SESSION NO. 1
SIMULTANEOUS BILATERAL PCNL
Laghari M. Shahzad, Memon S. Rehman, Naveed Akbar, Ansari A, Salam
Department Urology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
Objective: To present our experience of simultaneous bilateral PCNL in one session.
Patients and Methods: Between 2003 and 2007 125 patients under went bilateral PCNL simultaneously in one session. Mean patient age was 45 (range 6 to 62) years. 80 patients had general anaesthesia while 45 were done under spinal anaesthesia. 15 patients had staghorn stones in one kidney and 10 patients had bilateral staghorn stones. 17
patients had ureteric stone on one side which was pushed back and PCNL performed. 35 patients had compromised renal function with raised urea and creatinine. The mean (range) operating time was 120 (65 – 170) min.
Results: 90 patients were stone free. 15 patients required second session where as 20 patients underwent ESWL for residual stones. 15 patients had wound infection. 25 patients required blood transfusion.
Conclusions: Simultaneous bilateral PCNL is cost effective and safe procedure in experienced hands with minimal morbidity.
Keywords: Urolithiasis, bilateral PCNL, simultaneous.
DOES THE SIZE MATTER? USE OF NEPHROSTOMY TUBE FOLLOWING PCNL A RANDOMIZED CLINICAL TRIAL
Zaheer Alam, S. Raziuddin Biyabani, M. Hammad Ather
Secton of Urology, Departemet of Surgery, Aga Khan University Hospital, Karachi
Introduction: Following Percutaneous Nephrolithotomy (PCNL) large bore (20-24 Fr) percutaneous nephrostomy (PCN) tubes are generally used. Therefore, it is associated with significant postoperative discomfort and morbidity. We performed a randomized trial comparing 12 and 24 Fr PCN tubes to find difference in perioperative parameters, postoperative discomfort and complications.
Methods: Sixty consecutive patients were randomized into 12 Fr (Group 1) and 24 Fr (Group2) nephrostomy tubes (n=30 each). Data on Visual analog pain Score and analgesic requirement was collected at 6, 24 and 48 hours post operatively. Hemoglobin and hematocrit was determined at 24 hrs of surgery. Nephrostomy tube was removed on afternoon of first Postoperative day. Ultrasonography of ipsilateral kidney was performed on 2nd post operative day to look for perinephric collection and residual calculi.
Results: The mean pain score at 6, 24 and 48 hours were 2.77, 2.10 and 0.8 in group 1 and 5.63, 3.97 and 2.77 in group 2 (p 0.000). Patients in group 1 required less additional analgesic requirement of Ketorolac at 6, 24 and 48 hours (9 vs. 19, 6 vs. 24 and 0 vs. 7 respectively, p <0.05). There was no significant difference in the Hb drop in group 1 and group 2 (1.07 vs. 1.33 grams, p 0.919). None of the patient in either group had significant perinephric collection.
Conclusion: Small bore nephrostomy tube is associated with significantly lower pain score and analgesic requirement in postoperative period.
TUBELESS PCNL WITH WIDE BORE INTERNAL STENTING
S.R.Memon, M.S.Laghari, A.S Ansari, N.Akbar
Liaquat University of Medical & Health Sciences, Jamshoro
Objectives: We present our initial experience of tubeless PCNL at Hyderabad, 2nd largest city of Sindh province which cater people from interior of Sindh
Material & Method : 20 patients under went Tubeless PCNL with 8F DJS inserted antegradelly at the end of the procedure, position of distal end of DJS confirmed with fluoroscopy. Patients were discharged after 48 hours with advised to come back after two weeks for removal of DJS under local anesthesia as day case.
Result: Residual stone fragments were noted in six patients out of whom four had ESWL to clear stone fragments. Two patients head urosepsis which was managed with appropriate antibiotics as per culture & sensitivity result. In none of the patients leakage of urine was observed through PCNL tract.
Conclusion: Tubeless PCNL with wide bore internal stenting is safe and effective procedure, patient can be discharged early despite the fact that they live in far distant areas.
