ABSTRACT
Objective: to assess the efficacy of alfuzosin in accelerating spontaneous passage of distal ureteral stone
Material and Methods: sixty patients above 18 years of age from both sexes were randomized in two groups; Inclusion criteria was calculi =10mm in distal ureter [below pelvic brim]. Patients in group A were given 50 mg diclofenac sodium tablets twice a day, whereas, Group B patients received alfuzosin tablets [5mg] twice a day along with diclofenac sodium. Maximum duration of therapy was 4 weeks. Patients in both groups were given intramuscular injection of diclofenac sodium [75mg] as required. They were followed up at one week intervals. Stone expulsion rate, expulsion time, analgesia requirements and need of intervention were recorded and compared in two groups. Adverse effects of drug were also recorded
Results: comparison of age, sex and stone size did not reveal significant difference between the two groups [p>0.05]. Mean stone size in group A and B was 7 .13 mm and 7 .64 mm respectively. Expulsion rate was significantly higher in group B as compared to group A [53.3% vs 26.6% p<0.05]. Mean expulsion time was 9.57 days in group A and 5.93 days in group B [p<0.001]. Similarly requirement of number of analgesic injections was significantly less in group B than group A [mean 1.3 vs 3.5 p<0.05]. Only one patient required intervention in group A No correlation could be found between stone size and expulsion rate in either group
Conclusions: alfuzosin facilitates expulsion of· distal ureteral stones <10mm, reduces expulsion time and lowers analgesic requirement
ABSTRACT
Objective: This was a retrospective study to evaluate the results of a modified technique for ureterocolic anastomosis
Patients and Methods: Record of patients having ureterosigmoidostomy between Jan 1997 and Dec 2006 were reviewed. Parameters studied were age, disease entity, postoperative complications, duration of the procedure, and hospital stay
Results: There were 23 patients with mean age of 42.3 years. Out of these, carcinoma urinary bladder, ectopia vesicae and vesico vaginal fistula were seen in 14, 8 and 1 patients respectively. Mean duration of the procedure was 20.8 minutes, while mean hospital stay was 8.4 days and mean duration of maintenance of rectal tube was 7.13 days. The complications noted were pneumonia [4.35%], wound infection [8.7%], hypokalemia [43.48%], recurrent fever [17.4%] and bilateral hydronephrosis [8.7%]
Conclusion: We have concluded that the procedure is simple, quick and associated with minimal morbidity
ABSTRACT
Background: Object of this study was to assess the reliability of the symptomatology and residual urine in assessment of bladder outlet obstruction [BOO] due to benign prostatic enlargement [BPE]
Methods: Flowmetry of patients with IPSS greater than 20 and normal residual urine [<100ml] was done. Patients above age of 50 with IPSS >20, residual urine <100ml and voided volume >150ml were included. Those with stricture urethra or TURP were excluded. Study parameters were age, residual urine, maximum flow rate [Qmax], average flow rate [Qave], flow time and voided volume. SPSS version 15 was used for statistical analysis
Results: Out of 41 [mean age 64.3 years +/-8.49], 17 [41%] were found to have obstruction on the basis of Qmax, Qave, flow time and flowmetry tracings. Among the obstructed patients, Pearson correlation between voided volume and Qmax was [r=0.322, p <0.05] while it was [r=0.528, p = 0.117] between Qmax and residual urine
Conclusion: Assessing on residual urine and symptomatology alone would have misdiagnosed 41% and 59% patients respectively. Therefore IPSS or residual urine alone is not satisfactory and patients should be assessed by combining IPSS, residual urine and uroflowmetry
ABSTRACT
A young patient with gross haematuria was evaluated radiologically which revealed a solid mass measuring 7x7 cm in the urinary bladder. Cystoscopy showed a big solid mass at bladder dome. Biopsy was taken endoscopically. Histologically it turned out to be inflammatory pseudotumour. Later partial cystectomy was done with 1 cm healthy margins. Repeat biopsy confirmed the findings of previous histopathological examination
ABSTRACT
Background: To assess the efficacy and safety of pneumatic lithoclast in the management of ureteric calculi
