Fluoroscopy Guided Instillation Therapy in Chyluria Using
Combination of Povidone Iodine with Contrast Agent. Is a Single
Instillation
6XI¿FLHQW"
Gyanendra Sharma, Vinayak Chitale, Rajgopal Karva, Anshu Sharma, Abdul Bari Durug
Chitale Clinic Pvt. Ltd, Solapur, Maharashtra, India
ABSTRACT
Purpose:7RHYDOXDWHWKHVDIHW\DQGHI¿FDF\RIDVLQJOHLQVWLOODWLRQLQDFRPELQDWLRQRISRYLGRQHLRGLQHZLWKFRQWUDVWDJHQW
XQGHUÀXRURVFRS\JXLGDQFHIRUWKHWUHDWPHQWRIFK\OXULD
Materials and Methods: )URP'HFHPEHUWR-XO\DWRWDORISDWLHQWVZLWKFK\OXULDZHUHWUHDWHGE\UHQDO
SHOYLFLQVWLOODWLRQWKHUDS\53,67KHVFOHURVLQJVROXWLRQZDVSUHSDUHGXVLQJSRYLGRQHLRGLQHZLWKFRQWUDVWDJHQWGLOXWHG ZLWKVWHULOHZDWHULQDUDWLRRI,WZDVLQVWLOOHGRQWKHVLGHKDYLQJFK\ORXVHIÀX[XVLQJDEXOEWLSXUHWHULFFDWKHWHU 8QLODWHUDOLQVWLOODWLRQZDVGRQHLQFDVHVRQWKHULJKWVLGHDQGRQOHIW)RXUWHHQSDWLHQWVKDGELODWHUDOFK\ORXV HIÀX[DQG53,6ZDVSHUIRUPHGRQERWKVLGHVLQWKHVDPHVHVVLRQ)OXRURVFRS\ZDVXVHGWRHYDOXDWHWKHFRPSOHWH¿OOLQJ RIWKHSHOYLFFDO\FHDOV\VWHP7KHVFOHURVLQJVROXWLRQZDVNHSWLQWKHV\VWHPIRUPLQXWHVDQGWKHXUHWHULFFDWKHWHUZDV WKHQZLWKGUDZQ
Results:,PPHGLDWHFOHDUDQFHZDVREVHUYHGLQSDWLHQWV5HFXUUHQFHRFFXUUHGLQ¿YHSDWLHQWV7KH\ZHUHWUHDWHGDJDLQ
XVLQJWKHVDPHSURFHGXUHZLWKVDWLVIDFWRU\UHVXOWV7KHORQJHVWIROORZXSZDV¿YH\HDUVDQGWKHVKRUWHVW¿YHPRQWKV
Conclusion:53,6RIFK\OXULDXVLQJDVLQJOHLQVWLOODWLRQDFRPELQDWLRQRISRYLGRQHLRGLQHZLWKFRQWUDVWDJHQWLVVDIHDQG
HIIHFWLYH8VHRIÀXRURVFRS\KHOSVWRGHWHUPLQHWKHH[DFWDPRXQWRIVFOHURVLQJVROXWLRQUHTXLUHGWRFRPSOHWHO\¿OOWKH V\VWHPDQGWKHUHIRUHRYHU¿OOLQJLVDYRLGHG0RUHRYHUWKHFRPSOLFDWLRQVZKLFKDULVHGXHWRS\HORLQWHUVWLWLDOEDFNÀRZ DUHSUHYHQWHG
Key words: chyle; chyluria; povidone iodine Int Braz J Urol. 2008; 34: 270-6
INTRODUCTION
&K\OXULDLVEDVLFDOO\DXURORJLFDOPDQLIHVWD WLRQRIO\PSKDWLFV\VWHPGLVHDVHRFFXUULQJDVDUHVXOW RIFRPPXQLFDWLRQEHWZHHQWKHO\PSKDWLFVDQGUHQDO SHOYLV$OWKRXJKQRWOLIHWKUHDWHQLQJLWRIWHQFDXVHV PRUELGLW\GXHWRLWVSUHVHQWDWLRQOLNHKHPDWRFK\OX ULDFROLFVHWF,WDOVROHDGVWRQXWULWLRQDOGH¿FLHQF\ DQGDVWDWHRIFRPSHQVDWHGLPPXQRVXSSUHVVLRQ &K\OXULDLVDFRQGLWLRQZLWKVSRQWDQHRXVUHPLVVLRQV DQGH[DFHUEDWLRQV7UHDWPHQWZLWKKLJKSURWHLQDQG ORZIDWGLHWLVHIIHFWLYHLQVRPHSDWLHQWVZKHUHDVDQWL
