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.

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.

No abstract

No abstract

Background: Extracorporeal shock wave lithotripsy (ESWL) is one of the most used modalities in treatment of renal stones, but its effectiveness can be influenced by many factors related to the patient or the stone itself which may affect the success of stone disintegration. The aim of our study was to investigate the predictive value of some patient and stone-related factors for ESWL success for renal stones. Methods: A total of 100 patients with single radiopaque renal stone 10–20 mm in diameter, undergoing ESWL were enrolled in this study. All patients had non contrast computed tomography (NCCT) done before ESWL. We evaluated body mass index (BMI), skin-to-stone distance (SSD), stone size and Hounsfield density comparing these values between stone free (SF) and residual stone (RS) groups. Results: Of the 100 patients, 70% had successful disintegration. There was no significant difference between stone free (SF) and residual stone (RS) groups as regard age or BMI. Meanwhile, there was a significant difference between SF and RS groups as regard stones’ density and SSD, with higher values in RS group but there was statistically insignificant difference as regard stone size ( p = 0.522). Using logistic regression analysis, we found that Hounsfield unit (HU) was better in predicting successful disintegration than SSD but without statistical significance. Conclusion: HU and SSD are the independent predictive factors for ESWL outcome, and they should be considered when planning ESWL in treatment of medium size renal stones.

No abstract

Background: Nocturnal enuresis is a common disease of childhood. It can be classified into monosymptomatic nocturnal enuresis (MNE) or nonmonosymptomatic nocturnal enuresis (NMNE). Imipramine is a tricyclic antidepressant used to treat enuresis with initial success rates are high as 50% but some studies record a high relapse rate and it has a cardiotoxic effect when overdosed. Anticholinergics may be effective in the treatment of children with bladder storage dysfunction, including daytime incontinence. However, anticholinergics monotherapy is not effective in treating MNE. In our study, we used a low dose (25 mg) of imipramine in order to avoid its potential side effects and combined it with the synergistic anticholinergic action of solifenacin. Our objective was to evaluate the efficacy and safety of the combination of solifenacin and imipramine compared with placebo in the treatment of desmopressin refractory MNE. Methods: One hundred children aged 6 years or more with primary MNE unresponsive to desmopressin treatment were included. The children were randomly divided into two equal groups. Group A received imipramine 25 mg and solifenacin 5–10 mg oral tablets and group B received placebo once 1 h before bedtime for 3 months. The primary end point was to investigate the efficacy of the combined treatment of solifenacin and imipramine and the secondary end point was the safety of the drugs. Results: Our study showed that the mean post treatment wet nights per month was significantly lesser in the treatment group than placebo group ( p < 0.001) and cure rate was significantly higher in treatment group than placebo group ( p < 0.001). The relapse rate was statistically significantly lower in treatment group than placebo group ( p = 0.032). No significant side effects related to the drugs were reported. Conclusion: The combination treatment of solifenacin and imipramine is a useful and safe treatment for nocturnal enuresis after failure of everything else.

Objectives: To assess the safety and the effectiveness of bipolar energy in the transurethral resection of primary large bladder tumours (TURBT) and compare it to conventional monopolar energy. Patients and methods: From November 2015 to June 2017, 80 patients underwent endoscopic resection primarily for large bladder cancer tumours of >3 cm. They were randomly assigned into two groups: 40 patients underwent a TURBT with conventional monopolar current (M-TURBT) and 40 were treated with bipolar current (B-TURBT). Results: There were no statistically significant differences between the two groups for the patients' demographic and tumour characteristics. There was a significant difference between M-TURBT and B-TURBT for resection time, obturator reflex, hospital stay, and catheterisation time, which were all higher in the M-TURBT group; the mean (SD) resection time was 26.45 (5.73) vs 22.85 (7.52) min (P = 0.048), the obturator reflex was 25% vs 5% (P = 0.025), the median hospital stay and catheterisation times were 2 vs 1 day (P = 0.012 and P = 0.023, respectively). No statistically significant difference was found between the groups for bladder perforation, TUR syndrome, drop in haemoglobin level, and blood transfusion rate. However, there was statically significant difference in the postoperative haematuria rate, which was higher in the M-TURBT group, at 24 patients vs eight in the B-TURBT group (60% vs 20%; P = 0.01). After 1-year follow-up, there was no significant difference in the recurrence rate between the groups. Conclusion: B-TURBT is a safe and effective alternative procedure to M-TURBT for the management of primary large bladder tumours of >3 cm.