Tuesday, December 24, 2013

Supine Percutaneous Nephrolithotomy and ECIRS


Saturday, December 21, 2013

A Novel Approach to Managing Intravesical Magnetic Beads

Recent reports of magnetic beads inserted into the urethra have identified challenges for urologists during removal. Even moderate numbers of these beads in the bladder necessitate open removal due to their tendency to cluster tightly in a spherical formation. This case report describes a novel approach to using the magnetic property of the beads to aid in removal.

Does Limited Pelvic Lymphadenectomy in Low-Risk Prostate Cancer Patients Affect Biochemical Recurrence?

 With a 43-month median follow-up, D’Amico low-risk prostate cancers are no more likely to develop BCR when limited PLND is omitted than those who undergo limited PLND. A potentially confounding variable might be the variability in the extent of PLND.

Tuesday, December 17, 2013



Who should not use Urgent PC?

  1. Patients with pacemakers or implantable defibrillators.
  2. Patients prone to excessive bleeding.
  3. Patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function.
  4. Patients who are pregnant or planning to become pregnant during the duration of the treatment.
  1. Not intended for intra-cardiac or
    trans-thoracic use.
  1. Concurrent use of medical monitoring equipment during stimulation is not recommended.
  1. Not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide.

How does Neuromodulation work? part 2

          Percutaneous tibial nerve stimulation (PTNS) employs electrical stimulation of the sacral nerve plexus to treat urinary urgency, frequency and urge incontinence. 
              The intervention with PTNS consist of delivering impulses accessing the S1-S3 junction of the sacral nerve plexus via the less invasive route of the tibial nerve.
          The tibial nerve is accessed via a fine (34G) needle electrode inserted slightly above the ankle.  This anatomic area, long recognized as the “bladder center”, has projections to the sacral nerve plexus creating a feedback loop that neuromodulates bladder innervation.
    However  the exact mechanism of action of neuromodulation remains unclear.

How does Neuromodulation work? part 1

          The bladder and pelvic floor receive most of their innervations from the pudendal nerve, with 70% coming from the S3 nerve root and 30% from S2 and possibly S4. 
              Sacral parasympathetic preganglionic fibers in the pelvic nerve provide the major excitatory input to the bladder. 
               Fibers originating in the thoracolumbar sympathetic pathways provide the inhibitory input. 
              Afferent pelvic pathways are composed of small, myelinated A fibers and unmyelinated C-fibers. 

              These pathways, transmitting signals from the bladder mechanoreceptors, pelvic visceral organs, and somatic pathways, provide signals for the voluntary control of micturition.

Saturday, December 14, 2013

blood gases analysis

Friday, December 13, 2013

metabolic alkalosis

Thursday, December 12, 2013

FDA Clears First Drug Treatment for Peyronie's Disease

The US Food and Drug Administration (FDA) has approved collagenase clostridium histolyticum (Xiaflex, Auxilium Pharmaceuticals) for the treatment of men with Peyronie's disease.
"Xiaflex is the first FDA-approved non-surgical treatment option for men with this condition, who have a plaque (lump) in the penis that results in a curvature deformity of at least 30 degrees upon erection," the FDA said in a statement.
Peyronie's disease affects about 5% of men. It is caused by scar tissue that develops under the skin of the penis, which causes an abnormal bend during erection and can cause problems such as bothersome symptoms during intercourse.
Collagenase C histolyticum is believed to work for Peyronie's disease by breaking down the buildup of collagen (a structural protein in connective tissue) that causes the curvature deformity, according to the FDA.
As reported by Medscape Medical News, collagenase C histolyticum was first approved by the FDA in 2010 for thetreatment of Dupuytren's contracture, a progressive hand disease that can affect a person's ability to straighten and properly use their fingers.
The safety and effectiveness of collagenase C histolyticum for treatment of Peyronie's disease were established in 2 randomized double-blind, placebo-controlled studies in 832 men with Peyronie's disease with penile curvature deformity of at least 30 degrees.
As reported by Medscape Medical News, participants were given up to 4 treatment cycles of collagenase C histolyticum or placebo and were followed-up for 52 weeks. Treatment with collagenase C histolyticum significantly reduced penile curvature deformity and the related bothersome effects compared with placebo.
For Peyronie's disease, a clinician injects collagenase C histolyticum directly into the scar tissue, using a technique that requires training. One cycle of treatment involves 2 injections 24 to 72 hours apart. Treatment consists of a maximum of 4 treatment cycles. The most common adverse reactions include penile hematoma, penile swelling, and penile pain.
"Today's approval expands the available treatment options for men experiencing Peyronie's disease, and enables them, in consultation with their doctor, to choose the most appropriate treatment option," said Audrey Gassman, MD, deputy director of the Division of Bone, Reproductive and Urologic Products in the FDA's Center for Drug Evaluation and Research.
The FDA says collagenase C histolyticum for Peyronie's disease is available only through a risk evaluation and mitigation (REMS) program because of a risk for serious adverse reactions, including penile fracture and other serious penile injury. The treatment "should be administered by a health care professional who is experienced in the treatment of male urological diseases," the agency notes.
The REMS requires participating healthcare professionals to be certified within the program by enrolling and completing training in the administration of collagenase C histolyticum for Peyronie's disease. The REMS also requires certification of healthcare facilities to ensure the drug is dispensed only for use by certified healthcare professionals.

