Triggers of blood transfusion in percutaneous nephrolithotomy

To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy [PCNL]. Observational study. The Aga Khan University Hospital, Karachi, From 1988 to 2007. The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quality of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss of blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41 +/- 14 years. The mean haemoglobin drop was 1.68 +/- 1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender [p= 0.003], staghorn stone [p= 0.023], stone fragmentation with ultrasound [p= 0.054] and chronic renal failure [p= 0.001] were significantly predictive of the need for blood transfusion. Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients

Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. During the study period 5 patients were lost to follow up and were excluded. The rest of patients [n=55] were young, with age ranging from 20 - 35 years [Mean age 27.8 years, SD + 4.38]. All patients had unilateral left sided varicocele; two patients [3.6%] had grade I varicocele, 21 patients [38.2%] had grade II varicocele and 32 patients [58.2%] had grade III varicocele. Statistically significant improvement in sperm density [p value < 0.05], sperm activity [p value < 0.05] and sperm morphology [p value < 0.05] was observed after the surgical ligation. The mean operative time was 54.88 minutes [SD + 13]. The mean hospital stay in laparoscopic procedure was 33.4 [SD + 15.3]. Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Surgical ligation of scrotal varicocele is a safe and effective mode of treatment of male factor infertility in selected population

Metanephric adenoma: a rare benign renal tumor

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and rarity and the lack of clinical, radiographic, or cytologic means to establish a definite diagnosis, Metanephric adenoma remains primarily a pathologic diagnosis