LQYROYHVVHYHUDOVWHSVVXEMHFWWRKXPDQHUURU,WFDQ DOVREHDVVRFLDWHGZLWKVLGHHIIHFWVOLNHÀDQNSDLQ QDXVHD YRPLWLQJ LQWHUVWLWLDO QHSKULWLV FKHPLFDO F\VWLWLVSDSLOODU\QHFURVLVDUWHULDOKHPRUUKDJHSHO YLRFDO\FHDOFDVWIRUPDWLRQXUHWHULFVWULFWXUHVDFXWH UHQDOIDLOXUH0RUHRYHUHYHQGHDWKKDVEHHQUHSRUWHG ZLWKLWVXVH
,QWKHVHDUFKWRREWDLQDQHI¿FDFLRXVEXWOHVV WR[LFDQGVDIHDOWHUQDWLYHSRYLGRQHLRGLQHKDVEHHQ XVHG,WKDVEHHQXVHGHLWKHUDVDVLQJOHLQVWLOOD WLRQRIP/RIGLOXWHGVROXWLRQRUDVKRXUO\ LQVWLOODWLRQRIWRWDOGRVHVRULQFRPELQDWLRQZLWK GH[WURVHWZLFHDGD\IRUGD\V
:HKDYHVWXGLHGWKHFRPELQDWLRQRISRYLGRQH LRGLQH ZLWK FRQWUDVW DJHQW DV D VLQJOH LQVWLOODWLRQ XVLQJÀXRURVFRS\WRGHWHUPLQHWKHH[DFWDPRXQWRI VFOHURVLQJVROXWLRQQHHGHG
MATERIALS AND METHODS
)URP 'HFHPEHU WR -XO\ SDWLHQWV PDOHV IHPDOHV ZHUH WUHDWHG IRU FK\OXULD7KHPDMRULW\RISDWLHQWVZHUHLQWKH \HDUDJHJURXS7DEOH$OOSDWLHQWVSUHVHQWHGZLWK DSUHYLRXVKLVWRU\RISDVVDJHRIPLON\ZKLWHXULQH 7KHGXUDWLRQRIV\PSWRPVUDQJHGIURPHLJKW\HDUVWR IRXUPRQWKV7KHDVVRFLDWHGV\PSWRPVZHUHKHPD WXULDLQÀDQNSDLQLQ¿YHG\VXULDLQWKUHHIHYHU LQWKUHHDQGSDVVDJHRIFK\ORXVFORWVLQSDWLHQWV 2QHSDWLHQWKDGSUHYLRXVO\XQGHUJRQH53,6XVLQJ VLOYHUQLWUDWHEXWKDGQRUHOLHIIURPV\PSWRPV 7KHGLDJQRVLVRIFK\OXULDZDVPDGHE\WKH HWKHUWHVWLQDOOSDWLHQWV$EGRPLQDOXOWUDVRXQGZDV GRQHDVSDUWRIWKHSURWRFROLQDOOSDWLHQWV,WGLGQRW VKRZDQ\DEQRUPDOLW\LQDQ\SDWLHQW,QWUDYHQRXV
XURJUDSK\ ZDV FDUULHGRXW LQ WKH ¿UVW SDWLHQWV DQGZDVHVVHQWLDOO\QRUPDO3\HORO\PSKDWLFFRP PXQLFDWLRQZDVQRWREVHUYHGLQDQ\RIWKHSDWLHQWV RQ LQWUDYHQRXV XURJUDSK\ 6L[WHHQ SDWLHQWV KDG SUHYLRXVO\UHFHLYHGDFRXUVHRIGLHWK\OFDUEDPD]LQH 7KRVHZKRKDGQRWUHFHLYHGWKHFRXUVHZHUHVWDUWHG RQGLHWK\OFDUEDPD]LQH
$OO SDWLHQWV XQGHUZHQW F\VWRVFRS\ XQGHU JHQHUDODQHVWKHVLD7KH\ZHUHDVNHGWRLQFOXGHVRPH EXWWHULQWKHLUPHDOWKHQLJKWEHIRUHWKHSURFHGXUH 7KLVZDVYHU\KHOSIXOLQORFDOL]LQJWKHVLGHRIFK\ORXV HIÀX[,QFDVHVWKHFK\ORXVHIÀX[ZDVXQLODWHUDO RQWKHULJKWVLGHDQGRQWKHOHIWVLGH7KHHIÀX[ ZDVREVHUYHGELODWHUDOO\LQSDWLHQWV$OOWKHVLGHV VKRZLQJFK\ORXVHIÀX[ZHUHVXEMHFWHGWR53,6 7KHVFOHURVDQWVROXWLRQZDVSUHSDUHGE\XVLQJ SRYLGRQHLRGLQHFRQWUDVWDJHQW8URJUDI¿Q 6FKHULQJ3KDUP*HUPDQ\DQGVWHULOHZDWHULQWKH UDWLRRI$EXOEWLS&KHYDVVXXUHWHULFFDWKHWHU ZDVXVHGWRLQVWLOOWKHVFOHURVDQWLQWKHSHOYLRFDO\FHDO V\VWHP,PDJLQJLQWKHIRUPRI&DUPÀXRURVFRS\ZDV XVHGLQDOOSDWLHQWVWRYLVXDOL]HWKHFRPSOHWH¿OOLQJ RIWKHSHOYLRFDO\FHDOV\VWHP7KHV\VWHPZDV¿OOHG XQWLOEOXQWLQJRIDOOIRUQLFHVZDVVHHQ7KXVRYHU GLVWHQVLRQRIWKHV\VWHPDQGWKHFRQVHTXHQWULVNRI S\HORLQWHUVWLWLDOEDFNÀRZRIWKHVFOHURVLQJVROXWLRQ ZDVDYRLGHG7KHXUHWHULFFDWKHWHUZDVNHSWDWWKH XUHWHULFRUL¿FHWRSUHYHQWWKHVFOHURVDQWIURPEHLQJ GUDLQHGLQWKHEODGGHU7KHRWKHUHQGRIWKHXUHWHULF FDWKHWHUZDVEORFNHGWRSUHYHQWWKHVFOHURVDQWIURP GULSSLQJRXW7KHVFOHURVDQWUHPDLQHGLQWKHV\VWHP IRU¿YHPLQXWHVDQGWKHQWKHXUHWHULFFDWKHWHUZDV UHPRYHG
,QSDWLHQWVZLWKELODWHUDOFK\ORXVHIÀX[ERWK VLGHVZHUHWUHDWHGLQWKHVDPHVHVVLRQ
,QWKHFRXUVHRIIROORZXSVHUXPFUHDWLQLQH ZDVHYDOXDWHGLQWKRVHZKRKDGXQGHUJRQHELODWHUDO 53,6 ,QWUDYHQRXV XURJUDSK\ ZDV GRQH DIWHU RQH PRQWKLQWKH¿UVW¿YHSDWLHQWVEXWZDVQRWGRQHLQ WKHVXEVHTXHQWSDWLHQWV
RESULTS
2IWKHSDWLHQWVDOOH[FHSWRQHSDWLHQW KDGLPPHGLDWHFOHDUDQFHRIXULQH,QRQHSDWLHQWWKH FK\OXULDSHUVLVWHGIRUWZRGD\VDIWHU53,6EXWVXEVH Table 1 – Age distribution.
Age\HDUV N of Patients
TXHQWO\WKHFK\OXULDVWRSSHGDQGWKHSDWLHQWZDVIUHH IURPV\PSWRPVDWDIROORZXSRI¿YHPRQWKV 7KHUH ZDV UHFXUUHQFH RI FK\OXULD LQ ILYH SDWLHQWV2QHKDGUHFXUUHQFHDIWHURQHPRQWKWZR SDWLHQWVKDGUHFXUUHQFHDIWHUWKUHHPRQWKVDQGDQRWKHU WZR SDWLHQWV KDG UHFXUUHQFH DIWHU VL[ PRQWKV$OO ZHUHUHWUHDWHGXVLQJWKHVDPHSURFHGXUHDVGHVFULEHG DERYH1RUHODSVHZDVQRWHGDIWHUUHWUHDWPHQW 7KHSDWLHQWZKRKDGDSUHYLRXV53,6XVLQJ VLOYHUQLWUDWHGLGQRWVKRZDQ\UHFXUUHQFHDIWHU53,6 XVLQJSRYLGRQHLRGLQHZLWKFRQWUDVWDJHQW
7KHSRVWWUHDWPHQWSHULRGZDVXQHYHQWIXOLQ DOOSDWLHQWVH[FHSWIRUPLQLPDOSDLQDQGG\VXULDLQ VRPHFDVHV3RVWWUHDWPHQWLQWUDYHQRXVXURJUDSK\ ZDVGRQHLQRQO\LQ¿YHSDWLHQWV7KUHHRIWKHPKDG XQGHUJRQHELODWHUDO53,6,WZDVIRXQGWREHQRUPDO LQDOOSDWLHQWV,QYLHZRIWKLV¿QGLQJDQGWKHPLQLPDO WKHRUHWLFDOULVNRIUHQDOGDPDJHRUXUHWHULFVWULFWXUHV XVLQJWKLVWHFKQLTXHDQGVFOHURVLQJDJHQWVXEVHTXHQW SDWLHQWVZHUHQRWVXEMHFWHGWRLQWUDYHQRXVXURJUDSK\ 6HUXPFUHDWLQLQHZDVQRUPDOLQWKHIROORZXSVWXGLHV RIDOOSDWLHQWVZKRKDGXQGHUJRQHELODWHUDO53,6 1RQHRIWKHSDWLHQWVH[FHSWWKH¿YHPHQ WLRQHGDERYHKDGUHFXUUHQFHGXULQJWKHIROORZXS 7KLVZDVFRQ¿UPHGE\H[DPLQLQJWKHXULQHE\WKH HWKHUWHVW7KHORQJHVWIROORZXSZDV¿YH\HDUVDQG WKHVKRUWHVWZDV¿YHPRQWKV7KHDYHUDJHIROORZXS LVRQH\HDU
COMMENTS
