Which is better, fluoroscopic-guided or ultrasonic-guided shock wave lithotripsy for pediatric renal stones? Prospective randomized comparative study.

OBJECTIVES: To compare the efficacy and clinical outcomes of two different stone localization modalities (fluoroscopic or ultrasonic) in SWL treatment of pediatric renal stones. PATIENTS AND METHODS: This study was conducted in the period between January 2021 and June 2022 and included 100 children aged 2-16 years who presented with radio-opaque renal pelvic stones < 20 mm. The children were divided in two groups: group I, US-guided (50 patients), and group II, FS-guided SWL (50 patients). SWL was applied under general anesthesia. The follow-up of the patients included a visit every two weeks up to three months. RESULTS: Even though group II's stone-free rate after one month of follow-up was higher than group I's (90% vs. 84%), no statistically significant difference was found between the groups (p = 0.749). While the success rate was higher in group II than in group I (92% vs. 86%), no statistically significant difference was observed between the two groups (p = 0.338). The complication rate was 28% (14 patients) and 12% (6 patients) in Groups I and II, respectively. However, no significant difference was found between the two groups (p = 0.132). CONCLUSIONS: SWL is a non-invasive and safe method for treating pediatric renal stones. We recommend the use of the ultrasonic focusing modality in SWL of the pediatric age group, which has similar success rates, avoiding radiation and low complication rate instead of the fluoroscopic focusing modality, which uses ionizing radiation during SWL.

Primary versus deferred ureteroscopy for the management of obstructive anuria secondary to ureteric urolithiasis in children: a prospective randomized study.

To compare the role of primary and deferred ureteroscopy (URS) in the management of obstructive anuria secondary to ureteric urolithiasis in pediatric patients. This prospective randomized study included 120 children aged ≤ 12 years who presented with obstructive anuria secondary to ureteric urolithiasis between March 2019 and January 2021. The children were subdivided into group A, which included children who had undergone primary URS without pre-stenting, and group B, which included children who had undergone URS after ureteric stenting. All children were clinically compensated and sepsis-free. Patients with underlying urological structural abnormalities were excluded. The operative time, improvement of renal functions, stone-free rate, and complications were compared between the two groups. At the 1-month follow-up, urine analysis; kidney, ureter, and bladder radiography; and ultrasonography were performed. The patient characteristics of both groups did not show any significant difference. Primary URS had failed in ten children (16.6%) in group A. Moreover, failure of stenting was noted in six patients (11%) in group B. The mean operative time for group B was significantly lower than that for group A (p ≤ 0.001). The stone-free rate was significantly higher in group B (p ≤ 0.001). The rate of overall complications was higher in group A. Deferred URS is preferable over primary URS in the management of obstructive anuria secondary to ureteric urolithiasis". In children because of the lower need for ureteric dilatation, higher stone- free rate, shorter procedure time, and lower complication rate.

Laparoscopic versus open pyeloplasty: a multi-institutional prospective study.

INTRODUCTION: To prospectively compare the perioperative and functional outcomes of laparoscopic (LP) and open pyeloplasty (OP) in three academic institutions. MATERIAL AND METHODS: Between September 2012 and September 2016, 102 patients with primary uteropelvic junction obstruction (UPJO) underwent pyeloplasty (51 LP and OP for the other 51 patients). Demographic data, perioperative parameters, including operative time, estimated blood loss, complications, length of hospital stay, and functional outcome were compared, and SF-8 Health Survey scoring was recorded for each group.Patients were followed up by ultrasound (US) and /or intravenous urography (IVU) at 3, 6 and 12 months. A MAG-3 renal scan was performed at 3 months postoperatively. RESULTS: The mean operative time was significantly shorter in the open group (153.2 ±42 min vs. 219.8 ±46 min; P <0.001). Compared to OP, the mean postoperative analgesia (Diclofenac) requirement was significantly less in the LP group (101.1 ±36 mg vs. 459.1 ±123 mg; P <0.001). The median hospital stay was significantly shorter for LP (2.7 ±1.8 days vs. 9.09 ±7.3 days; P <0.001). The median follow-up period was 19.7 months (12-28 months). The success rate was 96.1% in the OP group and 94.1% in the LP group. CONCLUSIONS: In spite of being a technically demanding procedure, LP offers faster recovery and higher patient satisfaction. In our hands, OP still has a shorter operative time and relatively lower retreatment rate.

