PCNL in supine position is safe, effective and suitable for the patients. It offers the potential advantages of better urethral access, less patient handling, needing drape only once, ability to perform simultaneous PCNL and ureteroscopic procedures, better control of the airway during procedures, thus reducing over-all operative time compared to traditional prone position and performing PCNL while the surgeon is sitting. It may be considered for most patients requiring PCNL.
A Double-J stent may be used for ureteral injury because of a gynecologic procedure. Intravascular migration of a Double-J stent into the inferior vena cava as an uncommon complication of ureteral stent placement is reported. Percutaneous removal of the migrated stent was performed through the left femoral vein under angiographic and fluoroscopic guidance.
One-shot dilation was proved to be safe and effective like metal telescopic dilation even in patients with a history of ipsilateral open renal surgery. In this procedure, X-ray exposure is lower.
Objective
To evaluate the effect of botulinum neurotoxin type‐A (BoNT‐A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy.
Materials and Methods
Between November 2011 and January 2013, 60 men aged ≥18 years with CP/CPPS, and with National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) scores ≥10 and pain subscale scores ≥8, who were refractory to 4–6 weeks' medical therapy, underwent transurethral intraprostatic injection of BoNT‐A or normal saline in a prospective pilot double‐blind randomized study. The patients' NIH‐CPSI total and subscale scores, American Urological Association (AUA)‐symptom score (SS), visual analogue scale (VAS) and quality of life (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and at 1, 3 and 6 months after injection and also were compared between the two groups.
Results
A total of 60 consecutive patients were randomized to a BoNT‐A (treatment) or normal saline (placebo) group. In the treatment group at the 1‐, 3‐ and 6‐month evaluation the NIH‐CPSI total and subscale scores, and the AUA‐SS, VAS and QoL scores, along with frequencies of diurnal and nocturnal urinations, had significantly improved compared with baseline values (P < 0.05). By contrast, in the placebo group, none of these values showed improvement and the values were significantly different from those in the treatment group. Although the differences between the two groups in AUA‐SS and frequencies of nocturnal urination were not significant at 1‐month follow‐up, repeated‐measure analysis showed significant improvement in each of these values over the entire follow‐up period in the treatment group. The most prominent improvement was related to the pain subscale score, which decreased by 64.76, 75.63 and 79.97% at 1, 3 and 6 months after treatment compared with baseline, followed by the VAS score, which decreased by 62.3, 72.4 and 82.1% at each follow‐up, respectively. Only two patients developed mild transient gross haematuria, which was managed conservatively.
Conclusions
Transurethral intraprostatic BoNT‐A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL.
Complications, operative time, and the length of hospitalization in selected patients undergoing tubeless PCNL were all lower than those seen in the standard group. Tubeless PCNL was thus found to be safe and effective, even in patients with staghorn stones.
Uropathogens in many Asian countries had high resistance to broad-spectrum antibiotics. Knowledge of regional and local resistance data and prudent use of antibiotics are important for proper management of UTI in Asian countries.
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