ABSTRACT
Objective: To evaluate the role of open surgery in the management of staghorn calculi by comparing it with other available modalities of treatment i.e. percutaneous nephrolithotomy [PCNL] and extracorporeal shockwave lithotripsy [ESWL] and assessing improvement in the renal function [parenchymal thickness and glomerular filteration rate [GFR] after stone removal
Design: Institutional- based prospective study
Place and Duration of study: This study was conducted at the department of Urology, Nishter hospital, Multan from January 2000 to February 2002 [2 years]
Subjects and Methods: A total of fifty patients with staghorn calculi who underwent open surgery in the department and completed a three-month follow-up were included in the study. All patients had a complete blood examination [CBE], complete urine examination [CUE] [including culture and sensitivity [CIS], renal parameters [urea and creatinine], renal tract ultrasonography [USG] preoperatively and at first, second and third month of follow-up to assess the improvement in heamoglobin, control of urinary tract infection [UTI], parenchymal thickness and postoperative complications. Tc99m DTPA scan was employed before surgery and at third month of follow-up to evaluate the improvement in GFR for operated kidney
Results: The male to female ratio was 2.1:1, with a mean age of presentation of 42.70 years. Pain in the lumbar region [58%] was the most common presentation followed by lower urinary tract symptoms [LUTS 32%] and renal insufficiency [16%]. Fever [36%] was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. It fell to 10.21 gm at first month of follow-up but increased to 11.89 gm by the third month. . The mean GFR before surgery was 77.18ml/min, which increased to 81.56ml/min after surgery at third month of follow-up. The mean GFR of the kidney with stones was 32.46 ml/min before surgery, which increased to 39.84-ml/ min after surgery
Conclusion: Staghorn stones if left untreated lead to chronic UTI and renal insufficiency. Removal of the stone is the only way these consequences can be avoided. Nonavailability of resources, a poor health care system, the lack of PCNL and ESWL facilities and/or expertise, the cost and need for multiple sessions and/or ancillary procedures in these minimally invasive techniques and the vigorous follow-up required still make open surgery a viable and an applicable option in our socioeconomic setup
ABSTRACT
Genitourinary tuberculosis is a common accompaniment of pulmonary tuberculosis. If diagnosis and treatment are delayed, irreversible damage can result. Twenty three patients of genitourinary tuberculosis were treated at Nishtar Medical College Multan from 1992 to 1997. Mean age was 37 years. There was no typical symptom or sign. Radiological evidence of pulmonary tuberculosis was present in 11 [47%] patients. Five patients had renal failure at the time of presentation. Four patient had unilateral non functioning kidney, one patient had pyonephrosis and renal stone, six patients had unilateral stricture of ureter [2 upper, 4 lower] and one patient had bilateral stricture of ureter [lower], two patients had bladder mass, two patients had enlarged prostate, three patients had scrotal abscess, one patient had infertility and one patient had early changes. Ablative surgery was required in 5 patients while conservative and reconstructive surgery was done in 18 patients. Diagnosis of genitourinary tuberculosis requires high index of suspicion as there is no typical clinical feature. Early diagnosis is essential to avoid irreversible damage