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Year : 2015  |  Volume : 7  |  Issue : 7  |  Page : 126-133  


Date of Web Publication13-Oct-2015

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How to cite this article:
. Endo-Urology. Urol Ann 2015;7, Suppl S3:126-33

How to cite this URL:
. Endo-Urology. Urol Ann [serial online] 2015 [cited 2021 Sep 24];7, Suppl S3:126-33. Available from: https://www.urologyannals.com/text.asp?2015/7/7/126/167235

Uretero-pelvic junction obstruction in adults

Faris M. Ayyat, M. Al Jishi

Dhahran Health Centre, Dhahran, Saudi Arabia

Twenty-three adult patients were treated at Dhahran Health Center between 1982 and 1989 with a follow up range of 18 months to 87 months a mean follow up of 50.7 months, i.e., 4.1 years. The age ranges between 19 years and 49 years and a mean of 30 years. Male to female ratio 1.3:1, and all patients had unilateral disease, except 2 patients who had mild stenosis of the contralateral side. Left to right ratio 1.2:1. Patients presented with abdominal pain 78%, 18 cases. Two patients presented with abdominal mass and one with hematuria. One with a lower urinary tract infection and one incidental finding during a C-section. Twenty-three kidneys were operated 4 underwent nephrectomy, 16 patients underwent dismembered pyeloplasty, 2 patients had culp technique and one division of a fibrous band in front of the UPJ. Those patients were followed up by renal scans with diuretic or urography, serum electrolytes, BUN, creatinine, urinalysis and urine culture. Complications encountered in 3 patients who developed renal calculi and all were treated with ESWL. Those 3 patients and deteriorating renal function and one of them had developed hypertension, i.e., rate of complication of 13%. No mortality in the series. In conclusion, the adult UPJ differs from the paediatric by the equal male to female ratio versus 2.5:1 in paediatrics. Bilaterality is common under one year of age in paediatrics, but almost all of our series had unilateral disease. More nephrectomies were performed in the adult versus children with a higher complication rate. We recommend that all patients undergo a renal scan function evaluation before surgery and if the differential function index is less than 10% on the diseased side, nephrectomy should be contemplated and not reconstruction because of further complication. The three patients who developed the complication were very questionable for reconstruction.

Presented at the: 5th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Ileal replacement of the ureter

Ahmed A. Shokeir, Mohamed A. Gaballah, Mohamed A. Ghoneim

Urology and Nephrology Center, Mansoura, Egypt

Ileal replacement may be indicated for severely damaged trial to avoid the complications of reflux and dilatation of the simple ileal ureter, tailoring and nipple valve were carried out.

50 cases of ileal ureter were done in a prospective manner. Patients were randomized into 2 groups: In the first group no tailoring or nipple valve were done, while in the second group both procedures were carried out. Investigations included creatinine clearance, Na, K, blood gasses, urine culture, urine viscosity, KUB, IVU, retrograde pyelography under flouroscopy were performed. Patients were followed up for 6-19 months.

Tailoring and valve were superior to simple ileal ureter in terms of better renal function, lower incidence of urinary tract infection, less electrolyte and acid-base disturbances. Also none of the tailored group required TUR of the bladder neck due to low mucus secretion. The peristaltic activity of the tailored valved ileal ureter simulates the normal ureteral peristalsis. Desusception of the nipple valve occurring in some cases, early in the study, was minimized by technical modifications.

Tailoring and nipple valve can be considered as steps towards improving the function of the newly fashioned ureter. We recommend both procedures whenever ileal ureter is indicated except for recurrent stone formers.

