Acute kidney injury in Ureteric Stones: Single centre short term analysis

Objective: To analyze acute kidney injury [AKI] frequency, risk factors and outcome in ureteric stone Patients

Methods: This is an observational retrospective study performed in a single tertiary care centre in Abu Dhabi from October 2014 till August 2015. Convenient sampling was done on 152 consecutive patients who underwent decompression surgery [Ureterorenoscopy LASER Lithotripsy and DJ Stenting] for ureteric stones. Serum Creatinine was used to calculate creatinine clearance by cock croft Gault formula in all patients before and after procedure. Analysis was done on SPSS version 17

Results: Out of 152 patients who underwent decompression surgical procedure for ureteric stones AKI was seen in 49 [32.2%]. Patients with AKI were found to be more higher age, increased weight, bilateral stones, lower ureteric stones and with co morbidities in comparison to those who were without acute kidney injury. Patients developing AKI, 89.7% recovered either partially [20.4%] or completely [69.3%]

Conclusion: AKI is seen more in ureteric stone patients with older age, increased weight, bilateral stones, lower ureteric stones and with co morbidities. Recovery is good when obstruction is relieved

Mamun-TKC parathyroid retractor: Parathyroid glands squashed or scooped!

Parathyroid gland by its physiologic and anatomic diversity has interestingly been dealt by multiple specialties, including Urology. Besides primary hyperparathyroidism, urologists in close working relationship with nephrologists, tend to get referrals for tertiary hyperparathyroidism. Data from 1999 to 2012 was retrieved for all parathyroidectomies. Medical record of only cases undergoing parathyroidectomy utilising the instrument Mamun-TKC Parathyroid Retractor were reviewed. It is a metal body surgical instrument resembling Gil Vernet retractor having functional flat metal head attached to solid long handle, designed in two forms; one 'Straight' and other 'Angled' at 30°. During the period, 28 cases of parathyroidectomies were performed. The instrument was used in two cases. It was found to facilitate dissection, retraction and pedicle ligation of parathyroid gland by a-traumatic handling

Laparoscopy in urology practice at a tertiary care centre

To describe the results of laparoscopic procedures at a Urology - Nephrology tertiary care centre. Case series / observational study. The Kidney Centre Postgraduate Training Institute, Karachi, from August 2007 to March 2012. Medical records of all planned laparoscopic surgery conducted during the study period were reviewed. Those cases which to open surgery were excluded. All were performed by a single surgeon, initially as supervised and later independently. Data was maintained for demographic data, procedure details, length of hospital stay, and complications including conversion to open surgeries. Data was analyzed through SPSS 17.0. There were 36 planned laparoscopic surgeries in the specified period. Out of 36 cases, 8 were converted to open surgery. Those who underwent laparoscopic surgery include two diagnostic procedures and renal cyst deroofing each, four ureterolithotomy, nineteen simple nephrectomy and one radical nephrectomy. So in total 28 cases were performed on 15 females and 13 males with mean age of 33.01 A +/- 10.9 years. The mean operative time was 216 A +/- 100 minutes and mean length of hospital stay was as 2.7 A +/- 1.04 days. There were 10 complications in 28 cases, majority being Clavien Grade II including 7% [2/28] blood transfusion. There are technical challenges in learning laparoscopy for practicing urologists. Following some learning model in a systematic manner will help surmounting the technical challenges in learning laparoscopy

Informed consent or agreement under duress?

The concept of Informed consent stems from the right of patient to 'self-determination'. A non-coerced process has to be followed in acquiring an informed consent, which means that the patient should know what is being done on his body and who is going to perform along with expertise and complication rate of the performer. Additionally, he should be aware of the risks, benefits and alternatives to the proposed treatment. It is not just acquiring a signature as a means of legal protection or for personal moral satisfaction. Fact lies in its process and not what is done but how it is done. A fifty-five year old lady was being scheduled for procedure A and evaluation also revealed pathology related to other system. Surgeon B was consulted who examined the patient and advised procedure B. Surgeon A and B along with the patient agreed to carry out both procedures in one sitting and single anaesthesia. On the day of surgery when the patient was under spinal anesthesia after Procedure A it was found that Surgeon B has sent some other surgeon in his place and suggested that consent be taken from the new surgeon as the patient was awake. The question is, are we allowing her to exercise her free will and choice? Actually even if she had said yes to the new surgeon, this might not have been her will rather would have been an agreement under duress