Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia.

PURPOSE: Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. MATERIALS AND METHODS: A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. RESULTS: There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). CONCLUSION: This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Pneumatic ureteroscopic lithotripsy: is it still a reasonable treatment option for multiple ureteric stones?

OBJECTIVES: To assess the efficacy and safety of ureteroscopic pneumatic lithotripsy for multiple ureteric stones. MATERIALS AND METHODS: 36 patients with multiple ureteric stones were treated with ureteroscopic lithotripsy (URSL). A 8/9.8-Fr Wolf semirigid ureteroscope and pneumatic lithotripter were used for stone fragmentation. RESULTS: 87 stones were treated with URSL. Successful fragmentation was achieved in 77 (88.5%) of the stones. The retreatment rate was 11.5%. The stone-free rate (SFR) of lower ureteric stones (93.3%) and middle ureteric stones (87.5%) was significantly higher compared with upper (73.3%) ureteric stones (p < 0.05). For patients with stones less than 1 cm and greater than 1 cm, the SFR was 91.5 and 75.0%, respectively (p < 0.05). Perforation occurred in 1 patient, mucosal injury occurred in 5 and stone migration in 5. No long-term complication was observed in any patient. CONCLUSIONS: Ureteroscopic pneumatic lithotripsy is still a reasonable treatment option for multiple ureteric stones. The procedure has high success rates with minimal morbidity. However, success rate can be affected by stone size and ureteric location.

Single-session ureteroscopic pneumatic lithotripsy for the management of bilateral ureteric stones.

PURPOSE: In nowadays there is no consensus on single-session ureteroscopic lithotripsy (URSL) for the management of bilateral ureteric stones. The aim of this study was to evaluate efficacy and safety of single-session URSL in patients with bilateral ureteric stones. MATERIALS AND METHODS: 41 patients who have undergone bilateral single-session URSL were evaluted in this study. A 8/9.8 Fr Wolf semi-rigid ureteroscope was used for the procedures, and the stones were fragmented with pneumatic lithotripter. RESULTS: A high stone-free rate was achieved (90.2%) after single endoscopic procedure with a retreatment rate of 9.8%. The procedure was most successful for distal ureteric stones with a 96.2% stone-free rate followed by middle ureteric stones with a 81.8% stone-free rate while the least success was achieved for proximal ureteric stones with a 77.7% stone-free rate (p < 0.05). A greater stone-free rate was obtained in those with stones less than 10 mm (93.7%) than in those with stones larger than 10 mm (77.7%) (p < 0.05). Ureteral perforation occurred in only one patient (2.4%). No long-term complication was observed in any patient. CONCLUSIONS: Bilateral single-session URSL can be performed effectively and safely with a low complication rate in patients with bilateral ureteric stones. It can reduce the need of anaesthetics and hospital stay.

Management of bladder stones with pneumatic lithotripsy using a ureteroscope in children.

PURPOSE: To evaluate the effectiveness and safety of pneumatic lithotripsy by using a ureteroscope to treat bladder stones in children. PATIENTS AND METHODS: Twenty-seven boys presenting with bladder stones underwent transurethral cystolithotripsy. The indication for transurethral cystolithotripsy was stone size

Direct vision internal urethrotomy by using endoscopic scissors.

PURPOSE: To evaluate the effectiveness and safety of direct vision internal urethrotomy (DVIU) by using endoscopic scissors for incision of short (<1 cm) urethral strictures in adult men. PATIENTS AND METHODS: Twenty-one patients who had short bulbar urethral strictures were evaluated in this study. Endoscopic scissors was used for incision of urethral strictures in all patients. Retrograde urethrography (RGU) and maximum flow rate(Qmax) <15.0 ml/s by uroflowmetry were used for the definition of recurrences. RESULTS: The procedure was found successful in all patients. The mean size of stricture was 0.73 cm. The mean pre-procedure Qmax was 7.9 ml/s. The mean procedure time was 10.2 min. The mean Qmax was 19.4 ml/s at the third month postoperatively. RGU was normal in all patients at the third month postoperatively. The mean follow-up was 8.1 months. Three (14.2 %) patients underwent second DVIU due to recurrence. No complication was observed during the follow-up except urinary tract infection in two (9.5 %) patients. CONCLUSIONS: DVIU using endoscopic scissors appears to be an effective and safe treatment modality for incision of short urethral strictures in adult men.