Presented at the: 5th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Prognosis of radiology non-function kidney

Saoud A. Taha, Adel A.K. Sayed, K. Baher, R.A. Anikwe

Urology Division, King Fahd Hospital of the University, King Faisal University, Dammam, Saudi Arabia

Twenty patients found to have unilateral radiologically non-functioning obstructed kidneys on excretory urogram (IVU), and with normal contralateral kidneys, were further evaluated and treated. Ultrasonography, radio-nuclide imaging and CT scan were carried out pre-operatively to predict which of the kidneys were potentially recoverable after the relief of obstruction. Percutaneous nephrostomy was also performed on the last consecutive 7 patients 4 weeks before definitive treatment and the functions of the kidneys determined daily. The patients were re-evaluated 2 months after the relief of the kidney obstruction. Ultrasonography, radio-nuclide imaging and CT scan were found not to be reliable parameters for predicting whether these kidneys were potentially recoverable. We consider percutaneous nephrostomy a good procedure for obtaining prognostic information before the relief of kidney obstruction.

Presented at the: 5th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Endopyelotomy for pelviureteric junction obstruction obstruction: 5 years experience

M. El Kenawy, H. El Kappany, M.A. Ghoneim

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

We incised PUJ obstruction in 40 patients with a Cold Knife direct vision urethrotome inserted through a percutaneous Nephrostomy Tract. 36 were males and 4 females. Their age ranged between 10 and 62 years. Three (3) patients had Solitary Kidneys. 6 patients had primary while 34 had Secondary PUJ Obstruction (following pyelolithotomy, Pyeloplasty or PCNL). In 18 patients, Renal Calculi were removed eno-urologically during the same session.

An overall success rate of 85% was reported. Success rate was superior in secondary PUJ obstruction (91.2%) than primary (50%).

Technique as well as recommendation to prevent failures will be stated.

Presented at the: 7th Saudi Urological Conference

Riyadh Armed Forces Hospital

11-12 November 1992

Nephrectomy over a 4 years period

Faris M. Ayyat

Dhahran Health Centre, Saudi Aramco, Dhahran, Saudi Arabia

This is a retrospective study in which 35 cases of nephrectomy were performed in Dhahran Health Centre over 4 years. The age ranged between newborn and 78 years, with a mean of 32.5 years. Male to female, 15 to 20. Right side to left side, 22 to 12, and 1 transplant kidney. Of those 35 cases, 6 underwent partial nephrectomy, and 12 cases were carried out by General Surgeons before the arrival of a Urologist at Dhahran Health Centre in 1982, 23 cases were carried out by a Urologist. We compared the nephrectomies performed by a General Surgeon to the ones performed by the Urologist. 7 cases of cancer kidneys were encountered, 1 oncocytoma, and 6 cases of renal cell carcinoma. All of them underwent radical nephrectomy, 6 of those were on the left side and 1 on the right side. 1 case only was a Wilm's tumour. The other 28 cases were secondary to PUJ obstruction in 6 cases, calculi in 11, secondary to renal vein thrombosis and 1 in a rejected transplanted kidney. Hospital stay ranged between 5 to 27 days with an average of 13.4 days. The average blood loss of 500 ml for nephrectomy and 350 ml for a total nephrectomy.

Results: All patients are still alive and 2 of them had chronic renal failure, which pre-existed before surgery. 1 was a kidney transplant and 1 poorly functioning kidneys bilaterally. The 7 cases of cancer kidney are still alive with an average survival of 73 months. Follow up ranged between 46 months up to 131 months. When we compared nephrectomy performed by a General Surgeon to those performed by the Urologist, we have observed the following:

  • There were 4 missed cases of cancer kidneys on previous IVPs seen by General Surgeons and they were confirmed by the Urologist. 3 of them were 3 years late and 1 case 5 years later
  • No partial nephrectomy was carried out by any General Surgeon
  • 1 kidney was removed with no good reason for removal.

Therefore, we recommend that all cases of nephrectomy should be assessed and operated by a Urologist.

