Re: Safwat et al.: Percutaneous Suprapubic Stone Extraction for Posterior Urethral Stones in...
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Transcript of Re: Safwat et al.: Percutaneous Suprapubic Stone Extraction for Posterior Urethral Stones in...
![Page 1: Re: Safwat et al.: Percutaneous Suprapubic Stone Extraction for Posterior Urethral Stones in Children: Efficacy and Safety (Urology 2013;82:448-450)](https://reader036.fdocuments.net/reader036/viewer/2022080117/5750980e1a28abbf6bd8d862/html5/thumbnails/1.jpg)
Handan Cakmakci, M.D.Department of Radiology
Dokuz Eylul University Faculty of MedicineIzmir, Turkey
References
1. Alaygut D, Soylu A, Kasap B, et al. The relationships between renalcompensatory hypertrophy etiologic factors and anthropometricdevelopment in the pediatric age group [e-pub ahead of print].Urology. doi: 10.1016/j.urology.2013.03.024, accessed May 12, 2013.
2. Garg M, Singh V, Sankhwar S, et al. Re: Alaygut D et al.: Therelationships between renal compensatory hypertrophy etiologicfactors and anthropometric development in the pediatric age group.Urology. 2013;82.:1189-1190.
Re: Abdulwahed et al.: Sensitivity andSpecificity of Ultrasonography in PredictingEtiology of Azoospermia (Urology 2013;81:967-971)
TO THE EDITOR:
We congratulate the authors for describing the ultraso-nographic features of obstructive and functional azoo-spermia. The authors contend that ultrasonography canpossibly replace testicular biopsy in some men withazoospermia. However, the authors have used criteriasuch as evidence of prostatitis, epididymitis, small sizeprostate, and small size seminal vesicles for differentiatingobstructive with functional azoospermia. Most of thesecriteria are poorly defined in the published data anddifficult to evaluate.
We would like to know how the sensitivity and spec-ificity were calculated. The authors have describedmultiple findings on ultrasonography. Which parameteror combinations of finding were taken to calculate thesevalues? We should remember that ultrasonography is anoperator-dependant investigation and prone to error.Therefore, it may be difficult to interpret this test resultwith confidence.
Apul Goel, M.B.B.S., M.S., M.Ch. (Urology)D.N.B. (Urology)
Sagorika Paul, M.B.B.S., M.S. (General Surgery)Ved Prakash Verma, M.B.B.S., M.S. (General Surgery)
Department of UrologyKing George’s Medical University
Chowk, Lucknow, Uttar Pradesh, India
Reply by the Authors
TO THE EDITOR:
We agree that sonographic findings are suggestive ratherthan diagnostic to pathologic diagnoses such as prostatitisand epididymitis and might be prone to error.
UROLOGY 82 (5), 2013
In this study, we aimed to demonstrate how close is thediagnostic yield of ultrasound to the more accurate butinvasive testicular biopsy in differentiating obstructivefrom functional azoospermia.
Concerning calculation of the sensitivity and speci-ficity of scrotal and transrectal ultrasound in the presentstudy, the radiologist e who was blinded to the results ofbiopsy e was asked not only to collect ultrasound findingsbut also suggest a diagnosis and the nature of azoospermiawhether obstructive or functional in each case on thebasis of the findings of scrotal and transrectal ultrasoundseparately.
Comparing the radiological suggested nature of azoo-spermia e in each ultrasound modality e with the sureresults of histopathologic diagnosis of testicular biopsyallows detecting true and false, positive and negativediagnosis, and consequently the sensitivity and specificityof each technique separately.
Ehab ElGanainy, M.D.Department of Urology
Assiut UniversityAssiut, Egypt
Re: Safwat et al.: Percutaneous SuprapubicStone Extraction for Posterior UrethralStones in Children: Efficacy and Safety(Urology 2013;82:448-450)
TO THE EDITOR:
We read the article with interest and appreciate theauthors for describing the use of minimally invasivetreatment modality in children for posterior urethralstones. We have some comments regarding the study.
The authors have mentioned that in 45 of the 54patients, stone was removed intact with a 3-mm skinincision. The mentioned stone size was ranged from 0.8to 1.9 cm. It is quite difficult to remove a stone of thissize along with flanges of hemostat through a 3 mm skinincision, and forceful retrieval will increase the sizeof incision. In addition, the authors should clarifythat either they attempted for intact removal of stones inall patients or they choose any criteria such as stonesize or hardness for fragmentation. Discussion about themean stone size in patients in whom intact removalwas possible will give a better idea about the cutoff sizeof stones for intact removal by this technique.
