Ahmad Abolyosr

The management of penile fracture based on clinical and magnetic resonance imaging findings.

Associate Editor
Michael G. Wyllie

Laparoscopic ureterolithotomy: our experience with 74 cases.

Objectives:  We retrospectively evaluated our experience with a relatively uncommon procedure, the laparoscopic ureterolithotomy, for the treatment of ureteral stones.

Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi.

Objective. To evaluate the potential role of tamsulosin in the medical treatment of distal ureteral stones. Material and methods. Ninety patients with symptomatic distal ureteral calculi were enrolled. They were randomly divided into two groups: Group A (n=45) received diclofenac 100 mg on demand for 4 weeks plus levofloxacin 250 mg daily for the first week and were well hydrated; and Group B (n=45) received the same therapy plus tamsulosin 0.4 mg/daily for 4 weeks. Abdominal ultrasound scans and KUB X-rays were performed weekly. Stone expulsion rates, time to expulsion, pain episodes and analgesic usage were determined. Intervention by means of shock-wave lithotripsy (SWL) or ureteroscopy was evaluated. Results. The stone expulsion rate was 51.1% for Group A, compared to 88.9% for Group B (p=0.001). The average time to expulsion was 12.53±2.12 days for Group A and 7.32±0.78 days for Group B (p=0.04). The number of pain episodes was significantly lower in Group B and mean use of analgesics was lower for Group B (0.14±0.5 vials) than Group A (2.78±2.7 vials). Twenty-two patients in Group A failed to pass their stones after 4 weeks but only five in Group B. Of the patients who were not stone-free, 19 were treated with SWL and eight underwent ureteroscopy. Conclusion. Our study reveals the efficacy of tamsulosin for the treatment of distal ureteral stones. Tamsulosin should be added to the standard medical approach for treating these stones.

Laparoscopic versus open orchiopexy in the management of abdominal testis: A descriptive study

Aims: Treatment of patients with abdominal non‐palpable testis (NPT) is still controversial among pediatric urologists. This is a prospective randomized comparative study between open and laparoscopic orchiopexy for management of abdominal testis. The aim of this study was to evaluate the success rate and morbidity of both approaches.

Percutaneous suprapubic stone extraction for posterior urethral stones in children: efficacy and safety.

OBJECTIVE To evaluate the safety and efficacy of percutaneous suprapubic stone extraction (PSPSE) for pediatric posterior urethral stones. METHODS Between July 2007 and June 2010, 54 boys presenting with acute urinary retention due to posterior urethral stones underwent PSPSE. Patients were a mean age of 66.4 months (range, 8-180 months). The stone size was 0.7-1.9 cm. Patients were placed under general anesthesia, and a 7F urethroscope was used to pushback the stone to the bladder. A 3-mm suprapubic puncture with a scalpel was performed, followed by insertion of a straight narrow hemostat through the puncture aided with cystoscopic guidance. The stone was grasped with the hemostat in its narrowest diameter and was extracted percutaneously or crushed if friable. The suprapubic puncture was closed with a single 4-0 Vicryl (Ethicon) suture. RESULTS Intact stone retrieval was achieved in 45 patients, and the stone was crushed into minute fragments in 9 patients. Intraperitoneal extravasation developed in 1 patient that required open surgical intervention. Mean operative time was 22 minutes. Patients were monitored for up to 17 months, with complete resolution of symptoms and stone clearance. CONCLUSION PSPSE provides a minimally invasive approach for the extraction of urethral and bladder stones in the pediatric population. The use of a straight hemostat for suprapubic stone extraction or crushing is a good alternative to suprapubic tract dilation, with minimal morbidity.

In vitro Efficacy of Ureteral Catheters Impregnated with Ciprofloxacin, N-acetylcysteine and their Combinations on Microbial Adherence

Background Ureteral catheters are valuable indispensable devices may readily acquire biofilms on the inner or outer surfaces. This study evaluated the efficacies of ureteral catheters impregnated with ciprofloxacin, N-acetylcysteine each alone and in combination on microbial adherence. Methods Antimicrobial durability of ureteral catheters coated, through instant dip method, with ciprofloxacin were determined using modified Kirby-Bauer method. Ciprofloxacin-coated catheters showed zones of inhibition ranged from 15 to 45 mm in diameter (baseline) against nine clinical strains recently isolated from patients undergoing ureteral stent removal. Segments coated with ciprofloxacin, N-acetylcysteine each alone and in combination, through instant dip method, were incubated with the tested microorganisms, washed, sonicated, cultured and the number of viable cells were determined. Results Ciprofloxacin-coated catheters soaked in urine and incubated at 37 °C, maintained antimicrobial activities and produce zones of inhibition that measured 2–10 mm for at least 8 weeks. Effect of ciprofloxacin and N-acetylcysteine coated catheters on microbial adherence were found to be dose dependent. Catheters impregnated with ciprofloxacin/N-acetylcysteine showed the highest inhibitory effect on microbial adherence when compared with controls (85.5%–100%). Conclusion Catheters impregnated with ciprofloxacin, using instant dip method, were shown to have broad spectrum, prolonged antimicrobial durability and high efficacy. On the other hand, Catheters impregnated with ciprofloxacin/NAC showed the highest inhibitory effect on microbial adherence to stent surfaces.