Presented at the: 8th Saudi Urological Conference

King Fahd Military Medical Complex

9-10 November 1993

The value of percutaneous nephrostomy in obstructive uropathy

I. Al Oraifi, A. Al Dayel, M. Ezzibdeh, S. Egail, E. El Sayed, C. Layaz

Department of Urology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Percutaneous nephrostomy placement was carried out in 185 patients, 132 males and 53 females between 7 days and 89 years old with obstructed urinary tract. The percutaneous nephrostomy tube insertion was performed under ultrasound guidance and fluoroscopy using posterio-lateral approach under local anaesthesia in 164 patients, general anaesthesia in 19 patients, and epidural anaesthesia in 2 patients. The nephrostomy catheter was removed after dealing with the aetiology of obstruction. The indication was obstruction due to impacted ureteric stone in 77 patients, renal stone 31, steinstrasse 25, ureteric stricture 15, pyelonephrosis 12, renal impairment with hydronephrosis 11, pelvi-ureteric junction stenosis 4, post ureteral valves 3, and other causes 7 patients. Fifty four patients (29.2%) were found to have infected urine aspirated from the kidney at the time of insertion. There were 13 complications, 8 patients developed urinary tract infection, resolved with antibiotic treatment, 4 patients the catheter was displaced and replaced, and 1 patient developed hematuria upon removal of the catheter.

Ultrasonic guided percutaneous nephrostomy is a valuable technique to establish rapid renal decompression in complicated supravesical urinary obstruction, it provides access for antegrade examinations and allows to defer the management until the general condition of the patient improves.

Presented at the: 8th Saudi Urlogical Conference

King Fahd Military Medical Complex

9-10 November 1993

Management of reflux in case of ureteral duplication

Med. Burchardt

Department of Urology, Urology Service, Langen-Debstedt, Germany

In complete duplication vesicoureteral reflux is a common cause of acquired disease. Low grade reflux is not operated in only single ureters conservative treatment with low doses of prophylactic is preferred.

But in duplication, we never saw the disappearance of reflux by applying conservative treatment. Thus we operated 41 patients, most of them were children, 16 with reflux in upper segment ureters, 28 in lower segment ureters, 8 in both ureters, dystopic ureters in 10 patients.

Treatment should be selective with anti reflux operation for both ureters, with hemiureteronephrectomy in case of scared upper or seldom lower kidney segment with anti reflux operation of the other ureter. We would like to present our experience with these 41 patients.

Presented at the: 9th Saudi Urology Conference

King Fahad Hospital, Jeddah

14-16 November 1995

Chronic renal failure a significant risk factor in the development of acquired renal cystic disease and renal cell carcinoma: Case reports and review of literature

Mohamed Tarakji, Munzer Aragi, Ahmed Sirwi, A. Fallatah, F.A.M. Shaheen

Jeddah Kidney Center, King Fahd Hospital, Jeddah, Saudi Arabia

Three cases of renal cell carcinoma in three male patients with end-stage renal failure are reported here. One case was presented with hematuria, the second case was detected by screening ultrasound and the third was diagnosed after nephrectomy due to bilateral vesico-renal reflux before a kidney transplantation. The literature is reviewed, and the relationship between renal cell carcinoma and uremia is discussed.

A known complication of end-stage renal failure, acquired renal cystic disease (ARCD) and renal cell carcinoma had been reported with or without hemodialysis. The incidence rate of acquired renal cystic disease in patients not receiving hemodialysis is about 44% while this rate rises with time on dialysis and duration of chronic renal failure.

The reported incidence of renal cell carcinoma in chronic renal failure receiving dialysis ranges from 0.22% to 1.5%. This incidence rate is even higher in association with acquired renal cystic disease caused by end-stage renal failure reaching till 3% (Bretan, 1984). This incidence rate is highly significant if compared to the incidence rate in general population (0.08%).

Patients with chronic renal failure should be monitored carefully by routine ultrasound for the development of both renal cysts and tumours even though they have not started on chronic dialysis.