Correspondence to: Dr.Shafique-Ur-Rehman Memon
EARLY EXPERIENCE OF ELECTROMAGNETIC LITHOTRIPTOR AT ABBASI SHAHEED HOSPITAL
Irfan Feroz, Saeed Abidi, Prof. Mohammed Aslam
Institution: Department of Urology, KMDC & Abbasi Shaheed Hospital, Karachi
Abstract: With the increase in the incidence and prevalence of stone disease the treatment modalities are also changing. From open surgery to PCNL, a train of treatment modalities are available for urinary stone disease. Electromagnetic Lithotriptor is recently introduced in Abbasi Shaheed Hospital and we use it for treatment of Renal, Upper Ureteric and Lower Ureteric Stones. Here we would like to share our first year experience of Lithotripsy in the biggest City District Hospital of Karachi.
URETERORENOSCOPY IN CHILDREN
Zafar Zaidi
Objective: To report our experience of Ureterorenoscopy (URS) in the treatment of ureteric stones in children.
Material and methods: Between 2005 and 2008, URS was performed in 63 children 38 males and 25 females. Mean age of patients was 8 years (range 1-13 years). Ureteroscope used was semi-rigid 8F or 10F and stone fragmentation was by pneumatic lithocalst. Ureteric dilatation was achieved by balloon dilators. Stone sizes ranged between 5 and 25 mm and most were present in lower ureter.
Results: Ureteroscopy was performed on right in 48%, left 49% and bilateral3%. 7 stones were located in the upper ureter and were pushed back to the kidney and subsequently treated with ESWL. Of the remaining 56 patients, 52 had lower ureteric stones and 4 patients had mid ureteric stones. Successful stone clearance was achieved in 94.6% patients. 2 children required repeat URS for residual fragments while 1 child underwent ureterolithotomy because of inability to reach the stone by URS. Post operative complications included pain (7.1%), fever (7.1%) and Haematuria (5.3%). There were no long-term complications reported.
Conclusion: Ureterorenoscopy is a safe procedure in children with successful stone clearance achievable in up to 95% patients.
Key word: Ureterorenoscopy, pediatric urolithiasis.
DOES THE TYPE OF LITHOTRIPTER AFFECTS OUTCOME IN CHILDREN WITH UPPER TRACT UROLITHIASIS?
Syed Johar Raza, Aga Khan University Hospital, Karachi.
Abstract:
Objective: To compare the treatment out come and short term safety of Electro hydraulic and Electromagnetic Lithotripters in Children.
Methods: Comparative analysis of children undergoing Shock Wave Lithotripsy (SWL) with Dornier MPL 9000(tm) Electro hydraulic (EHL), and Siemens Modularis(tm) Electro magnetic (EML) lithotripter was done. All shock wave lithotripsy (SWL) treatments were performed by a single operator under the supervision of an admitting urologist. The demographic features, stone and treatment related parameters including complications were analyzed for both groups. Stone Free rates (SF), Retreatment rate (RR) and Efficiency Quotient (EQ) were calculated and compared for the two groups.
Results: Ninety-eight children had SWL for renal and proximal ureteric stones. There were 58 children in the EHL group and 40 in the EML group. There were no statistically significant differences between the groups in terms of age, gender, type of aesthesia, diagnostic modality, site, side and size of the stones. Number of shock waves used in EML was greater than EHL (p 0.00). SF rate was 95% and 77%, for EHL and EML respectively with a statistically significant difference (p 0.00). The retreatment rate was equal in either group. The complication rate was higher with EHL compared to EML, though not reaching statistical significance. Steinstrasse being the most common complication noted. EQ was 66 % for EHL, in comparison with 53% with EML.
Conclusions: EHL has a better SF and EQ than EML, however short term safety is marginally better with EML.
COMPARATIVE STUDY OF THE EFFECTIVENESS OF ELECTRO HYDRAULIC AND ELECTROMAGNETIC LITHOTRIPTERS IN THE MANAGEMENT OF 10-20 MM UPPER URINARY TRACT UROLITHIASIS
Anila Jamshaid, M. Hammad Ather, Department of Surgery Aga Khan University, Karachi.
Objective:
To compare the efficacy and safety profile of Electro hydraulic (EH) and electromagnetic (EM) Lithotripters’ in the treatment of 10-20 mm renal and proximal ureteric stones at a single centre and by a single operator.