Effects of pulsed and sinusoidal electromagnetic fields on MMP-2, MMP-9, collagen type IV and E-cadherin expression levels in the rat kidney: an immunohistochemical study.

OBJECTIVE: To investigate the role of extremely low frequency pulsed and sinusoidal electromagnetic fields on kidney tissues. STUDY DESIGN: Twenty-seven male Wistar albino rats were used. The rats were divided into 3 groups (n = 9): control group, sinusoidal electromagnetic field (SEMF) group, and pulsed electromagnetic field (PEMF) group. The SEMF and PEMF groups (pulse time 25 microsn, pulse frequency 50 Hz) were subjected to 1.5 mT, 50 Hz, exposure 6 hours a day, 5 days a week for 28 days in methacrylate boxes. Formalin-fixed, paraffin-embedded kidney tissue sections were stained with hematoxylin-eosin, Gomori and periodic acid-Schiff. In addition, matrix metalloproteinase-2 (MMP-2) and 9 (MMP-9), E-cadherin and collagen type IV expression levels were examined immunohistochemically. RESULTS: Thickening of glomerular basement membranes was evident in electromagnetic fields, especially in the SEMF group. In addition, expression levels of E-cadherin were decreased with electromagnetic field (EMF) exposure. The expression level of MMP-9 increased, and MMP-2 and collagen type IV expression levels were not altered with EMF exposure. CONCLUSION: Both EMFs changed the molecular component of the kidney adversely.

Technique using a percutaneous nephroscope and nephroscopic scissors transurethrally for treatment of complicated orthotopic ureterocele in adult women.

OBJECTIVE: To present an endoscopic technique for the decompression of complicated orthotopic ureterocele in adult women. METHODS: Five women with complicated orthotopic ureterocele were evaluated in the present study. The ureterocele was complicated by stones in 2 patients and urinary tract infection in 4. An endoscopic technique was used for the treatment of these ureteroceles. A 26F rigid nephroscope was placed into the bladder. When the ureterocele was seen in the bladder, the nephroscopic scissors was advanced through the nephroscopic channel to the ureterocele. A puncture was made on the anterior wall of the ureterocele using the nephroscopic scissors. Next, a ureteral catheter was introduced to puncture the ureterocele. Next, a window approximately 5-10 mm in diameter was opened on the wall of the ureterocele using the nephroscopic scissors. Finally, a double-J stent and urethral catheter were placed. The stones were fragmented using a pneumatic lithotripter. All the patients were evaluated with urinalysis, urine culture, ultrasonography, and voiding cystourethrography at the third month postoperatively. RESULTS: The mean procedure time was 18.4 minutes. No complication was observed during the procedure, except for mild hematuria. The mean postoperative hospital stay was 19.8 hours. All patients with stones were stone free after the procedure. No cases of postoperative urinary tract infection developed. None of these patients had de novo reflux or obstruction at 3 months postoperatively. CONCLUSION: This technique could be an alternative treatment option for decompression of complicated orthotopic ureterocele in adult women.

Experience with the diagnosis and management of symptomatic ureteric stones during pregnancy.

