Morshed A. Salah

Comparison of 150 Simultaneous Bilateral and 300 Unilateral Percutaneous Nephrolithotomies

Purpose: To compare the results, complications, efficiency, and safety of simultaneous bilateral percutaneous nephrolithotomy (SBPN) and unilateral percutaneous nephrolithotomy (PCNL). Patients and Methods: We compared the results and complications of 150 SBPNs with those of 300 unilateral PCNLs. All the procedures were performed by one surgeon which provides relatively constant parameters. The success rates, preoperative and postoperative laboratory results, and complications were compared on the basis of stone size and the number of nephrostomy tracks. Results: There were no significant differences between the results and complications of SBPN and PCNL. The SBPN itself did not cause more blood loss than unilateral PCNL. In both groups, the blood loss was in direct proportion to the size of the stones and the number of nephrostomy tracks. After SBPN, kidney function improved >20% in 12.2% of the patients and worsened for more than 3 days in only 4%. Temporary worsening of kidney function occurred in the ...

Simultaneous bilateral percutaneous nephrolithotomy in children.

In the paediatric section, two papers relating to the upper urinary tract are presented. The first, from Hungary, describes simultaneous bilateral percutaneous nephrolithotomy in 13 patients, where it was deemed feasible; this is the first such report. Authors from London report on unilateral nephrectomy in patients with nephrogenic hypertension, and found that it was successful in normalising blood pressure in patients with renal hypertension with a normal contralateral kidney.

Percutaneous Suprapubic Cystolithotripsy for Pediatric Bladder Stones in a Developing Country

Objective: To evaluate our experience with percutaneous suprapubic cystolithotripsy (PCCL) in Yemeni children with endemic urinary bladder stones. Patients and Methods: Between January 1993 and December 1998, 117 children underwent percutaneous suprapubic lithotripsy in Arabia Felix Modern Hospital, Sana’a Republic of Yemen. The patients’ ages ranged from 8 months to 14 years (average 3.7 years). Ninety patients (77%) were under 5 years old; 20 patients (16%) were between 6 and 10 years old, and 7 patients (6%) were between 11 and 14 years old. There were 116 boys and 1 girl. The stone size ranged from 0.7 to 4 (average 2.3) cm. Five patients had coexisting urinary bilharziasis and another 5 patients had coexisting renal stone. In 10 patients, the stone was in the urethra. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was an adult 26–french nephroscope, the same as that used for percutaneous nephrolithotripsy. Ultrasound disintegration was needed for stones of >1 cm. A suprapubic catheter was left for 24 h, and a urethral catheter was kept for 48 h. Results: All patients became stone free. The average operating time was 15 (5–50) min. The average hospital stay was 2.7 (2–5) days. No severe intra– or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 109 patients (93%). Conclusion: Based on our experience we can conclude that percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. Our series proves the nutritional etiology of endemic pediatric bladder stones. To our knowledge, this is the largest series reported on percutaneous suprapubic management of endemic bladder stones in children.

Percutaneous nephrolithotomy in early pregnancy

We report on an 11-weeks pregnant woman, who under went a percutaneous nephrolithotomy without the use of X-rays during the procedure due to 8-mm left upper ureteric stone. In the available literature, we didn’t find any reported case about percutaneous stone removal without the use of X-rays.

Ultrasonography of urinary tract lesions caused by bilharziasis in Yemeni patients

Objective To evaluate abnormalities detected by ultrasonography in Yemeni patients with active Schistosoma haematobium infection.

Laparoscopic removal of a paracaval air gun bullet in a child.

Air guns are known as low-velocity arms and are considered harmless. However, injuries from air weapons can be serious and even fatal, particularly in children. We present a potentially life-threatening penetrating retroperitoneal injury of a 3-year-old boy caused by an air gun, and the successful removal of the bullet via a laparoscopic approach. The patient was brought to our center with a penetrating air gunshot wound on his right side in the waist area. He was accidentally shot by his brother at their home. The patient’s clinical condition was stable. Computed tomography scan showed the bullet in the retroperitoneum near the inferior vena cava. A three-port laparoscopic transperitoneal approach was performed. The bullet was found just 0.5 cm caudal to the right renal hilum and 0.5 cm near the inferior vena cava; it was then removed. Operation time was 42 min and the postoperative course was uneventful. Thanks to improvements in laparoscopic surgical techniques, laparoscopy has become a feasible and effective treatment modality even for the removal of foreign bodies in children.

