To evaluate the efficacy and safety of mini percutaneous nephro-lithotripsy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones larger than 20mm in its longest diameter. Patients & Methods: In a prospective randomized study including 40 patients divided into two groups each 20 patient. Gathering An included 12 guys and 8 females with age went from 15 to 62 years had smaller than expected PCNL for renal pelvic and calyceal stones. Gathering B included 8 guys and 12 females with age extended from 18 to 65 years of age had RIRS. Adaptable ureteroscopy was utilized for pelvic and calyceal stones utilizing holmium:YAG laser (tidying approach). In the two gatherings the strategy result regarding Operative time, Blood misfortune, clinic remain, entanglements utilizing changed Clavien reviewing framework , the need of assistant systems , stone free rates following 3 weeks by utilizing CTUT, were assessed measurably. Measurable investigation of the information indicated that there was immaterial contrast between the {mean ± SD} of the BMI in patients of gathering A which was {27.850±3.183} kg/m2; while in patients of gathering B was {29.700±7.927} kg/m2 . With respect to measure, there was immaterial contrast between the {mean ± SD} of gathering A which was 2.57±0.22mm, while in bunch B was 2.6±0.24mm. With respect to usable time the {mean ± SD} of gathering A was 104.43±14.79 minutes which was altogether (P<0.05) higher contrasted with bunch B 59.71±19.44 minutes. As with respect to emergency clinic stay it was unimportantly (P lower 0.05) higher in bunch A 1.41±0.46 days contrasted with bunch B 1.29±0.44 days. Concerning free rate 89 % of patients rewarded with bunch A were without stone (17 out of 20), while in bunch B 83.4% of patients were sans stone (16 out of 20) following 3 weeks by utilizing CTUT imaging. As to utilizing changed Clavien evaluating correlation with our investigation in which Grade 1: 1 in bunch An and 0 in bunch B , grade 2: 1 in bunch An and 0 in bunch B , grade 3A : 1 in bunch An and 0 in bunch B likewise grade 3B : 0 in bunch An and 0 in bunch B additionally 0 in grade 4 and 5 in the two gatherings In patients with renal stones bigger than 20 mm , results indicated that little PNCL has higher stone free rate and longer employable time than RIRS in cost of higher entanglements rate, blood misfortune, and longer medical clinic remain.
Evidence has been arising suggesting that Botulinum toxin type A [BTX-A] injections can relax smooth muscles fibers in the treatment of obesity and Detrusor muscle over-activity, similar effect on cavernosal smooth muscles would help in the treatment of erectile dysfunction [ED] resistant to oral and intracavernous injection [ICI] therapy, thus it could be an alternative option for failed medical and other injectable therapy.. to compare safety, efficacy and durability of different doses of BTX-A [50 and 100 Unit] in the treatment of Vasculogenic Erectile Dysfunction after failure of other ICI therapy.. Forty-five patients with Vasculogenic erectile dysfunction who are failed treatment with non-surgical options were included at this study after elimination of all patients who are not matching eligible criteria or not complete the follow up program. The patients were randomized into 3equal groups, each group include 15 patients. Group [I] injected with 100U BTX-A, group [II] injected with 50U BTX-A and Control group injected with normal saline. All groups underwent follow up at 2 weeks, 3 months and 6 months intervals after injection, for assessment of all subjective data as, IIEF-5 Questionnaire [SHIM score], Erection hardness score [EHS], Sexual encounter profile [SEP 2 and 3], Global assessment score[ GAS 2 and 3]. Also assessment of objective data by penile Doppler details.. Although 25 patients [55.6%] respond to BTX-A injection subjectively and objectively {13 patients [28.9%] in group [I] and 12 patients [26.7%] in group [II]}, but this impressive effect was not durable especially in group [II] as 9 patients [20%] show lost effect through complete follow up till 6 month in comparison to 5 patients [11.1%] in group [I] show same lost effect. Besides that, 5 patients [11.1 %] not responding to this treatment option {two patients [4.4%] in group [I] and 3 patients [6.7%] in group [II], also patients in Control group show non-significant subjective improvement. BTX-A could be a potential but not durable therapy for erectile dysfunction, as BTX-A [50 and 100 Unite] show almost same efficacy but, with complete follow up through 6 months, BTX-A 100U is more durable than 50U.
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