Percutaneous suprapubic cystolithotripsy approach: for whom? Why?

BACKGROUND AND PURPOSE: To evaluate the success and complications of percutaneous suprapubic cystolithotripsy (PCCL) in pediatric and adult patients with neurogenic bladder. PATIENTS AND METHODS: Between 2000 and 2004, 72 patients, all male (30 children aged 2 to 7 years [mean 4.7 years] and 42 spastic paraplegic adults aged 34 to 62 years [mean 53 years]), with sterile urine underwent PCCL under general anesthesia in one sitting. An 18-gauge needle, Amplatz dilatation set, 30F Amplatz sheath, rigid nephroscope, lithotripter (pneumatic, mechanic), and stone forceps were used. Fluoroscopy was not. A suprapubic catheter was placed in the first two patients only. RESULTS: The dimensions of the stones were on average 3.2 cm (range 1-5 cm) for the pediatric patients and 5.5 cm (4-10 cm) for the adult patients. The operating time was 20 minutes (10-35 minutes). In all cases, the stones were taken out. No serious intraoperative or postoperative complications were observed. In all cases, the transurethral catheter was removed on postoperative day 5. No recurrence was observed during the follow-up period (mean 20 months). CONCLUSION: As urethral diameters are narrow in pediatric patients and adult spastic paraplegic patients in whom an endoscopic approach could not be performed, PCCL is a safe alternative with low morbidity and complication rate. The technique is also more advantageous than open surgery with regard to cosmetic outcome and length of the hospital stay.

Does hyaluronan affect inflammatory cytokines in knee osteoarthritis?

Our aim was to investigate the effects of hyaluronan on inflammatory cytokines in the synovial fluid of patients with knee osteoarthritis. The study was single blind, placebo-controlled, and randomized. We administered hyaluronan to 22 patients in the study group and placebo to 19 in the control group. Enzyme-linked immunosorbent assay was used to determine the levels of cytokines. Both HA and placebo caused a significant decrease in interleukin (IL)-6 levels (P=0.0001 and P=0.04, respectively). But it was more significant in the study group. However, IL-8 and tumor necrosis factor alpha (TNF-alpha) levels did not change in either group (P>0.05). The amount of effusion decreased significantly in the study group (P=0.001) but not in the control group (P=0.133). It can be concluded that hyaluronan considerably decreased IL-6 levels, which correlated with clinical improvement, but had no effect on IL-8 and TNF-alpha levels in synovial fluid. However, larger studies with longer follow-up periods are needed to explain the effect of hyaluronan on cytokines.