Urology Journal
Volume:10 Issue: 2, Spring 2013

To review the acute and chronic pathological effects of sulfur mustard on the genitourinary system and male fertility. related to the sulfur mustard-induced genitourinary effects and male infertility. Information in the abstracts of non-English related papers as well as those in the proceedings of congresses on sulfur mustard were reviewed as well. In acute phase after sulfur mustard exposure, evidences are in favor of microscopic and macroscopic renal lesions, very low androgen levels, and impaired spermatogenesis. Several years following sulfur mustard exposure, the long-term pathological effects vary from the renal function impairment to the gonadal damage, in particular, the spermatogenesis. Nevertheless, carcinogenic effect of sulfur mustard on the genitourinary system as well as the prevalence of male infertility among sulfur mustard-exposed veterans in the chronic post-exposure phase is still unclear. Sulfur mustard causes both acute and chronic injuries to different parts ofthe genitourinary system.

To report our recent experience of treating patients with stones associated with renal failure, some of the factors underlying this problem, and few suggestions to avert this tragedy. From January 2010 to December 2010, a total of 2838 new patients with stone disease and renal failure were reviewed and compared with a cohort of 878 patients with normal renal functions. Their demographic and clinicopathological parameters were noted and analyzed. Of 2838 patients, 278 presented with acute and chronic renal failure, 40 (1.4%) with unilateral non-functioning kidneys, and 25 (0.8%) with pyonephrosis and perinephric abscess.Management in 278 (9.7%) subjects was divided into initial relief of obstruction by percutaneous gery, percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and ureterorenoscopy to make these patients stone-free. Results of treatment showed that 72% of patients either recovered their renal functions or became dialysis-free at the end of the follow-up period. Complications of renal calculi in the era of modern treatment can be prevented by public education and organizing courses for family physicians as well as opening new stone clinics in the rural areas of the country equipped with modern treatment facilities and strategies for prevention of renal calculi.

To review our 5-year experience in percutaneous nephrolithotomy (PCNL) for horseshoe kidney with large stone burden or failed shockwave lithotripsy (SWL). During 5 years (2006 to 2011), PCNL was performed on 21 patients with horseshoe kidney stone. We evaluated patients (age, gender), stones characteristics (size, number, side, and site), surgical technique, and outcomes. Sixteen (76.16%) subjects were man and 5 (23.80%) were women, with the mean age of 35 ± 12 years. Mean stone size was 37.2 ± 16.6 mm. Percutaneous nephrolithotomy was performed because of the stone size (over 20 mm) in 18 (85.68%) and failed SWL in 3 (14.28%). Stone numbers were more than one in 18 (85.68%) subjects, and were in the pelvis and at least one calyx. The most common access site was superior posterior calyx (66.64%). Stone-free rate with single sessionand rigid nephroscope was 71.40%. No major complication occurred during the surgery or in post surgical period. Postoperative minor complications occurred in 3 (14.28%) patients, including transfusion in one (4.76%), fever in one (4.76%), and ileus in one (4.76%) subject. Percutaneous nephrolithotomy has acceptable results in horseshoe kidney stone and kidney in our study.

To compare the results obtained from three routine laparoscopic entry techniques, including Direct Trocar (DT), Veress Needle (VN), and Open Approach (OA). were evaluated prospectively in 453 consecutive patients who had undergone laparoscopy. Of 453 patients, 105 (23.2%) were operated on with the DT, 168 (37.1%) with the among the groups in terms of mean age (P =. 003), male-to-female ratio (P <. 001), indications for the operation (P <. 001), and mean trocar insertion time (P <. 001). Three major complications (1 colon perforation and 2 iliac artery injuries) occurred in DT and one (iliac =. 04). Four major complications required laparotomy. Minor complications were seen in 6 (5.8%), 9 (5.4%), and 17 (9.4%) patients (P =. 274) and gas leakage in 4 (3.8%), 16 (9.5%), and 27 (15%) patients. Although DT and VN are rapid and relatively safe, they can be associated with able due to less major complications.