ABSTRACT
Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques
Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013
Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated
Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05
Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain
ABSTRACT
Background: urinary stones disease is a global problem with a declining incidence since 19[th] century. Commonly seen in Middle East and China, bladder stones are however rare in the western world. Giant vesical calculi especially those weighing more than 100 grams, are even rare in today's urologic practice due to early sought medical attention and prompt treatment
Case Presentation: the current case report is about a 40 years old Asian male who presented with dysuria, suprapubic pain, difficulty in micturition and intermittent pyrexia and hematuria for the last 1 year. Investigations revealed severe anemia, raised white blood cell count, serum urea and creatinine. Radiological investigations confirmed the presence of a large vesical stone. Initial management included Percutaneous Nephrostomy along with pre-operative preparation of the patient followed by open vesicolithotomy. Clearance of the obstruction resulted in improvement of renal function and patient was discharged home in satisfactory condition
Conclusion: despite the overall decline in the incidence of urinary stones and development in the diagnostic and interventional urology, neglected cases are still seen in the outdoors due to lack of knowledge and awareness at the patient level and inadequate availability of investigation facilities in the developing countries. This sufficiently delays the treatment and results in severe complications which at times may be permanent and un compensate able
ABSTRACT
Background: Adequate vascular access is of utmost importance for hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair cannulation and can cause significant complications and inconvenience for the technicians and patients
Objective: We intended to present the technique of superficialization [transposition] of the brachiobasilic fistula [BBF] and its clinical outcome regarding patency and complications
Materials and Methods: Twenty two brachiobasilic fistulas were fashioned in 20 patients between October 2010 to November 2011.The second stage superficialization [transposition] was carried out at a median of 59.1 days [range: 40-90 days] after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the antero-medial aspect of the arm and transposing it beneath skin
Results: During the study period 20 brachiobasilic fistulas [BBF] were fashioned in 20 patients. There were 8 [40%] males and 12 [60%] females. The mean age was 53.45years + 12.34 years [range: 21-70years]. The patency rates were 90% at 6 months. Surgical complications of transposition were infection in 2 [10%] patients and lymphocoele in 4 [20%] patients
Conclusion: Transposition of brachiobasilic fistulas is technically feasible and relatively safe procedure. Patency rates at 6 months are excellent
ABSTRACT
Background: Urinary incontinence leaves the sufferer with physical and psychological stresses. Majority of the cases are caused by an underlying treatable condition however the it is under reported to medical care providers. The objective of this study was to explore the psychosocial impacts of urinary incontinence and assess quality of life in patients with urinary incontinence in Pakistan
Methods: This study was conducted at five tertiary care hospitals in the city of Karachi during January 2013 to December 2013. Self-administered questionnaire was prepared and adjusted according to the local social dynamics of the community based on 'Incontinence Impact Questionnaire' and 'The Kings Health questionnaire'. Inclusion criteria included urinary incontinent patients visiting outpatient departments
Results: The study comprised of 280 participants with a response rate of 80%. Overall 89 males and 191 females participated. Majority of the sample population [40.7%] believed that the weak anatomy was the etiology of their Urinary Incontinence. More than 40% of the participants declared that they would rate 'the fear that an embarrassing condition could arise in result of their disease' as 'Moderate' followed by 38.2% as 'Highly'. 39.64% stated that their social life including interaction with people was 'Moderately' affected and 21.7% believed that they their social interaction was 'highly' limited. Regarding travel, majority of the participants asserted that their travel has been restricted to a great extent and rated as Highly [30.7%] or Moderate [29.6%]. In total 28.5% patients stated that their exercise schedule had been 'Moderately' affected as a consequence of their disease
Conclusion: Patients with urinary incontinence should be heard comprehensively by the care providers. Coping techniques for patients and education regarding Urinary incontinence should be provided by the medical practitioner to the sufferers
ABSTRACT
Introduction: Migration of intrauterine contraceptive device [IUD] into urinary bladder is not very common. Secondary stone formation is a rare complication. It occurs as a result of complete migration of the IUD into urinary bladder. To date, more than 80 cases of IUD migration to the bladder have been reported in the literature with varying stone sizes. A series of 15 cases to whom an IUD migrated from the uterus to the bladder and resulted in formation of a stone over it
Methods: A cohort of fifteen women was treated for bladder stones over migrated IUD within June 2004 to May 2012. Detailed history was maintained, diagnosis was established by pelvic ultrasonography and/or X-rays pelvis. All cases were managed by endoscopy. All cases undergo Cystoscopy and litholapexy
Results: The mean age of participants was 39.7+5.29 years [28-49]. Major objection in almost all cases was lower urinary tract symptoms; which were not responding to medical treatment, six patients had few episodes of macroscopic hematuria. The interval between insertion of IUD and onset of symptoms ranged from 2 to 5 years. In twelve cases IUD was embedded in urinary bladder wall and an entire intravesical IUD in rest 3 with calculus formation in all of them. Stones were crushed along with retrieval of IUD as a result of which mild hematuria was reported in 4 cases. Patients remained with Foley catheter from 7 - 14 days. Postoperative recovery was uneventful
Conclusion: Intrauterine contraceptive device [IUD] perforation to the bladder, with stone formation, is an uncommon event. Clinically it is difficult to reach its diagnosis but persistence of lower urinary tract symptoms in women with IUD should raise the suspicion of intravesical migration. Sonologist can define intravesical migrated IUD. Endoscopy proved a better and safe procedure with a very low complication rate