Efficacy of pubovaginal sling using fascia lata for treatment of urodynamic stress incontinence in females

To evaluate results of pubovaginal sling surgery for the treatment of urodynamic stress incontinence in females. Descriptive study. This study was carried out in Pakistan Naval Services Shifa, Karachi and Armed Forces Institute of Urology, Rawalpindi from February 1997 to February 2004. Thirty two Pubovaginal sling operations using fascia lata were performed at Pakistan Naval Ship Shifa, Karachi and Armed Forces Institute of Urology, Rawalpindi in females having severe urodynamic stress incontinence. The inclusion criteria was women with stable bladder, having post void residual urine [PVRU] <100 ml and P det 720 cm of water. Patients with detrusor overactivity, impaired detrusor function and marked cystocele were excluded from the study. The procedure involves placing a band of sling material using fascia lata directly under the bladder neck, which acts as a physical support to prevent bladder neck and urethral descent during physical activity. All patients were evaluated postoperatively by clinical examination, PVRU, Peak flow rate on uroflowmetry and urodynamic assessment. Mean patients age was 46.5 years [range 27-68] and mean parity was 6 [range 0-10]. Follow up was completed in all 32 patients over a mean follow-up period of 26 months [range 3-38]. Overall success rate [completely cured and partially cured] was 84%. De. novo detrusor over activity was observed in 25% patients, while 2 patients underwent undo operation for urinary obstruction. Pubovaginal sling surgery is the first line surgical treatment for all types of urodynamic stress incontinence

Presentation and evaluation of renal masses

To find out the various disorders presenting as renal mass to a referral centre for Urology over a 2 year period. A descriptive study. The study was conducted at Armed Forces Institute of Urology Rawalpindi and Combined Military Hospital, Kharian Pakistan from March 2002 through March 2004. A total number of 43 patients who presented as a renal mass or found to have renal mass during the course of investigations and subsequently underwent treatment at the institute were analyzed in the study. Their mode of presentation as various age group distribution and workup, histological break-up, treatment offered and follow-up was recorded. A total number of 43 patients presented as renal mass during the period of study. Seventy four percent of the masses turned out to be renal cell carcinoma and radical nephrectomy was the most common procedure performed [34 patients]. Hematuria was the most common mode of presentation as seen in 32 [74%] patients followed by lumbar pain in 30 [70%] patients. Majority of the lesions was in 46-55 year age group with 33 [77%]. Advances in diagnostic modalities such as CT and MRI will continue to expand the role of preoperative imaging for the diagnosis of renal masses. Surgery remains the mainstay of treatment for the majority of such masses and with increasing detection at an early stage, may possibly improve the cure rate of renal malignancies as well

Effects of intravesical BCG therapy on superficial bladder cancer [recurrence and progression]

The present study was conducted to determine the efficiency of the intravesical BCG therapy on superficial bladder tumor recurrence and progression. 39 patients at AFIU Rawalpindi from Jan 1999 to Jan 2002. All patients with superficial bladder tumor were included in the study. Patients with Carcinoma Urinary Bladder were evaluated with Ultrasound Kidney and Urinary Bladder, examination under anaesthesia, cystoscopy, and histopathological examination. Sixteen patients with superficial bladder tumor were given BCG therapy two weeks after transurethral resection. This consisted of induction with six instillations at weekly intervals, followed by three monthly check cystoscopies. Control group [twenty three patients] underwent transurethral resection followed by check cystoscopy at three monthly intervals. Both recurrence rate and tumor progression was low [12.05% and 6.25% respectively] in BCG treated group, compared with higher tumor recurrence and tumor progression [65.25% and 26.10% respectively] in the control group. BCG instillation therapy in superficial bladder tumors significantly reduced the rate of tumor recurrence and tumor progression

Hypospadias: one stage repair

To evaluate the cosmetic and functional results of one stage repair of hypospadias, using parameatal based flip-flap urethroplasty. A prospective study from 1990 to 2002 at AFIU Rawalpindi, CMH Kohat, Jhelum, and Pano Aqil Cantt. And AK CMH Muzaffarabad. Fifty patients underwent one stage repair of hypospadias by parameatal based flip flap urethroplasty, using ventral penile and scrotal axial skin flap. The urethral meatus was subcoronal in 6 [12%], Distal penile in 32 [64%], proximal penile in 8 [16%] and penoscrotal in 4 [8%]. Some modifications and combinations were used to ensure better vascularity of the flaps; natural verticals slit meatus and reduce complications. An 8 Fr polythene feeding tube used as stent with its tip inside the urinary bladder was removed on 7th or 8th postoperative day. The mean follow up period was 12 to 36 months. We achieved good cosmetic and functional results in 86% patients. Urethrocutaneous fistula occurred in 3[6%] patients, meatal stenosis in 2 [4%], residual chordee in 1[2%] and disruption of repair due to flap necrosis in 1 patient. Only four patients required redo surgery for fistula, residual chordee and failed repair due to flap necrosis. Meatal stenosis responded well to regular dilatation with the cone tip of an ophthalmic ointment tube, twice daily for 2-4 weeks. Postoperatively the penis was straight with natural vertical slit meatus and good stream of urine. One stage parameatal based flip flap urethroplasty, with some modifications, give very good functional and cosmetic results in primary as well as salvage repair of hypospadias

Transurethral resection of prostate for BPH-Assessment by uroflowmetry

To assess the improvement in the urinary flow rate in patients with benign prostasic hypertrophy [BPH] following transurethral resection of prostate [TUR] [P] with the help of Uroflowmetry. It was a prospective study. This study was conducted at Armed Forces Institute of Urology [AFIU] Rawalpindi. 100 patients with BPH were included in the study. Patients were evaluated by digital rectal examination [DRE], ultrasound kidney, ureter and bladder [KUB] and Prostate size, PSA., Uroflowmetry preoperatively as well as post operatively at monthly interval for 03 months. There was significant improvement in the maximum flow rate with decrease in the time to maximum flow rate. There was also increase in the voided volume. In Conclusion, TUR [P] is the commonest method of treatment for BPH. Uroflowmetry is a simple, quick and easiest way to assess degree of obstruction and improvements in the flow rate postoperatively