Presented at the: 9th Saudi Urology Conference

King Fahad Hospital, Jeddah

14-16 November 1995

Early renal insufficiency secondary to ovarian vein syndrome

Mahmoud Tarsin

Department of Urology, Riyadh Central Hospital, Riyadh, Saudi Arabia

Although ovarian vein syndrome was sometimes questionable entity, since was first described by Clerk in 1964. There has been much more controversy over its existence since then. Many authors recognised the syndrome after the initial skepticism about its reality the syndrome was described to be more common in multi-para women, but has been reported in younger ones who have never been married and never been pregnant. We report 4 cases of ovarian vein syndrome as a separate clinical entity and not a myth as advocated by (Dure-Smith), causing significant renal impairment secondary to either bilateral or unilateral ureteral obstruction, the main presenting complains of these cases are lumber or bilateral loin pain of long duration, occasionally resembles severe renal colic, associated sometimes with increase fluid intake or hydration. Other patients may present with recurrent urinary tract infection secondary to either stasis or stone formation.

The diagnosis was made by intravenous pyelography, ultrasonography, retrograde ureterogram, and venography in 3 cases, and in one case we confirmed our diagnosis with Laparoscopy. The close relationship of the ureter and gonadal blood vessels is often clearly demonstrated by computed tomography.

Surgical ligation of the ovarian veins has been used effectively in our small series of patients with this condition.

Presented at the: 9th Saudi Urology Conference

King Fahad Hospital, Jeddah

14-16 November 1995

Uretero-cytoplasty and reimplantaion of proximal ureters via an intussusception valve - Preliminary report

A.H. Kardar, T. Sundin, E. Lindstedt, A. Peracha

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Aim of Study: To evaluate the outcome of management by a new technique in patients with a hypocompliant small bladder and dilated upper tracts due to reflux and/or obstruction.

Materials and Methods Used: Three patients with the diagnosis of hypocompliant bladder, hydronephrosis and bilateral hydroureter with renal failure, were operated upon. The technique used was augmentation of the bladder by the distal part of both ureters and reimplantation of proximal ureters behind an intussusception valve which was constructed from a segment of ileum and anastomosed to the augmented bladder. Age ranges were between 13 and 52 years (mean 26.6). Two of the patients were males and one female. Serum creatinine ranged between 124 and 277 umol/l (mean 216.6). The etiology of hypocompliant bladder included spina bifida, chronic bilharzial cystitis and non-neurogenic bladder.

Results: After eight months of follow up, all patients have been asymptomatic, renal function has improved in one patient and stabilized in the other 2 patients. Eight months after the procedure, there was sliding of one nipple valve which was successfully repaired. Two of these patients are on intermittent catheterization and one is voiding spontaneously.

Conclusions: This method seems to be a satisfactory treatment option for hypocompliant detrusor patients with poor renal functions and hydroureter over a short follow up.

Presented at the: 10 th Saudi Urology Conference

King Fahad National Guard Hospital

26-28 November 1996

Minimal invasive surgery in complicated and high risk patients with hepato-biliary stones

K. Al Otaibi, A. Al Nammi, M. Ashour, R. Boyd, N. Al Khudairy, Z. Rasim

Dharan Health Center, Saudi Aramco, Dhahran, Saudi Arabia

Purpose: To review our experience in managing complicated and high risk patients with hepato-biliary stones.

Materials and Methods: A total of 14 patients presented with hepato-biliary stones. 3 with gall bladder stones, 9 with common bile duct stones and 2 presented with multiple intrahepatic duct stones. All patients underwent minimally invasive intervention, including ESWL, Endoscopic Laser Lithotripsy and stone manipulation. All except one patient were managed with local analgesia or intravenous sedation.

Results: Only 3 out of 6 patients had a successful ESWL. Percutaneous endoscopic stones managements carried out for 8 patients, including 3 managed with Holmium YAG Laser.

Conclusion: Complicated and high risk patients with hepato-biliary stones could be managed with minimally invasive intervention without subjecting patients for a major risky procedure. Percutaneous endoscopic management of stones in the hepato-biliary system is safe and feasible.