Sometimes, in impacted stones, push back of stones inbladder is not possible and in situ fragmentation mightrequire. In the study by Maheshwari and Shah,1 in 18 ofthe 42 patients who presented with symptomatic urethralcalculi, attempted push back was failed.1 They concludethat intracorporeal intraurethral holmium lasertripsy is afeasible, safe, and effective modality for impacted maleurethral stones.1 However, the authors’ approach is a
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better alternative in conditions of unavailability of laseror in nonimpacted stones.
Jai Prakash, M.S.Pradeep Sharma, M.S.
Satya Narayan Sankhwar, M.S., M.Ch. (Urol.)Department of Urology
King George Medical UniversityLucknow, Uttar Pradesh, India
Reference
1. Maheshwari PN, Shah HN. In-situ holmium laser lithotripsy forimpacted urethral calculi. J Endourol. 2005;19:1009-1011.
Reply by the Authors
TO THE EDITOR:
Percutaneous suprapubic stone extraction is a new mini-mally invasive modality in children for the managementof posterior urethral stones. Forty-five of 54 patients’stones were removed intact with a 3-mm incision.Mechanical properties of the skin, especially elasticity,change over lifetime.1 Pediatric skin elasticity allows forthe delivery of relatively large stones through the smallincision, that is, an 8-mm stone can be delivered througha 3-mm incision without the need for incision extension.For larger stones, incision widening or in situ stonecrushing might be required. In our study, the initialattempt is for intact stone extraction through the skinincision; however, if the stone size is large to be delivered(>10 mm), widening of the incision or stone crushing isthen attempted. Another factor in decision is the stonehardness. If on stone manipulation, the stone is friable,then stone crushing into minute fragments is performed.
Holmium laser lithotripsy is an effective modality forpediatric stone manipulation, especially ureteral stones.2
This has been extended for urethral stones. Our tech-nique of suprapubic stone extraction is a minimallyinvasive, minimally resource for the management ofpediatric posterior urethral stones in the event of lackof equipment and special instrumentation.
Ahmed S. Safwat, M.D.Diaa A. Hameed, M.D.
Mohammed Elgammal, M.D.Yasser M. Abdelsalam, M.D.
Department of UrologyAssiut University
Assiut, Egypt
Ahmad Abolyosr, M.D.Department of Urology
Qena UniversityQena, Egypt
References
1. Luebberding S, Krueger N, Kerscher M: Mechanical properties ofskin in vivo: a comparative evaluation in 300 men and women [e-pub
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ahead of print]. Skin Res Technol. doi: 10.1111/srt.12094, accessedAugust 8, 2013.
2. Safwat AS, Bissada NK, Kumar U, et al. Experience with uretero-scopic holmium laser lithotripsy in children. Pediatr Surg Int. 2008;24:579-581.
Re: Kuehhas et al.: A ProspectiveEvaluation of Pain Associated With StonePassage, Stents, and Stent Removal Usinga Visual Analog Scale (Urology 2013;82:521-525)
TO THE EDITOR:
We congratulate the authors1 for their interesting studydescribing the prospective evaluation of pain associatedwith stone passage, stents, and stent removal usinga visual analog scale. We have some comments.
In the study, before stent removal lignocaine gel wasadministered in urethra, which causes local anaesthesiaand it might give falsely low score on visual analog scaleduring stent removal.
The results showed that pain perception was signifi-cantly greater when first year residents performed thestent removal (P <.001). As the dose of lignocaine geladministered per urethra before stent removal was notstandardized in the study, it may be one of the reasons fordifferent visual analog scale during double-J (DJ) stentremoval for different patients, besides the experience ofthe resident.
Arvind Kumar, M.S.Satya N. Sankhwar, M.S., M.Ch.Vishwajeet Singh, M.S., M.Ch.
Department of Urology, King George Medical University,Lucknow, Uttar Pradesh, India
Reference
1. Franklin E. Kuehhas, Arkadus Miernik, Varun Sharma, et al. Aprospective evaluation of pain associated with stone passage, stents,and stent removal using a visual analog scale. Urology. 2013;82:521-525.
Reply by the Authors
TO THE EDITOR:
We thank the authors for their interest in our articleregarding the evaluation of pain associated with stonepassage, stents, and stent removal using a visual analogscale.
The urethral application of lidocaine gel is a stan-dardized and well-tolerated method for the reduction ofurethral discomfort during transurethral manipulation.Several studies have shown that pain during cystoscopy
UROLOGY 82 (5), 2013