Materials and methods: Between January 2001 and December 2003, patients meeting study inclusion criteria were treated on MPL 9000 Dornier™ electro hydraulic shock wave lithotripsy unit. From January 2004 to December 2006, patients meeting identical study inclusion criteria were treated using an EM Siemens modularis™ shock wave lithotripsy unit. All shock wave lithotripsy (SWL) treatments were performed by a single operator under the supervision of admitting urologist. The demographic features, stone and treatment related parameters including complications were analyzed for both groups. In each group stone-free rate and efficiency quotient was determined at 1-3 months.
Results: Of 274 patients, 112 were treated on the EH and 162 on the EM lithotripters. The pre SWL patient and stone related parameters were similar in the two groups. The mean number of SWL sessions, need for ancillary procedure, re treatment rate, stone free rate and efficiency quotient were not significantly different in the two groups. The mean number of shock waves required for fragmentation was 2977 and 6044 (p 0.000) for the EH and EM groups respectively.
Conclusion: Single center, single operator experience on two types of lithotripters indicated that both are equally efficacious, with similar safety profile. The only significant difference in the two groups is the number of shock waves required for fragmentation. It was lower in electro hydraulic lithotripter.
SESSION NO. 2
LAPAROSCOPIC NEPHRECTOMY: SINGLE CENTER EXPERIENCE
Sanaullah, Senior Registrar Urology, LGH, Lahore
Objective: To report experience of 80 consecutive laparoscopic nephrectomy (LN), with the aim of evaluating the durability of laparoscopic dissection from a technical stand point and various parameters including learning curve.
Materials and methods: During the last 2.5 years, at Lahore general hospital, 80 patients (46 male, 34 female) having mean age of 29 years had LN. Indications were end stage hydronephrosis (35) / pyelonephritis (24) with or with out stone disease, renal mass< T3a (10), Pyonephrosis (5), tuberculous kidney (3), poorly functioning kidney having uretero/ pyelocutaneous fistula (2) and a hypoplastic kidney with ectopic ureter leading to incontinence since birth (1). All patients had pure laparoscopic transperitoneal approach in lateral position using one or two10mm and two 5mm ports. In radical nephrectomy, the oncological principles of renal surgery were followed during dissection and the specimen was extracted intact. To evaluate the technical adequacy, comparison was made between 1st and 2nd 40 cases.
Results: Mean surgical time was 2.7 hours; blood loss was 150ml and hospital stay 2.8 days. Complications occurred in 16 patients; major in 5(6%) and minor in 11(13.2%). Two major complications managed laparoscopically were renal vein bleed and colonic injury. Two (2.4%) patients were converted to open surgery; failure to progress due to dense fibrosis and duodenal injury. Postoperatively, two (2.4%) patients required exploration; one for fecal peritonitis and second for bleeding. Surgical margins were negative in all radical nephrectomy. While evaluating the learning curve, short surgical time and decreased complications appeared to be the significant variables.
Conclusion: LN is a good alternative to open surgery for benign and malignant renal diseases with significantly reduced morbidity.
Key words: kidney diseases, laparoscopy, nephrectomy, learning curve.
LAPAROSCOPIC VARICOCELE LIGATION.
Zafar Zaidi and Abdus Sabooh Rizvi, The Indus Hospital, Korangi Crossing, Korangi Krachi
Abstract:
Objective: To review our experience of Laparoscopic Varicocele ligation.
Material and Methods: Between January 2007 and July 2008 Laparoscopic Varicocele Ligation was performed on 12 patients. Ages of these men ranged from 18 – 38 years with mean age of 28.9 years. 9 patients had varicocele on left while 3 had bilateral varicocele. Pain and dragging sensation was the presenting complaint in 9 patients while 3 presented due to infertility. Laparoscopic Varicocele Ligation was performed using 3 ports. The surgical procedure is supported by a video.
Results: Of the 9 patients undergoing the procedure due to pain 7 became pain free with marked reduction in swelling while 2 patients showed minimal improvement. Of the 3 patients with male factor infertility 1 had a child and 2 showed moderate improvement in sperm count and morphology. Lymphocele or wound complications were not seen in any patient. Hospital stay was less than 24 hours.
Conclusion: Laparoscopic Varicocele Ligation is a safe, effective and minimally invasive method of managing this problem.
Key words: Laparoscopy, Varicocele
MANAGEMENT OF VESICOVAGINAL FISTULA
An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach
M. Younis, M. Arshad Saleem,syed saleem jafry, M. Nawaz Chughtai.
Department of Urology, King Edward Medical University/Mayo Hospital Lahore
Abstract:
Purpose: We aim to present our experience for the repair of vesicovaginal fistula (VVF) with special reference to surgical approach.