Presented at the: 15 th Saudi Urological Conference

King Fahd Hospital, Madinah Al Munawarah

7-9 May 2002 (24-26 Safar 1423)

Endo-urology: International perspective ureteroscopy and percutaneous nephrostomy in 2000

Demetrius H. Bagley

Department of Urology and Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Endourology is a young field, which has become a major component of urologic treatment. Endourologic techniques have become essential for the treatment of many lesions in the upper urinary tract.

Calculi remain the most frequent indication for endourologic procedures. ESWL is most commonly used to treat calculi, but recognition of its limitations and advances in endourologic instruments and techniques have begun to change this pattern. The developments of small diameter rigid and flexible ureteroscopes permit easier access to the ureter and kidney. The Holmium laser has added a very efficient endoscopic lithotripter, which can be delivered throughout the upper urinary tract with small caliber instruments. High success has been seen for renal calculi.

Endoscopic techniques have also changed the approach to filling defects and neoplasms in the upper urinary tract. Lesions can be inspected directly and biopsied to give an accurate diagnosis before treatment. Endoscopic laser therapy has been an effective technique for neoplasms. The success of treating small low grade tumors has extended these techniques to patients with normal contralateral kidneys.

Endopyelotomy has become the standard form of treatment for ureteropelvic junction obstruction. Ureteroscopic techniques have been added to the earlier percutaneous approaches with resultant similar success rates.

In these 3 groups of patients, the indications and success of ureteroscopic therapy have expanded with the development of new endoscopes and more efficient working instruments.

Presented at the: 13 th Saudi Urological Conference

Riyadh Armed Forces Hospital

14-17 February 2000 (09-12 Dhu Al Qa'dah 1420)

Arab perspective of endo-urology

Mohamed Lamine Smida

Department of Urology, College of Medicine, Tunis University, Tunis, Tunisia

Advances in technology have reduced the need for surgical techniques, replacing them with minimally invasive treatment options. We are observing astonishing changes in urology for the last twenty years. Diagnosis and treatment of urological diseases have become less invasive and more accurate with the development of new technologies in Endo-Urology.

The Endo-Urology includes so many procedures with which to reduce the invasiveness of our diagnosis and treatment. Initially, we were concerned primarily with percutaneous nephrolithotomy perfected by Alken and Wickham in the 80s. We then became interested in extracorporeal lithotripsy and ureteroscopy.

Percutaneous nephrostomy improved the treatment of stones and tumours allowing an access to the kidney with a minimal traumatism, to avoid technical difficulties shown among patients already operated, to remove parietal complications and to reduce the hospitalization duration. We are now familiar with the many devices for Endo-Urological lithotripsy.

Beyond the Tunisian experience of Endo-Urology, a review of publications and presentations made in the Arab World allowed us to deliver an Arab perspective on Endo-Urology.

Presented at the: 13 th Saudi Urological Conference

Riyadh Armed Forces Hospital

14-17 February 2000 (09-12 Dhu Al Qa'dah 1420)

Percutaneous endopyelotomy, experience in 28 cases

S. Khalil, M.A. Abdel Salam, A. Ghobeish, H.M. Kamel

Department of Urology, Al Amen Hospital, Taif, Saudi Arabia, Department of Urology, Zagazig and Suez Canal University, Egypt

Objective: Percutaneous endopyelotomy is effective in treatment of PUJ obstruction. This study evaluates our experience with 28 cases.

Materials and Methods: Twenty-eight cases of primary PUJ obstruction were documented by IVP and diuretic renography were treated by percutaneous endopyelotomy. Patients were 17 males and 11 females of mean age 24 years. They were all symptomatic. Renal stones were associated in 8 cases. Patients showed grade II and III hydronephrosis. The PUJ was incised by hot knife starting with the pelvic portion to identify the presence of a crossing vessel then the ureteral portion was incised. An internal double-J stent 7 Fr. Was left in all patients for 6 weeks. Cases were followed by diuretic renography at 2 months post-op.

