Frequency of prostate cancer in patients undergoing trans-urethral resection of prostate [TURP] for clinically benign symptomatic enlarged prostate

To determine the frequency of carcinoma prostate in patients undergoing trans-urethral resection of prostate [TURP] for clinically benign symptomatic enlarged prostate. A descriptive study including all patients who had the clinical symptoms of BPH and operated with TURP in the RMI was designed. The study spanned from June 2009 to June 2010. Patients' data, clinical history, examination and operation notes were saved in a file. All the patients were properly evaluated by the team comprising of the authors pre-operatively. On the basis of these evaluations, a malignancy was not anticipated. All the patients were operated using TURP by the same team under spinal anesthesia. Prostate chippings collected at TURP from each patient were sent as routine, for histopathological evaluation and reporting. Majority of patients [n=44, 66.7%] were older than 60 years. Patients' ages ranged from 48 to 100 years with a mean of 69.5 years. Out of all the patients in this study, 9 patients [13.6%] presented with acute urinary retention and 57 patients [86.4%] presented with Lower Urinary Tract Symptoms [LUTS] and chronic urinary retention. In 9 patients [13.6%] malignancy of the prostate on histopathological examination was confirmed with 8/9 having definitive adeno-carcinoma. Two patients had Gleason score 6/10 and 6 patients had Gleason score 8/10] of the prostate while 1/9 had carcinoma in situ. Out of the 9 patients with malignancy 8 patients [88.9%] were more than 60 years of age ``while 1 patient [11.11%] was aged 56 years. The substantial proportion of patients with confirmed PCA in patients undergoing TURP for clinically symptomatic benign enlarged prostate emphasizes the need for early diagnosis through histopathological examination

Experience of rubber band ligation for haemorrhoidal disease

To assess symptomatic relief in haemorrhoidal disease using rubber band ligation. Surgical unit, Hayatabad Medical Complex, Peshawar from July 2007 to June 2009. All patients presenting with rectal bleeding or prolase underwent proctoscopy to determine the cause of bleeding. Only patients with 1[st], 2[nd] and 3[rd] degree haemorrhoids [bleeding and prolapse] were selected for the study and they underwent rubber band ligation in two sessions, 6 weeks apart. Patients were followed in the OPD at 3 months and one year when their subjective and objective symptoms were noted followed by rectal examination and proctoscopy. Therapeutic response was assessed by symptomatic improvement in bleeding and prolapse of hemorrhoids and any complications. A total of 105 patients underwent rubber band ligation. There were 65[62%] males and 40[38%] females with a male to female ratio of 1.6:1. Age of the patients ranged from 21-65 years [ +/- 2.4SD]. Twenty three [21.9%] patients had 1[st] degree, 50[47.6%] had 2[nd] degree and 32[30.5%] had 3[rd] degree haemorrhoids. Forty-eight patients [45.7%] presented with prolapse, 33[31.4%] had both bleeding and prolapse and 23[21.9%] had bleeding only. At 3 months of follow up rubber band ligation cured 76[72.4%] patients, improved 13[12.4%] and failed in 7[6.7%] patients. At one year follow up, recurrence of bleeding and prolapse occurred in 16[15.2%] patients having 3rd degree haemorrhoids. Overall success was achieved in 89[84.8%] cases. Complications were seen in 20[19.1%] patients which were of mild to moderate nature and no serious/ life threatening complications were noted. Rubber band ligation is a rapid and safe non operative procedure for treating 1[st], 2[nd] and early 3[rd] degree haemorrhoids on out patient basis

Bilateral orchiectomy with or without flutamide for advanced carcinoma prostate

To assess the effects of flutamide in patients suffering from advanced carcinoma of the prostate who underwent bilateral orchiectomy. Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, from March 2008 to July 2009. A total of 100 patients having advanced carcinoma prostate who had undergone bilateral orchiectomy were divided into two groups .Group A consisted of 50 patients who were treated with flutamide while group B having 50 patients received placebo. Relief of bone pain was more in group A than B. No significant difference was seen in the occurrence of adverse effects like nausea, vomiting, hot flashes and anemia between the groups. Eight patients in each group were lost to follow up. The benefit of combined androgen blockade was better in relief of bone pain

Optical urethrotomy in strictures following fracture pelvis

Management of posterior urethral injuries with pelvic fracture remains a major controversy and has always been a challenge to urologists. Objective of this study was to see the outcome of optical internal urethrotomy in treatment of urethral strictures following fracture pelvis. This prospective study was conducted at the Urology Department, Lady Reading Hospital, Peshawar from January 2007 to July 2008. A total of 45 male patients [20-60 years of age] and having urethral strictures following fracture pelvis were treated with internal optical urethrotomy. Follow-up ranged from 3 months to 1 year. Fracture pelvis resulting from the road traffic accident, was the cause of urethral stricture. The good and fair results of internal optical urethrotomy were 68.56% patients who were treated with single internal optical urethrotomy. Internal optical urethrotomy was repeated in 22.86% of patients. Clean intermittent self urethral dilatation was applied as adjuvant treatment to prevent recurrence of stricture for variable period ranging from 1 to 3 months. Internal optical urethrotomy is safe and effective procedure for short yet inaccessible strictures from the perineum