Methods: One hundred and four patients with ureteric calculi were treated by pneumatic lithoclast at department of Urology Services Hospital Lahore from Jan 2005 to December 2006. Record of the patients was analyzed retrospectively. Patients above 15 years from both sexes with calculi measuring more than 0.5cm [in the largest diameter] were treated in upper, middle, and lower ureter. Calculi were approached with 8fr ureteroscope and fragmented with Swiss lithoclast. After the completion of the procedure, ureter was stented. Patients were followed up till they became stone free. Following parameters were assessed: stone size, site, laterallity, degree of fragmentation, success rate, stone migration, type and duration of stenting, post operative hospital stay and complications. Requirement of another procedure or inability to enter the ureter were considered failure
Results: One hundred and six ureteric calculi were treated in 104 patients. Amongst those, 22 stones were in upper ureter, 16 in the middle ureter and 68 stones were in lower ureter. Mean stone size was 11.2mm [largest diameter]. Overall success rate was 89.2%. Whereas success rate in upper, middle and lower ureter was 63.6 %, 87.5% and 95.6% respectively. Mean postoperative hospital stay was 26.5 hours. There were no major complications
Conclusions: Pneumatic lithoclast with URS is effective and safe in the management of the ureteric calculi. However, success is limited in the upper ureter
ABSTRACT
Background: SIMS/Services Hospital Urology department presented its initial experience of Percutaneous Nephrolithotomy [PCNL] with promising results
Aim: To assess the efficacy and safety of PCNL in the management of Renal stones
Methods: Prospective study of 40 patients who underwent PCNL. Procedure performed in General Anasthesia. Placement of ureteric catheter in Lithotomy position to visualize the collecting system. Ureteric catheter and Foley catheter retained in a sterilized bag. Patient shifted to prone position with C-Arm at 0[degree]. Nephrostomy needle placed over desired calyx and tract dilated with metallic dilators. Stone crushed with swiss lithoclast and fragments removed with stone graspers. Foley catheter placed at the end of procedure percutaneously. X-Ray KUB done post operatively and both Foley and ureter removed subsequently
Results: In total 40 patient 27 [67.5%] male and 13 [32.5%] female the success rate with PCNL as monotherapy was 72.5%. It was 82.5% when combined with ESWL
Conclusion: Percutaneous Nephrolithotomy [PCNL] is effective monotherapy for renal stones and gives excellent results when combined with ESWL
ABSTRACT
Background: Urolothises is one of the most common and oldest diseases of urinary tract. It is endemic Pakistan and the incidence of calculus renal failure is high. This is due to poor initial management
Methods: it is an observational study conducted at the Department of Urology, Services Hospital, Lahore from April 2001 to March 2003. In this study we evaluated the patients with calculus renal failure regard; their preoperative, operative, postoperative management and improvement in renal function after the removal of stones. Twenty patients, 13 male and 7 female were included in this study. The chief presenting symptom was anuria in 20 [100%] of patients. Ultrasonography, X-ray KUB and Ante-grade pyeiogrqahy were the main investigations regarding the site, size of stone, degree of hydronephrosis and echogenicty of the kidneys. Percuta-neous Nephrostomy alone, Acute Peritoneal Dialysis alone and Pereutaneous Nephrostomy with Acute Peritoneal Dialysis were the emergency procedures performed to save the lite ot the patients and to plan for a definite surgical procedure. After the stabilization of the renal function. definite surgical procedure in the tom of pyelo-lithotomy and ureterolithotomy were performed
Results: Results were analyzed by considering the duration of anuria, degree of obstruction [hydrawephmsis] and duration of maximum improvement. Overall thirteen [65%] patients had good result five [25%] patients had satisfactory results and two [10%] patients had poor results. Anuria due to stones in the unnary tract is a urological emergency
Conclusion: Prompt and early interventions can save the patient from developing irreversible renal damage