Comparison of morbidity of three flank approaches for open renal surgery

The aim of this study was to compare the morbidity of three flank incisions, subcostal, transcostal and supracostal for open renal surgery in terms of incision times, postoperative pain, postoperative hospital stay and long term complications. Prospective comparative and analytic study. This study was conducted at Department of Urology, Nishtar Hospital Multan and Department of Urology, Ghulam Mohamed Maher Medical College/Teaching Hospital Sukkur from January 2007 to December 2011. In this study twelve hundred sixty [n-1260] patients who underwent open surgical procedures over a period of five years are analyzed. Patients were studied in three groups. Group A, subcostal,[n-407] 32.3%. Group B transcostal [n-526] 41.7% and Group C, supracostal, included [n-327] 25.9%. Mean incision time in Groups A, B and C was 17.3 min, 21.08 min and 23.81 min respectively. Mean amount of injectable analgesic required in first three post operative days in Groups-A, B and C was 41.36 mg, 46.87 mg and 49.40 mg of Nalbin respectively. Mean Post operative hospital stay in Group A Band C was 4.63, 5 days and 4.64 days respectively. Pleural injury was none in Group A, thirty five [n- 35] cases [6.61%] in Group B and thirty nine [n-39] cases [11.9%] in Group C. Incisional hernia was noted in Group A 12 cases 3%, Group B 6 cases 1.1 % and none in group C. With subcostal approach, incision time, dose of analgesia and pleural injury is minimum but high incidence of incisional hernia is there. In transcostal and supracostal approach the incision time, dose of analgesia and incisional hernia is minimum but incidence of pleural injury is relatively high

Management of stricture urethra

To determine the role of internal optical urethrotomy [IOU] alone arid IOU followed by clean intermittent self catheterization [CISC] in the management of the uretheral stricture disease and to investigate the effect of CISC or prevention of urethral stricture recurrence after IOU. The study was carried out in the Department of Urology, Nishtar Hospital, Multan from January 1997 to December 1999. A total of 37 patients were included in the study. Most of strictures [5 1%] resulted from some sort of trauma while infections and indewelling urinary catheters were responsible for strictures in 21% patients and 13.5% respectively. Three patients had post prostatectomy strictures and in 2 patients etiology remained unknown. Patients commonly presented with symptoms and difficulty with micturition [94%], poor flow [75%] and split stream in 62%. Three patients [23%] in group-A developed recurrence of uretheral stricture within first year while stricture recurred in 12 patients [75%] in group-B. In 14 [37%] patients some complications occurred after IOU. In these patients bleeding was commonest complication [18%] followed by infection and urinary extravastion 5% and 16% respectively. Optical urethrotomy is a safe and effective means to manage urethral strictures, its success rate approaches 70% with simple strictures less than 2 cm in length in selected group of patients. It can be performed under spinal or general anaesthesia

Efficacy of paroxitine for the management of premature ejaculation

Premature ejaculation is a common male sexual disorder and has been managed by psychosexual counseling, topical anesthetics and pharmacological treatments. We evaluated the efficacy of paroxetine, a potent and highly selective serotonin reuptake inhibitor, antidepressant in patients with premature ejaculation. This comparative study was carried out in the Department of Urology, Nishtar Hospital, Multan for 3 months. A total of 100 patients complaining of premature ejaculation were selected and randomly grouped-A and B. Patients in group-A received 20 mg paroxetine [n-50] and in group-B placebo for 3 first weeks regularly then on demand for 3 months. Pretreatment evaluation included history, physical examination, intra-vaginal ejaculation latency time and satisfaction with sexual intercourse. Efficacy of 2 treatments was assessed at 3 weeks and 3 months at study end point where patient reported impression of change was recorded. Trial was completed by 39 patients in each group [78%], Analysis revealed a difference in WELT increase in 2 groups. In group-A IVELT increased after paroxetine from 1 mm 10 sec to 4 min 17 sec at 3 weeks and 4 mm 6 sec at 3 months while in placebo group IVELT increase from 1 mm 1 sec at beginning to 1 min 15 sec at 3 weeks and 1 min 8 sec at c months [2 tail sig .000]. Regarding patient reported impression of change there was 2 category improvement in 56.4% patients in paroxetine group while 12.8% in placebo group. Paroxetine has significantly better results in terms of IVELT and intercourse satisfaction. Further studies are required to draw final conclusions on the efficacy of this drug in PE