Calculus nephrectomy: dilemma of developing countries

Objectives: to determine the frequency of simple nephrectomy in patients presenting with Urolithiasis

Material and methods: this is a retrospective study of patients presented at University hospital with urolithiasis during January 2007 to December 2010. The data were collected for patients who underwent nephrectomy for stone disease

Results: total number of patients admitted with urolithiasis was 2600. Out of these, 88 [3.38%] patients underwent simple nephrectomy for non-functioning kidney. Mean age of patients was 32.5 years, males were 62 [70.45%] and females were 26 [29.55%]. Flank pain was predominated symptom in 88% of patients. Mean duration of symptoms was 2.4 years. Mean size of stone was 4.1cm. Seventy patients had stones in renal pelvis

Conclusion: percentage of calculus nephrectomy among patients of urolithiasis is 3.38%

Pattern and sensitivity of microorganisms causing urinary tract infection at teaching hospital

Objective: to determine the pattern and sensitivity of pathogens causing urinary tract infection at tertiary care hospital

Methods: using clean catch method, urinary samples were collected from patients admitted in Urology Ward, Liaquat University Hospital Jamshoro from 1[st] January 2011 to 31[st] December 2011 who had suspected urinary tract infection. Samples sent to Diagnostic and Research Laboratory at Pathology Department, Liaquat University of Medical and Health Sciences, Jamshoro. All samples were tested by international standard method under supervision of qualified microbiologist. Antibiotic sensitivity of isolated micro-organisms was tested for commonly used antibiotics by Kirby Baur technique

Results: out of admitted patient's total of 458 samples were sent during study period. Significant bacteriuria was found in 335 [73.14%] samples, insignificant bacteriuria in 23 [5.02%] samples, while 100 [21.8%] samples were sterile. The most common pathogens isolated were E Coli in 297 [64.41%] samples, Klebseilla Spp and Enterobacter each in 51 [11.31%] samples, Proteus in 36 [7.8%] samples, Pseudomonas in 15 [3.27%] samples and Citrobacter in 8 [1.74%] samples

Conclusion: seventy three percent of samples showed significant growth. High yield of positive cultures showed good clinical co-relation in suspected cases of UTI. Organisms isolated in urine cultures were gram negative rods. Study proves that pathogens causing urinary tract infections are developing resistance against commonly used antibiotics

Push and perc

Objective: to document the feasibility and clearance rate of Percutaneous Nephrolithotomy for proximal ureteric stones

Patients and methods: this was a retrospective review of patients who presented with upper ureteric calculi of 1.5 cm or more at Department of Urology Liaquat University of Medical and Health Sciences Jamshoro which is one of the busiest Urology centre in Sindh. Patient's demographic data, clinical presentation, radiological findings, operative finding and clearance were noted on a proforma. All patients who had preoperatively urinary tract infections were treated with appropriate antibiotics. Those who presented with urosepsis, raised creatinine and hydronephrotic kidneys underwent percutaneous nephrostomy tube to drain the infected urine and optimize for definite treatment. Before puncturing the kidney, stones were pushed back in the kidney with the help of ureteric catheter and ureteroscope. Open ended 5 Fr ureteric catheters placed for opacification of pelvicalyceal system followed by percutaneous nephrolithtomy procedure. Data was analyzed on SPSS version 16

Results: from January 2006 to December 2010, Percutaneous Nephrolithotomies were performed for 101 patients with upper ureteric stone. There were 70 males and 31 females with mean age of 26 years. The location of stone[s] confirmed and function of the kidneys was assessed with an Intravenous Urogram or CT Kidney Ureter and Bladder. Majority of patients had gross hydronephrosis with a stone diameter ranging from 1.5cm to 2.6cm with mean of 1.9 cm in size. Percutaneous Nephrolithtomy was the modality of treatment. At the end of the procedure 18 Fr nephrostomy or 6fr Double J Stent was left for all the patients, which was removed after 2 and 14 days respectively. Post -operative x-ray KUB or Ultrasound KUB was done to confirm the clearance. Complete clearance was noted in 99 [98.7%] patients. Regarding complications, 2 patients had post-PCNL Urosepsis and 4 patients required blood transfusions secondary to hemorrhage

Conclusion: percutaneous Nephrolithotomy is safe, economical and effective method in treating impacted upper ureteric stone