Focal segmental glomerulosclerosis in adults

Objective: To discover the burden of focal segmental glomerulosclerosis in patients of nephrotic range proteinuria [i.e.>3.5gm/24 hours/ 1.73m[2] body surface area]

Study design: A case series study

Place and duration: At the department of Nephrology Jinnah Post Graduate Medical Centre from 1st May 2011 to 30th Nov 2011

Methodology: Patients with nephrotic range proteinuria diagnosed by 24 hours urinary protein [>3.5gm/24 hours/1.73m[2] BSA] were included. Serum creatinine, total proteins, serum albumin, 24 hour urinary proteins, creatinine clearance, coagulation profile as well as renal biopsy was performed in every patient. In renal biopsy <50% glomerular involvement with involvement of a portion of the glomerular tuft was confirmed as patients having the focal segmental glomerulosclerosis

Results: The mean age of the patients was 25.93 +/- 5.923 years. Out of 144 patients there were 38[26.38%] females and 106[73.31%] males. There were 67[46.5%] patients with focal segmental glomerlusclerosis with nephrotic range proteinuria

Conclusion: The burden of focal segmental glomerulosclerosis in patients with nephrotic range proteinuria is high

Rural surgery; experience at rural and backward desert region of Pakistan

To study the pattern of Urological and Non-Urological cases and their management at rural hospital. Descriptive and case series study. All surgical patients managed at civil hospital Mithi, from 3rd June 2009 to 3rd June 2012. In this study 4657 patients were enrolled. All patients presented with symptoms suggesting surgical disease and managed as surgical cases were included in the study. These patients were either admitted via outpatient department [OPD], emergency department or operated as OPD cases. The patients who received 1st aid medication and referred to tertiary care were not included. The variables noted and analyzed were patient's demographic data, provisional and final diagnosis, disease pattern, presentation, mode of admission, mode of treatment, nature of operation, complications and final outcome. All the data was analyzed by SPSS version-16 on computer. During three year study period, 4657 patients were managed either conservatively or operated upon. Out of total, 2591[55.6%] were emergency and 2066[44.36%] were elective admissions. The male female ratio was 4:1 .The mean age of patients was 36.5 Years. Urinary tract diseases were responsible for 1638 [35.17%], alimentary tract diseases 1242 [26.6%], trauma 932 [20.01%], soft tissue infections 546 [26.9%], superficial lumps 367 [18.13%] admission. Most common operative procedures for urinary tract diseases 409 [20.20%], soft tissue infections 546 [26.9%]. superficial lumps 367[18.13%], alimentary tract diseases [15.06%] 305, trauma [soft tissue repair and fractures 14.9%[303], were major bulk for operations. Regarding procedures Abscesses incision and drainage in 197 [22.6%] patients, cystolithotomy in 153 [17.6%], Hernioraphy [130] 14.9%, appendecectomy 105 [12.09%], haemorrhoidectomy 51[5.8%],breast abscess 38 [4.3%] breast lump [fibroadenoma] 25 [3.6%], hydrocele23 [2.6%], Ureterolithotomy 22 [2.5%] laparotomy 15 [1.7%], pyelolithotomy12, [1.3%] fissure in ano 13, [1.4%] undecended testis 12 [1.3%] Orchidectomy11 [1.3%] and abscesses psoas, perinal, scrotal 13 [1.4%], 18 [2.07%], 12 [1.3%] respectively. The concluded that the most common cause of seeking surgical care at back ward rural Tharparker was urinary tract diseases. Presence of surgical specialist at remote and back ward region Tharparker is candle in the dark. Main reason of patient referral to tertiary care was deficient in skill medical and surgical professionals, paramedic staff and medical equipments

Extracorporeal shock wave lithotripsy; can alpha blocker improves stone clearance?

