Factors affecting recurrence and progression of high grade non invasive bladder cancer treated by intravesical BCG

The rate of recurrence in high grade non muscle invasive bladder cancer [NMIBC] is 70% with progression rate of 15-40% at 5 years. The treatment of high grade NMIBC is intravesical BCG therapy, however for high risk cases radical cystectomy is recommended. In this study we determined the response of high grade NMIBC to BCG therapy and the factors affecting it in south Asian population. This retrospective cohort study was conducted on 64 patients treated with intravesical BCG for high grade NMIBC from Dec 2008 to July 2012. Smoking, tumor size, location and multiplicity were taken as prognostic factors. Recurrence and progression were determined by cystoscopy and upper tract imaging according to European Association of Urology guidelines. The association of prognostic factors with recurrence and progression was determined. The rate of recurrence and progression was found to 45.8% and 27.1% respectively after a mean follow up 28.36 months. Smokers had 4 times greater odds of progression of tumor as compared to non-smokers. Patients with large tumors had 6.7 times greater odds of progression as compared to patients with small tumors. Smokers with large and multiple high grade NMIBC constitute the high risk group. These patients may be offered early radical cystectomy and advised to stop smoking

Grading complication following radical cystectomy and ileal conduit for bladder cancer using clavien grading system

To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system. An analytical descriptive study. The Aga Khan University Hospital, Karachi, from 1990 to 2010. Patients who had undergone ileal conduit [IC] formation, following radical cystectomy [RC] for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system [CG]. Results were presented using descriptive statistics. Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients [56.2%] did not have any complications. Most common complication of wound infection was seen in 7 patients [CG-2], followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia [GC-3a]. Mortality rate was 4.5%, classified as CG-V. Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life

Instrument failure: a preventable cause of conversion in laparoscopic cholecystectomy

This study was done to assess the association between quality of laparoscopic instruments and the incidence of conversation from laparoscopic to open cholecystectomy. Observaional and descriptive study from October 2004 to September 2006. This study was conducted at Baqai Medical University Hospital and two other private hospitals in Karachi. All patients who underwent laparoscopic cholecystectomy, including those that had to be converted. The records of all attempted laparoscopic cholecystectomies were studied retrospectively. Apart from demographic data, the clinical diagnosis, histopathology, conversion rate and quality of the instrument i.e. old or new was studied. SPSS Version 11 was used for statistical analysis. The frequencies were drawn and association between conversion rate and quality conversion rate and quality of instruments was noted using odds ratio. Laparoscopic cholecystectomy was attempted in 93 patients during the study period. Amongst them 79 were females and 14 males, with an age range 16 to 72 years [mean 46 years]. Seven [7.53%] patients had to be converted from laparoscopic to open cholecystectomy. The causes of this conversion were instrument failure in five cases, CBD stone in one and unclear anatomy at Calot's triangle in one case. The laparoscopic instrument that failed during surgery included insufflators in two cases while monitor, camera, and clip applicator, each in one case. Fifty six surgeries were performed with old instruments and 37 with new instruments. Correlating the two variables i.e. conversion rate and quality of laparoscopic instruments revealed that only one case was converted with new instrument, while six conversions were with old instrument. All the instrument failures were with old instruments and the odds ratio was 4.32. The chances of conversion from laparoscopic to open cholecystectomy are 4.32 times more if old instruments are used compared to the new ones. The difference in conversion rate due to instrument failure is stasitically significant