IntroductionThe aim of this study was to evaluate oral single/multiple doses of Fosfomycin Trometamol with clinical and microbiological efficacy in:Asymptomatic bacteriuria in pregnancy.Endourological procedures.Lower urinary tract infections. Material and methodsThis prospective, uncontrolled, open label study was conducted in two tertiary hospitals over a period of three years. A total of 400 patients were included in the study. Group A (200 patients) with asymptomatic bacteriuria in pregnancy and Group B (200 Patients) with symptomatic lower urinary tract infections and with any day care endourological procedures were enrolled in our study. Efficacy end points like post- antibiotic urinalysis, microbiological efficacy and clinical improvement with adverse effects of the drug were evaluated.ResultsOf the 400 patients studied, 98% returned for follow-up. Out of the 304 urinary isolates in Table 2 (ASB and symptomatic LUTS) grown on urinary culture, majority of the isolates were Gram-negative Enterobacteriacae family. After oral single/multiple doses of fosfomycin, bacterial eradication, bacterial persistence, bacterial reinfection were 96.3%, 3.9%, 3.9% respectively (Figure 2). No isolates were grown in 8 cases (Table 2). However, on administration of the drug 23.5% patients noticed diarrhea (loose stools) followed by itching (19.7%) in genital area (Figure 1).ConclusionsFosfomycin Trometamol is a bactericidal antibiotic with a broad spectrum activity against Gram-positive also Gram-negative bacteriae. It has an advantage of oral single /multiple doses, higher eradication rate of bacteria after 48 hours, excellent tolerability and safety in pregnancy and other female age groups. We recommend Fosfomycin Trometamol as the drug of choice particularly in patients with poor drug compliance and for minor day care endourological procedures.

Objective:To evaluate the effectiveness of single-session ethanol sclerotherapy in the treatment of symptomatic simple renal cysts. Materials and methods:Between March 2006 and June 2011,42 consecutive patients with 45 symptomatic renal cysts were treated with percutaneous aspiration and ethanol sclerotherapy. The volume of the cyst fluid ranged from 75 to 650 mL (mean 220 mL), and the cysts were categorized into three groups: <150 mL. 150-300 mL, and >300 mL. The cysts were aspirated under local anesthesia with ultrasound guidance using an 18-gauge 20 cm spinal puncture needle. After near-total cyst aspiration, volumes of 25 mL, 50 mL, and 75 mL of an ethanol sclerosing agent were used in the three cyst groups, respectively. The patients were reassessed at 1,3, and 6 months. Results:The procedure was technically feasible in all of the patients. The final assessment at 6 months showed that, of the 45 cysts treated, there was a complete response (symptomatic with complete cyst resolution) in 33 (73%) cysts and a partial response in 10 (22%); the procedure was unsuccessful for 2 (4%) cysts. There was a correlation between the initial cyst volume and the response to treatment. There were no major complications related to the procedure. Minor complications, including pain, fever, hematuria, and small perinephric hematoma were observed in 11 (26%) patients and were managed conservatively. Conclusion:The treatment of symptomatic simple renal cysts using ethanol sclerotherapy under ultrasound guidance is a simple, safe, minimally invasive, and cost-effective outpatient procedure with satisfactory short-and mid-term results. The procedure can be performed with good efficiency and low morbidity, particularly in moderately sized cysts (<300 mL) and therefore should be considered as a feasible therapeutic option for the treatment of symptomatic simple renal cortical cysts. However, a longer follow-up period is needed to assess the long-term results of this procedure. ÖZET Amaç:Böbrek taçlan olan seçilmi § olgularda sirt üstü pozisyonda tüpsüz PNL'nin güvenilirligi, uygulanabilirligi ve etkinligini degerlendirmek.Gereç ve yöntem: Mart 2006 -Haziran 2011 tarihleri arasmda, 45 semptomatik böbrek kisti olan ardi §tk 42 hasta perkutan aspirasyon ve etanoi skieroterapisi ile tedavi edildi. Kist sivismm hacmi 75-650 mL arasmdaydi (ortalama 220 mL) ve kistler <150 mL, 150-300 mL ve >300 mL olmak üzere 3 gruba ayrildi. Kistler lokal anestezi altmda, ultrason rehberliginde, 18 G 20 cm spinal igne kuUanilarak aspire edildi. Tama yakm kist aspirasyonundan sonra, sklerozan ajan etanoi, üc kist grubunda sirastyla 25 mL, 50 mL ve 75 mL hacminde kullanildi. Hastalar 1,3 ve 6. aylarda yeniden degerlendirildi. Bulgular: Teknik olarak i §lem bütün hastalarda uygulanabilir durumdaydi. Alt) aylik periyottaki son degerlendirmede, tedavi edilen 45 kistin 33'ünde (%73) tam yanit (tam kist rezolüsyonu ile semptomatik), lO'unda (%22) kismi yanit vardi, buna kar §m 2 (%4) kistte i §lem ba §arisiz oldu. Baglangiçtaki kist hacmi ve tedaviye yanit arasi...

