Is ultrasound detect renal infections?

Objective: To asses culture and sensitivity of renal infection patients detected on ultrasound

Study Design: Prospective cohort study

Place and Duration of Study: This study was conducted at the Rimsha Medical Center Dadu from January 2012 to June 2015

Materials and Methods: Hundred patients suffering for renal infection detected on ultrasound were included in the study. Diabetic and urolithiasis patients excluded from the study. Urine culture and sensitivity of renal infection patients detected on ultrasound carried from collection point of diagnostic and research laboratory liaqaut university of medical and health sciences Jamshoro/Hyderabad in Dadu

Results: Out of 100 patients 65 [65%] were female and 35[35%] male. The age of the patients ranged from 15 to 45 years with mean age 28.9 SD +/- 8.8 The presenting features were lumbar pain with on and off fever in 60[60%] cases, dysuria in 15[15%], and in 35[35%] cases was asymptomatic. The renal infection detected in ultrasound bilaterally in 30[30%], Right sided in 35[35%], left sided in 25[25%] and chronic pyelonephritis [change of small size kidney with increase echogenicity and small size kidney with irregular border] in 10[10%] cases. culture and sensitivity seen positive in 27[27%] cases. Pyuria and haematuria seen in 17[17%]. The commonest micro-organism detected E.coli in 60[60%], Klebsiella 15[15%], Proteus 5[5%], Enterococcus 5[5%], staphylococcus saprophyticus 5[5%], streptococcus 7[7%], Pseudomonas 3[3%] and insignificant mixed bacterial growth seen in 7 cases. Drug senstivity seen in 100% with meronam, pipracilllin/tazobactam, aztreonam. Nitrofurantoin and amikacin 90% Amoxi- clavulanic acid in fusidic acid, ceftrixone, cotirmoxazole, ofloxin, cefuroxime, cefixime 75% and resistance pattern seen more in ceftazidime, gentamycin, ciprofloxacin and ampcillin

Conclusion: Renal infection detected on ultrasound even with insignificant pyuria and haematuria should not be neglected because having significant positive culture and sensitivity report findings

Primary neuroendocrine tumors

To evaluate clinical presentation and surgical out come of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland. A Retrospective study. Urology Department, SMBBMU Larkana. 2001-2011. Series of 6 patients of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland were identified from 1890 cases of urinary tract tumors. Two cases of renal carcinoid, two cases of small cell carcinoma of urinary bladder and two cases of small cell carcinoma of prostate glands. Renal carcinoid tumors presenting with lumbar pain and microscopic haematuria and identified on the ultrasound. Small cell carcinoma of urinary bladder presenting with dysuria, gross haematuria and on ultrasound while small cell carcinoma of prostate gland presenting with irritatory and obstructive symptoms and confirmed on DRE. 6 patients [5 male and 1 female],Mean age of patients were 45years and range was 35-55 years. All patients treated primarily by definitive surgery like Radical Nephrectomy, TURBT and Pallitive TURP and all tumors confirmed on histopathological examination and referred to LINAR Larkana for proper managements. primary neuroendocrine tumors of Kidney, U.bladder and Prostate gland are rare tumors. Carcinoid tumors have good prognosis but small cell carcinoma have poor prognosis so require prompt treatment

Calculus anuria and its remedy

Urinary lithiases have been a major urological problem. The objective was to determine the out come of treatment for patients with calculus anuria. A descriptive study was conducted at Department of Urology Chandka Medical College Hospital, Larkana from March 2007 to April 2009. All patients with a diagnosis of calculus anuria of all ages and either sex were included in the study. Detailed history, physical examination and examination of genitourinary tract was performed. Investigations included complete blood examination, blood urea, serum creatinine, ultrasonography of KUB area, and X-Ray KUB. Among the 66 patients the cause of anuria was bilateral obstruction by the calculi in 46 cases, unilateral obstruction with small/absent/nephrectomised contralateral kidney in 20 cases. In most of the cases, ureteric catheterisation was done to relieve the obstruction. Five deaths were observed, despite emergency urinary diversion and appropriate treatment. Calculus anuria is a urological emergency. Prompt and early intervention can save the life of patient and prevent to develop chronic renal failure

