RESUMEN
The aim of this study was to evaluate the safety and efficacy of the supracostal access for percutaneous nephrolithotomy (PCNL). Between July 2007 and June 2010, 122 patients underwent PCNL, of whom 28 (23%) had supracostal access. All procedures were performed in a single sitting under general anesthesia. The data were analysed for indications, stone clearance rates and the complications associated with supracostal puncture. The indications for a supracostal access were staghorn stones (50%), pelvis stones (28.5%), calyceal stones in high-lying kidney (18%) and upper ureter/ureteric stones (3.5%). All tracts were made in the 11th intercostal space. Single tract access was used in 22 cases (78%), but 6 (22%) required a second tract. Additional punctures were required mainly for staghorn stones (4 out of 14). Overall, 82% of the patients were rendered stone free or had clinically insignificant residual stones with PCNL monotherapy, and this increased to 96% with secondary procedures. In patients with staghorn stones, they were completely cleared in 78%. Overall complication rate was 28% and included hydrothorax in 3 (10%) patients, which required insertion of a chest tube. One (3.5%) patient developed haemothorax secondary to injury of the intercostal artery, pelvic perforation in 1 (3.5%), perinephric collection in 1 (3.5%), infection/sepsis in 2 (7%). Except those patients who had complication, all other patient recovered uneventfully. Postoperative hospital stay ranged from 2 to 9 days. In conclusion, supracostal access gives high clearance rate with acceptable complications and should not be avoided for fear of chest complications.
Asunto(s)
Cálculos Renales/cirugía , Nefrostomía Percutánea/métodos , Cálculos Ureterales/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefrostomía Percutánea/efectos adversos , Adulto JovenRESUMEN
Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra which might cause ischemia of the urethra. The present study was conducted to determine the feasibility and short-term outcomes of applying dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization approach. This hospital based prospective interventional study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July, 2009 to December, 2010. Total 30 patients with long-segment anterior urethral strictures were selected and treated by a dorsolateral free buccal mucosa graft. The test statistics used to analyse the data were Chi-square (chi2) test and Student's t-Test. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. After 6 months follow up results were prepared. Three (10%) patients developed wound infection. One (3.3%) patient developed urethrocutaneous fistula and one (3.3%) patient had chordee. Wound infections were treated conservatively. Twenty eight (93.3%) patients out of 30 had subjective improvement of urine flow after operation. All of these patients had postoperative Q(max) > 10 ml/sec. Postoperative Retrograde Urethrogram (RGU) of 28 (93.3%) patients was free of stricture and 2 (6.7%) patients showed stricture who had postoperative Q(max) < 10 ml/sec. Overall success rate was 93.3% at 3 to 12 months follow up. Unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for long segment anterior urethral strictures with good short-term success.
Asunto(s)
Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Bangladesh , Estudios de Factibilidad , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Estrechez Uretral/fisiopatologíaRESUMEN
This study was carried-out to find-out better and effective treatment option for Lower Ureteric Stones (LUS) by comparing Extracorporeal Shock Wave Lithotripsy (ESWL) with ureterorenoscopic (URS) Intracorporeal Pneumatic Lithotripsy (ICPL). A total of 60 patients attending the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with lower ureteric stones were divided into two groups, 30 in group-I (URS + ICPL) and the remaining 30 in group-II (ESWL). In group-I, 60% were male with mean age of 32.76 years and in group-II, 40% were male with mean age of 36.23 years. The ratio of involvement of right to left ureter was 1.7:1. The mean stone size was 10.7 + 2.69 mm (SD) in group-I and 9.9 + 1.97 mm (SD) in group-II. The differences in age, sex and side of involvement of ureter were not significant (p > 0.05) between the two groups. Among the groups 24 (80%) in group-I and 26 (86.61%) of patients in group-II were found stone free. The post procedure loin pain, fever and haematuria were more common in group-I than in group-II. The LUTS and loin pain were significantly more in group-I than in group-II (p < 0.05). The post procedure fever was significantly more in group-I than in group-II (p < 0.001). The mean post procedure hospital stay was 5.7 + 2.54 days for group-I and 1.57 + 0.531 days for group-II. Post procedure hospital stay was significantly less in group-II than in group-I (p < 0.05). The post procedure follow up attendance in this study was significantly low in group-I than in group-II (p < 0.05). ESWL was found effective method than URS + ICPL for the treatment of lower ureteric stones.