SODIUM DODECYL SULPHATE POLYACRILAMIDE GEL ELECTROPHORESIS (SDS-PAGE) FOR DIFFERENTIATION OF DIFFERENT SCHISTOSOME AND FASCIOLID SPECIES.

Fasciola and Schistosoma spp. are digenetic trematodes that have a major detrimental impact on human health worldwide. It is not unusual to find common molecules among parasites of different species, genera, or phyla. In this study Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) was used to identify the common proteins of adult Fasciola and Schistosoma spp. Adult Fasciola spp, were collected from the bile ducts of naturally infected cattle and sheep. Schistosoma mansoni and S. haematobium adults surface antigens were prepared in Theodor Bilharz Research Institute were used. Results showed sharing bands between all worms, which have the same molecular weight of 36 kDa. On the other hand, band with molecular weight 41 kDa was sharing between them except F. hepatica. Bands at 48 and 170 kDa were sharing between all species of Fasciola spp and Schistosoma mansoni.

Evaluation of the effect of sildenafil and/or doxazosin on Benign prostatic hyperplasia-related lower urinary tract symptoms and erectile dysfunction.

PURPOSE: To verify the association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) and evaluate the influence of sildenafil and doxazosin either as single agents or combined on both symptoms. MATERIAL AND METHODS: A prospective randomized study including 150 patients presented with LUTS caused by BPH in association with clinically diagnosed ED, with age equal or more than 45 years from April 2010 to April 20011. They were categorized into three comparative groups each one containing 50 patients. These groups were comparable regarding pretreatment international prostate symptoms score (IPSS) and international index of erectile function (IIEF). The patients of the first group were given sildenafil 50 mg as monotherapy, those of the second group were given doxazosin 2 mg and those of the third group were given combination of both drugs for 4 months for each group. The main post-treatment parameters for assessment and comparison include assessment of patient's symptoms by repeated IPS Sand IIEF, uroflowmetry and assessment of PVR. The statistics was done by use of the Qui--square test. RESULTS: Pre-treatment parameters were assessed and compared between the three groups. After 4 months of treatment, the comparative parameters were applied to all groups and the differences were measured post-treatment regarding IPSS, erectile function score, uroflowmetry, and post-void residual (PVR) urine. Sildenafil alone caused mild improvement in IPSS, more improvement in IIEF score, and little effect on flow rate and PVR urine. Doxazosin alone caused more improvement in IPSS, flow rate and PVR urine and less improvement in IIEF score. A combination of both sildenafil and doxazosin caused more improvement in all of the comparative parameters than when each drug was given alone. CONCLUSIONS: There is a strong relationship between LUTS and ED. Doxazosin or sidenafil as a single drug could be used in treating mild or mild to moderate symptoms but more severe symptoms may usually need a combination of both drugs.

Management of symptomatic ureteral calculi during pregnancy: Experience of 23 cases.

