OBJECTIVE To study the effects of tamsulosin on ureteric contractions and its effects on the basal tone of human ureteric specimens, as clinical trials with tamsulosin have shown promising results in the spontaneous expulsion of lower ureteric calculus, but the mechanism of action of tamsulosin in the expulsion of ureteric calculus has not been elucidated in in‐vitro studies on human ureters. MATERIALS AND METHODS Human mid‐ureteric specimens were obtained from live kidney donors. The specimen was transported in Krebs’ solution and the isometric contraction of human ureteric smooth muscle was recorded in the presence of tamsulosin. Ureteric rings from 19 kidney donors were studied. RESULTS At 100 µm tamsulosin the frequency of ureteric contraction was blocked completely, or the contraction frequency was reduced in 89% of specimens. There was no change in the frequency or in the amplitude of contraction in the remaining specimens. The basal tone of the ureter was reduced in 16% of the specimens. CONCLUSION Our results suggest that peristaltic activity in human ureteric smooth muscle is inhibited by tamsulosin. The effect of tamsulosin on basal tone is marginal.
A 47-year-old woman presented with continuous urinary incontinence for 1 year. There were recurrent episodes of haematuria associated with intense frequency and urgency earlier. She was treated with several courses of antibiotics before being referred to our centre. On intravenous urogram there was right hydroureteronephrosis with left not seen kidney and a tiny bladder the size of a water droplet (Fig. 1). A clinical diagnosis of tuberculosis of the urinary tract was considered. Right-sided percutaneous nephrostomy was carried out and she became dry. Anti-tuberculous therapy was started using four drugs. Four weeks later, left nephroureterectomy and ileal conduit was carried out. She had refused to consider the possibility of intermittent catheterization associated with an augmented bladder. Histology confirmed tuberculosis and she completed 6 months of anti-tuberculous therapy. At 6 months follow up her creatinine was stable at 79.56 lmol/L. Augmentation cystoplasty is the common method of treatment for the small-capacity bladder. 1 Orthotopic neobladder has been attempted in a thimble bladder with successful outcome. 2 REFERENCES 1. Johnson WD Jr, Johnson CW, Lowe FC. Tuberculosis and parasitic disease of the genitourinary system. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (eds).
Context:There are different methods of continuous ambulatory peritoneal dialysis (CAPD) catheter placement. Open surgical technique is a widely followed method. The complication rate following catheter placement varies and catheter blockage due to omental plugging is one of the main reasons.Aim:To analyze the need for routine omentectomy during CAPD catheter placement.Materials and Methods:This was a retrospective analysis of 58 CAPD catheter placements performed between July 2002 and June 2007. Tenckhoff double cuffed catheter was used in all. The postoperative complications were analyzed.Results:There were 44 males and 14 females. The mean age was 51 years ranging from 15 to 76 years. Of these, 40 (69%) patients underwent omentectomy (group A) and 18 (31%) did not (group B). Laparoscopic and open techniques were performed in 5 and 53 patients, respectively. Omentectomy was not performed in 13 patients with open technique and all the five in the laparoscopic group. One patient in group A developed hemoperitoneum which was treated conservatively. None from group A developed catheter blockage, whereas five (27.8%) from group B developed catheter blockage postoperatively. The median time interval between the primary procedure and development of catheter blockage was 45 days (ranged from 14 to 150 days).Conclusions:Omentectomy during CAPD catheter placement prevents catheter blockage and secondary interventions.
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