Results: Patients were discharged 3-8 days post-operatively. Two cases had febrile urinary tract infection, which needed IV antibiotics. On follow up these cases persisted to symptomatize despite the absence of conclusive evidence of obstruction on diuretic renography. Twenty-three (82%) cases had good results for the follow up period 6-9 months. Three cases were offered open pyeloplasty and a crossing vessel were found in two. The association of stone or degree of hydronephrosis did not affect the outcome.

Conclusion: Percutaneous endopyelotomy is a safe effective treatment modality for managing cases of primary PUJ obstruction. The development of post-op. febrile UTI is an indicator of failure.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospitals Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Analysis of causes for surgical removal of the kidney at King Abdulaziz University Hospital in Jeddah, a 10 years experience

H.A. Mosli, M.A. Atwa, F.K. Al Thobaity

Department of Urology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Study Objective: To determine the most common cause of surgical loss of the kidney in patients seen at a tertiary referral university hospital during a ten-year period.

Methodology: Cases of nephrectomy performed at our hospital were reviewed. The items examined were: (1) Age at presentation, (2) sex distribution, (3) nationality of the patients, (4) the clinical presentation, (5) the associated general and urological conditions in particular renal stone disease, (6) the diagnostic imaging techniques used, and finally (7) the results of the histopathological examination of the excised renal tissue.

Findings: The data on ninety-one patients were available. There were 58 males and 33 females (male:female ratio 2:1). Coincidentally, 58 patients were non-Saudis and 33 only were Saudi nationals (ratio also 2:1). The causes for nephrectomy will be elaborated upon in the presentation but the majorities were performed for non-malignant causes.

Conclusions: The results of this study agree with one previous report from another center in the Kingdom that the majority of the diseases that end in nephrectomy were non-malignant in our country. This study puts more emphasis on the role of early diagnosis and treatment of those preventable diseases. We also need to know the experience of other centers that may deal with a different pattern of referred patients.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospitals Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Results of renal sympathetic denervation and nephropexy in nephroptosis

Ahmed N. Ghanem

Department of Urology, King Khalid Hospital, Najran, Saudi Arabia

Objective: To report results of RSD&N on 31 kidneys in 28 patients suffering from severe Loin Pain Nephroptosis Syndrome (LPNPS).

Materials and Methods: In a 5-year period, 28 patients suffering from intractable LPNPS consented for 31 RSD&N surgery. These patients were selected for surgery from a series of 120 females as based on failure of conservative treatment, frequent hospital admissions, nephroptosis of grades III and IV on an erect IVP film and the positive new sign and clinical tests of LPNPS. All the genito-urinary and other system investigations were repeatedly negative over a minimum period of 4 years follow up prior to surgery. Results were independently assessed and statistically analyzed.

Results: RSD&N cured the intractable renal pain in >87% of 31 kidneys of 28 patients, without postoperative morbidity or mortality, with a mean follow up period of 34.7 months (range 24-56 months). Renal pain and ptosis were bilateral but marked on the right side in 16 (57%), affected only the right kidney in 12 (43%) but pain was contra lateral to the marked right nephroptosis in 5 (18%) of cases. Visceroptosis with gastro-colonic symptoms and backache are common associations.

Conclusion: LPNPS is common in Najrani females causing severe incapacitation in 40% of cases. RSD&N are a curative and recommended procedure in LPNPS. A sympathetic-vascular hypothesis is proposed for explaining the pathophysiology of LPNPS and the associated symptoms of viscroptosis.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospitals Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Cutaneous ureterostomy long term follow up results

M. Aslam, A.H. Kardar, A.M. Peracha, E. Lindstedt, T. Merdad, H. Al Zahrani, S. Kattan, K.A. Hanash

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Introduction: In patients with advanced pelvic malignancy, ureteric obstruction can be relieved by stents, nephrostomy or cutaneous ureterostomy. We assessed indications as well as complications following cutaneous ureterostomy (CU).

