Experience with impacted upper ureteral Stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast?

<p>Abstract</p> <p>Introduction</p> <p>The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ureteral stones is around 81% when treated by either SWL or ureteroscopy (URS).</p> <p>Complication rates, most notably ureteral perforation and long-term complications of URS such as stricture formation rates, have been reduced to < 5%. Moreover, impacted ureteral calculi are more difficult to fragment with SWL because of the lack of natural expansion space for stones, this result in a situation that is better managed by ureteroscopy. The aim of this study is to assess the efficacy, safety, and complications of impacted upper ureteral stone disintegration using semirigid ureteroscopes and pneumatic lithotripsy.</p> <p>Methods</p> <p>We retrospectively analyzed the records of 267 consecutive patients with impacted upper ureteral stones (9–20 mm) who were treated by semirigid ureteroscopes and pneumatic disintegration. The efficacy of treatment was estimated using the stone-free rate and all treatment related complications were analyzed.</p> <p>Results</p> <p>Except for 24 cases where the stone migrated to the kidney, the stone was successfully treated ureteroscopically, with a low rate of minimal complications such as mild hematuria (18.4%), short term low grade fever (13.5%). Only 3 patients (1.1%) had high grade fever and none had post operative stricture.</p> <p>Conclusion</p> <p>The use of semirigid URS and pneumatic lithotripsy in impacted upper ureteral stones in experienced hands has very satisfactory results with minimal complications. When Holmium laser and flexible URS are not available, semirigid URS and pneumatic lithotripsy is a good alternative that shouldn't, yet, be abandoned.</p

Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcinoma? a prospective comparative study

<p>Abstract</p> <p>Background</p> <p>Local pelvic recurrence after radical cystectomy for muscle invasive bilharzial related squamous cell carcinoma accounts for 75% of treatment failures even in organ confined tumors. Despite the proven value of lymphadenectomy, up to 60% of patients undergoing cystectomy do not have it. These factors are in favor of adjuvant radiotherapy reevaluation. objectives: to evaluate the effect of adjuvant radiotherapy on disease free survival in muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder and to test the predictability of radio-sensitivity using the anti apoptotic protein Bcl-XL.</p> <p>Methods</p> <p>The study prospectively included 71 patients, (47 males, 24 females) with muscle invasive bilharzial related squamous cell carcinoma of the bladder (Stage pT2a-T3N0-N3M0) who underwent radical cystectomy in Assiut university hospitals between January 2005 and December 2006. Thirty eight patients received adjuvant radiotherapy to the pelvis in the dose of 50Gy/25 fractions/5 weeks (Group 1), while 33 patients did not receive adjuvant radiotherapy (group 2). Immunohistochemical characterization for bcl-xL expression was done. Follow up was done every 3 months for 12 to 36 months with a mean of 16 ± 10 months. All data were analyzed using SPSS version 16. Three years cumulative disease free survival was calculated and adjusted to Bcl-XL expression and side effects of the treatment were recorded.</p> <p>Results</p> <p>The disease free cumulative survival was 48% for group 1 and 29% for group 2 (log rank p value 0.03). The multivariate predictors of tumor recurrence were the positive Bcl-XL expression (odd ratio 41.1, 95% CI 8.4 - 102.3, p < 0.0001) and radiotherapy (odd ratio 0.19, 95% CI 0.05 - 0.78, p < 0.02). With Cox regression, the only independent multivariate predictor of radio-sensitivity was the Bcl-XL expression with odd ratio 4.6 and a p value < 0.0001. All patients tolerated the treatment with no life threatening or late complications during the period of follow up.</p> <p>Conclusions</p> <p>Adjuvant radiotherapy for muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder has potential effectiveness and minor side effects. Moreover, Bcl-XL expression is a valuable tool for predicting those who might not respond to this adjuvant treatment.</p

Huge incisional hernia: A case report

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