Materials and Methods: From January 2005to June 2008, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms.
Results: Thirty-two (61.5%) had simple fistulas and 20 (38.5%) complex fistulas. The most common etiology was obstetric trauma in 31 (59.6%) patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5%) patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2%) patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2%) complained of mild to moderate dyspareunia.
Conclusion Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.
Keywords: Fistula, management, tuberculosis, vesicovaginal
LAPAROSCOPIC PYELOPLASTY: EXPERIENCE OF FIRST 10 CASES
Sanaullah, Mumtaz Ahmad, Sajjad Husain,
Objective: Laparoscopic pyeloplasty (LP) for pelviureteric junction (PUJ) obstruction has not yet been reported in Pakistan. The aim of the study is to report first 10 cases performed at our institution.
Materials & Methods: During the last 2 years, six male and four females (mean age 18.4 years), underwent LP for primary PUJ Obstruction at Lahore general hospital. All patients had radiographic evidence of obstruction with normal contralateral kidney except one who had laparoscopic nephrectomy. Three patients having non-obstructive renal calculi underwent concomitant laparoscopic pyelolithotomy. Preserving the principles of open surgery, transperitorial approach was attempted using one 10 mm, three 5mm parts and a ureteric stent (which remained in place for 4 weeks). Primary end point was treatment success; defined as symptomatic relief of pain / obstruction (T ½ <15min) or both.
Results: Average operating time was 4.1 hours (3.5–5.2 hours), blood loss 70ml and hospital stay 4days (3–7days). Pure laparoscopic intra-corporeal repair was done in all patients except one requiring small (5cm) incision, due to instrument malfunction, to complete the repair. Three patients had increased drain out put; transient ileus and urine leakage along the drain side was observed in one each. On follow up, all patients were unobstructed but symptomatic relief was observed in nine cases.
Conclusion: It is early to conclude from this small study, LP is an effective alternative option, and results are durable and comparable to open pyeloplasty with minimal morbidity.
Key worlds: PUJ obstruction, laparoscopic pyeloplasty, minimal morbidity.
RENAL TRAUMA; IS TRAUMA CENTER ESSENTIAL FOR PUBLIC SECTOR HOSPITAL.
Saeed Abidi, Prof. Mohammed Aslam, Department of Urology, KMDC & Abbasi Shaheed Hospital, Karachi
Abstract: Renal trauma contributes about 20 percent of solid organ injuries secondary to trauma with mortality of about 1 in 16. The concept of Trauma Unit in Public sector has been a much needed requirement in our setup. Trauma Center at Abbasi Shaheed Hospital is the only Trauma Center with State of art equipment and ventilators. Here we present our experience of dealing blunt and penetrating renal trauma managed surgically and conservatively.
CAN REOCCURENCE OF URETHRAL STRICTURE BE PREVENTED?
ROLE OF CLEAN SELF DIALATATION . STUDY OF 300 CASES
M. Akram Malik, Safdar Hassan Sial, Madina Teaching Hospital/University Medical College, Faisalabad.
Abstract: Urethral stricture is notorious for reoccurrence. Various preventive measures have been adopted to prevent its reoccurrence with variable success.
Due to collagen fibers in the fibrous tissue of the healed area, it tries to contract for 04-06 months.
Active dialatation and passive dialatation for this periode may prevents its reoccurrence.
More than 300 patients of urethral strictures managed by optical internal urelhrotomy or Urethroplasty at Department of Urology Allied Hospital Faisalabad / and Department of Urology Madina Teaching Hospital / University Medical College Faisalabad, were subjected to clean self dilatation with nelton catheter. Patient were advised for CSD initially once a day for 30 days, followed by addition of one day internal after each week for 6 months. Compliance rate was more than 90%. Patients who completed the protocol were satisfied with stream with a very few complications.
SESSION NO. 3
CLINICO-PATHOLOGICAL FEATURES OF BLADDER CARCINOMA IN WOMEN IN PAKISTAN AND SMOKELESS TOBACCO AS A POSSIBLE RISK FACTOR.
