Ahmed M. Al-Kandari

Role of Ureteral Stenting After Uncomplicated Ureteroscopy for Distal Ureteral Stones: A Randomized, Controlled Trial

PURPOSE We determined the differences in outcome between ureteral stenting and nonstenting following uncomplicated ureteroscopy for distal ureteral stones. MATERIALS AND METHODS A total of 220 patients treated with successful ureteroscopy for distal ureteral stones were randomized to 2 equal groups according to postoperative placement of a ureteral stent (Cook Ireland, National Technological Park, Ireland), including group 1--without a stent and group 2--with a stent. Outcome measures were flank pain and dysuria at 48 hours and 1 week, early postoperative complications, analgesia need, rehospitalization, return to normal physical activity, stone-free rate, stone recurrence and late postoperative complications. Patients were followed a mean +/- SD of 25 +/- 9 months (range 12 to 49). RESULTS Early postoperative complications, including low grade fever, hematuria and urinary tract infection, were observed in 22 patients (20%) in group 1 and 19 (19%) in group 2, a difference of no significant value. Mean initial hospitalization and time to return to normal physical activity were not different between the 2 groups. At 48 hours and 1 week there was no significant difference in flank pain between the 2 groups, while dysuria was significantly less in the nonstented group. The amount of analgesics required in the recovery room was not different but after discharge from the hospital stented patients used a larger amount of analgesia while the stent was still in the ureter. The stone-free rate at 4 weeks was 100% in each group. Late postoperative sequelae, including stone recurrence and ureteral narrowing, were reported in 6 patients (5.5%) in group 1 and 4 (3.6%) in group 2, a difference of no significant value. CONCLUSIONS Uncomplicated ureteroscopy for treatment of distal ureteral stones is safe without stent placement. Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of increased complications.

Modified Tubularized Incised Plate Urethroplasty for Hypospadias Repair : A Long-Term Results of 764 Patients

OBJECTIVES To present our experience with a modification of tubularized incised plate (TIP) urethroplasty for treatment of anterior penile hypospadias. METHODS A total of 764 children with primary anterior penile hypospadias (462 subcoronal and 302 coronal) underwent hypospadias repair by using modified TIP urethroplasty. The technique involves, in addition to the standard TIP, the use of the dorsal prepuce which was divided in 2 flaps. The right flap was de-epithelialized on both the outer and inner sides and transferred as interposing layer between the neourethra and the coverings. The left flap was de-epithelialized on the inner side and transferred ventrally as skin coverage. The follow-up ranged between 3 and 52 months with a mean of 17 months. RESULTS Excellent functional and cosmetic results were achieved in 738 patients (96.6%). Urethral fistulae were encountered in 16 cases (2%) and were repaired successfully. Meatal stenosis was noted in 8 cases (1%) and successfully treated. Two patients had complete disruption of the wound (0.2%), which was corrected. CONCLUSIONS Excellent functional and cosmetic results can be achieved after repair of anterior penile hypospadias by using TIP urethroplasty with the modification of using double breasted de-epithelialized skin flap.

Percutaneous nephrolithotomy for management of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease.

OBJECTIVES To evaluate the role of percutaneous nephrolithotomy in management of the patients with autosomal dominant polycystic kidney disease and associated nephrolithiasis. METHODS A total of 19 patients with autosomal dominant polycystic kidney disease and upper urinary tract stones were included in the study. One patient had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size >2 cm in the largest diameter. All patients were treated by percutaneous nephrolithotomy at 2 centers. Therefore, 20 percutaneous nephrolithotomy procedures were performed. Most of the procedures were performed in 1 stage by the urology team under fluoroscopic guidance; 6 cases were done in 2 stages. The success rate and morbidity and mortality of the technique and hospital stay were recorded. RESULTS The pelvicaliceal system was successfully approached in all cases but 1. The overall stone-free rate was 89.4%. Renal function improved in the patients who presented with azotemia and was stable in the others. No patient died. Complications occurred in 3 procedures and consisted of mild postoperative hematuria in 1, bleeding through the nephrostomy tube in 1, and low-grade fever in 1. The mean hospital stay was 3 days. CONCLUSIONS Percutaneous nephrolithotomy is a safe and effective method for the treatment of patients with autosomal dominant polycystic kidney disease and associated upper urinary tract stones.