&K\OXULDXVXDOO\DIIHFWVWKHORZHUVRFLRHFR QRPLFFODVVDQGLVQRWXQFRPPRQLQ,QGLD&KLQD -DSDQ7DLZDQ$IULFDRULQ6RXWK(DVW$VLDQFRXQWULHV $OWKRXJKDYDULHW\RISDUDVLWLFDQGQRQSDUDVLWLF FDXVHVFDQFDXVHFK\OXULDLWLVJHQHUDOO\DJUHHGWKDWLW VKRXOGEHFRQVLGHUHGDV¿ODULDOXQOHVVSURYHGRWKHU ZLVHSDUWLFXODUO\LQDUHDVZKHUHO\PSKDWLF¿ODULDVLV LVRUZDVHQGHPLF1RQSDUDVLWLFFDXVHVVXFK DVPDOLJQDQWWXPRUVRIWKHWKRUDFLFGXFWSUHJQDQF\ WUDXPDHWFDUHUDUH
3DUDVLWLFLQIHFWLRQFDXVHVREVWUXFWLRQWRWKH UHWURSHULWRQHDOO\PSKDWLFVOHDGLQJWRGLODWDWLRQSUROLI HUDWLRQDQGVXEVHTXHQWUXSWXUHRIWKHO\PSKDWLFVLQWR WKHSHOYLRFDO\FHDOV\VWHP5HFHQWREVHUYDWLRQV VXJJHVWWKDWWKHH[WHQVLYHO\PSKDQJLHFWDVLDREVHUYHG
LQ%DQFURIWLDQ¿ODULDVLVLVVHFRQGDU\WRO\PSKDWLF G\VIXQFWLRQFDXVHGE\F\WRNLQHVOLEHUDWHGE\DGXOW ¿ODULDOZRUPVDQGE\WKHKRVWLPPXQHUHVSRQVHVWR WKHSDUDVLWH
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
&K\OXULDLVGHELOLWDWLQJDQGFDXVHVPRUELGLW\ EXWLVQRWOLIHWKUHDWHQLQJ+HQFHWKHWUHDWPHQWRIFK\ OXULDVKRXOGEHVDIHHIIHFWLYHDQGPLQLPDOO\LQYDVLYH 53,6KDVEHHQFRQVLGHUHGWKHPRVWSRSXODUIRUPRI WUHDWPHQW7KHEDVLFSULQFLSOHLVWRLQVWLOODVFOHURVDQW LQWKHUHQDOSHOYLVVRWKDWLWFDQHQWHUWKHS\HORO\P SKDWLFFRPPXQLFDWLRQVDQGLQGXFHDQLQÀDPPDWRU\ UHDFWLRQ7KLVFKHPLFDOO\PSKDQJLWLVOHDGVWRHGHPD RIWKHO\PSKDWLFFKDQQHOVDQGWKHUHVXOWDQWEORFNDJH OHDGV WR LPPHGLDWH UHOLHI 6XEVHTXHQW KHDOLQJ E\ ¿EURVLVUHVXOWVLQSHUPDQHQWUHPLVVLRQ
,QDGGLWLRQWKHUHLVDVLJQL¿FDQWIDLOXUHUDWHUDQJLQJ IURP
,QWKHVHDUFKWRDFKLHYHDPRUHVDIHDQGHI IHFWLYHVFOHURVDQWYDULRXVVXEVWDQFHVKDYHEHHQXVHG 3RYLGRQHLRGLQHKDVEHHQUHFHQWO\HYDOXDWHGHLWKHU DORQHRULQFRPELQDWLRQZLWKGH[WURVHVROXWLRQ ,WLVDQLRGLQHFRPSOH[ZLWKWKHQRQLRQLFVXU IDFWDQWSRO\PHUSRO\YLQ\OS\UUROLGRQH,WLVDOVRZD WHUVROXEOHDQGUHOHDVHVLRGLQHVORZO\7KLVSURFHGXUH SURYLGHVDQRQWR[LFQRQLUULWDWLQJQRQYRODWLOHDQG QRQVWDLQLQJIRUPRILRGLQH,WH[HUWVDORFDOVFOHURVDQW DFWLRQDQGKDVDQWLEDFWHULDODQWLVHSWLFaQGDQWLIXQJDO
SURSHUWLHV0RUHRYHULWLVLQH[SHQVLYHHDVLO\DYDLODEOH DQGFDQEHHDVLO\GLOXWHGWRWKHUHTXLUHGFRQFHQWUDWLRQ
6KDQPXJDPHWDOWUHDWHG¿YHSDWLHQWVZLWKDVLQJOH LQVWLOODWLRQRIVROXWLRQSUHSDUHGE\GLOXWLQJ SRYLGRQHLRGLQHZLWKGLVWLOOHGZDWHULQWKHUDWLRRI $OOWKHLUSDWLHQWVZHUHIUHHRIV\PSWRPVDWVL[PRQWKV IROORZXS*RHOHWDOSHUIRUPHGHLJKWKRXUO\LQ VWLOODWLRQVRISRYLGRQHLRGLQHWRDWRWDORIQLQH GRVHV7KH\¿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
