Penile fracture: presentation and management

To evaluate the clinical presentation, therapeutic options and outcome of the treatment of penile fracture. Case series. The Department of Urology and Transplantation, Civil Hospital Quetta, between March 1995 and March 2009. One hundred and thirty seven patients of penile fracture were admitted. Detailed history was taken. Physical examination was done in order to get the extent of penile hematoma, sign of blood at the meatus and side of curvature. Patients with rupture of the superficial and deep dorsal vein on the penis were excluded from the study. The operative plan consisted of immediate exploration, debridement and primary repair of the tear in tunica albuginea and urethra via a degloving incision. Data analysis was performed to obtain descriptive statistics. The mean age was 25 years [ranging from 14-50 years]. Causes of fractures were manipulation in 56 [40.87%] cases, sexual maneuver in 39 [28.46%] cases, rolling or fall on bed in 18 [13.13%] and direct blow on erect penis in 11 [8.02%] patients. Injury involved unilateral corpora cavernosa in 126 [87.78%] and bilateral corpora cabernosa plus urethra in 11 [8.02%] respectively. The interval from time of injury to presentation was 4 hours to 45 days. All the patients presented with the typical clinical picture of a characteristic sound at the time of injury, pain, detumescence, and hematoma. In all the patients the tunical and urethral injuries were promptly repaired. Complication occurred in 7 [5.10%] patients. The mean hospital stay was 2 days. Eighty nine [64.96%] patients available for follow-up reported achieving adequate erection for intercourse without erectile or voiding dysfunction. Common clinical presentation were snapping or popping sound, sudden penile pain, detumescence and penile deviation, The aim of surgical repair was to avoid compilations and preserve both sexual and voiding functions which was satisfactorily achieved in the majority

Benign Prostatic Hyperplsia: mode of presentation and postoperative outcome

To find out various modes of benign prostate hyperplasia [BPH] presentation in our region and their relation to postoperative failure to void after transurethral resection of prostate [TURP]. A study was conducted at Urology Department, Sandeman Teaching Hospital Quetta and Akram Hospital [Private] Quetta from January 2000 to December 2003. All BPH patients in whom the primary mode of presentation was accurately determined and later on underwent TURP were included in the study. Four modes of presentation were defined: [1] lower urinary tract symptoms [LUTS], [2] acute retention, [3] chronic retention and [4] and acute on chronic retention. After relevant investigations all these patients underwent TURP. Postoperatively catheter was removed when the urine was clear, usually within 48 hours of operation. Patients failing to void were recatheterized and given a second trial without catheter [TWOC] at third day of recatheterization. Resumption of spontaneous voiding on either the first or second TWOC was defined as "successful TWOC". Failure to void on second TWOC was defined as "failure to void" and was managed by a six week period of catheterization, followed by an additional TWOC. Statistical analysis was used to see any significant relation of failure to void postoperatively to mode of presentation of BPH, age of the patients and weight of the resected prostatic tissues. A total of 345 BPH patients were included in the study. Of these 270 [78.3%] patients presented with urinary retention and 75 [21.7%] with lower urinary tract symptoms [LUTS]. Patients who presented with retention were acute retention 129 [37.4%], chronic retention 81[23.5%] and acute on chronic retention 60 [17.4%]. The proportion of men failing to void after TURP was significantly higher [P <0.05] in those with [I] acute retention as compared to LUTS [ii] chronic retention compared to acute retention and [iii] acute on chronic retention as compared to acute retention. The proportion of men failing to void postoperatively was highly significant [P <0.005] in those with retention of any type as compared to LUTS. Age of the patients and weight of the resected prostatic tissues were found not significant factors in relation to failure to void postoperatively. BPH patients in our region present very late, most of them [>78%] with complication of urinary retention. Mode of presentation of BPH greatly influences the postoperative outcome of this disease. Patients presenting with complications of chronic and acute on chronic retention have less favourable results regarding postoperative voiding after TURP. Moreover age of the patient and weight of the prostate are not significant factors in relation to failure to void postoperatively

Xanthogranulomatous Pyelonephritis due to calculi: report of 63 cases and review of literature

To examine the relationship between clinical history and results of renal investigations in patients with xanthogranulomatous pyelonephritis. A retrospective review was conducted on 63 cases presenting with histopathological diagnosis of xanthogranulomatous pyelonephritis between 1995 to 2002, at the department of Urology, Bolan Medical College and Sandeman Provincial Teaching Hospital Quetta. There were 26 males and 37 females having an average follow up of two years. Positive findings on examination and investigations at presentation were fever and flank pain in 59 [93.6%] patients and pyuria in 34 [53.9%] patients. All the patients had renal and ureteric calculi with no or severe reduction in the function of the affected kidney on DTPA scan. Hypertrophy of the contra lateral kidney was seen in 56[88.8%] patients. Xanthogranulomatous pyelonephritis is a common entity in this part of the world. Late referral leads to loss of the kidney. Pre-operative diagnosis of the condition is desirable and if surgery is mandatory then all infected tissues have to be removed