Asunto(s)
Endoscopía , Litotricia/métodos , Cálculos Ureterales/terapia , Ureteroscopía/métodos , Adulto , Femenino , Humanos , Tiempo de Internación , Litotricia/instrumentación , Masculino , Estudios Prospectivos , Factores de TiempoRESUMEN
Medical treatment for symptomatic Benign Prostatic Hyperplasia (BPH) has become popular for the last few years. This study was designed to find out and compare the efficacy of terazosin, a alpha1 adrenoceptor blocker and finasteride, a 5alpha-reductase inhibitor in symptomatic BPH. A total of 60 patients (30 in terazosin group and 30 finasteride group) of symptomatic BPH were selected. Terazosin group received 1 mg daily at bedtime for 3 days, 2 mg at bedtime for 7 days, thereafter 5 mg at bedtime daily for 6 months. Finasteride group received 5 mg once daily. In terazosin treated patients, improvement after 3 months were as follows, IPSS 3.93 +/- .74 points reduction, Qmax 2.13 +/- .68 ml/s increase, post-voided residual urine volume (PVR) 20.67 +/- 10.56 ml reduction (significant, p<0.001) and prostate volume 0.57 +/- 1.54 ml reduction (not significant). Similar statistical differences were observed at 6 months follow up. In finasteride treated patients, improvements after 3 months were as follows, International Prostate Symptom Score (IPSS) 1.38 +/- .63 points reduction, Qmax 0.55 +/- 0.78 ml/s increase, PVR 5.93 +/- 7.64 ml reduction (significant, p<0.001) and prostate volume 0.17 +/- 5.6 ml reduction (non-significant). At 6 month follow up statistical differences were significant in all parameters including prostate volume 4.57 +/- 5.30 ml reduction (p<0.001). In comparison, statistically significant superiority of terazosin over finasteride was found in improving IPSS, Qmax and PVR in both follow up visits. But terazosin had nonsignificant effect in reducing prostate volume; in contrast, finasteride had significant effect in second visit. It can be concluded from this study that terazosin 5mg once daily is effective in mild to moderate cases of symptomatic BPH. On the other hand, finasteride 5mg once daily may be useful in large prostate and to be given for at least 6 months.
Asunto(s)
Antagonistas Adrenérgicos alfa/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Finasterida/uso terapéutico , Prazosina/análogos & derivados , Hiperplasia Prostática/tratamiento farmacológico , Anciano , Bangladesh , Humanos , Masculino , Persona de Mediana Edad , Prazosina/uso terapéutico , Hiperplasia Prostática/orina , Resultado del TratamientoRESUMEN
This study was aimed to demonstrate the significance of free/total Prostate Specific Antigen (PSA) ratio in the diagnosis of prostatic enlargement. The study was carried out in a total number of 100 subjects, of which 58 had benign prostatic hyperplasia (BPH), 42 had carcinoma prostate and 50 were age matched control. The subjects were collected from Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU). Venous blood (5ml) was drawn from each subject before digital rectal examination or pre-urethral manipulation for estimation of PSA. Final diagnosis was made by histopathological examination, specimen being obtained by transurethral resection of prostate (TURP), open prostatectomy and per rectal tru-cut biopsy with biopsy gun. The study showed a highly significant difference of serum PSA and free/total PSA ratio in differentiating BPH from carcinoma prostate. Free/total PSA ratio was highly significant in differentiating between BPH and carcinoma prostate (p<0.001) and carcinoma prostate and control (p<0.001). In the marginally elevated PSA, free/total PSA ratio reduced biopsy by 81-85% in BPH and carcinoma prostate respectively. The overall specificity, positive predictive value and efficiency of free/total PSA was much higher than that of total PSA in differentiating BPH from carcinoma prostate.