Patients and Methods: Medical records (1986-1996) were reviewed to determine diagnosis, indication, type of cutaneous ureterostomy and complications. Stabilization of deterioration of upper tract determined by radiographic and renal function parameters.

Results: 39 patients had (CU): 27 males, 12 females. M-F ration=2.2:1, age 20-76 years, mean 52 years, followed up 1-118 months (mean 20 months) one lost to follow up. Squamous cell carcinoma of the bladder 16 (41%), T cell carcinoma 16 (41%), ca. cervix 2 (5%), VV fistula 2 (5%), neurogenic bladder 1 (2.5%), ca. rectum with vesicorectal fistula 1 (2.5%) and 1 (2.5%) pseudoextrophy bladder who was 20 years old. Transureteroureterostomy with cutaneous ureterostomy performed in 21 (53%), double barrel in 3 (7%) and end cutaneous ureterostomy in 14 (35%), 30 (76%) underwent CU with skin flap and 9 without skin flap. 8 (21%) developed stomal stenosis, stoma revised in 5 (13%), skin excoriation occurred in 10 (26%), upper tract deterioration 15 (39%), renal function improvement in 19 (49%), 4 (10%) required stenting, bacteriuria occurred in 19 (49%), renal impairment in 7 (18%) and upper tract remained stable in 26 (68%), 3 (7%) developed pyelonephritis. Only 3 out of 30 (9.9%) with skin flap developed stomal stenosis.

Conclusion: Cutaneous ureterostomy seems a reasonable alternative to nephrostomy in ureteral obstruction due to advanced pelvic malignancy with anticipated life expectancy of 6 months or more when performed with skin flap, it considerably reduced the risk to develop stomal stenosis.

Presented at the: 13 th Saudi Urological Conference

Riyadh Armed Forces Hospital

14-17 February 2000 (09-12 Dhu Al Qa'dah 1420)

Role of steroids in treatment of idiopathic retroperitoneal fibrosis

A.H. Kardar, E. Lindstedt, S. Kattan, K. Hanash

King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Introduction: The conventional method of treatment of idiopathic retroperitoneal fibrosis (IRF) has been surgical ureterolysis. Although surgery relieves the obstruction of the ureters, there remains the problem of ipsilateral recurrence and/or contralateral obstruction in addition to the compression of other retroperitoneal structures. We analyzed the results of treatment with glucocertiroids.

Materials and Methods: Ten patients (8 males and 2 females) between 29 and 56 years of age were diagnosed to have IRF. They were all of Middle Eastern origin (8 Saudis, 1 Bahraini, and 1 Egyptian). Most of them presented with raised creatinine and two of them were anuric. Prednisolone 60 mg was given orally on alternate days for two months and then tapered off to a daily maintenance dose of 5 mg for a total of two years. The response was monitored on the basis of changes in ESR, relief of obstruction of ureters on contrast study and changes in the size of the retroperitoneal mass on CT.

Results: Between 4 and 84 months after initiation of treatment, symptomatic relief was achieved in all patients and kidney function had improved or was preserved in previously functioning renal units. Two patients developed recurrence of their symptoms due to poor compliance of the treatment strategy.

Conclusion: Steroids may be used as primary treatment of IRF after histological/cytological diagnosis to exclude retroperitoneal malignancy. Patients with IRF should be followed for the rest of their lives, even after discontinuation of steroid therapy.

Presented at the: 11 th Saudi Urology Conference

King Fahd Military Medical Complex, Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Antegrade and retrograde endopyelotomy: A comparison of two techniques

Ashraf J. Abusamra, Karen Psooy, Denis Hosking

London Health Sciences Centers, London, Department of Urology, University of Western Ontario, Ontario, Canada

Objective: To evaluate our experience with antegrade and retrograde endopyelotomy retrospectively in order to compare our success rates with these two different techniques.