M. Rafique Anjum, Nishtar Medical College, Multan
Objective: Bladder carcinoma is common Genitourinary malignancy in Pakistan. Cigarette smoking is known risk factor for bladder carcinoma but smokeless tobacco use as a risk factor has not been much evaluated. Smokeless tobacco (chewable or moist snuff) use is common in rural areas of Pakistan. The objective of the present study was to determine the clinico-pathological features of bladder carcinoma in women and to investigate the role of smokeless tobacco use as a possible risk factor for its development.
Methodology: 204 patients (160 male and 44 female M:F ratio 3.6:1) of newly diagnosed bladder carcinoma were treated at Nishtar Medical College Hospital, Multan from January 1998 to December 2004.. Data were collected and prospectively updated at the time of discharge from hospital and during follow-up in urology out-patient clinic. Detailed information about smoking habits, use of smokeless tobacco (chewable or snuff), use of hair coloring dyes, occupational exposure to chemicals was obtained from all patients. .Many of the women had long history of smokeless tobacco use, its duration and frequency of use was inquired from such patients. Possible effect of smokeless tobacco on the depth (T category of TNM staging) of bladder carcinoma in such patients was studied and compared with patients not using any form of tobacco.
Results: Transitional cell carcinoma accounted for all of the bladder carcinoma in women. Median age of the patients was 55 years and 68 % patients were under 60 years of age. Majority of patients (88%) presented with hematuria. Eleven (25%) patients had superficial (pTa/T1) while 33(75%) patients had muscle invasive (T2-T4) bladder carcinoma. Most (81%) superficial tumors were papillary while muscle invasive tumors had solid configuration a cystoscopy. Twenty one (47%) patients had long history of smokeless tobacco use (moist snuff 12 pts, chewable tobacco 5 pts, chewed tobacco with beetle nuts 4 pts). By employing cross tabulation of duration of smokeless tobacco use and depth (T category) of bladder carcinoma, it appears that majority of such patients had muscle invasive carcinoma at presentation. The correlation between the depth of bladder carcinoma and duration of smokeless tobacco use was 0.473 which is statistically significant (p=0.03).
We applied two independent sample t test for the comparison of depth of invasion of bladder carcinoma in users and non-users of smokeless tobacco. The datum showed that carcinoma are of higher depth (T category) in users, however, t vale for difference between groups was not statistically significant.
The present study has shown that there is significant correlation between stage of bladder carcinoma and duration of smokeless tobacco use.
Conclusion: Transitional cell carcinoma is the most common bladder malignancy in women in Pakistan. Many women with bladder carcinoma have long history of use of smokeless tobacco. Majority of the patients present with hematuria and are under 60 years of age. At the time of diagnosis, 75% women have muscle invasive bladder carcinoma. In women using smokeless tobacco, correlation between the stage of bladder carcinoma and duration of smokeless tobacco use was significant (p=0.03). Further studies are needed to clarify the role of smokeless tobacco use in the development of bladder carcinoma.
SEPARATE SUBMISSION OF STANDARD LYMPHADENECTOMY IN 6 PACKETS VERSUS EN BLOC LYMPHADENECTOMY IN BLADDER CANCER.
M Hammad Ather, Zaheer Alam, Anila Jamshaid, Khurram M Siddiqui, M Nasir Sulaiman,
Secton of Urology, Departemet of Surgery, Aga Khan University Hospital, Karachi
Introduction: Our aim was to evaluate detection of nodal metastasis during radical cystectomy with standard pelvic lymph node dissection versus en bloc lymphadenectomy for the treatment of bladder cancer.
Materials and Methods: Hospital records of a total of 77 patients with radical cystectomy and either standard pelvic lymph node dissection or en bloc lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examination in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. En bloc dissection specimens were sent in 2 containers marked as the right and the left pelvic nodes. Clinical and pathological findings of these two groups were compared in terms of the number of dissected lymph nodes, number of nodes with metastasis, lymph node density, and clinical outcomes.
Results: There were 34 patients with standard lymph node dissection and 43 with en bloc lymphadenectomy (anterior pelvic exenteration). Age, sex, duration of the disease, number of transurethral resections prior to cystectomy, pathological grade at cystectomy, and stage of the primary tumor were comparable in the two groups of patients. The median numbers of nodes removed per patient were 15.5 (range, 4 to 48) and 7.0 (range, 1 to 24) in those with standard and en bloc lymphadenectomy, respectively (P < .001). Nodal involvement was detected in 10 (29.4%) and 9 (20.9%) patients, respectively (P = .43).