Difficult conditions in laparoscopic urologic surgery

Introduction.- Difficulties in Laparoscopic Access.- Difficulties in Anesthesia for Urologic Laparoscopy.- Difficulties in Urologic Laparoscopic Instrumentation.- Cost-Reductive Measures in Laparoscopy: Tips and Tricks for Developing Countries.- Difficulties in Laparoscopic Simple Nephrectomy.- Difficulties in Transperitoneal Laparoscopic Radical Nephrectomy.- Difficulties in Retroperitoneal Laparoscopic Radical Nephrectomy.- Difficulties in Laparoscopic Live Donor Nephrectomy.- Difficulties in Laparoscopic Nephroureterectomy.- Difficulties in Laparoscopic Partial Nephrectomy.- Difficulties in Laparoscopic Adrenalectomy.- Difficulties in Laparoscopic Renal Cyst Removal and Giant Hydronephrosis Nephrectomy.- Difficulties in Laparoscopic Simple Prostatectomy.- Difficulties in Laparoscopic Radical Prostatectomy.- Difficulties in Robotic Radical Prostatectomy.- Difficulties in Robotic-Assisted Nerve-Sparing Radical Prostatectomy.- Difficulties in Laparoscopic Urologic Surgery in Kidney Transplant Patients and Obese Patients.- Difficulties in Laparoscopic Retroperitoneal Lymph Node Dissection.- Difficulties in Laparoscopic Radical Cystectomy.- Difficulties in Laparoscopic Pyeloplasty.- Difficulties in Laparoscopic Surgery for Urinary Stones.- Difficulties in Laparoscopic Ureteral and Bladder Reconstruction.- Difficulties in Laparoscopic Ureterolysis and Retroperitoneal Lymph Node Dissection.- Difficulties in Laparoscopic Management of Vesicovaginal Fistula.- Difficulties in the Laparoscopic Treatment of Female Genital Prolaspe.- Difficulties in Pediatric Laparoscopic Urologic Surgery.- Difficulties in Single Port Laparoscopic Procedures.- Difficulties in Urologic Laparoscopy Complications.- Difficulties in Laparoscopic Training, Mentoring, and Medico-Legal Issues.-

Single Versus Double Ureteral Stent Placement After Laser Endoureterotomy for the Management of Benign Ureteral Strictures: A Randomized Clinical Trial

BACKGROUND AND PURPOSE Endoureterotomy is a viable option for treating patients with benign ureteral stricture. We compared the efficacy and safety of double versus single ureteral stent placement after laser endoureterotomy. PATIENTS AND METHODS This study included 55 patients with benign ureteral strictures; all patients underwent retrograde laser endoureterotomy. Patients were randomized either to single or double ureteral stents. Single stents were placed in 27 ureters while double stents were placed in 28 ureters. The stent diameter used was 7 F, and stents were indwelling for 8 weeks. Imaging was performed 1 month after stent removal and repeated regularly every 3 months. Clinical characteristics, operative results, and functional outcomes were compared for strictures managed in both groups. Success was evaluated both subjectively and objectively. RESULTS Fifty-five patients with a mean age of 46 (16-75) years had benign ureteral strictures; the mean stricture length was 1.92 (1-3) cm. The mean follow-up was 25.7 (9-42) months. The overall success rate was 67.3% (37 patients) with no radiologic evidence of obstruction, 6 (10.9%) patients showed symptomatic improvement while 12 (21.8%) patients underwent surgical reconstruction. Success was significantly higher for ureteral strictures (>1.5 cm) managed with double stent placement (82.4%), compared with single stent placement (38.9%) with a P value of 0.009. CONCLUSIONS Double stent placement of the ureter after laser endoureterotomy achieved a higher success rate compared with single stent placement in cases of benign ureteral strictures. Although ureteral strictures (≤1.5 cm) achieved better outcome after laser endoureterotomy, strictures (>1.5 cm) favored better with double stent versus single stent placement.