7KHVH VWXGLHV GHPRQVWUDWH WKDW SRYLGRQH LRGLQHLVDVVRFLDWHGZLWKVDWLVIDFWRU\UHVXOWVLQWKH WUHDWPHQWRIFK\OXULD,QDGGLWLRQPHJOXPLQHGLDWUL ]RDWH8URJUDI¿QKDVEHHQXVHGIRU53,6 :HKDYHVWXGLHGWKHHI¿FDF\RIDFRPELQDWLRQRI SRYLGRQHLRGLQHZLWKFRQWUDVWDJHQW8URJUDI¿Q GLOXWHGZLWKVWHULOHZDWHULQDUDWLRRI7KLVUDWLR ZDVDUELWUDULO\GHFLGHGDQGDVLWLQLWLDOO\SURGXFHG JRRGUHVXOWV$VÀXRURVFRS\ZDVXVHGGXULQJWKH SURFHGXUHZLWKDFRQWUDVWDJHQWWKHSHOYLRFDO\FHDO V\VWHPZDVZHOOGHOLQHDWHG7KHPRVWFRPPRQVLWHRI O\PSKDWLFXULQDU\FRPPXQLFDWLRQLVDWWKHIRUQLFHV KHQFHWKHVFOHURVLQJVROXWLRQZDVLQVWLOOHGXQWLOWKH EOXQWLQJRIDOOIRUQLFHVZDVVHHQ7KXVWKHFKDQFHVRI
RYHUORRNLQJDQ\¿VWXODHZHUHPLQLPL]HG,QDGGLWLRQ WKHLQVWLOODWLRQRIWKHVFOHURVLQJVROXWLRQZDVVWRSSHG RQFHDOOWKHIRUQLFHVZHUHEOXQWHG2YHUGLVWHQVLRQ RI WKH SHOYLRFDO\FHDO V\VWHP ZLWK LWV DVVRFLDWHG ULVNRIS\HORLQWHUVWLWLDODQGS\HORYHQRXVEDFNÀRZ ZDVWKXVDYRLGHG6KDQPXJDPHWDOXVHGDVLQJOH LQVWLOODWLRQRIP/RIGLOXWHGSRYLGRQHLRGLQH $V WKH FDSDFLW\ RI WKH SHOYLRFDO\FHDO V\VWHP YDULHVIURPHDFKLQGLYLGXDOLWLVRQO\ORJLFDOWKDWWKH DPRXQWRIVFOHURVLQJVROXWLRQQHHGHGWRRSWLPDOO\¿OO WKHSHOYLRFDO\FHDOV\VWHPFRXOGYDU\IURPSDWLHQWWR SDWLHQW3ULRUUHWURJUDGHS\HORJUDSK\FDQGHWHUPLQH WKHH[DFWSHOYLFYROXPH&RQVLGHULQJWKHVHIDFWVZH KDYHFRPELQHGFRQWUDVWDJHQWZLWKSRYLGRQHLRGLQH %\XVLQJÀXRURVFRS\ZHFDQYLVXDOL]HWKHFRPSOHWH ¿OOLQJRIWKHV\VWHP,QDGGLWLRQWKHLRGLQHFRQWHQW RIWKHFRQWUDVWDJHQWKHOSVWRHQKDQFHWKHVFOHURVLQJ HI¿FDF\RIWKHVROXWLRQ7KLVLVVXSSRUWHGE\WKHIDFW WKDWJRRGUHVXOWVZHUHREWDLQHGE\RWKHULQYHVWLJDWRUV ZKHQFRQWUDVWDJHQWVDORQHZHUHXVHG
7KHRSWLPXPWLPHIRUZKLFKVFOHURVLQJDJHQW VKRXOGEHLQWKHSHOYLRFDO\FHDOV\VWHPLVQRWNQRZQ EXWLWVKRXOGEHORQJHQRXJKWRLQGXFHFKHPLFDOO\P SKDQJLWLVDQGHGHPDRIO\PSKDWLFFKDQQHOV0RVWRI WKHLQYHVWLJDWRUVKDYHXVHGIURPWKUHHWRQLQHLQVWLOOD WLRQVIRU53,6,QRXUVWXG\ZHLQVWLOOHGWKH VFOHURVLQJVROXWLRQXVLQJDEXOEWLSXUHWHULFFDWKHWHU DQGRQFHWKHV\VWHPZDVRSWLPDOO\GLVWHQGHGEORFNHG WKHHQGRIWKHXUHWHULFFDWKHWHUDQGNHSWLWDWWKHXUH WHULFRUL¿FHWRSUHYHQWWKHVFOHURVLQJVROXWLRQIURP HIÀX[LQJRXWRIWKHV\VWHP7KHVFOHURVLQJVROXWLRQ ZDV NHSW LQ WKH V\VWHP IRU ¿YH PLQXWHV:KHWKHU NHHSLQJWKHVROXWLRQLQWKHFROOHFWLQJV\VWHPIRUD OHVVHUSHULRGRIWLPHZLOOSURGXFHWKHGHVLUHGUHVXOW PD\EHDQVZHUHGE\DVHSDUDWHVWXG\