Healthcare professionals are encouraged to report adverse reactions from the use of collagenase C histolyticum to MedWatch, the FDA's safety information and adverse event reporting program, by telephone at 1-800-FDA-1088; by fax at 1-800-FDA-0178; online athttps://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm; with postage-paid FDA form 3500, available at http://www.fda.gov/MedWatch/getforms.htm; or by mail to MedWatch, 5600 Fishers Lane, Rockville, Maryland 20852-9787.

Thursday, December 5, 2013

Important questions to ask during history taking to child’s urinary incontinence

When does your child wet itself: only at night or also
during the day time?
How often does this occur (for example, every night or
several times every month)?
Where does it occur (only at home, only outside the
How often does your child go to the toilet every day;
does he/she have to get up at night?
Do your child’s underpants have yellow staining during
the day?
Have you observed so-called holding maneuvers?
How does your child urinate?
Is the urine stream intermittent; does your child have to
strain or squeeze?
Has your child had urinary tract infections in the past
Does your child suffer from constipation, soiling, encopresis?
What are your child’s drinking habits (how much, what,
Does your child drink large volumes of fluids, especially
in the evening?
Have you observed signs of a general developmental
Have you observed psychological or behavioral abnormalities?
Does your child have comorbidities or has he/she had
What has already been done to treat the child’s urinary
Does your child encounter stressful situations within the

family or at school?

Wednesday, December 4, 2013

Discoordinated micturition

Discoordinated micturition is characterized by continued tightening of the pelvic floor during micturition and resulting bladder voiding problems (1). Mostly, this is due to acquired malfunction (for example, an incorrect sitting posture, or as a reaction to painful micturition during urinary tract infections/Lichen sclerosus).
The cardinal symptoms are a weak urine stream and staccato متقطع micturition. Urinary tract infections and bowel voiding disorders are common comorbidities.

1. van Gool JD, de Jong TPVM, Winkler-Seinstra P, et al.: A comparison of standard therapy, bladder rehabilitation with biofeedback, and pharmacotherapy in children with non-neuropathic bladder sphincter dysfunction. Neurourol Urodyn 1999; 18: 261–2.

Organic urinary incontinence

This form of incontinence is rare. Especially in treatment-refractory cases, special efforts have to go into the detection of possible organic causes.

1- The permanent leaking of small amounts of urine during the day and at night is typical for girls with duplex kidney and ectopic ureter. Malformations of the urethra may also be the cause of organic urinary incontinence.

2- Polyuric renal disease—such as tubulopathies, chronic renal failure, or diabetes insipidus—can also manifest as enuresis. Typically, children awake at night owing to a pronounced sensation of thirst.

3- Neurogenic disorders: In congenital (for example, myelomeningocele/spina bifida) or acquired neoplastic
or inflammatory disorders of the nervous system, the innervation of the bladder is often affected. Occult spinal dysraphisms (for example, spina bifida occulta, tethered cord syndrome, sacral agenesis) often remain undetected for a long time. The clinical features of a neurogenic bladder depend on the location of the lesion and is heterogeneous (for example, pathological residual urine, recurrent urinary tract infections, urinary incontinence, lacking perception of the need to urinate, abnormal uroflowmetry, thickened and trabeculated bladder wall).

4- In the rare “non-neurogenic neurogenic bladder,” (Hinman syndrome), the symptoms resemble those of neurogenic bladder, but no neurological lesion is identified.

Diagnostic categories in urinary incontinence

Tuesday, December 3, 2013

Urinary Incontinence in Children

Urinary incontinence (bedwetting, enuresis) is the commonest urinary symptom in children and adolescents and can lead to major distress for the affected children and their parents. Physiological and non-physiological types of urinary incontinence are sometimes hard to tell apart in this age group.



To our knowledge, this is the first time exogenous melatonin has been evaluated in the treatment of MNE. Although we observed a change in level and peak-time of melatonin in saliva after the use of melatonin, we did not observe a significant change in enuresis frequency, nor did we observe a change in sleep-wake cycle. Therefore, we conclude that the role of melatonin in the treatment of therapy-resistant MNE is limited. However, the studied population was relatively small and consisted of a select group of patients resistant to all other forms of therapy. Further studies are necessary to explore new treatment options for this difficult group of patients.