To determine the efficacy of Alpha blocker as adjunctive medical therapy, which increases the stone clearance after extracorporeal shock wave lithotripsy [ESWL] to treat renal stones. Quasi Experimental study. Department of Urology, Liaquat National Hospital, Karachi. September 2010 to March 2011. Ultrasound guided Dornier Alpha Impact lithotripter was used for shock wave lithotripsy. Study was carried out on 60 patients who underwent single session of ESWL for renal calculus. Patients were divided in two groups, Group A [n=30] received conventional treatment and Group B [n=30] received Alpha-1 Blocker in addition to conventional treatment. All patients were evaluated with X-ray and Ultrasound [KUB] after 2 weeks and repeated at the end of month. Failure is defined as unsuccessful expulsion after 4 weeks and patient desire to remove the stone before day 30. Out of 60 patients, 45[75%] were males and 15[257%] were females with male to female ratio was 3:1. The average age of the patients was found 36.32 +/- 14.8 [Ranging from 15 to 75] years. Complete clearance was achieved in 76.7% of those receiving Alpha-1 Blocker and in 46.7% of controls at 1 month [P = 0.001]. This difference was statistically significant. The results of my study demonstrate that Alpha-1 Blocker therapy, as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equally safe

Suprapubic cystolitholapaxy: a variable option for paediatric bladder stones

To assess the complications of suprapubic cystolitholapaxy as an alternative procedure for bladder stones in pediatric age group. Prospective analystical study. This study was carried out in Department of Urology, University of Medical and health sciences Jamshoro from May 2006 to December 2010. this study consisted of 148 patients admitted though the outpatient department of Liaquat University Hospital Jamshoro/Hyderabad. All patients underwent base line and specific investigations especially ultrasound of abdomen and pelvis as diagnostic modality for assessment of bladder stones. Inclusion criteria were all these patients who after counseling for this study and gave written consent parents. Irrespective of their sex and age < 12 years of age presented with bladder stone of < 3cm. Exclusion criteria included were patients having history of previous surgery, posterior urethral valves, stricture urethra and stone > 3 cm were excluded from the study. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 148 patients, 124 [83.78%] were boys and 24 [16.21%] were girls with ratio 5.1:1 respectively. Mean age of the patients was 5.3 years with range from 1 to 11 years. Twelve [8.1%] patients presented with retention of urine due to impacted stone at bladder neck or prostatic urethra while 16 [10.81%] patients had coexisting renal stones. The mean size of the stones was 1.9 cm with range from 1.1 to 2.8 cm. Total operative time ranged from 25 to 40 minutes. Patients were discharged after observing first void on 2[nd] post-operative day 136 [91.89%] while twelve [8.11%] patients required further stay due to either suprapubic urinary leakage in 5[3.37%] or urinary retention in 7[4.72%] patients. Percutaneous suprapubic cystolitholapaxy is safe and cost-effective alternative to open surgery in children with

Early removal of 3 way foleys catheter after transurethral resection of prostate in beneficial?

To compare the outcome of three way foleys catheter removed on 2[nd] and 5[th] day after Transurethral resection of Prostate for BPH regarding postoperative retention of urine, urine culture and hospital stay. Quasi Experimental study. This study was carried out in Department of Urology, University of Medical and health sciences Jamshoro from July 2010 to December 2011. This study consisted of 50 patients were divided in two groups. Group A for catheter was removed on 2nd post operative day of Trans Uretheral resection of prostate and group B for catheter was removed on 5th Post Operative Day of Trans Uretheral resection of prostate, each group consist of 25 patients. Detailed History was taken from all the patients with special regard to the urinary retention. Inclusion criteria were that all diagnosed as case of BPH on the basis of history and investigations. Exclusion criteria included unfit patients for general anesthesia, presented with chronic urinary retention, hematological disorders, pre operative infected urine and concurrent uretheral structure. Re-catheterization were in 2 patients [8%] group A and 1 patient [4%] in group B. Post operative urine culture growth of organism [bacteriuria] were 1 patient [4%] A and 3 patients [12%] in group B. Duration of hospital stay in group A was 5.68 as compared to the patients in group B was 8.44 days. In conclusion, early catheter removal had a dramatic impact on hospital stay. Catheters can be removed early after transurethral resection of prostate with no increase in morbidity and maintain the efficacy of the procedure, resulting in considerable savings to their patients. Our study confirms the safety of an irrigation-free and early catheter removal policy after TURP

Metanephric adenoma: a rare benign renal tumor

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and rarity and the lack of clinical, radiographic, or cytologic means to establish a definite diagnosis, Metanephric adenoma remains primarily a pathologic diagnosis