OBJECTIVE: To present our experience to describe diagnosis and management of symptomatic ureteric stones during pregnancy. MATERIALS AND METHODS: Thirty-six pregnant women with symptomatic ureteric stones were evaluated in this study. The diagnosis was done by history, physical examination, symptoms, signs, ultrasonography, or ureteroscopy if needed. Initially, conservative management was performed on all patients. When conservative treatment failed, temporizing therapies (double-J stenting or percutaneous nephrostomy [PCN]) and (ureteroscopic lithotripsy) URSL were performed on the patients. RESULTS: In 25 (69.4%) of the patients, ureteric stones was diagnosed on US. In the other 11 (30.6%) of the patients, definitive diagnosis was done by ureteroscopy in 5, and 6 of them passed their stones spontaneously. Conservative management was successful in 24 of 36 (66.6%) the patients. Temporizing therapies and URSL were required in 12 of 36 (33.4%) patients. A double-J stent was successfully placed in only 3 (8.3%) of the patients, and URSL was performed in 9 (25%). In 1 (2.7%) patient, PCN was performed because of persistent renal colic, fever, and pyonephrosis. In this patient, URSL was performed after symptoms and signs resolved, and then the percutaneous tube was removed. CONCLUSION: If ultrasonography fails, ureteroscopy may be an alternative approach for definitive diagnosis. When conservative approach fails, URSL may be a good alternative approach for definitive treatment.

Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia

ABSTRACT Purpose Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. Materials and Methods A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. Results There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). Conclusion This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Giant vesical diverticulum: a rare cause of defecation disturbance.

Vesical diverticula frequently result from bladder outlet obstructions. However, giant vesical diverticula which cause acute abdomen or intestinal obstruction are very rare. Our review of the English medical literature found 3 cases of bladder diverticula which caused gastrointestinal symptoms. Here, we present a 57-year-old man with a giant diverticulum of the urinary bladder who complained of abdominal pain, nausea and vomiting, constipation, no passage of gas or feces, and abdominal distension for 3 d. A 20 cm x 15 cm diverticulum was observed upon laparotomy. The colonic obstruction was secondary to external compression of the rectum against the sacrum by a distended vesical diverticulum. We performed a diverticulectomy and primary closure. Twelve months postoperatively, the patient had no difficulty with voiding or defecation.

Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin.

PURPOSE: To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS. METHODS: We performed a non-randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients' drug history. Usage or non-usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients' theatre notes. RESULTS: Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9-836.5); RR 99.3 (95% CI 30.0-327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks. CONCLUSIONS: Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS.

Is routine ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy for lower ureteral stones larger than 1 cm?

We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragments > or =4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P < 0.05). One patient (4.5%) in the unstented group required re-hospitalization for severe flank pain with fever (>38 degrees C) compared to one patient (4.7%) in the stented group for proximal stent migration (P > 0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragments > or =4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.

Single-session ureteroscopic pneumatic lithotripsy for the management of bilateral ureteric stones

PURPOSE: In nowadays there is no consensus on single-session ureteroscopic lithotripsy (URSL) for the management of bilateral ureteric stones. The aim of this study was to evaluate efficacy and safety of single-session URSL in patients with bilateral ureteric stones. MATERIALS AND METHODS: 41 patients who have undergone bilateral single-session URSL were evaluted in this study. A 8/9.8 Fr Wolf semi-rigid ureteroscope was used for the procedures, and the stones were fragmented with pneumatic lithotripter. RESULTS: A high stone-free rate was achieved (90.2%) after single endoscopic procedure with a retreatment rate of 9.8%. The procedure was most successful for distal ureteric stones with a 96.2% stone-free rate followed by middle ureteric stones with a 81.8% stone-free rate while the least success was achieved for proximal ureteric stones with a 77.7% stone-free rate (p < 0.05). A greater stone-free rate was obtained in those with stones less than 10 mm (93.7%) than in those with stones larger than 10 mm (77.7%) (p < 0.05). Ureteral perforation occurred in only one patient (2.4 %). No long-term complication was observed in any patient. CONCLUSIONS: Bilateral single-session URSL can be performed effectively and safely with a low complication rate in patients with bilateral ureteric stones. It can reduce the need of anaesthetics and hospital stay.