Purpose: Ureteric substitution using the Yang-Monti principle was reported as a modifi cation of simple ileal ureter replacement. In this study, we evaluate its safety, surgical outcome and impact on renal function. Materials and Methods: Sixteen patients underwent ileal ureter replacement using the Yang-Monti principle to overcome long ureteric defects. Exclusion criteria included patients with elevated serum creatinine > 1.8 mg/dL, infl ammatory bowel syndrome or irradiated bowel. Antirefl ux implantation into the bladder was performed in 12 patients while 4 patients with intact healthy lower ureters underwent distal ileal-ureteral anastomosis. Follow-up protocol was carried out for up to 3 years in 9 patients. Results: No intra-operative or postoperative mortality or signifi cant complications occurred. There were minor complications in the form of urinary leakage that necessitated prolonged ureteric stenting in one patient, superfi cial wound infection in another one and 3 patients developed treatable urinary tract infection without late harmful effects. During follow up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function (improved in 13 patients and stabilized in 3) without any evidence of urinary obstruction. Conclusions: The reconfi gured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antirefl ux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction.

ObjectiveTo evaluate and compare the clinical (patient’s morbidity, quality of life [QoL]) and economic impact of autologous vs synthetic slings in female stress urinary incontinence (SUI), as over the last decade, the introduction of synthetic vaginal tapes for managing SUI has gained wide acceptance being quicker with low morbidity. Synthetic vaginal tapes have been progressively replacing the use of autologous rectus fascia. However, the high cost of these synthetic tapes is almost always an obstacle for most patients of limited socio-economic resources in the Egyptian community.Patients and methodsThis retrospective study included 126 women with SUI. Data for patients that matched the study inclusion criteria were collected from the Urology Department of Ain-Shams University Hospitals from March 2011 to May 2013. Patients were categorised into two groups: Group I included 62 patients who underwent an autologous sling procedure using rectus sheath; and Group II included 64 patients that had a synthetic sling, using transobturator tape (TOT). The following variables were compared: operative time, postoperative pain scores, duration of indwelling urethral catheter, hospital stay, cost including the price of the synthetic tape when used, return to normal activity, and QoL assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) before and after discharge from hospital.ResultsPatients amongst the two groups were normally distributed with no statistically significant differences in patient’s demographic data and comorbidities. The mean hospital stay was longer and the return to normal activity was delayed in Group I compared to Group II. The highest mean postoperative pain score was recorded in Group I. The overall morbidity was 12.9% and 4.68% in groups I and II, respectively. The mean (SD) overall cost was 2571.65 (254.8) and 3502.34 (196.9) Egyptian pounds (local currency) in groups I and II, respectively, being insignificantly lower in Group I when compared to Group II (P > 0.05). There were statistically significant differences between groups I and II for operative time, hospital stay, and postoperative pain scores. However, the differences in hospital cost amongst Group I and Group II were in favour of Group I. Post-surgical outcome was categorised into either complete cure (dry) or improved or failed with no significant differences in success rate and QoL amongst the study groups. The mean (SD) change in the QoL score was 10.95 (4.19) and 12.32 (4.1) in groups I and II, respectively. The higher success rate (complete cure) was in Group II, at 93.75%. Also, a statistically significant improvement of >70% of mean ICIQ-UI-SF score was shown in all groups when compared to baseline on both the 1- and 6-month follow-up visits.ConclusionAutologous grafts should be considered as a repair option in females with SUI in countries were health insurance policies do not cover the cost of synthetic materials in many instances. The cost-effectiveness of synthetic TOT...

Objective We aimed to compare the cost-effectiveness and safety of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for pediatric kidney stones management. Patients and methods Ninety pediatric patients with single or multiple renal stones 1–3 cm in diameter were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The groups were compared for fluoroscopy and operative time, postoperative hospital stay time, stone-free rate (SFR), need for auxiliary procedures, and cost as well as complications. Results There were no differences found between RIRS and mini-PCNL groups with regard to operative time and postoperative DJ stent application, while the mean of fluoroscopy time and postoperative hospital stay was significantly shorter in the RIRS than in the mini-PCNL group. The SFR, auxiliary treatment on residual stones, and complications were comparable. In both groups, no major (Clavien IV–V) complications were observed. The mean cost of RIRS was $1210 and $733 for the mini-PCNL. Conclusions Both RIRS and mini-PCNL are effective and safe treatment modalities for pediatric renal stones 10–30 mm in size. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.

According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.

ObjectiveTo evaluate and analyse the efficacy of computed tomography (CT) virtual cystoscopy in comparison to conventional cystoscopy for the follow-up of patients with non-muscle-invasive bladder cancer.Patients and methodsThe study was done over 3 years, from April 2010 to June 2013, and included 30 patients who all had non-muscle-invasive transitional cell carcinoma (Ta, T1). The patients all underwent complete transurethral resection of the tumour and presented for first follow-up check cystoscopy. The examination was performed using a 16-slice multi-detector (MD) CT scanner. The results were compared for sensitivity and specificity in relation to the site, size, and shape of the tumour.ResultsIn all, 20 lesions were detected by CT virtual cystoscopy in 18 patients, whilst the remaining 12 were lesion free. Conventional cystoscopy, detected 23 lesions in 19 patients. The sensitivity of the virtual images was 87%; its specificity in identifying lesions was 100%, with a positive predictive value of 100% and negative predictive value of 78.5%.ConclusionCT virtual cystoscopy is a promising technique for detecting bladder tumours and some other bladder lesions. However, the detection rate for recurrent NMIBC does not appear to be adequate to replace conventional cystoscopy.