Conclusion: Although nodal involvement was not significantly different between the two groups, standard lymphadenectomy submitted in 6 different containers significantly improved the nodal yield over en bloc resection. Obturator nodes were the most commonly involved nodes in our study.
Renal Tumour (Dr. Asif Sheikh, Department of Urology, Victoria Hospital, Bahawalpur)
COMPARISON OF TURP WITH TVP
Muhammad Jawaid Rajput Associate Professor of Surgery
Abstract
Objective: To compare the results of transurethral resection of prostate with transvesical prostatectomy in respect to the incidence, and severity of postoperative urinary inconlinence.
Design: Comparative cross sectional.
Place and Duration Of Study
This study was carried out in two tertiary care centres. Liaquat University of Medical and Health Sciences Jamshoro from were all cases of TRUP were collected and Muhammad Medical College, Mirpurkhas where all transvesical prostatectomies were performed. It was a two years study from April 2004 to March 2006.
Patients and Methods: Two groups were made and 50 cases were kept in each group patient underwent TURP were kept in grourj A and transvesical prostatectomy group was titled as B.
Patients having associated stricture urethra, urinary bladder stones or bladder diverticulum and later on proved as carcinoma of prostate were excluded from the study.
Results: From group-A (TURP group) 07 (14%) patients developed incontinence postoperatively and all had stress type of incontinence. While in group B (Transvesical prostatectomy eleven (22%) patients developed urinary incontinence. 05/11 (45.45%) had stress incontinence and 06/11 (54.55%) developed continuous urinary leakage. Rate of recovery after conservative measures remained rapid with group A as compared to group B.
Conclusion: Frequency and severity of postoperative urinary incontinence is more with transvesical approach. But the facility of TURP is not freely available. Therefore improvement in the technique of open prostatectomy is mandatory. For which recommendations have been given.
Key Words: TURP - Transvesical prostatactomy - Urinary incontinence.
FOREIGN BODY URETHRA AND BLADDER 8 YEARS EXPERIENCE
M. Akram Malik, M. Irfan Munir, Zahid Iqbal, Zikria Rasheed, A.G. Rehan, Madina Teaching Hospital/University Medical College, Faisalabad.
Abstract: Foreign bodies in urinary tract are less common as compared to foreign body in Respiration tract and Gastrointestinal tract.
Every conceivable object has been found inserted into urethra and bladder. Various objects like pencil, tooth pick, metallic pin, hair pain, fish bone, IUCD etc have been reported in the literature.
10 cases of foreign body in urethra and bladder were managed in the department of Urology Madina Teaching Hospital/University Medical College Faisalabad for and Department of urology Allied Hospital/Punjab Medical College Faisalabad. Although careful history and examination was diagnostic in urethral foreign bodies, however, the foreign bodies bladder were detected by radiological investigation like ultrasound and X-Rays and with the help of Cystoscopic examinations.
Dysuria, increased urinary frequency, nocturia, bleeding per urethra, perineal & scrotal swellings suprapubic pain and urinary reten were various clinical presentation of the patients.
Endoscopic removal were treatment of choice with minimal morbidity and complications. Open surgical procedure had to adopted in those patients where endoscopic manipulation was not successful.
Various objects which were removed were pencil, match stick, safety pin, cycle wires from the urethra. IUCD, Beauty stick, wooden stick, common pin, piece of foly catheter, foetal bone were the foreign bodies retrieved from urinary bladder.
EFFECT OF ALFUZOSIN IN PATIENTS WITH ACUTE URINARY RETENTION (AUR) SECONDARY TO BENIGN PROSTATIC ENLARGEMENT (BPE).
M. Irfan Nazir, Aga Khan University Hospital, Karachi
Abstract: Acute urinary retention (AUR) commonly affects older men. Previously considered an absolute indication for surgery. Alpha blockers have shown significant role in alleviating symptoms and delaying or postponing surgery in these patients. Our objective was to study the effect of ALFUZOSIN (alpha blocker) in treating and to determine factors affecting its success in treating AUR.
Methodology: This one year descriptive study was conducted at Urology clinics, wards and emergency of Aga Khan University, Pakistan. Cohort of 64 patients was inducted using convenience sampling. Male patients above 50 years presenting with AUR were included.
