethral slings (n=48 in each group) at the University of Nebraska Medical Center. Both groups were similar in mean age, parity, weight, preoperative post-void residual, cystometric capacity, flow rate, and urethral closure pressures. Postmenopausal status and previous incontinence surgery rates were also comparable. Intraoperative complications, ease of trocar placement, postoperative voiding difficulties, subjective and objective cure rates, and postoperative interventions were assessed. During statistical analysis, p<0.05 was used as cut-off for significance.

Results: Half of the patients in both groups underwent multiple procedures. There were two (4%) trocar injuries with the TVT and three (6%) with the Lynx (p=.21). Early postoperative voiding dysfunction was 21% (10 patients) for the TVT group versus 15% (7 patients) for the Lynx (p<0.001), whereas prolonged catheterization for two weeks was similar at 4% (2 patients) for both. UTI rate for the TVT was 10% (5 patients) and 13% (6 patients) for Lynx (p=0.02). Subjective cure rates were 94% (45 patients) and 92% (44 patients), respectively (p=.08). Urethral closure pressure <14 cm H₂O was the identifiable risk for objective failure. Objective cure rates were 96% (46 patients) for the TVT and 94% (45 patients) for the Lynx (p=.12), suggesting that some subjective failure was likely due to de novo bladder overactivity. One sling in the Lynx group was removed for skin cellulites, and one sling slit in TVT group was removed for voiding dysfunction due to duplicated ureter on the left side.

Conclusion: Despite similar efficacy, complication rates, and failure rates, the incidence of postoperative voiding difficulties was better with Lynx, due likely to the mid-urethral seal. However, it was difficult to place the Lynx trocar in patients with prior surgeries, probably due to the blunt needle and notch. An increased rate of vaginal graft exposure was seen with the Lynx. Residents favored the Lynx trocar because of its light weight and greater stability.

Keywords: TVT, Lynx, Synthetic mid-urethral tension-free slings

Correspondence: Neena Agarwala, University of Nebraska Medical Center, Omaha, NE 68198, nagarwala@unmc.edu

No abstract available.

Correspondence: amelman@montefiore.org