Long-term outcome of transobturator suburethral tape procedure for treatment of female stress urinary incontinence

The aim is to evaluate the long-term safety and efficacy of transobturator tape [TOT] procedure in the treatment of women with stress urinary incontinence [SUI] by subjective and objective measures. A total 48 women with SUI underwent the TOT procedure during the period from December 2005 to February 2008. The follow-up period ranged between 60 and 84 months [mean 71 months]. Mean age was 44.21 +/- 7.52 [range: 30-58]. Preoperative and early postoperative data were retrieved from the patient's medical files. Follow-up evaluation was carried out every 3 months during the 1st year and yearly afterwards by history taking [including incontinence and quality-of-life questionnaire], clinical examination, urine analysis, abdominopelvic ultrasonography, and urodynamic studies when indicated. At 12-month follow-up, the cure, improvement, and failure rates were 3[patients [81.25%], 5 [10.42%] and 4 [8.33%], respectively. The corresponding rates at the last follow-up were 38 [7[.15%], 5 [10.42%] and 5 [10.42%] respectively. The postvoid residual urine and peak flow rates did not differ significantly between the preoperative values and at the last follow-up. The complication rates after a mean 71-month included one patient with voiding difficulty and two patients with de novo urgency. No case was recorded with retention of urine or erosion. Transobturator tape procedure appeared to be effective minimally invasive procedure for SUI with low rate of complication and good long-term outcome

outcome of surgical interference in patients with acute obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of acute obstructive renal failure. Thirty six clinically diagnosed patients as having acute obstructive renal failure [22 men 61.1% and 14 women 38.9% ranging in age between 28 and 62 years, mean 45 years] in the period from October 2005 to October 2008. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 21[58.3%] patients, oliguria 12 [33.33%] patients, loin pain 16 [44.44%] patients, nausea and vomiting 23[63.9%] patients. 30 Patients underwent direct intervention and 6 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. There was a highly significant increase in the incidence of improvement among studied patients.100% [36 patients] out of 36 patients with acute obstructive renal failure showed improvement after surgical intervention. The syndrome of acute renal failure was reversed to a stable renal function that probably represents the preobstructive state of every patient. There was no morbidity or mortality rate in our series if compared with other series dealing with corrective surgery in obstructive renal failure. Surgical correction of acute obstructive renal failure show excellent results, so more efforts must be done for suspected obstruction in acute uremic patients to avoid the dialysis or kidney transplantation

outcome of surgical interference in patients with chronic obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of chronic obstructive renal failure. We will try to assess some of the factors that may predict favorable outcomes. Sixty four clinically diagnosed patients as having chronic obstructive renal failure [41 men 64.1% and 23 women 35.9% ranging in age between 25 and 69 years, mean 47 years] in the period from October 2005 to October 2008. The patients on this study were divided according to past history of renal impairment and/or regular dialysis into two groups as follow: Group [A]: Patients with chronic renal failure with no regular dialysis [36 patients] Males: 26 [72.22%] Females: 10[27.78%]. Group [B]: Patients with chronic renal failure with regular dialysis [28 patients] Males: 18 [64.29%] Females: 10 [35.71%]. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 17 [26.6%] patients [9 group A and 8 group B], oliguria 24 [37.5%] patients [14 group A and 10 group B], loin pain 42 [65.6%], patients [27 group A and 15 group B], nausea and vomiting 27 [42.2%] patients [8 group A and 19 group B]. 50 Patients underwent direct intervention and 14 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. In our series patients with chronic obstructive renal failure [group A], showed improvement in 31 patients [86.1%] and did not improve in 5 patients [13.9]. Out of the 5 patients who did not improve after management 1 patient [2.8%] remained unchanged and 4 patients [11.1%] continued to have progressive renal failure up to regular dialysis. In patients with chronic obstructive renal failure [group B], renal functions showed different degrees of improvement as follow: In 15 patients [53.6%] good improvement and subsequent complete weaning from dialysis occurred, while in 5 patients [17.8%] there was a decrease in weekly dialysis sessions from 3 to 2 sessions/week. In the remaining 8 patients [28.6%] there was no improvement and patients continued to have regular dialysis as preintervention. The overall complications in this series were [15.6%]. The incidence was much more in the chronic cases group B. The mortality rate in our series is [3.1%] which is not high if compared with other series dealing with corrective surgery in obstructive renal failure. The degree of improvement of renal function found to be correlated to preoperative residual parenchyma thickness, parenchymal echogenicity, corticomedullary differentiation, presenting hemoglobin value and radioisotope GFR. Finally there is evidence of reversibility of renal function after long standing obstruction which provides justification for efforts to identify and treat urinary tract obstruction even if a patient with an obstruction requires dialysis to avoid the dialysis or kidney transplantation or helping patients under dialysis for complete weaning form dialysis or decrease their number of weekly sessions