Patients fulfilling inclusion and exclusion criteria were enrolled for the study. After clinically establishing AUR and excluding other causes, patients were catheterized and started on ALFUZOSIN. They were subsequently given Trial without Catheter (TWOC) after at least 36 hours of treatment. Need for recatheterization was the main outcome variable. Means and standard deviations of age, residual volume, interval between retention and catheterization and duration of LUTS with their grouped frequencies were assessed.
Results: Mean age of the patients was 65.1 +/- 9.5 years. Majority were good functional class, TWOC was successful in 53.1% of patients. Correlation between duration of symptoms was inversely proportional to TWOC success (p-value= 0.012). No positive correlation was seen in TWOC V/S interval of catheterization, residual volume and functional class of the patients.
Conclusions: Significant correlation existed between duration of symptoms and TWOC. Our study has proven the significance and efficacy of TWOC in patients presenting with AUR.
Key Words: AUR, TWOC.
POSTER SESSION
HYDATID CYST WITH A RARE PRESENTATION OF RENAL & HEPATIC INVOLVEMENT Sajida, Noman, Saqib U. Khan, Irfan Feroz, Moin Qureshi, Saeed Abidi, Mohammed Aslam
Department of Urology, KMDC & Abbasi Shaheed Hospital, Karachi
Abstract: Hydatid cyst is a commonly encountered clinical condition involving mostly liver but its presentation as simultaneous occurrence in kidney as well as liver is a rarity. Here we present a case of 28 years old female with hydatid cysts in Liver and Right kidney successfully managed surgically.
FOURNIER’S GANGRENE: HIT AS HARD YOU CAN
Saeed Abidi, Atif Raees, Irfan Feroz, Saqib U. Khan, Noman, M. Qureshi, Prof. Mohd. Aslam
Department of Urology, KMDC & Abbasi Shaheed Hospital, Karachi
Abstract: Fournier's gangrene is a polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. It is one of the most hazardous urological emergencies and needs an aggressive approach. Our poster covers various aspects of this rare but lethal condition.
A RARE CASE OF VERRUCOUS CARCINOMA PENIS IN A MUSLIM MALE
M. Arshad Saleem, M. Younis, M. Nawaz Chughtai.
Department of Urology, King Edward Medical University/Mayo Hospital Lahore
Abstract: A 42 year old male Muslim presented with a large fungating growth of the glans penis with bilaterally palpable inguinal lymph nodes. Growth was extremely foul smelling. CT pelvis did not reveal any pelvic lymph nodes, biopsy proved it to be verrucous carcinoma. He was managed by partial penectomy. Lymph nodes disappeared following antibiotic treatment.
Key Words: Penile growth, verrucous carcinoma, partial penectomy.
RENAL MALIGNANCIES ASSOCIATED WITH RENAL CALCULI
M. Rafique Anjum, Department of Urology, Nishtar Medical College, Multan.
From January 1997 to July2008, 108 patients were diagnosed to have renal malignancies at surgery. In 10 (9.5%) patients renal malignancies were associated with renal stones. Median age of the patients was 50 years (range 38-65 years). There were 8 male and two female patients (M:F 4:1).Six ( %) patients presented with flank pain. Two patients had flank pain and hematuria. While one patient had hematuria and one patient had loin pain, flank mass and weight loss. Median duration of symptoms was 6 months (range 3 months to 10 years).
In all patients renal stones were reported by sonologists but associated renal malignancies were missed in 8 (80%) patients. Intravenous urography (IVU) was normal in one patient while in two patients there was good excretion of contrast and associated renal masses were also reported. In 7 patients there was no excretion of contrast on the ipsilateral side. In patients reported to have renal masses on ultrasonography and IVU, CT scan was performed that confirmed the presence of renal mass in these patients.
All patients underwent exploration of kidneys. In two patients with pre-operatively diagnosed renal mass and renal stones radical nephrectomy was performed. In 5 patients, renal masses were found on exploration and radical nephrectomy was done. In two patients there was suspicion of renal malignancy associated with renal stones and biopsy was taken. After positive histopathological report from pathologist, these patients underwent re-exploration and radical nephrectomy was carried out
In one patient there was locally very advanced malignancy and nephrectomy was not possible and biopsy was taken that confirmed renal malignancy in this patient.