Difficult cases in endourology

Difficult cases in endourology / , Difficult cases in endourology / , کتابخانه دیجیتال جندی شاپور اهواز

Current trends in percutaneous nephrolithotomy: an internet-based survey

Background: The aim of this study was to report current practices of percutaneous nephrolithotomy (PCNL) among endourologists. Methods: An internet survey was administered to Endourological Society members. Responders were distributed into three groups according to the number of PCNL cases per year (<50, 50–100, >100). PCNL technical details as well as opinions regarding specific clinical case scenarios were evaluated and compared between groups. Results: We received 300 responses from 47 different countries. Prone position was used in 77% of cases, while 16% used supine position and only 7% used modified lateral decubitus. Most endourologists performed their own access. There were no significant differences between the three groups regarding patient position (p = 0.1), puncture acquisition by urologist or radiologist (p = 0.2) and fluoroscopic puncture technique (p = 0.2). Endourologists with high annual PCNL practice (>100) had least probability to utilize nephrostomy tube (p = 0.0005) or use balloon dilator (p = 0.0001). They also had the highest probability of performing mini-PERC (p = 0.0001). Conclusions: The majority of endourologists performing PCNL obtain their own access. Prone positioning is predominant, while totally tubeless PCNL are uncommon. Mini-PERC is gaining more popularity among endourologists. Most endourologists follow the guidelines for their choice of treatment modality in different sizes and locations of upper tract calculi.

Can endourology fellowship training enhance minimally invasive surgery in urology practice

Abstract Objective To evaluate the influence of fellowship training in endourology on different endourological procedures in a single institution. Subjects and methods The operative records of endourological and open surgeries were reviewed. Data analysed included numbers, types, and technical issues related to surgeries. The early study period ranged from September 1998 to September 2004, and the later period from January 2014 to June 2016. The study duration was classified into three periods according to the availability of an endourology fellowship trained member of staff (EFTS). In period A (September 1998 to September 2001) no EFTS was available, in period B (October 2001 to September 2004) an EFTS joined the urology unit, and in period C (January 2014 to June-2016) the EFTS had left the urology unit. Results In periods B and C the number of rigid ureteroscopy (URS) significantly increased compared with period A. Also, flexible URS was used for the first time in period B and continued in period C. The number of percutaneous nephrolithotomies increased in period B and continued to be performed in period C. Laparoscopic urological surgery was not undertaken in period A, and only done in four cases in period C, whilst it was performed in 62 patients in period B. Holmium laser enucleation of the prostate was carried out in 36 patients during period B and not performed in periods A and C. Finally, the number of open stone surgeries decreased in periods B and C. Conclusion The introduction of an EFTS definitely enhanced the practice of minimally invasive procedures.

Visceral Complications of Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) was introduced in the 1970s as a minimally invasive procedure in the treatment of renal stones, with further development in its technique in the ensuing years. Indications for PCNL have diminished with the appearance of extracorporeal shock wave lithotripsy (ESWL) in the early years of 1980s, but then they gradually increased. Currently, the role of PCNL is mainly in the treatment of large, multiple, complex, and lower calyceal stones. The efficacy of PCNL has increased with the improvement and introduction of new instruments such as the flexible nephroscope, the ureteroscope, and intracorporeal lithotripsy technology (ultrasound, pneumatic, and laser devices).

Difficulties in Laparoscopic Access

Laparoscopic surgery has developed rapidly over the last few years, and many surgical procedures formerly carried out through large abdominal incisions are now performed laparoscopically. Reduction of the trauma of access by avoidance of large wounds has been the driving force for such development.1 However, the insertion of needles and trocars necessary for the pneumoperitoneum and the performance of the procedure are not without risk.2 The technical modifications imposed by surgical laparoscopy are obvious (e.g., number and size of trocars, location of insertion sites, specimen retrieval), and therefore morbidity may be substantially modified. Complications such as retroperitoneal vascular injury, intestinal perforation, wound herniation, wound infection, abdominal wall hematoma, and trocar site mestastasis have been reported.3