SDUWLFLSDWHGLQWKHVWXG\7KHUHZDVPLQLPDOSDLQ1R PDMRUVLGHHIIHFWVRUFRPSOLFDWLRQVZHUHREVHUYHG 7KHSURFHGXUHZDVGRQHELODWHUDOO\LQSDWLHQWVLQ WKHVDPHVLWWLQJZLWKQRVLGHHIIHFWV7KHLQFLGHQFH RIELODWHUDOFK\ORXVHIÀX[ZDVKLJKHULQRXUVWXG\ KRZHYHUZHFRXOG¿QGQRSDUWLFXODUH[SODQDWLRQIRU WKLVRFFXUUHQFH
CONCLUSION
7KHDXWKRUVVXJJHVWWKDWWKHXVHRIDFRPEL QDWLRQRISRYLGRQHLRGLQHZLWKFRQWUDVWDJHQWLVVDIH DQGHIIHFWLYHIRUWKH53,6RIFK\OXULD)OXRURVFRSLF JXLGDQFHKHOSVWRRSWLPDOO\¿OOWKHSHOYLRFDO\FHDO V\VWHP7KXVXQGHU¿OOLQJRIWKHV\VWHPLVDYRLGHG DQGWKHFKDQFHVRIUHVXOWDQWIDLOXUHRIWKHWKHUDS\DUH PLQLPL]HG,QDGGLWLRQDVRYHU¿OOLQJRIWKHV\VWHP GRHVQRWRFFXUDQGWKHFRPSOLFDWLRQVGXHWRS\HORLQ WHUVWLWLDODQGS\HORYHQRXVEDFNÀRZDUHSUHYHQWHG 7KLVZRXOGRWKHUZLVHRFFXULIWKHVFOHURVLQJVROX WLRQZHUHLQVWLOOHGLQUDQGRPDPRXQWVH[FHHGLQJWKH FDSDFLW\RIWKHSHOYLRFDO\FHDOV\VWHP
,QWKLVVWXG\DVLQJOHLQVWLOODWLRQZDVDVHI IHFWLYHDVPXOWLSOHLQVWLOODWLRQVGRQHE\RWKHULQYHV WLJDWRUV7KLVDOVRUHGXFHGWKHQHHGIRUSURORQJHG KRVSLWDOL]DWLRQRIWKHSDWLHQWV
$GUDZEDFNRIWKLVVWXG\LVWKHDEVHQFHRID FRQWURODUPDQGDUHODWLYHO\VKRUWIROORZXSLQPDMRULW\ RIWKHSDWLHQWV+RZHYHURXUUHVXOWVLQIDFWVXJJHVW WKDWWKLVSDUWLFXODUIRUPRI53,6XVLQJÀXRURVFRS\IRU WKHLQVWLOODWLRQRIDFRPELQDWLRQRISRYLGRQHLRGLQH ZLWKFRQWUDVWDJHQWLVVDIHLQH[SHQVLYHHIIHFWLYH PLQLPDOO\ LQYDVLYH DQG LV DVVRFLDWHG ZLWK D VKRUW KRVSLWDOVWD\$OVRWKHSURFHGXUHFDQHDVLO\DQGVDIHO\ EHUHDSSOLHGLQSDWLHQWVZLWKUHFXUUHQFH
CONFLICT OF INTEREST
1RQHGHFODUHG
REFERENCES
2K\DPD&6DLWD+0L\DVDWR16SRQWDQHRXVUHPLV VLRQRIFK\OXULD-8URO
'DWH$-RKQ7-&KDQG\.*5DMDJRSDODQ069DVND 3+3DQGH\$3HWDO$EQRUPDOLWLHVRIWKHLPPXQH V\VWHPLQSDWLHQWVZLWKFK\OXULD%U-8URO
%UXQNZDOO-6LPRQVHQ2%HUJTYLVW'-RQVVRQ. %HUJHQW]6(&K\OXULDWUHDWHGZLWKUHQDODXWRWUDQV SODQWDWLRQ$FDVHUHSRUW-8URO 6DEQLV5%3XQHNDU69'HVDL50%UDGRR$0%DSDW
6',QVWLOODWLRQRIVLOYHUQLWUDWHLQWKHWUHDWPHQWRI FK\OXULD%U-8URO
'DOHOD'.XPDU$$KODZDW5*RHO7&0LVKUD9. &KDQGUD+5RXWLQHUDGLRLPDJLQJLQ¿ODULDOFK\OXULD LVLWQHFHVVDU\LQGHYHORSLQJFRXQWULHV"%U-8URO
7DQ/%&KLDQJ&3+XDQJ&+&KRX<+:DQJ&- ([SHULHQFHVLQWKHWUHDWPHQWRIFK\OXULDLQ7DLZDQ-8URO
6KDQPXJDP793UDNDVK-96LYDVKDQNDU*3RYLGRQH LRGLQHXVHGDVDVFOHURVLQJDJHQWLQWKHWUHDWPHQWRI FK\OXULD%U-8URO
*RHO60DQGKDQL$6ULYDVWDYD$.DSRRU5*RJRL 6.XPDU$HWDO,VSRYLGRQHLRGLQHDQDOWHUQDWLYHWR VLOYHUQLWUDWHIRUUHQDOSHOYLFLQVWLOODWLRQVFOHURWKHUDS\ LQFK\OXULD"%-8,QW