Very Late Relapse of Testicular Tumour in Combination with Renal Cancer and Their Retroperitoneoscopic Removal

Late relapse of a testicular cancer is an uncommon occurrence. We report a case of late relapse of a testicular tumour combined with a renal cancer and their successful removal with retroperitoneoscopy. The 36-year-old patient underwent left orchiectomy, retroperitoneal lymph node dissection, and chemotherapy, because of mixed tumor including teratoma and embryonal carcinoma. 18 years after the successful primary therapy elevated serum alpha-fetoprotein level had been confirmed, then MRI and PET-CT scans demonstrated a 30 mm left renal mass and 22 mm retroperitoneal lymph node above the bifurcation of the left common iliac artery. We performed retroperitoneoscopic lymph node dissection and left renal tumour resection in the same session. The histology revealed embryonal carcinoma for the retroperitoneal lymph node and renal cell carcinoma for the left renal mass. We can conclude that late followup of patients with testicular tumour is important. Retroperitoneoscopy is feasible approach for the removal of retroperitoneal lymph node metastasis and resection of renal tumor.

Renal tumor-like pyonephrosis with foreign body.

We report on a male patient who underwent abdominal ultrasound examination because of another disease. Ultrasonography showed a left renal mass, which was suspicious of renal tumor. Computerized tomography (CT) confirmed the suspicion. Nephrectomy was performed. The removed kidney was pyonephrotic and a foreign body was found in the collecting system. The foreign body had been in the kidney for 36 years. The patient had not had any symptoms for more than 3 decades. To our knowledge we report the first case of this kind. CASE REPORT A 56-year-old man was treated for anterior wall myocardial infarction. During treatment an abdominal ultrasound examination showed a 10 cm. hypoechogenic mass with central hyperechogenic structures in the upper pole of the left kidney. CT revealed a well-defined 10 cm. cystic lesion occupying the upper half of the left kidney. The mass had a chunky wall and cystic structures with smaller and bigger calcifications inside them (fig. 1). The structure of the lower half was normal and it had good excretion without dilatation of the collecting system. Renal tumor was strongly suspected. In 1963 the patient had undergone pyeloplasty due to a ureteropelvic junction stricture. According to the report of the operation ,a2t o 3c m.segment of the ureter was resected and a new anastomosis was performed with stenting of the ureter and placement of a transrenal drain. The patient had an acute myocardial infarction in 1998 and 1999. He did not have any voiding symptoms and only slight blunt loin pain, which was thought to be related to rheumatical origin. Fever and loss of body weight were not noted. Physical examination did not reveal any abnormality. Red blood count was 4.3 mmol./L., homozygous typing cells were 0.39, white blood count was 7.0 3 10 9 /l., platelets were 181 10 9 /l., urea was 59 mmol./l. and creatinine was 78 mmol./l., which were all normal. After a complete examination, exploration was performed. The retroperitoneum was explored via a lumbar incision. The fetal head-like kidney was mobilized from its surrounding scarred tissues. The kidney was removed en bloc with its fatty capsule after ligation of the renal pedicle and ureter. After the operation, the removed kidney was cut longitudinally. The parenchyma was only in the lower pole, and above it there was a large sack containing thick, yellowish-red pus. Inside the pus, a textile tissue was found (fig. 2). Convalescence was uneventful. The patient was discharged from the hospital on postoperative day 8. Histological examination demonstrated atrophic renal tissue, chronic interstitial inflammation, scarring in the pelvis and peripelvic fatty tissue, and deteriorated gauze in the collecting system. Postoperatively the patient was symptom-free with no flank pain. Ultrasonography showed normal right kidney and the bed of the left kidney was empty. Laboratory tests were normal. DISCUSSION