Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children.

OBJECTIVES: To evaluate the efficacy of tamsulosin for promoting ureteric stone expulsion in children, based on the confirmed efficacy of tamsulosin as a medical expulsive therapy in adults. PATIENTS AND METHODS: From February 2010 to July 2013, 67 children presenting with a distal ureteric stone of <1 cm as assessed on unenhanced computed tomography were included in the study. The patients were randomised into two groups, with group 1 (33 patients) receiving tamsulosin 0.4 mg and ibuprofen, and group 2 (34) receiving ibuprofen only. They were followed up for 4 weeks. Endoscopic intervention was indicated for patients with uncontrolled pain, recurrent urinary tract infection, hypersensitivity to tamsulosin and failure of stone passage after 4 weeks of conservative treatment. RESULTS: Sixty-three patients completed the study. There were no statistically significant differences between the groups in patient age, body weight and stone size, the mean (SD) of which was 6.52 (1.8) mm in group 1 vs. 6.47 (1.79) mm in group 2 (P = 0.9). The mean (SD) time to stone expulsion in group 1 was 7.7 (1.9) days, vs. 18 (1.73) days in group 2 (P < 0.001). The analgesic requirement (mean number of ketorolac injections) in group 1 was significantly less than in group 2, at 0.55 (0.8) vs. 1.8 (1.6) (P < 0.001). The stone-free rate was 87% in group 1 and 63% in group 2 (P = 0.025). CONCLUSIONS: Tamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone.

Efficacy and Safety of Percutaneous Nephrolithotomy in Children with Previous Renal Stone Operations.

PURPOSE: To determine the impact of open pyelolithotomy or nephrolithotomy on the results and complications of subsequent percutaneous nephrolithotomy (PCNL) in children. PATIENTS AND METHODS: We retrospectively reviewed the files of 121 children with 135 renal units (RUs) who underwent PCNL between February 2008 and October 2014. We compared RUs with no previous intervention (group 1, 87 RUs) with those that had preceding open pyelolithotomy or nephrolithotomy (group 2, 48 RUs). The demographic characteristics, mean operative time, mean fluoroscopy time, mean hemoglobin changes, number of percutaneous accesses, analgesic requirement, mean hospitalization time, stone-free rate, and complications were all reported and compared. RESULTS: The study included 135 RUs in 121 children (74 boys and 47 girls) who underwent PCNL. No statistical differences were detected between the two groups in terms of age, sex, stone size, stone laterality, and stone opacity. Mean operative time, mean fluoroscopy time, mean hemoglobin change, number of percutaneous accesses, supracostal access, analgesic requirement, and hospitalization stay were similar in each group (P>0.05). The stone-free rate in group 1 was higher than that in group 2 (81.61% vs 79.17%). This was not statistically significant (P>0.05), however. CONCLUSION: Previous open pyelolithotomy or nephrolithotomy does not affect the efficacy and morbidity of subsequent PCNL in pediatric patients.

Stone expulsion rate of small distal ureteric calculi could be predicted with plasma C-reactive protein.

Ureteral stones tend to induce inflammatory lesions in the ureteric wall; such lesions may interfere with the probability of spontaneous ureteral stone passage. Plasma C-reactive protein (CRP) is an acute-phase protein whose serum level is increases in response to inflammation, as in ureteric inflammatory disorders induced by stone impaction. Patients with distal ureteric stones were included in this study. All patients were subjected to history taking KUB, urinary tract ultrasound, Non-contrast CT (NC-CTKUB) scan, and plasma CRP estimation. All patients received medical expulsive therapy. Patients were examined weekly using KUB and urinary tract ultrasound until spontaneous stone passage or intervention after 4 weeks. Patients who failed to expel the stone within 4 weeks underwent ureteroscopy. Spontaneous stone expulsion within 4 weeks was recorded in 129 patients (54.9 %), while 106 patients (45.1 %) underwent ureteroscopy for stone extraction. Patients with spontaneous stone expulsion had significantly lower serum CRP levels (16.45 + 2.58) than those who failed to pass the stone spontaneously (39.67 + 6.30). Receiver operator characteristic curve is used to determine CRP cut-off point for prediction of spontaneous ureteric stone expulsion. A cut-off point of 21.9 mg/L for CRP yielded appeared optimal for prediction of spontaneous ureteric stone expulsion. Medical expulsive therapy success for management of small distal ureteric calculi could be predicted with plasma CRP. Patients with CRP >21.9 mg/L have low stone expulsion rate and should directly be subjected for an immediate, minimally invasive ureteroscopy.

Dorsal dartos flap rotation versus suturing tunica albuginea to the pubic periosteum for correction of penile torsion: a prospective randomized study.

PURPOSE: To compare the results of dorsal dartos flap rotation versus suturing tunica albuginea to the pubic periosteum for correction of congenital penile torsion. PATIENTS AND METHODS: Seventeen patients with congenital penile torsion were evaluated and managed from 2006 to 2010. On a random basis, 9 patients underwent surgical repair using a dorsal dartos flap rotation technique (group 1), and 8 patients by suturing tunica albuginea to the pubic periosteum (group 2). All were followed up every 6 months. RESULTS: The mean age in group 1 was 52.3 ± 24.8 months, while in group 2 it was 53.4 ± 33.6 months. Mean follow up was 22.3 ± 10.2 and 21.5 ± 7.2 months in group 1 and group 2 respectively. Torsion was corrected in 6 (66.7%) patients of group 1; 3 (33.3%) had residual torsion < 10°. In group 2, correction was achieved in 6 (75.0%) patients and 2 (25.0%) had residual torsion < 10°. The mean operative time was significantly less for group 1 than for group 2: 45.3 ± 7.1 and 74.5 ± 5.3 min, respectively (P < 0.0001). CONCLUSIONS: In short-term prepubertal follow up, both dorsal dartos flap rotation and suturing tunica albuginea to the pubic periosteum are effective for correction of congenital penile torsion. The former technique is easier to perform as it requires much less dissection.

The value of measuring the prostatic resistive index vs. pressure-flow studies in the diagnosis of bladder outlet obstruction caused by benign prostatic hyperplasia.

OBJECTIVE: To compare the prostatic resistive index (RI) and measurements from pressure-flow studies (PFS) for the diagnosis and follow-up of bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: In all, 338 men (aged 55-82 years) presenting with lower urinary tract symptoms were evaluated prospectively for BOO secondary to BPH. In all patients, the prostatic RI was measured by transrectal power Doppler ultrasonography. PFS were assessed in all patients and depending on the results the patients were divided into an obstructive and an unobstructive group. The receiver operating characteristic (ROC) curve was used to determine the prostatic RI threshold value for predicting BOO secondary to BPH. Patients who were confirmed to have BOO secondary to BPH received either medical or surgical treatment, and they were re-evaluated after 3 and 6 months with prostatic RI measurements. RESULTS: According to the PFS the obstructive group included 158 patients and the unobstructive group 180 patients. The mean (SD) prostatic RI was significantly higher in the obstructive group, at 0.73 (0.04), than in the unobstructive group, 0.65 (0.05) (P < 0.001). Using the ROC curve a prostatic RI of â©¾ 0.71 predicted BOO secondary to BPH, with 84.6% sensitivity, 78.4% specificity and 83.8% overall predictability. After management, the prostatic RI of the obstructive group, 0.69 (0.08), was significantly lower than before treatment, 0.73 (0.04) (P < 0.05). CONCLUSIONS: The prostatic RI can predict BOO with high specificity and sensitivity. We believe that the prostatic RI could be a useful variable for the diagnosis and follow-up of patients with BPH.