1DQG\35'ZLYHGL869\DV13UDVDG0'XWWD %6LQJK3%3RYLGRQHLRGLQHDQGGH[WURVHVROXWLRQ FRPELQDWLRQVFOHURWKHUDS\LQFK\OXULD8URORJ\ GLVFXVVLRQ
3DQGH\$3&K\OXULD,Q0RUULV3-:RRG:/HGV 2[IRUG7H[WERRNRI6XUJHU\2[IRUG2[IRUG8QLYHU VLW\3UHVVYROSS
'DVK6&%KDUJDY<6D[HQD6$JDUZDO6.7LZDUL 6&'LQGD$$FXWHUHQDOIDLOXUHDQGUHQDOSDSLOODU\ QHFURVLVIROORZLQJLQVWLOODWLRQRIVLOYHUQLWUDWHIRUWUHDW PHQWRIFK\OXULD1HSKURO'LDO7UDQVSODQW
6ULYDVWDYD'1<DGDY6+HPDO$.%HUU\0$UWHULDO KDHPRUUKDJHIROORZLQJLQVWLOODWLRQRIVLOYHUQLWUDWHLQ FK\OXULDWUHDWPHQWE\FRLOHPEROL]DWLRQ$XVWUDODV 5DGLRO
*XODWL066KDUPD5.DSRRU$%HUU\03HOYLFDO\ FHDOFDVWIRUPDWLRQIROORZLQJVLOYHUQLWUDWHWUHDWPHQW IRUFK\OXULD$XVWUDODV5DGLRO 0DQGKDQL$ .DSRRU 5 *XSWD 5. 5DR +6 &DQ
VLOYHUQLWUDWHLQVWLOODWLRQIRUWKHWUHDWPHQWRIFK\OXULD EHIDWDO"%U-8URO
+HPDO$.*XSWD135HWURSHULWRQHRVFRSLFO\PSKDWLF PDQDJHPHQWRILQWUDFWDEOHFK\OXULD-8URO
1RU}HV-$GGLVV'6DQWRV$0HGHLURV=&RXWLQKR $'UH\HU*8OWUDVRQRJUDSKLFHYLGHQFHRIDEQRUPDO O\PSKDWLFYHVVHOVLQ\RXQJPHQZLWKDGXOW:XFKHUHULD EDQFURIWLLQIHFWLRQLQWKHVFURWDODUHD-8URO
1XWPDQ7%.XPDUDVZDPL95HJXODWLRQRIWKHLP PXQHUHVSRQVHLQO\PSKDWLF¿ODULDVLVSHUVSHFWLYHVRQ
EDITORIAL COMMENT
7KH DXWKRUV KDYH LQVWLOOHG D PL[WXUH RI SRYLGRQHLRGLQHDQGPHJOXPLQHGLDWUL]RDWHLQWKH LQYROYHGSHOYLRFDO\FHDOV\VWHPXVLQJDEXOEWLSSHG XUHWHULFFDWKHWHU:KLOHWKHFROOHFWLQJV\VWHPLVEHLQJ ¿OOHGLWLVPRQLWRUHGÀXRURVFRSLFDOO\WRDFKLHYHDVR FDOOHGµFRPSOHWHO\IXOO¶V\VWHP7KHEXOERIXUHWHULF FDWKHWHULVLQWHQGHGWRNHHSWKHXUHWHUµFRPSOHWHO\¶ RFFOXGHGIRUµ¿YHPLQXWHV¶7KHDXWKRUVFODLPWKDW E\XVLQJWKLVPHWKRGRORJ\WKH\SUHYHQWRYHU¿OOLQJ RIV\VWHPDQGWKXVWKHS\HORLQWHUVWLWLDOEDFNÀRZDQG LWVFRQVHTXHQFHVDUHDYRLGHG
7KLVFODLPDSSHDUVWREHPRUHRIDFRQMHFWXUH EHFDXVHGXULQJWKHSHULRGRI¿YHPLQXWHVZKLOHWKH XUHWHULVRFFOXGHGE\EXOEWLSSHGXUHWHULFFDWKHWHU WKHNLGQH\ZLOOFRQWLQXHWRSURGXFHXULQHZKLFKDW OHDVWWKHRUHWLFDOO\PD\EORZXSWKHV\VWHPDQGRSHQ XSS\HORLQWHUVWLWLDOS\HORO\PSKDWLFEDFNÀRZV 1HYHUWKHOHVVLWLVWKH¿UVWUHSRUWRQXVHRI SRYLGRQHLRGLQHZLWKFRQWUDVWPHGLD7RGDWHWKH SUREOHPRIEHVWGRVHEHVWFRQFHQWUDWLRQDQGQRRI
LQVWLOODWLRQVUHPDLQVYH[HG&RQWUROOHGVWXGLHVDUH QHHGHGWRFODULI\WKHVDPH
5HFHQWUHSRUWVKDYHJHQHUDWHGLQWHUHVWLQWKH UROHRIGR[\F\FOLQHDVDGUXJWRUHGXFHWKHSDWKRORJ\ RIO\PSKDWLF¿ODULDVLV,WVDSSOLFDELOLW\WRSDWLHQWV ZLWKFK\OXULDQHHGVWREHORFNHGLQWR