Methods: Between 1992 and 2000, 41 patients underwent 47 antegrade endopyelotomy procedures, and between July 2001 and February 2003, 20 retrograde endopyelotomies were done on 20 patients. Mean age was 44.4 years (1-77) and 44.5 years (13-75) for the antegrade and retrograde patients respectively. The main indications for the ante- and retrograde procedures were pain (83 and 95%), stone (26 and 5%), sepsis (13 and 5%), renal impairment (2 and 5%), and perinatal hydronephrosis (2 and 0%) respectively.

Results: 19/47 (40%) and 11/20 (55%) of ante- and retrograde procedures, respectively, were post failed open and/or endoscopic surgery for ureteropelvic junction obstruction. Mean follow up was 25.8 months (12-76) and 26.2 months (12-27) for ante- and retrograde procedures respectively. The median hospital stay (2 vs. 5 days) was less with the retrograde approach. The objective (84 vs. 78%), subjective (84 vs. 72%), and the total (79 vs. 67.5%) success rates were higher with the retrograde approach.

Conclusion: Although our experience and follow up with retrograde endopyelotomy is limited, our initial results demonstrate a higher success rate than antegrade endopyelotomy, with a shorter hospital stay. Based on our results to date, combined with our impression of it being technically easier and faster procedure, retrograde endopyelotomy is our preferred technique for treating patients with ureteropelvic junction obstruction without associated renal calculi.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Accuracy of Tc-99m MAG3 renogram in assessing differential renal function in patients with partial/complete unilateral renal obstruction

Adel Al Hunayan, Awni Al Ateeqi, E.O. Kehinde, Hamdy Abdul Halim, K.A. Al Awadi, Loutffi, O.A. Mojiminiyi

Departments of Surgery, Nuclear Medicine and Pathology, Mubarak Al Kabeer Hospital, Kuwait

Aim: To evaluate the ability of Tc-99m MAG3 renogram to accurately reflect differential renal function (DRF) compared with creatinine clearance in the presence of partial/complete unilateral ureteral obstruction.

Materials and Methods: This was a prospective descriptive study from August 2000 till December 2004 that included 58 patients with partial or complete unilateral renal obstruction in whom percutaneous nephrostomy (PCN) tube was inserted to relief the obstruction. One week after nephrostomy tube insertion, all patients had Tc-99m MAG3 renogram to determine differential renal function (nuclear DRF). Simultaneously, 24-hour urethral and nephrostomy tube urine were collected separately and were used to calculate individual-kidney creatinine clearance which in turn was used to calculate differential renal function (biochemical DRF). Variables such as medical renal disease, duration of obstruction or presence of renal infection were recorded to see what effect they had in the calculation of DRF. Data were analyzed statistically by linear regression, Bland-Altman plot, and ROC curve. Ethical committee approval was obtained and consent was waived.

Results: Nuclear and biochemical DRF showed a good correlation: r1 = 0.81, r2 = 0.66 (n = 41). Subgroup analysis revealed the highest correlation between nuclear and biochemical DRF was within the normal DRF category. However, using the Bland-Altman analysis, nuclear and biochemical DRF compared unfavorably. The limits of agreement were from -2801% (95% CI -35.8 to -20.3) to 28.0% (95% CI 20.2 to 35.7).

Conclusion: Although good correlation existed between Tc-99m MAG3 renogram and biochemical DRF, Bland-Altman analysis revealed that they are in poor agreement.

Presented at the: 17 th Saudi Urological Conference

King Fahd Military Medical Complex

8-10 March 2005

Uteroscopic ureteric injuries

I. Al Oraifi, S. El Sayed, M. El Najar, S. Egail, A. Al Dayel

Department of Urology/Nephrology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

We reviewed our experience with 474 ureteroscopies, which were done for different urological problems, to evaluate the sequelae of ureteroscopic perforation as well as other complications. The incidence of esoteric perforations was around 6%. There will be discussion concerning the relation between the perforation and the surgeons' experience as well as the length of the procedure.

All perforation cases were stented with mini 1 sequelae concerning stricture formation and urinomas. This indicates that ureteric perforation if recognized and managed early will rarely lead to stricture fixation.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)


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