Prognostic value of p53 expression intensity in urothelial cancers

Objective: To determine association of immunohistochemical expression intensity of p53 with grade and stage of urothelial cancers

Study Design: Descriptive cross-sectional analytical study

Place and Duration of Study: Pathology Department, King Edward Medical University, Lahore, from January to December 2016

Methodology: Data of transurethral resection/radical cystesctomy urinary bladder biopsies was collected. Clinical, radiological and cystoscopic findings of patients were noted from patients' charts in the Urology Ward. Biopsies were graded histologically according to WHO 2004 grading system. TNM system was used for pathological staging. On selected slides, immunoshistochemistry for p53 was applied. Nuclear immunoreactivity was considered positive if present in >10% of tumor cells and negative if <10% of tumor cells. Intensity was considered weak [less than 15% cells] and strong [more than 15% cells]. Data was analyzed by SPSS version 21. Linear-by-linear association was calculated between p53 expression and stage of urothelial tumors, Chi-Square test was used to see association between grade and intensity of p53. Qualitative variables, like grade and stage of carcinoma along with p53 expression, were calculated in terms of frequencies and percentages. P

Results: Out of the 70 patients, 61 [87%] were males and 9 [13%] females. Out of 25 low grade lesions, 4 [16%] cases were p53 positive; and out of 45 high grade lesions, 41 [91%] cases were p53 positive. There was 33% [2/6 cases] positivity in Tis, 55% [16/29 cases] in T1, 72% in T2 [21/29], and 100% in T3a [5/5 cases] and T3b [1/1 case]. Strong intensity of p53 staining was noted to be 5.4% [n=25] of low grade and 94.6% [n=45] of high grade tumors

Conclusion: p53 expression was greater and more frequently strong in higher grade and stage of urothelial carcinoma. It can be used as a prognostic marker in predicting higher grade and stage of bladder cancer

Lymphocele incidence following renal transplantation our experience in sims/services hospital Lahore

To determine the incidence of lymphocele in patients who under went renal transplantation, as well as potential factors responsible or associated to its development. All records of 25 patients who were operated for renal transplant in SIMS/SHL between March 2006 to December 2007 were reviewed for lymphocele. The surgical technique was the standard one. All lymphatic vessels were either ligated or diathermized. Baseline post operative ultrasound after one week done or whenever indicated for lymphocele. 10% povidone iodine instilated in case of lymphocele. Patients were followed for an average of six months with history, physical examination and ultrasound on each visit. 25 patients [20 male and 5 female] have received renal allograft from live donors. There was 1[4%] instance of lymphocele; encountered at two weeks after renal transplantation. Careful ligation of lymphatic vessels both during graft preparation and during implantation can significantly contribute to reducing incidence of lymphocele following renal transplantation. Instillation of 10% povidone iodine in the lymphpcele can cure and prevent its recurrence

Clinical outcome of modified thiersch duplay urethroplasty for proximal hypospadias

To report the functional results, complications and cosmesis by using Thiersch Duplay urethroplasty repair for hypospadias. Between years 2006 to 2007, 30 patients underwent repair of proximal hypospadias [penoscrotal] with chordee. Two stage repair was performed in all cases. 1[st] stage consisted of chordee correction by excising fibrous cord between ectopic meatus and corona along with incision of glans. The grafting of the dorsal hood skin was made on ventral aspect of tunica albuginea. In second stage repair U shaped incision was made around hypospadiac meatus and a ventral skin flap was dissected superficially to allow tubularization around a suitable size silicon Foley catheter [5 -8 Fr in children, 10-12 Fr adolescence and 14-16 Fr in adults] without tension. The Thiersch Duplay tube was constructed using 5/0 vicryl. A subcutaneous fascial layer was closed over tube to support neourthra. The Foley catheter was left for 10-12 days. Age range was 3-25 years with mean +/- SD of 12.7 +/- 5.09. Total hospital stay was 10-12 days with mean +/- SD of 11.9 +/- SD 0.85. Twenty five patients [80.2%] could void on standing and had a good caliber straight single stream of urine in forward direction. The cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans achieved in twenty five patients. Period of follow up was 4-8 month mean with mean +/- SD of 6 +/- 1.43. Main complications seen were urethrocutaneous fistulae in three [9.9%], meatal stenosis in three [9.9%], hematoma in one [3.3%], complete disruption in one [3.3%] infection in two [6.6%] and painful bladder spasm in two [6.6%]. These seen in five [16.5%] patients. Staged urethroplasty for proximal hypospadias results in a normal penis with good functional, minimum complications and excellent cosmesis, with short hospital stay

Significance of uroflowmetry in small voided volume

Uroflowmetry is a useful diagnostic tool for the evaluation of bladder outlet obstruction. Significance of uroflowmetry was studied in small voided volumes as many of the patients with bladder outlet obstruction, are unable to void required volumes i.e. > 150 ml were included. The patients above the age of 50, having IPSS >20, post void residual urine less than 100 ml and voided volumes less than 150 ml. Study parameters were; patients' age, residual urine, traces of uroflowmetry, maximum flow rate [Qmax], average flow rate [Qave], flow time, voiding time and voided volume. Out of 77 patients 23 voided less than 150 ml. 12 patients proved to be obstructed [5 developed retention and 7 were operated due to bothersome score]. Out of 23 patients 12 [52%] proved to be obstructed and 10 [43.45%] were diagnosed by uroflowmetry. Pearson correlation coefficient between voiding time and voided volume was 0.432 [p<.05]. There was no correlation between voided volume and Qmax among these patients who voided less than 150ml. It has been concluded that in some of the cases even with small voided volumes, uroflowmetry can be helpful in diagnosing bladder outlet obstruction