Minimally invasive approach for paediatric ureteric calculi

To find out the efficacy and safety of ureteroscopy in the management of paediatric ureteric calculi in terms of stone clearance rate and hospital stay. Descriptive study. Department of Urology Chandka Medical College Larkana, From January 2006 to October 2008. All children with ureteric calculi were thoroughly examined. Blood CP, blood urea, serum creatinine, ultrasound KUB and IVP were carried out in all. They underwent URS. 8.5 FR [Wolf] ureteroscope was used. Stones were broken down with Swiss lithoclast There was no rigid protocol for placement of ureteric stent but ureteric catheter was placed in all. Follow up x-ray KUB was done in all the children to find out the clearance of stone fragments. During the study period nineteen children with mean age of 7 years [range - 5 year to 12 years] having ureteric calculi of 7 mm to 1.2 cm [average size - 1cm] were managed. In most of the cases the stone were in the lower one third of the ureter. Presenting symptoms were abdominal pain in 7 [36.84%], dysuria in 4 [21.05%], haematuria in 3 [15.79%] and recent episodes of urinary tract infection in 5 [26.32%] children respectively. In 10 [50.54%] calculi were on right side. In 17 patients stones were located in lower 1/3 while in 2 patients stones were present in both the ureters. In two patients repeat ureteroscopy was required as initially ureteroscope could not be negotiated hence ureteric catheter was left for 48 hours. Successful stone clearance was achieved in 95%. One child developed haematuria. No long term complication was found during the study. Ureteroscopy is safe and effective management for ureteric calculi in children

Extracorporeal shock wave lithotripsy; Efficacy of in situ echoguidance in upper and lower ureteral calculi

amanullah7860@yahoo.com. To assess efficacy of ESWL as a single modality in upper and lower ureteric calculi. department of Nephro-Urology Chandka Medical College Hospital, Larkana. January 2003 to April 2006. 62 patients underwent ESWL. Upper and lower ureteral calculi were treated by using Dornier MPL-9000 Lithotripter with ultrasound localization. Among 62 cases 56[90.3%] patients had upper ureteric calculi, whereas 06[9.7%] patients had lower ureteric calculi. Size of stones ranged from 0.5 mm to 18mm having mean size of 10mm. All patients were followed for period of 6 weeks. Of these 62 patients 58 patients were stone free at the end of 2 weeks follow up. In 2 cases stones failed to fragment, where as 2 cases failed to attend out patient department for follow up. This study concluded that in situ echoguided ESWL was effective modality of treatment for upper and lower ureteric stones. Localization of ureteric stones with ultrasound has the advantage of elimination of radiation exposure to the patient and lithotripsy team

Vesico-vaginal fistula experience of surgical repair at Larkana

To assess the causes of Vesico-vaginal fistula and evaluate the results of surgical repair ot'Vesico-vaginal fistula A retrospective study was conducted in Ch and ka Medical College Hospital and Larkan Medical Centre from March 1999 to February 2005. Forty patients of Vesico-vaginal fistula resulting from causes other than malignancies and radiations were included in the study. Majority of the patients had fistula secondary to an obstetrical cause. Of the total 32 patients were repaired trans-vaginally. Prolonged labour was the major cause of Vesico-vaginal fistula [80%]. Thirty two [80%] patients were operated trans vaginally and 8 trans-abdominally. Success rate was 85.8% for the transvaginal approach in the first instance. Stress urinary incontinence was noted in 2 patients while 1 patient with transabdominal approach developed recurrence. In developing countries the major cause of Vesico-vaginal fistula is obstructed labour which can be repaired trans. vaginally in majority of cases under skilled surgeon

Experience with cold knife optical internal urethrotomy and temporary dilatation

to evaluate the out come and efficacy of cold knife optical urethrotomy and temporary dilatation. Design: a retrospective analysis of 127 cases. Place and duration of study: the study was carried out over a period of three years [March 1997 To April 2000] In The Larkana Medical Centre Private Larkana. One hundred and twenty seven male patients with urethral stricture were treated with cold knife optical urethrotomy over a period of three years. An analysis was carried out of the short-term results of optical internal urethrotomy and temporary dilatation to determine the out come and efficacy of the procedures. The age range was 15-75 years, the mean age being 36.6 years. the follow-up period of treated patients ranged from three months to three years. The results showed that early morbidity was 15% with no mortality. The recurrence rate was 8.9%. The results are consistent with other studies and confirm this as the preferred initial procedure in urethral stricture of penile,bulbar, membraneous and prostatic urethra. Optical urethrotomy is the preferred initial management of urethral stricture. Urethroplasty should be considered in failed optical urethrotomy and recurrent urethral stricture disease