Lasers in Urology – what has Survived of our Research Starting 1970*

 

Short Communication

In 1970 I started to investigate the Laser-Technology for urologic surgery together with H. Müßiggang. First of all, it was to check the interacting of the different lasers with biological tissue. The result you can gather from the Figure 1 Decisive are the two factors: absorption and scattering of light into the tissue. The strong light absorption of the CO2 – laser leads to an excellent incision effect with low edema reaction. The light of the is mainly absorbed in the tissue by hemoglobin and pigment colorings and therefore suitable for the destruction of highly vascularized tumors or malformations. For achieving greater volume effects, - necessary for destruction of solid tumors, bilharzial bladder-lesions and inflamed areas in interstitial cystitis, - the Nd:YAG – laser was used by us since 1976 (Figure 2). Presupposed for the clinical application of lasers was the developing of a quartz glass fiber transmission system by Nath, a physicist from the Neuherberg Laser Labor (1973) and the developing of a special cystoscope insert, designed by my working-group (Staehler, Frank et al.) and constructed by the Storz Compagny/Tuttlingen/Germany (Figure 3). The next steps were the laser induced shock wave lithotripsy, developed between 1978 to 1986 (Munich/Lübeck) and the photodynamic procedures for early tumor diagnosis (Figures 5a & 5b).

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Chronic Kidney Disease, Data from MIKD

 

Abstract

Chronic kidney disease (CKD) is a leaping up public health matter. It has an augmented effect on cardiovascular diseases and affects every system in body. In developed countries the extent of prevalence is available due to renal registries. In middle or low socio economic countries the proportion of this evolving health issue is not known. CKD is rising and a major contributor is soaring number of diabetes mellitus worldwide. Other significant addition in this cohort of CKD is by rising numbers of obese and hypertensive patients. In order to curtail this rising health matter immediate and intense measures both at preventive and curative levels are required.

Aim: Due to lack of formal renal registry we wanted to see spectrum of chronic kidney disease (CKD) in our catchment area and at what CKD stage they present to tertiary care hospital.

Methods: All patients who presented to Emergency department of Multan Institute of kidney disease from 01 Sep 2017 till Sep 2019 data were evaluated. Record of Emergency department patients were taken from electronic system of our hospital. Some patients had multiple visits and we took first visits kidney function in our analysis. eGFR was calculated from serum creatinine with help of CKD-EPI equation.

Results: Total 4303 patients were included in study. Males were 60% and females 40%. Age range from 13 years to 96 year old. 945 patients were excluded as they were not falling in chronic kidney disease category. Remaining 3358 patients had chronic kidney disease. Sub-analysis according to CKD stage showed 66.17% patients presented at CKD stage V.

Conclusion: Kidney disease is rising globally. Countries where renal registries are established provide incidence of chronic kidney disease ranging from 10 to 15%. Still a lot of countries worldwide do not have established system of data collection so true incidence is not established. Our work is first of its kind reported from this area. Drastic preventive strategies are need of time from health budget planners.

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Lymphocele after Renal Transplantation: A Contemporary Review and a Modern Approach for Prevention and Treatment

 

Abstract

A lymphocele is a common finding after renal transplantation. The majority of patients are asymptomatic. However, once a lymphocele has become symptomatic, this condition has to be treated. Lymphoceles may originate either from the lymphatic system of the recipient or the transplanted kidney. The most sensible measures to prevent their occurrence therefore seems to be to restrict the transplant bed to the smallest permissible level with careful ligature of the lymphatic vessels in the area of the kidney hilum.

Therapy of a lymphocele after renal transplantation should commence with minimally invasive measures and continue with invasive procedures only if these are unsuccessful, namely, puncture and drainage then sclerotization, and then laparoscopic or open marsupialization.

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