Comparison between double J [DJ] ureteral stenting and percutaneous nephrostomy [PCN] in obstructive uropathy

To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A and B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy [PCN] was 92.0% [p < 0.0001]. Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications

Frequency of carcinoma of prostate in clinically benign prostatic hyperplasia and role of different screening tests

To assess the frequency of carcinoma in clinically benign prostatic hyperplasia and role of digital rectal examination [DRE] and prostatic specific antigen [PSA] in assessment of these patients. Patients admitted to the Department of Urology and Renal Transplantation with lower urinary tract symptoms [LUTS] due to enlarged prostate. Descriptive Study. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College /Bahawal Victoria Hospital, Bahawalpur, from January 2007 to December 2010. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal ultrasonography. The selection criteria were; Refractory retention of urine, Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 300 patients were selected. Patient's blood sample was sent to laboratory to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transurethral resection of prostate [TURP] or transvesical prostatectomy [TVP] and prostatic tissue was sent for histopathology. In this study, 13.33% patients were found to have carcinoma of prostate inspite of being clinically benign prostates in all patients, irrespective of PSA range. The PSA value was found < 4ng/ml in 211 [20.33%] patients and remaining 89 [29.67%] patients had PSA value > 4ng/ml. In this study, 9.95% patients had carcinoma prostate inspite having normal PSA and benign prostate on DRE while with rising PSA levels and normal DRE, chances of malignancy detection increases [66.67%]. We conclude that although frequency is low the possibility of malignancy in clinically benign enlarged prostate should be borne in mind whenever subjecting the patient for screening, assessment and treatment. DRE alone is insufficient to detect malignancy. PSA in combination with DRE is beneficial in predicting prevalence of carcinoma prostate.

Ultrasonography, X-ray and intravenous urography [IVU]

To know the sensitivity and specificity of ultrasound with plan abdominal film [X-ray KUB] compared to IVU in evaluation of renal colic. To develop a protocol for investigations of renal colic. Experimental. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur. From July 2010 to December 2011. The number of cases for the study were one hundred and fifty. Patients of either sex of age range from 10 to 50 years with suspected urinary tract stone disease, PUJ obstruction and structure ureterovesical junction were included in this study. While patients of age <10 years, renal failure and with history of hypersensitivity to contrast media were excluded from the study. After routine investigations, ultrasonography, plain X-ray KUB and IVU were performed in every patient at radiology department, Bahawal Victoria hospital, Bahawalpur. The mean age of patients was 41.14 +/- 1.30 years. The ratio of male to female was 2.8:1. Presenting complaints of patients were flank pain. Maximum duration of complaint was 5-6 years. USG + X-ray KUB findings were obstructing renal stone, ureteric stone and PUJO in 97[64.67%], 25[16.67%] and 28 [18.67%] patients respectively. While on IVU, obstructing renal stone, PUJO and ureteric stone was found in 87[58%], 31[20.67%] and 32[21.33%] patients respectively. this study shows that ultrasonography and plain X-ray abdomen [KUB] in sufficient for the diagnosis of renal disease presenting with renal colic