Histological examination of malignant tumors was renal cell carcinoma 7 patients, squamous cell carcinoma 2 patients and synchronous renal cell carcinoma and transitional cell carcinoma in one patient.
Pathological stage of the renal tumors was Stage I in 6 patients, stage III two patients and stage IV in one patient. One patient had synchronous renal cell carcinoma (stage II) and transitional cell carcinoma. (Stage IV).
Three patients lost to follow-up. The mean duration of follow-up in other patients was 10.5 months (range 1month-8.5 years) . Three patients with advanced malignancy died within 1-6 months after surgery while 4 patients are alive (all with stage I) with median followup of 2 years.
Conclusion: There is high prevalence of renal calculi in Pakistan. Renal malignancies are not uncommon. In middle aged and older patients with renal calculi, especially with nonfunctioning kidneys on intravenous urography, possibility of associated renal malignancy should also be considered.
FOETAL BONES IN URINARY BLADDER: A UNIQUE PRESENTATION.
M. Akram Malik, Madina Teaching Hospital/University Medical College, Faisalabad.
Report of a female presented at department of Urology Madina Teaching Hospital/ University Medical College Faisalabad with haematuria, Irritative voiding symptoms and dysuria for 71/2 years. Patient recorded a history of D&C, 71/2 years back for amenorrhea.
Radiological investigations proved a radiographic shadow at the level of trigone. P/V examination showed intact vaginal mucosa with palpable hard object anteriorly. Cystoscopy revealed a conical object embedded in the postsior wall of bladder above ureteric bar. On Resection of bladder mucosa, multiple small pieces were removed endoscopically which proved to be faetal bones on histopathology.
RENAL MALIGNANCIES ASSOCIATED WITH RENAL CALCULI
M. Rafique Anjum, Department of Urology, Nishtar Medical College, Multan
From January 1997 to July2008, 108 patients were diagnosed to have renal malignancies at surgery. In 10 (9.5%) patients renal malignancies were associated with renal stones. Median age of the patients was 50 years (range 38-65 years). There were 8 male and two female patients (M:F 4:1).Six ( %) patients presented with flank pain. Two patients had flank pain and hematuria. While one patient had hematuria and one patient had loin pain, flank mass and weight loss. Median duration of symptoms was 6 months (range 3 months to 10 years).
In all patients renal stones were reported by sonologists but associated renal malignancies were missed in 8 (80%) patients. Intravenous urography (IVU) was normal in one patient while in two patients there was good excretion of contrast and associated renal masses were also reported. In 7 patients there was no excretion of contrast on the ipsilateral side. In patients reported to have renal masses on ultrasonography and IVU, CT scan was performed that confirmed the presence of renal mass in these patients.
All patients underwent exploration of kidneys. In two patients with pre-operatively diagnosed renal mass and renal stones radical nephrectomy was performed. In 5 patients, renal masses were found on exploration and radical nephrectomy was done. In two patients there was suspicion of renal malignancy associated with renal stones and biopsy was taken. After positive histopathological report from pathologist, these patients underwent re-exploration and radical nephrectomy was carried out
In one patient there was locally very advanced malignancy and nephrectomy was not possible and biopsy was taken that confirmed renal malignancy in this patient.
Histological examination of malignant tumors was renal cell carcinoma 7 patients, squamous cell carcinoma 2 patients and synchronous renal cell carcinoma and transitional cell carcinoma in one patient.
Pathological stage of the renal tumors was Stage I in 6 patients, stage III two patients and stage IV in one patient. One patient had synchronous renal cell carcinoma (stage II) and transitional cell carcinoma. (stage IV).
Three patients lost to follow-up. The mean duration of follow-up in other patients was 10.5 months (range 1month-8.5 years). Three patients with advanced malignancy died within 1-6 months after surgery while 4 patients are alive (all with stage I) with median followup of 2 years.
Conclusion: There is high prevalence of renal calculi in Pakistan. Renal malignancies are not uncommon. In middle aged and older patients with renal calculi, especially with nonfunctioning kidneys on intravenous urography, possibility of associated renal malignancy should also be considered.
HIDDEN WORLD EXPOSED: A TO Z OF PENILE INJURIES
Saeed Abidi
Abstract: Penile injuries though not so common in civilized world, but its variety ranges vast which includes circumcision trauma to penile fracture. Here we present our experience of various varieties of penile injuries.
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