Living donor renal transplantation our experience in SIMS/Services Hospital, Lahore

Kidney transplantation is the treatment of choice for end stage renal disease [ESRD] patients. However organ shortage remains the central problem in kidney transplantation. To deal with the widening gap between supply and demand of organ for renal transplantation, efforts to expand the organ donor pool have received increased attention. To solve this problem, we have initiated a living related and unrelated living donor programe using emotionally related persons, friends and well motivated volunteers as organ donors. A total of 18 patients with live donor underwent kidney transplantation in Sims /Services Hospital over a period from March 2006 to December 2006. The aim of study is to highlight the problems and identification of factors limiting the number of transplantation and further prospects of renal transplantation in Pakistan. The cause of ESRD was HTN 7 [38.89%], Chronic Glornerulonephritis 4 [22.22%], Calculus Renal failure 4 [22.22%], and Diabetic Nephropathy 3[16.67%].The donor age ranged between 20-55 years [mean 28.39].The recipient age ranged 17-56 years [mean32.73]. Relationship of donor to recipient was sister 1 [5.56%], 1st degree relatives 3 [16.7%], friends 4[22.22%], unrelated 10[55.56%]. In our study graft survival was 88.89%, patient survival 94.45%, mortality 5.56%. Transplanted patient has to be better motivated to take medication regularly and get the investigations. It was observed that 1st degree relation are very limited source of donors in this part of the world and unrelated donors certainly encourage, transplantation

Meatal stenosis in circumcised males - Is it preventable?

Meatal stenosis is most commonly seen among the circumcised males. The true incidence of this post circumcision complication is not known. The most favored hypothesis regarding the etiology is ammoniacal fumes produced in the wet diapers, which cause meatitis of unprotected glans. It is treated by meatoplasty. 26 pediatric patients suffering from meatal stenosis were treated between Jan. 2003 and Dec. 2005 both inclusive [Mean age was 4.36 years and ranging 2 - 10] and mean follow up was 4 months. Patients were studied for presenting symptoms, size of meatus, perimeatal balanitis, pyuria and postoperative complications such as bleeding, infection and recurrence. They were advised postoperative dilatation with ophthalmic ointment nozzle for one month. Patients with prior history of circumcision were included in the study. The most common symptom in our study was thinning of urinary stream 17 [65.4%] cases. Other common symptoms were painful micturition in eight and bloody spotting in seven cases. Eight patients were having pin hole meatus and three cases were having pyuria. Compliance for post operative dilatation was 76.9% [20 cases]. No case of recurrence was seen. It can be concluded that meatal stenosis is related to infant circumcision. It is treated by meatoplasty with satisfactory outcome. Whether we would be able to prevent this post circumcision complication ? There is no obvious solution to this problem for the time being

Outcome of Priapism after early and late management

To assess the outcome of patients presenting with priapism during the last six years. Record of the patients presenting with priapism was evaluated retrospectively. Following parameters were assessed; etiology, duration, management, complications and final outcome. Fifteen patients with mean age of twenty seven years presented from Jan 2000 to Dec. 2006. Etiological factors were intracavernosal injection of papavarine 6 [40%]. hakeem medication 4 [26.7%], thalasemia 2 [13.3%] and idiopathic in 3[20%] patients. Mean duration of priapism was 80.8 hours. Initial conservative management was successful in 7 [46.7%] patients. Non responders were treated with distal cavernosospongiousus shunt. Out of eight, three [37.5%] patients responded and remaining four ended up with corporeal fibrosis and erectile dysfunction[ED]. One patient develop urethrocutaneous fistula. Intracavernosal injection of papaverine and hakeem medicines are common etiological factors. Patient usually present late because of embarrassment. Outcome of management depends upon duration of priapism

Acute epididymo-orchitis - is empirical therapy for Chlamydia trachomatis justified?

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20's. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 [43%] patients and in only 12 [14%] of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis

Stone clearance and fragmentation after ESWL in operated and non operated patients

A comparative study was conducted in 78 renal stone patients to evaluate the efficacy of ESWL in operated and non operated cases. The operated group consisted of 38 patients whereas non operated group comprised of 40 patients. After ESWL stone fragmentation was 80%, 90% and 96% in the operated group at one, two and three months respectively. In the non operated group stone fragmentation was 86% at one month and 100% at two and three months. In the operated group stone clearance was 8%, 18%,49% at one, two and three months. In the non operated group stone clearance was 7% at one month, 38% at two months and 53% at three months after ESWL. No significant difference in stone fragmentation between the operated and non operated group was found up to three months. The stone clearance was also similar at one month but was significantly lower at two months and again similar at three months in the operated group as compared to the non operated group

role of urinary cytology in the early diagnosis of bladder cancer

A prospective study was conducted on 50 patients with urinary bladder carcinoma to evaluate the role of urinary cytology in the early diagnosis of bladder cancer. Urinary cytology was clearly positive in 87.5% and negative in 12.5% of cases when bladder tumour was visible on cystoscopic examination. Whereas it was clearly positive in 40% and negative in 60% of cases when no tumour was seen on cystoscopy but detected on biopsy. It was observed that urinary cytology is almost as accurate as cystoscopy in appraising the presence or absence of bladder tumour. It may provide information about the neoplastic state of the epithelium not provided by cystoscopic examination. It is recommended that being practical and simple procedure, urinary cytology may be done as a routine procedure in the high risk patients and also suspected cases of bladder carcinoma presenting with unexplained frequency, urgency or haematuria