Background: Among various intracorporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. Purpose: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 88% in the holmium: YAG group and 66% in the pneumatic lithotripsy group (p < 0.05). The four weeks stone free rates were 98% and 94% respectively (p = 0.07). The mean ± SD operative time in the holmium: YAG group (40 ± 26 min) was shorter than those with pneumatic lithotripsy group (60 ± 40 min). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (70.4%) and shorter than those for pneumatic group (29.6%) (p < 0.002). Post treatment complications such as ureteral perforation were encountered in only two patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever; there was no statistically significant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (14%) in comparison to laser group (12%) (p = 0.02). On the other hand, the overall complication rates between the two groups was statistically significant (8%) laser group vs. (32%) pneumatic group (p = 0.003). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data suggest that holmium: YAG lithotripsy was safe and more effective than Pneumatic lithotripsy in the aspect of immediate stone free rate. We believe that holmium: YAG is an excellent treatment modality for managing ureteral calculi.
Background: Urinary incontinence (UI) is generally defined as the involuntary loss of urine from the bladder through the urethral meatus. Filling cystometry is the method by which the pressure/ volume relationship of the bladder is measured during bladder filling. Purpose: To determine the value of diagnostic cystoscopy in addition to Urodynamic study (UDS) in patients with primary urinary incontinence. Material and Methods: 200 patients with primary incontinence studied prospectively from January 2013 to June 2014. Their age ranges from (14-93 years), 86.5% were female, and 13.5% of them were male. In addition to physical, neurological examination and biochemical investigations, urine analysis and urine culture with Ultra-sound and Post void residual volume (PVRV), all patients underwent diagnosticflexible cystoscopy under local anesthesia, and urodynamic study. Result: 43.5% of patients age were between (34-53 years), (39%) between (54-73 years), (9%) between (14-33 years) and (8.5%) were between (74-93 years). Atonic bladder on UDS were (40.5%), Detrusor over activity (29%), patients with normal UDS were (22%) and patients that had DSD (Detrusor Sphincter Dyssynergia) were (8.5%). Eighty-four cases (42%) were found to have normal cystoscopy, those with grade-I-II bladder wall trabeculations were (49%) and patients with grade-III were (8.5%). Sixty-one patients (30.5%) with normal diagnostic cystoscopy have abnormal UDS (Atonic bladder, over-active bladder and DSD) while twenty-one (10.5%) patients with normal UDS had bladder wall trabeculations (grade-I-III) on diagnostic cystoscopy. Conclusion: Diagnostic cystoscopy in addition to urodynamic study will put in further knowledge in the assessment of patients with urinary incontinence. To some extent, it can predict the diagnosis.
Background Female urinary incontinence is a major health issue affecting about 30% of adult women and majority of them is stress type. Transobturator tape (TOT) technique is relatively safe and associated with minimum complication rate. Objectives To identify the safety, success rate and efficacy of TOT procedures performed for female patients with stress urinary incontinence. Patients and Methods A prospective study included thirty patients with history of urinary incontinence (22 patients with stress type and 8 patients with mixed type UI). They underwent TOT procedure in Sulaimani teaching hospital under general or spinal anesthesia; they were collected over a year from June 2014 to June 2015, all of them referred from urological clinic with history of stress or mixed urinary incontinence. The response of TOT surgery was assessed in both subjective and objective ways, using the ICIQ-UI short form and both cough stress test and Q-tip test (before and after surgery), 20 of them had urodynamic study before surgery to confirm the diagnosis, follow up done at one week, three months and six months postoperatively. Results A total of 30 females with mean age (48.8±9.51) years, Mean number of deliveries for studied females was (4.9±2) deliveries. Main type of urinary incontinence among studied females was stress urinary incontinence (73, 3%); followed by mixed urinary incontinence (26, 7%), all of them were from Sulaimani city and its peripheries. In this study; we found that the success rate is 80% (considering both objective and subjective outcome) which is comparative to similar studies. The early complications were mainly perineal (groin) and upper thigh pain, while the late complications were the development of de novo detrusor over activity, there were no vaginal or urethral erosions. Conclusion Transobturator tape (TOT) is an efficient and safe way of managing stress urinary incontinence with high success rate and short hospitalization with minimum and simple early complications.
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