Aim:The objective was to compare the use of autologous dermal and temporalis fascia grafts in the treatment of acquired penile curvatures.Materials and Methods:It was a prospective observational study of 33 cases, conducted in Sher-i-Kashmir Institute of Medical Sciences, Srinagar from March 2007 to September 2013. All the patients had stable Peyronies disease (PD). Dorsal, dorsolateral and vental curvatures with good preoperative erections were included. PD index with visual analog scales for curvature was used preoperatively. An informed written consent was taken from all the patients with main emphasis on erectile dysfunction.Results:After an average follow up of 2 years, complete straightening of penis was observed in all patients with satisfactory sexual intercourse in 30 patients (90%). Three patients (10%) required frequent use of type 5 phosphodiesterase inhibitors for adequate erections. Overall 91% of patients and partners were satisfied with the procedure and cosmetically donor site was better in temporalis fascia graft site. No rejection of any graft was noted and glans hypoesthesia was noticed in 4 patients (12%). None of the patients required penile prosthesis. Total operative time for harvesting and application of the graft was more in dermal grafts (>3 hrs) than for temporalis fascia graft (2 hrs).Conclusion:Tunical lengthening procedures by autologous free grafts represents a safe and reproducible technique. A good preoperative erectile function is required for tunical lengthening procedure. Temporalis fascia graft is thin, tough membrane and effective graft for PD with good cosmetic and functional results.

Objective To analyze role of phosphodiesterase 5 (PDE5) inhibitors on urodynamic parameters in patients with suprasacral spinal cord injury. Materials and Methods This was a prospective observational hospital-based study conducted on a cohort of patients, aged between 18 and 65 years with suprasacral spinal cord injury, who were registered in Department of Neurosurgery/Urology. Cutoff period since injury was 2 years. After taking consent, baseline urodynamic study was performed, which was repeated 2 hours after taking single oral dose of 20 mg tadalafil. Urodynamic parameters such as maximum detrusor filling/voiding pressures, maximum bladder capacity, and bladder compliance before and after taking drug were compared for final results and conclusion. Results Following administration of 20 mg of tadalafil, maximum bladder capacity in mL showed statistically significant improvement from 268.39 ± 130.0 to 298.55 ± 112.0.(p < 0.05). Bladder compliance improved from 18.68 ± 6.4 to 20.25 ± 7.5 mL/cm H2O (p > 0.05). Maximum detrusor filling pressure improved from 36.03 ± 20.54 to 32.90 ± 16.47 cm H2O (p > 0.05). Maximum detrusor voiding pressure improved from 64.65 ± 33.19 to 58.13 ± 20.7 cm H2O (0 > 0.05). In patients with injury above D6 spinal cord level, statistically significant improvement was seen in maximum bladder capacity and bladder compliance after 2 hours of single oral dose of tadalafil (p < 0.05). Conclusion Our study suggests a positive role of PDE inhibitors in improving urodynamic parameters in patients with suprasacral spinal cord injury with improvement in parameters such as bladder capacity, detrusor pressures, and bladder compliance. Because this is a small study group, more studies such as this are required to reach to final conclusion.

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