Wednesday, November 27, 2013

Procedure Guideline for Tumor Imaging with 18F-FDG PET/CT 1.0*


Tuesday, November 26, 2013

Biograph mCT Flow ---FlowMotion, the end of stop and go.

Diagnostic imaging is expected to deliver  definitive and timely answers to clinical  questions. And, in today’s increasingly competitive and rapidly changing healthcare environment, these answers must be provided in the safest and most efficient way possible. While every hospital and physician strives to deliver the best care, patient expectations for a comfortable, stress-free imaging experience continue to increase. To meet these growing demands for higher-quality and more patient-centered care, PET/CT must overcome the limitations defined by conventional stop-and-go technology.

Until now, PET examinations have been performed in sequential bed positions, alternating between acquisition and patient table motion. As such, planning and scanning have always been restricted by the fixed size of the detector array. Additionally, the inherent complexity of stop-and-go scanning has limited the routine use of advanced PET/CT imaging technology, and often resulted in higher dose, greater patient anxiety, lower efficiency and the potential for patient motion and related image degradation. Siemens understood the only way to break through the limitations of stop-and-go and enable further clinical advancements was to fundamentally change how PET imaging is performed. Powered by Siemens’ revolutionary Flow Motion™ technology, Biograph mCT Flow™ is the world’s first PET•CT system to eliminate the demand for stop-and-go imaging. Now with Biograph mCT Flow and Flow Motion, planning and scanning is based on a single continuous motion of the patient table.  With the new Biograph mCT Flow, physicians benefit from the finest* image resolution in every organ and every scan. Furthering the ability to understand disease, now you can also confidently rely on molecular imaging with accurate and reproducible quantification in all dimensions. Simple and precise range planning eliminates over-scanning and the associated radiation exposure, while simultaneously streamlining workflow. Biograph mCT Flow incorporates a host of proven solutions that support the use of the lowest possible dose, all while scanning patients faster than ever before. Finally, FlowMotion’s sense of continuous progress provides a more comfortable exam experience for patients.

Road to RSNA 2013: Molecular Imaging Preview

The field of molecular imaging and nuclear medicine continues to attract great enthusiasm for what many observers see as limitless possibilities for an expanding range of clinical applications.

Of particular note is Sunday's nuclear medicine poster session (CL-NMS-SUB, 1:00 p.m.-1:30 p.m., Room S503AB), which offers six studies on the roles of FDG and choline with PET/CT to assess various forms of cancer.

In the opening presentation, Dr. Erik Paulson, chairman of the department of radiology at Duke University School of Medicine, details the value of iodinated contrast and PET/CT. In addition, Dr. Andrea Rockall, a professor and a consultant radiologist with the Imperial College Healthcare NHS Trust, shows how to recognize typical findings on FDG-PET/CT in pelvic malignancies, as well as gynecologic and urologic cancers.



Monday, November 25, 2013


A 32-week prenatal sonogram of a male fetus followed for hydronephrosis reveals increasing bilateral hydronephrosis, a dilated bladder, and new-onset marked oligohydramnios. What is your recommendation?

Posterior urethral valves leading to bilateral hydronephrosis with oligohydramnios is the most likely etiology, and this situation potentially represents a rare urologic indication for induction of labor or fetal intervention.

1- Fetal lung maturity should be evaluated with a lecithin/sphingomyelin amniotic fluid ratio prior to a final recommendation.

2- If fetal surgical intervention is considered, fetal renal function should be estimated by the urinary sodium chloride, osmolality, and Beta 2 microglobulin obtained by fetal bladder aspiration.

3- A high-grade obstruction of a single system also requires a similarly rapid response. The outcomes for fetal intervention with respect to improvement of renal function are mixed.


This woman delivered a 7 lb, 3 oz otherwise healthy male infant. Postnatal sonography confirms the presence of unilateral hydronephrosis. What further evaluation do you recommend?

Careful physical examination with an emphasis on observing the infant’s active voiding is an important first step. The infant should be started on antibiotic prophylaxis as the incidence of urinary tract infection is approximately 3% to 4% in the first 6 months of life. A voiding cystourethrogram (VCUG) and nuclear renogram (DTPA or MAG 3) should also be scheduled. Recent work suggests a conservative approach to nuclear renography in patients with mild hydronephrosis.

MCQ pedia urology

A 23-year-old pregnant female presents for evaluation of prenatally detected unilateral hydronephrosis. There is no oligohydramnios. What would be your consideration and recommendation to the patient?

Prenatal fetal hydronephrosis is the most commonly diagnosed fetal urologic abnormality. While the overall incidence of hydronephrosis on prenatal sonography is between 1% and 1.5%, the incidence of clinically significant hydronephrosis is between 0.2% and 0.4%. With normal amniotic fluid levels, close follow-up throughout the pregnancy and in the neonatal/newborn period as well as through the first year of life are required. The majority of cases of prenatal low-grade hydronephrosis may stabilize and resolve within the first year of life.

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