Background:Flexible ureterorenoscopies continue to assume an increasing role in the armamentarium of the endourologist. In many centers around the world, prior stenting is carried out before retrograde intrarenal surgery (RIRS) to passively dilate the ureter, which facilitates passage of a flexible ureteroscope with or without an access sheath. In our series, the first stage of passive dilatation with prior stenting was totally avoided without compromising the success of the procedure.Materials and Methods:From January 2004 to December 2007, 54 patients with 55 renal units underwent RIRS. The patients were between 28 and 65 years old. All patients had renal stones ranging in size from 8 mm to 22 mm. The mean serum creatinine level was 1.1 mg%. The lower ureter was dilated under ‘C - arm’ fluoroscopy guidance up to 14 FR. An access sheath of 10/12 Fr was passed over the working guide wire. RIRS (7.5/9.3 Fr) was introduced into the access sheath. The stones were fragmented using a holmium laser. The mean operating time was 85 mins (45-130 mins).Results:In 52 out of 55 renal units (94.5%), a flexible ureteroscope could be passed successfully into the kidney through an access sheath. In 3 of the cases (5.4%), the lower ureter could not be dilated. In these patients, the procedure was staged after passing a 6/26 JJ stent. An X-ray KUB was done at the 3-month follow-up visit. A total of 50 renal units (94.3%) were stone free at the 3-month follow-up visit.Conclusion:In a majority of the cases, RIRS could be accomplished successfully during the first sitting. Single stage RIRS did not alter the subsequent stone clearance or increase the incidence of morbidity or complications.
Androgen blockade (surgical or medical castration) is a standard procedure for patients with metastatic carcinoma prostate. Sub-epididymal orchiectomy involves removal of testis leaving behind epididymis. This epididymal stump over a period gives a pseudo testicular feel within the scrotum. We present a prospective randomized study to assess the functional utility of this procedure and compare it with total orchiectomy in terms of achieving castrate levels. From July 2005-Jan 2008, 60 patients with metastatic carcinoma prostate were alternately randomised and allotted to two groups, 30 underwent sub-epididymal orchiectomy (group A) and remaining 30 (group B) underwent total orchiectomy. Age: 56-80 years. Serum PSA: 55-268 ng/ml. Preoperative serum testosterone: Group A-300-650 ng/ml and group B-320-640 ng/ml. Postoperative serum testosterone: group A-2-18 ng\ml and group B-7-15 ng\ml on day 7 after surgery. Operating time-26-40 mins for group A and 20-34 mins for group B. Follow up-6 weeks and 3 months. At 3 months patients were asked to grade appearance of scrotum for asthetic value on a scale of 1-100 using visual analogue score. Postoperative serum testosterone reached castrate levels in seven days (both groups). Duration of surgery in both groups was comparable. Complications-wound infection in 1 patient (group A) & 1 scrotal hematoma (group B). Satisfaction score for group A (83.5 ± 9.7) was significantly (p < 0.05) better (95%CI-18.58-28.42), compared to that of group B (60 ± 9.4) by using't' test. Sub epididymal orchiectomy is comparable to total orchiectomy in terms of achieving castrate levels with similar operating time. It has significant advantage in terms of mental satisfaction to patients. It is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anaesthesia.
Placenta accreta spectrum (PAS), particularly placenta percreta, is a dreaded complication of pregnancy in which there is abnormal invasion of placental trophoblast into the muscular wall of usually the lower segment of the uterus and the adjacent urinary bladder with abundant neo-vascularization in the utero-vesical space. Rising cesarean section rates 1 and in vitro fertilization conceptions 2 ensure increasing incidence of PAS disorders.One definitive method of care is classical cesarean section followed by total hysterectomy without disturbing the placenta.Another approach is to resect the part of the myometrium invaded by the placenta and repair the defect to conserve the uterus. 3,4 The major challenge is to control blood loss during separation of the bladder from the invaded lower segment so that remaining steps of hysterectomy can be completed. The numerous newly
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.