Ten-year -experience in the management of renal cell carcinoma: a retrospective study

The evolution of diagnostic tools and therapy protocols for renal cell carcinoma [RCC] during the last decades dictates regular evaluation of the results and achievements. Through this retrospective study, we aimed to review our results in the diagnosis and treatment of RCC during the last 10 years. The complete files of 53 patients treated for RCC during the last 10 years were reviewed. The clinical records, imaging studies, operative notes and post operative surveillance data were all analyzed. A total of 45 patients presented with symptoms related to the tumour while 8 were discovered incidentally. CT scans showed a sensitivity and specificity of 100% and 92% in diagnosing caval extension; and of 87.5% and 93.3% in diagnosing nodal involvement, respectively. MRI was more precise in evaluating thrombus extension to the vena cava. Radical nephrectomy was performed in 35 patients with one prioperative mortality and an overall complication rate of 28.6%. Meanwhile, 18 patients underwent nephron sparing surgery [NSS] half of whom were for imperative indications. Complication rate in this group mounted to 55.6%. However, most complications were smoothly manageable. After a mean follow up period of 26.4 months, 3 patients died of unknown causes, 2 died with pulmonary metastases and 1 with local recurrence. Furthrmore, 5 patients showed evidence of local recurrence and were all alive at the conclusion of the study. Regular ultrasonographic check ups are essential for earlier diagnosis of RCC. CT assessment of such tumours supported by MRA yielded excellent results in assessing caval extension but nodal assessment may be still fallacious. NSS when performed in small tumours, can yield very encouraging results. However, we still need to gain more experience in this field

Safety and efficacy of supracosatal access for percutaneous nephrolithotomy: a 3-year experience

Successful removal of stones in percutaneous nephrolithotomy requires the accurate placement of a percutaneous track that provides direct access for stone manipulation. Supracostal approach is usually avoided be-cause of concerns about potential chest complications. We evaluated the hazard, safety and efficacy of supracostal approach for percutaneous nephrolithotomy. During the years 2003-2005 a total of 24 patients underwent PCNL through a supracostal track at Al-Hussain University Hospital. The indications for a supracostal approach were upper caliceal stone resistant to ESWL, upper caliceal stone with narrow neck, upper ureteric stone, Staghorn stone and sizable pelvic stone in a highly situated kidney. In 22 patients the punctures were performed just above the 12th rib; while in 2 cases the punctures were performed above the 11th rib. The data were analyzed for stone clearance, intra-operative and post-operative complications. Twenty one patients [87.5%] were rendered stone-free or had clinically insignificant residuals by PCNL alone. Overall complication was [20.8%]. Chest complications developed in only 2 patients [8.3%] in the form of hydro-pneumothorax and were managed successfully by intercostal chest tube drainage with an under water-seal connection. The study concluded that with proper choice of candidates, supracostal access for PCNL is safe and effective. The possible inadvertent pleural injury is rare and is easily manageable