Complications of Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Objective: To compare grade I complication as per Clavien-Dindo classification in patients undergoing standard (with tube) verses tubeless percutaneous nephrolithotomy. Study design: Hospital based randomized control study. Place and Duration of Study: Urology Clinic, Sindh Institute of Urology & Transplantation Karachi from 3rd June 2016 to 2nd December 2016. Methodology: Seventy four patients (37patients) in each group were enrolled. In group 1 patients, a 20 F nephrostomy tube were placed in the kidney over the guide wire, which was removed later. Group II patients had antegrade placement of a Double-J stent without nephrostomy and the wound compressed for 5min. The demographic like age, gender and complications grade I complications according to Clavian-Dindo classification were noted. Results: The mean age was 49.42±7.06 years. There were 46 (62.16%) males and 28 (37.84%) females. There was no significant difference in stone clearance rate between the groups; 91.9% in standard percutaneous nephrolithotomyg roup and 94.6% in tubeless percutaneous nephrolithotomy group. Need for analgesics for pain control was high in standard percutaneous nephrolithotomy group 86.5% versus 64.9% in tubeless percutaneous nephrolithotomy group (p=0.03). Frequency of urine leakage was 18.9% in standard percutaneous nephrolithotomy group and only 2.7% in tubeless percutaneous nephrolithotomy group (p=0.02). Conclusion: Tubeless percutaneous nephrolithotomy procedure has fewer complications as per Clavien-Dindo classification regarding need for analgesics and urine leakage. In suitable cases, the tubeless procedure can be safely used as the standard for percutaneous nephrolithotomy. Keywords: Percutaneous nephrolithotomy (PCNL), Clavien-Dindo classification, Complication

Neo-modified Koyanagi technique for severe hypospadias with one-stage sealed Y-shaped penis foreskin vascular protection surgery

A total of 89 children had their urinary catheters removed 4 weeks after the operation.The children, diagnosed with urine leakage, were successfully repaired after the leakage occurred one year later at one time.The one-time success rate of this operation was 87.6% and the incidence of the urethral fistula was 12.6%

Low Intensity Extracorporeal Shock Wave Therapy as a Novel Treatment for Stress Urinary Incontinence: A Randomized-Controlled Clinical Study

Background and Objectives: To evaluate the effects of low intensity extracorporeal shock wave therapy (LiESWT) on stress urinary incontinence (SUI). Materials and Methods: This investigation was a multicenter, single-blind, randomized-controlled trial study. Sixty female SUI patients were randomly assigned to receive LiESWT with 0.25 mJ/mm2 intensity, 3000 pulses, and 3 pulses/s, once weekly for a 4-week (W4) and 8-week (W8) period, or an identical sham LiESWT treatment without energy transmission. The primary endpoint was the changes in urine leakage as measured by a pad test and validated standardized questionnaires, while the secondary endpoint was the changes in a 3-day urinary diary among the baseline (W0), the W4 and W8 of LiESWT, and 1-month (F1), 3-month (F3), and 6-month (F6) follow-up after LiESWT. Results: The results showed that 4 weeks of LiESWT could significantly decrease urine leakage based on the pad test and validated standardized questionnaire scores, as compared to the sham group. Moreover, 8 weeks of LiESWT could significantly reduce urine leakage but increase urine volume and attenuate urgency symptoms, which showed meaningful and persistent improvement at W8, F1, F3, and F6. Furthermore, validated standardized questionnaire scores were significantly improved at W8, F1, F3, and F6 as compared to the baseline (W0). Conclusions: Eight weeks of LiESWT attenuated SUI symptoms upon physical activity, reduced urine leakage, and ameliorated overactive bladder symptoms, which implied that LiESWT significantly improved the quality of life. Our findings suggested that LiESWT could serve as a potentially novel and non-invasive treatment for SUI.

Demirtaş Erciyes-Mid urethral fibrin fixation technique (DE-MUFFT) for female stress urinary incontinence: A case series

Factors including suburethral blood flow impairment, collagen deficiency, and the lack of tissue healing factors are known to play a role in stress urinary incontinence (SUI). Autologous fibrin (AF) appears to be a viable material for the treatment of SUI. The aim of this study was to present the initial clinical outcomes of a novel technique named “Demirtaş Erciyes-Mid Urethral Fibrin Fixation Technique (DE-MUFFT)” that involved the placement of AF material in the suburethral space instead of sling material (mesh). In this study, the clinical outcomes of five women with pure SUI who underwent the placement of AF material in the suburethral space were examined retrospectively. The complaint of urine leakage during physical exertion and patients’ quality of life were assessed using Incontinence Quality of Life Scale (I-QoL), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Incontinence Impact Questionnaire (IIQ-7), and 24-h pad test. Patient outcomes were evaluated preoperatively, at sixth week and third month postoperatively. Significant improvement was obtained in the quality-of-life tests and 24-h pad test. In all patients, the complaint of urine leakage disappeared almost completely. No adverse event or postoperative complication occurred in any of the patients. These results indicated that DE-MUFFT can be a promising procedure in the treatment of SUI due to its biocompatibility, minimally invasive nature, re-applicability, and cost-effectivity.

Time course for urethral neuromuscular reestablishment and its facilitated recovery by transcutaneous neuromodulation after simulated birth trauma in rats

The aims of the study were to determine the time-course of urinary incontinence recovery after vaginal distension (VD), elucidate the mechanisms of injury from VD leading to external urethral sphincter (EUS) dysfunction, and assess if transcutaneous electrical stimulation (TENS) of the dorsal nerve of the clitoris facilitates recovery of urinary continence after VD. Rats underwent 4-h VD, 4-h sham VD (SH-VD), VD plus 1-h DNC TENS, and VD plus 1-h sham TENS (SH-TENS). TENS or SH-TENS were applied immediately and at days 2 and 4 post-VD. Micturition behavior, urethral histochemistry and histology, EUS and nerve electrophysiology, and cystometrograms were evaluated. VD induced urine leakage and disrupted EUS fibers and nerve-conduction. Urine leakage disappeared 13 days post-VD. Structural and functional recovery of the EUS neuromuscular circuitry started by day 6 post-VD but did not fully recovered by day 11 post-VD. TENS significantly decreased the frequency of urine leakage post-VD (p<0.01). We conclude that rat urinary continence function after VD requires 2 weeks to recover, although urethra structure is not fully recovered. Treatment to facilitate neuroregeneration should be applied within one-week after damage. TENS facilitated urinary continence recovery after VD. This treatment may have potential to decrease postpartum urinary incontinence in women.