Repeating Hydrodistension Does Not Improve Symptoms in the Interstitial Cystitis Patients

Objective: To evaluate effect of second hydrodistension on symptoms of patients who have diagnosed interstitial cystitis and have been performed hydrodistension before. Material-Methods: Data of the patients who have diagnosed interstitial cystitis and were performed hydrodistension between June 2015 and June 2017 were retrospectively evaluated. Diagnosis of interstitial cystitis was done on three criteria according to clinical guidelines. Hydrodistension was performed by a single surgeon under spinal anesthesia. The bladder was distended with normal saline through a cystoscope to provide pressure of 80 cmH2O. After hydrodistension for 5 minutes the bladder was evacuated, which might lead to hemorrhage of the apparently normal bladder mucosa (glomerulations). O’Leary–Sant’s symptom and problem index (OS combined), Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale and the Likert visual analog scale (VAS) for pain were used to evaluate the severity of symptoms. After the hydrodistension, patients were followed-up by without medication. Second hydrodistension was performed when symptoms were recurred. Results: Total 17 patients were diagnosed interstitial cystitis. Symptoms of seven patients were not improved by first hydrodistension, so second hydrodistension was not performed to these patients. These seven patients were excluded. Total 10 patients were included the study. Median OS combined (24 vs 20.5 p= 0.356), PUF (33 vs 29 p= 0.113) and VAS (8 vs 7 p= 0.452) score were similar before and after second hydrodistension. Conclusions: Second hydrodistension is not effective in interstitial cystitis patients whom were treated hydrodistension before

Ureteroscopy Outcomes, Complications and Management of Perforations in Impacted Ureter Stones

Objective To evaluate ureteroscopy (URS) outcomes and management of perforations in impacted ureteral stones. Materials and Methods We retrospectively evaluated data from 81 patients who had undergone URS for impacted ureteral stones. Per-operative complications were evaluated visually and retrograde ureterography was performed when needed. Injuries of less than 50% around the ureter were classified as minor perforation and greater levels, as major perforation. Perforations were treated by double-j stent or a primary repair with consideration of the perforation grade. Results The stone-free rate was 69% on the first URS attempt and 79% at the end of 3 months. Complications occurred in 34 (42%) patients. Minor perforation occurred in five patients and only double-j insertion was performed at the end of the procedure. Permanent ureteral stricture occurred in four of five patients. Three patients were treated by open ureterolithotomy, fibrotic segment resection and ureteroureterostomy due to major perforations. Transient or permanent ureteral stricture occurred in none of the three patients. The stricture rate was significantly higher in patients who were treated with double-j stent (80% vs. 0% p=0.028) although they had lower perforation rate. Upper location, bigger size (>10 mm) of the ureteral stones and not using smash and go strategy were found to be significant predictors of complications. Conclusion URS for impacted ureteral stone has low success and high complication rates, especially for proximal and big stones. The conservative treatment may fail and result in stricture when perforation is present. Therefore, perforation treatment must be done by fibrotic segment excision and ureteroureterostomy

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux

ABSTRACT Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received. Materials and Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O’Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow's three groups contained 18 EI procedures, and each of the second fellow's 17. Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar. Conclusions: An acceptable rate of success for EI may be reached after about 20 procedures and a high success rate after about 35-40 procedures

Synthetic Cannabinoid Can Do Voiding Dysfunction: Reporting of three cases

Synthetic cannabinoids (SC) have been distributed as an alternative to Cannabis marijuana, it is not legal in many countries. Cannabinoid receptors and their endogenous ligands termed as the cannabinoid system have been used as molecular targets for the treatment of various diseases, including neurodegenerative diseases, neuropathic or inflammatory pain, cardiovascular disorders and metabolic syndrome. A lot of study have been done and are continuing about anti proliferative effect of SC on many cancers various. We aimed to share our experience the effect of synthetic cannabinoid to voiding by evaluating three cases

Znaczenie wyników elektrokardiografii w diagnozowaniu ubytku przegrody międzyprzedsionkowej

Background: Atrial septal defect (ASD) is the most frequent heart defect observed in adulthood. Although it is usually non-symptomatic, it may result in heart failure, arrhythmic complications, and paradoxical embolism-related morbidity or mortality if the diagnosis is late. Aim: This study was planned in order to investigate the importance of electrocardiographic findings in the diagnosis of ASD. Methods: Sixty-one patients with a diagnosis of ASD and 66 healthy volunteers without cardiac disease were enrolled in the study. Electrocardiographs (ECG) were performed on all patients to investigate the presence of right bundle branch block (RBBB), incomplete RBBB, defective T wave (DTW), and notch finding in the R wave of inferior derivations (crochetage R wave). ASD types and diameters were determined via transthoracic and transoesophageal echocardiography. Results: It was determined that incomplete RBBB (56% vs. 5%), DTW (48% vs. 3%), and R wave crochetage (57% vs. 8%) in inferior derivations were more frequent in ASD patients compared to the control group patients. The specificity of the defined ECG findings in the diagnosis of ASD were 95%, 97%, and 92%, respectively. No correlation was detected between the ASD diameter and incomplete RBBB, whereas significant correlation was observed between the ASD diameter and the presence of crochetage R wave (17.5 ± 4.0 mm in patients with crochetage R wave, and 20.9 ± 8.2 mm in patients without crochetage R wave, p = 0.057). Conclusions: Detection of RBBB, DTW, and crochetage R wave in superficial ECG may contribute to early detection in patients with ASD.  Wstęp: Ubytek przegrody międzyprzedsionkowej (ASD) jest najczęstszą wadą serca występującą u osób dorosłych. Zwykle nie powoduje ona objawów, lecz jeśli nie zostanie wcześnie rozpoznana, może być przyczyną niewydolności serca, zaburzeń rytmu i zatorów paradoksalnych oraz związanych z tym śmiertelności i chorobowości. Cel: Celem pracy była ocena znaczenia parametrów elektrokardiograficznych (EKG) w diagnozowaniu ASD. Metody: Do badania włączono 61 chorych z ASD i 66 osób zdrowych (bez chorób serca). U wszystkich pacjentów wykonano badanie EKG w celu sprawdzenia, czy występują: blok prawej odnogi pęczka Hisa (RBBB), niezupełny RBBB, nieprawidłowy załamek T (DTW) i wcięcia w załamku R w odprowadzeniach II, III i aVF (zazębiony załamek R). Typy i wymiary ASD określono za pomocą echokardiografii przezklatkowej i przezprzełykowej. Wyniki: Ustalono, że niezupełny RBBB (56% vs. 5%), DTW (48% vs. 3%) i zazębiony załamek R (57% vs. 8%) w odprowadzeniach II, III i aVF występowały częściej u chorych z ASD niż u osób z grupy kontrolnej. Swoistość określonych cech w EKG w stosunku do rozpoznania ASD wynosiła odpowiednio 95%, 97% i 92%. Nie wykazano żadnych korelacji między średnicą ASD a niezupełnym RBBB, stwierdzono natomiast istotne zależności między średnicą ASD a obecnością zazębionego załamka R (17,5 ± 4,0 mm u chorych z zazębionym załamkiem R i 20,9 ± 8,2 mm u pacjentów bez zazębienia załamka R; p = 0,057). Wnioski: Stwierdzenie RBBB, DTW i zazębionego załamka R w zapisie powierzchniowego EKG może się przyczynić do wczesnego wykrycia ASD.