Stress urinary incontinence is the involuntary loss of urine on effort or physical exertion. It is a highly prevalent condition affecting both men and women. Treatment is performed in a step-wise approach involving conservative measures, such as weight loss and pelvic floor exercises, medical treatment with duloxetine and a variety of surgical treatment options. However, recent restrictions in the use of synthetic mesh and tape have limited the surgical treatment options, leading to the need for new and novel treatment for stress urinary incontinence. Stem cell therapy is a developing medical field and offers the potential to restore normal physiological function of the urethral sphincter. The effectiveness of stem cell therapy in stress urinary incontinence has been demonstrated in pre-clinical studies, leading to its evaluation in several clinical studies. This review assesses the current evidence for the safety and efficacy of stem cell treatment for patients with stress urinary incontinence who have failed conservative and/or medical management and have not undergone previous surgical treatment for stress urinary incontinence. Evidence Level: Not applicable
Renal cell Carcinoma is the twelfth common cancer worldwide with 338000 cases diagnosed in 2012. The recurrence rates after nephrectomy for RCC is about 20-30% and about 40% eventually dying from the cancer progression. This high rate of recurrence after nephrectomy underscores the importance of post-surgical surveillance. Metastasis can be synchronous or metachronous type and solitary or multiple in origin. Metastasis post nephrectomy tends present early or very late after surgery. We carred out a review of solitary metastasis patients who have had surgery and study their survival time. Kaplan–Meier survival plot analysis was done to find out the cumulative time of survival for all the patients who have had solitary Metastatectomy. The Median and mean survival time for 225 patients from the time of solitary metastasis removal by surgery was about 43 months (95% CI, 38.2 to 47.7 Months) and 61 Months (95% CI, 46.8 to 75.2 Months) respectively. We present you the findings of the behaviour of RCC in terms of different sites of metastasis and its time taken underlying its indolent nature.
Introduction: The leftover ureteric stump after a simple nephrectomy is rarely symptomatic. Here, we report a unique case of ureteric stump stones that likely developed de novo and patients became symptomatic.
Case Report: We report the case of a 53-year-old female, who had benign right nephrectomy for a non-functioning kidney 17 years ago and presented with three years history of recurrent urinary tract infections and right-side abdominal pain. A continuous unenhanced computed tomography scan confirmed the presence of multiple de novo stones in the leftover ureteric stump, which was successfully treated by an open transperitoneal ureteric stumpectomy. She was asymptomatic at 12 months post-operative follow-up. We describe problems of leftover ureteric stumps and the possible pathophysiology of the stones formation in this group of patients.
Conclusion: Albeit rare, various symptoms and complications can develop in the leftover stump, including stumpitis, urinary tract infections, and calculi. Therefore, discussion with patients of ureteric stump complications is recommended.
Introduction: Pyeloplasty is a standard and highly successful treatment for ureteropelvic junction obstruction. However, stenosis is a late complication causing symptom recurrence. The purpose of this study was to evaluate the use of holmium laser stenosis incision—“laser endopyelotomy”—to manage this. Patients and Methods: Fifteen adult patients were referred for loin pain recurrence after pyeloplasty. Subsequent to ureteropelvic junction stenosis confirmation with intravenous urogram and dynamic isotope renogram investigations, the patients underwent ureteroscopic laser endopyelotomy. Eleven patients had stents in situ before endopyelotomy. Ureteric stents (7F) were placed for 6 weeks postprocedure when ureteroscopy was repeated and stents removed. All patients had repeat intravenous urogram and renograms at 3 months postprocedure. Results: Patients presented at a median of 3.2 years (range, 9 months to 8 years) after pyeloplasty (nine open dismembered, three Culp, and three laparoscopic). Three patients (all nonstented) required a second incision. All patients were discharged from hospital within 23 hours with no complications. Symptomatic improvement was documented in all of the patients, and improved drainage was recorded in the 3-month nuclear scans. Conclusion: Laser endopyelotomy is an appropriate minimally invasive procedure for postpyeloplasty stenosis. Results are better in patients with ureteric stents in situ before the procedure.
Objective: Our aim was to determine whether flexible ureterorenoscopy and laser lithotripsy is efficacious and safe in treating lower pole renal calculi. Materials and methods: Patient, procedure and stone data of patients who underwent flexible ureterorenoscopy and laser lithotripsy at our referral centre were collected prospectively between November 2005 and November 2011 and entered into a designated database. In all, 242 procedures were performed in 198 patients. Results: The mean age was 51.2 years. The mean calculi size was 10.51 mm (range 4–27 mm). Thirty seven patients had more than one stone in the lower pole. An access sheath was used in 19 patients (9.6%), 171 (86.4%) had a ureteric stent inserted after the procedure, and 165 patients had a single procedure. Re-operation rate was 16.7%. Stone-free rates after one procedure were 89%, 80% and 41%, respectively, for calculi measuring 4–10 mm ( n=107), 11–20 mm ( n=76) and > 20 mm ( n=15). The overall stone-free rate was 83%, 91% and 95% after one, two and three procedures, respectively. Conclusion: Flexible ureterorenoscopy and laser lithotripsy is a safe and effective minimally invasive treatment option for patients with 4–20 mm lower pole calculi. Staged procedures, however, become necessary as the size of the stone increases greater than 20 mm, and this should be mentioned when counselling patients for their primary procedure.
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