Role of Tamsulosin in Improving Double-J Ureteric Stent-Related Symptoms

Objective: To evaluate the efficacy of tamsulosin in improving stent- related symptoms and quality of life (QoL) in patients with double-J (DJ) ureteric stents.Subjects and Methods: A total of 136 patients were prospectively evaluated and distributed randomly in two groups. Group 1 was 69 patients with mean age 35 years (range 20-56) and Group 2 was 67 patients with mean age 29 years (range 19-42). In Group 1, 43 cases had lower and 26 had upper ureteric stones. In Group 2, 47 patients had lower and 20 had upper ureteric stones. Ureteroscopic lithotripsy was performed in all patients and a DJ stent (6F, 26cm) was inserted post-operatively for about 4 weeks. Group 1 received tamsulosin 0.4mg orally once per day for 4 weeks. The patients were evaluated with the International Prostate Symptom Score (IPSS) which consists of seven questions, three for irritative and four for obstructive symptoms. QoL was assessed with the QoL section of the IPSS and the short form 36 (SF-36) questionnaire which assesses patients in eight domains, including physical functioning, role limitations due to physical health or emotional disorders, vitality, mental health, social functioning, pain and general health.Results: The IPSS irritative and obstructive symptom scores as well as the QoL scores were significantly lower in Group 1 than Group 2 (p<0.031). The SF-36 role limitation due to physical health and pain scores were  significantly better in Group 1 than Group 2 (p<0.027). There were no significant differences in any other parameters. Five patients with  tamsulosin (7.2%) had side-effects in the form of headache and dizziness and the rest of the patients had no side-effects related to tamsulosin.Conclusion: The administration of a selective alpha1 blocker, such as tamsulosin improves ureteric stent-related urinary symptoms after ureteroscopy and disintegration of ureteric stones

Combined use of Mathieu and incised plate technique (Snodgrass technique) for repair of distal hypospadias in older children

Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep urethral plate incision (Snodgrass technique). Each patient was evaluated according to the site of original urethral opening, original urethral stenosis, the presence and degree of chordee. The operative and postoperative results and complications were reported. Follow up of the patients was done weekly for 3 weeks postoperatively and then every month for at least 1 year. Results: The mean age was 6.5 ± 2.5 years (range 6–9 years). Bleeding was reported in one case. Wound infection was reported in two cases. Forcible slippage of stent occurred in one case. Meatal stenosis occurred in two cases and urethrocutaneous fistula occurred in one case. No urethral stenosis was reported in any of the patients. Conclusion: Combined use of Mathieu and incised plate technique is suitable for primary distal hypospadias in older children with original meatal stenosis

Long term complications after radical cystoprostatectomy with orthotopic diversion in male patients: Preliminary experience

Introduction: Radical cystectomy is the standard treatment for patients with invasive bladder cancer and for those with superficial bladder cancer who did not respond to conservative TUR and intravesical therapy. Many diversions are available after radical cystectomy; the most attractive for the patients is orthotopic diversion due to better quality of life associated with this diversion. Objective: To evaluate the long-term outcomes beyond 1 year, both functional and oncological, in male patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer. Patients and methods: This is a retrospective study done at Cairo university hospitals. A total of 44 male patients underwent radical cystectomy and orthotopic diversion (W-pouch) for invasive bladder cancer with minimum follow up 1 year. Assessment included; neobladder function, renal pattern and function, ureteroenteric anastomotic stricture or reflux, survival, recurrence, erectile function, urolithiasis, and urinary tract infection. The tools used to assess the complications during each visit included; history including voiding diary and IIEF questionnaire, examination including PR, laboratory investigations including urine analysis and kidney function tests, pH (acidosis) and bicarbonates and radiological investigation including ultrasound, chest X-ray, CT abdomen and pelvis. Results: The mean follow up was 88 months (range 12–138). Stones developed post-operatively in four patients (two of them were pouch stones and the other two were renal stones), incision hernia developed in two patients (4.5%), uretero enteric anastomotic stricture in two patients (4.5%), recurrent UTI was recorded in 10 cases (23%), uremia and dialysis in 9.2% of cases, metastasis was recorded as follows: local 2%, distant 11.5% and both 4.5% and the mortality rate was 19% (over all survival was 81%). Nocturnal incontinence 29.5% (13 patients), stress incontinence 9.5% (4 patients), urge incontinence 9.5% (4 patients), total incontinence 4.5% (23 patients); while the remaining 21 patients (47.5%) were continent day and night. Erectile dysfunction developed post-operatively in 35 cases (80.5%). Conclusion: Long term follow-up for patients with radical cystectomy and orthotopic diversion is associated with high complication rate. Long term follow up for those patients is needed to verify the causes of complications and how to prevent them