PURPOSE: To present our experience in the management of symptomatic ureteral calculi during pregnancy. MATERIALS AND METHODS: Twenty-three pregnant women, aged between 19 and 28 years presented to the obstetric and urology departments with renal colic (17 cases, 73.9%) and fever and renal pain (6 cases, 26.1%); suggesting ureteric stones. The diagnosis was established by ultrasonography (abdominal and transvaginal). Outpatient follow-up consisted of clinical assessment and abdominal ultrasonography. Follow-up by X-ray of the kidneys, ureter, and bladder (KUB), or intravenous urography (IVU) was done in the postpartum period. RESULTS: Double J (DJ) stent was inserted in six women (26%) with persistent fever followed by extracorporeal shock wave lithotripsy (ESWL) one month post-partum. Ureteroscopic procedure and pneumatic lithotripsy were performed for 17 women (distal ureteric stone in 10, middle ureter in 5, and upper ureteric stone in 2). Stone-free rate was 100%. No urologic, anesthetic, or obstetric complications were encountered. CONCLUSIONS: Ureteroscopy, pneumatic lithotripsy, and DJ insertion could be a definitive and safe option for the treatment of obstructive ureteric stones during pregnancy.

Management of calcular anuria in adults caused by ureteric stones: By using of ureteroscopy and holmium laser.

PURPOSE: To present our clinical outcomes in the management of anuria in adult patients caused by ureteral calculi by using of ureteroscopy and holmium laser. MATERIALS AND METHODS: Nineteen patients presented with calcular anuria with ages between 19 and 48 years. The presentation was anuria with serum creatinine levels of 2-5.5 mg% (mean 3.5) and hyperkalemia in nine patients (5.2-6.1 mmol/L). There were bilateral ureteric stones in 14 (73.7%) and unilateral in five (26.3%) with single functioning kidney. Thirty-three ureteroscopic procedures were performed for 19 patients including bilateral ureteroscopy in 14. Laser lithotripsy was delivered using holmium laser via 356 µm laser fibre, with energy (1-1.2 J) and pulse rate (10 Hz). Post-operatively, monitoring of urine output, serum creatinine and K levels was done until normal values were obtained. RESULTS: Ureteroscopy was performed for all 19 patients (33 procedures), but laser lithotripsy was done successfully in 30 procedures. The operative time was 46 min (25-70). The successful fragmentation rate was (100%). The stone-free rate was 90.9%. There were mucosal abrasions in 6 (31.5%), and mild to moderate haematuria in 9 (47.4%), and high fever in two patients (10.5%). Serum creatinine and potassium levels returned to normal within 7-10 days. Urine output gradually reached normal level within a week. CONCLUSIONS: Ureteroscopy and holmium laser lithotripsy represent an effective and safe modality for the treatment of anuria caused by ureteral calculi.

Dry hot air: is it a reliable method of disinfection for urological endoscopes? Preliminary study.

OBJECTIVES: To evaluate dry hot air effect as a reliable method of disinfection of urological endoscopes. METHODS: Two groups of urological endoscopic instruments (2 cystoscopic sheaths, 2 bridges, and 2 working elements of resectoscope and urethrotome for each group), after being sterilized by full immersion in 2% glutaraldehyde solution for 10 hours, were contaminated by immersion in suspensions of Staphylococcus saprophyticus (3 x 10(3) CFU/mL), Escherichia coli (28 x 10(2) CFU/mL), and Candida albicans (27 x 10(2) CFU/mL). Group I was exposed to disinfection by full immersion in 2% glutaraldehyde solution for 20 minutes. Group II was exposed to dry hot air obtained by using a hair dryer for 3 minutes. The surfaces and lumens of the instruments of both groups were washed with specific volumes of saline. The surface and luminal specimens were collected separately and used for culture on different media specific for these organisms. Colony-forming units were estimated. RESULTS: In group I, the cultures isolated from the instrument surface washes were negative but those isolated from the luminal injected saline were all positive for S. saprophyticus (60 CFU/mL), E. coli (50 CFU/mL), and C. albicans (50 CFU/mL). In group II, the cultures isolated from both the instrument surface and luminal saline washes were negative for all 3 above-mentioned microorganisms. CONCLUSIONS: Hot dry air by using a hair dryer is an inexpensive, rapid, easy, easily available, and effective method of disinfection compared with glutaraldehyde solution.