REFERENCE
'HEUDK$<0DQG66SHFKW60DUIR'HEUHN\HL< %DWVD/3IDUU.HWDO'R[\F\FOLQHUHGXFHVSODVPD 9(*)&V9(*)5DQGLPSURYHVSDWKRORJ\LQO\P SKDWLF¿ODULDVLV3/R63DWKRJH
Dr. D. Dalela
Department of Urology King George Medical University Lucknow, Uttar Pradesh, India E-mail: [email protected]
DFXWHDQGFKURQLFLQIHFWLRQZLWK:XFKHUHULDEDQFURIWL LQ6RXWK,QGLD3DUDVLWH,PPXQRO 'DOHOD'5DVWRJL0*RHO$*XSWD936KDQNKZDU
616LOYHUQLWUDWHVFOHURWKHUDS\IRUµFOLQLFDOO\VLJQL¿ FDQW¶FK\OXULDDSURVSHFWLYHHYDOXDWLRQRIGXUDWLRQRI WKHUDS\8URO,QW
Accepted after revision: January 18, 2008
Correspondence address:
'U*\DQHQGUD6KDUPD &KLWDOH&OLQLF3YW/WG '5DLOZD\/LQHV 2SSRVLWH%XV'HSRW
EDITORIAL COMMENT
6FOHURWKHUDS\WKDWLVDPLQLPDOO\LQYDVLYH WUHDWPHQW PRGDOLW\ LV MXVWL¿HG RQFH FRQVHUYDWLYH PRGDOLWLHV IDLO 'LIIHUHQW LQYHVWLJDWRUV KDYH XVHG PDQ\VFOHURVDQWVLQGLIIHUHQWFRQFHQWUDWLRQV+RZ HYHUWKHPD[LPXPH[SHULHQFHKDVEHHQZLWKVLOYHU QLWUDWH%HFDXVHRIWKHYDULRXVSUREOHPVDVVRFLDWHG ZLWKVLOYHUQLWUDWHUHFHQWO\WKHUHKDVEHHQVKLIWDQG PDQ\XURORJLVWVKDYHVWDUWHGXVLQJSRYLGRQHLRGLQH 7KHUHVXOWVRIFK\OXULDDUHPRVWO\HYDOXDWHGEDVHG RQSDWLHQW¶VKLVWRU\RIDQ\UHFXUUHQFHRIPLON\XULQH ZKLFK PD\ EH DVVRFLDWHG ZLWK SLWIDOOV OLNH XQGHU RURYHUUHSRUWLQJ,QWKHVWXG\UHSRUWHGE\6KDUPD HWDOWKHDXWKRUVKDYHQRWPHQWLRQHGWKHIROORZXS SURWRFRO,QDOOSUREDELOLW\LWLVDOVREDVHGRQWKH SDWLHQW¶VHYLGHQFHRIPLON\XULQH,WZRXOGEHLQWHU HVWLQJWRVHHLIWKHGLVHDVHDOVRUHVSRQGVFRPSOHWHO\ ELRFKHPLFDOO\ (VWLPDWLRQ RI XULQDU\ WULJO\FHULGHV LV FRQVLGHUHG VHQVLWLYH DQG VSHFL¿F WHVW IRU
FK\OXULD,WLVQRQLQYDVLYHDQGFRVWHIIHFWLYHDQG LVLQGHSHQGHQWRIPDQXDOHUURU:KHWKHUFK\OXULDLV FRQWLQXRXVLQWHUPLWWHQWPLOGRUVHYHUHXULQDU\WUL JO\FHULGHVDUHLQYDULDEO\GHWHFWHGLQPRUQLQJVDPSOHV (VWLPDWLRQRIXULQDU\WULJO\FHULGHOHYHOVSUHDQG SRVWLQVWLOODWLRQRIVFOHURVDQWVPD\DOVRJLYHLQVLJKW DERXWWKHSDWLHQWVZKRDUHOLNHO\WRUHFXU)ROORZXS RISDWLHQWVRIFK\OXULDLVH[WUHPHO\GLI¿FXOW,IZHFDQ SUHGLFWUHFXUUHQFHEDVHGRQELRFKHPLFDOWULJO\FHUL GXULDWKHQLWPD\KHOSXVLQGHVLJQLQJEHWWHUWKHUDS\ IRUWKLVSUREOHP
REFERENCE
-RKQVWRQ':&K\OXULD&OLQLFDOODERUDWRU\DQGVWD WLVWLFDOVWXG\RISHUVRQDOFDVHVREVHUYHGLQ+DZDLL -8URO
'DOHOD',VVXHVLQHWLRORJ\DQGGLDJQRVLVPDNLQJRI FK\OXULD,QGLDQ-8URO
Dr. Apul Goel