Vesicovaginal fistula; surgical management

Objective: To present the efficacy and complications of vesicovaginal fistulae repair in our setting

Place and Duration of the Study: Surgical unit-III, Bolan Medical Complex Hospital, Akram Hospital Zarghoon Road, Quetta and Uhad Charity Hospital Quetta from April 1999 to March 2003

Patients and Methods: A total of 32 patients of vesicovaginal fistulae resulting from causes other than malignancies and pelvic radiations were included in the study. Patients were divided in to two groups on the basis of the site of the fistula and the method of repair. Group-I comprised of 18 patients who had type-II and low type-I fistulae and were operated by vaginal approach while group-II consisted of 14 patients who had type-III and high type-I fistulae and were operated by abdominal approach. Patients of both groups were discharged to go home after 5-7 days postoperatively. Postoperative follow up was carried out at out door on weekly basis for two months

Results: The cause of vesico-vaginal fistulae was obstetrical in 28 [87.5%] and gynaecological [hysterectomy] in 4 [12.5%] patients. Trans-vaginal repair of fistula was successful in 16 [88.9%] patients at first operation while in abdominal approach the cure rate was 100%. However preoperative bleeding requiring blood transfusion occurred in 5 [35.7%] patients of group-II. Another one patient in this group developed wound infection. Dysuria/urinary frequency and hematuria persisted for few days postoperatively in some patients of both groups. Urinary stress incontinence was present postoperatively in 5 [27.7%] and 3 [21.4%] patients of group-I and group-II respectively but it subsided in two months time in all except 2 [11.1%] patients of group-I

Conclusion: Birth trauma is still a major cause of vesicovaginal fistula in our region. Improvement in health services and socio-cultural status can help to reduce the incidence of this demoralizing injury. Once occurred VVF, can successfully be repaired by strictly adhering to principles of; a tension free repair, adequate blood supply, prevention of infection and adequate postoperative bladder drainage

Evaluation of low ligation and high ligation procedures of varicocele

To describe the mode of presentation of varicocele and to compare the low ligation [Inguinal approach/Ivanissevich's procedure] and high ligation [Retroperitoneal approach / modified Palomo's procedure] of varicocele repair regarding efficacy and postoperative complications. Design: Institutional-based randomized comparative clinical trial. Place and Duration of Study: This study was conducted at the Urology Department, Bolan Medical College and Sandeman Provincial Teaching Hospital, Quetta from December 1996 to November 2001 [5 years]. Subjects and A total of 213 patients of varicocele who underwent treatment in the department and completed 6 months follow-up were included in the study. The mode of presentation of varicocele was recorded for all patients. For treatment purpose patients were randomly divided into two groups: in group I [n: 115] varicocele was ligated by inguinal approach [Ivanissevich's procedure] while in group II [n: 98] by retroperitoneal approach [modified Palomo's procedure]. The efficacy and postoperative complications of the two procedures were carefully recorded and compared between the two groups. The mean age of the patients of group-I and group-II was 27.2 and 27.5 years respectively. More than 50% patients of both groups presented with feeling of heaviness/ dragging sensation on ipsilateral side. Presentation with infertility/sub fertility in group-I and group-II was 16.5% and 15.3% respectively. Majority of patients of both groups had grade III varicocele with visible deformity. The rate of postoperative complications was very low in both groups of patients. Recurrence of varicocele and postoperative hydrocele formation were slightly more common in group-II as compared to group-I but the difference was statistically not significant [p>0.05]. An extremely significant improvement occurred postoperatively in both sperms density and motility in infertile /sub fertile patients of both groups. Both procedures of varicocele repair are equally effective and have a low rate of complications. There is no significant difference in postoperative complications. An extremely significant improvement occurs in semen parameters of infertile/sub fertile patients postoperatively, irrespective of method / technique of varicocelectomy

Retrocaval ureter

Two cases of retrocaval ureter are reported. A 22 years old male patient presented to us with the complaints of right flank pain and hematuria and a child of 2 years referred to us for evaluation of right side moderate hydronephrosis detected on ultrasound. The diagnosis was confirmed on intravenous urography and retrograde pyelography. Both the ends were transected and anastomosed above a JJ stent in front of the inferior vena cava. Postoperatively the patients remained asymptomatic and the hydronephrosis improved

Clinical efficacy of transurethral resections for prostate

A retrospective study was done on 300 patients who had TUR[P] from 1997 through 2001 for lower urinary tract symptoms [LUTS]. Patients who had palliative TURP with a known history, or of incidental findings of adenoma carcinoma of the prostate were also included. TURP for both BPH and carcinoma of the prostate were preformed with 5% dextrose solution. Operative time was 45.0 minutes. Interval to catheter removal ranges from 48 hours to 5 days [mean 26 hours]. Symptomatic improvement has been observed with minimal morbidity [15%]. Incidence of postoperative retention [3%], secondary hemorrhage [2%], epididymo-orchitis [1%], stricture urethra [3%], retrograde ejaculation [1%] and impotence [4.33%] were observed respectively. Nine patients [3%] revealed neoplastic changes in respected tissues. None of the patient developed incontinence of urine. Patients were followed up to six months