Prognostic value of p53 expression intensity in urothelial cancers

Objective: To determine association of immunohistochemical expression intensity of p53 with grade and stage of urothelial cancers

Study Design: Descriptive cross-sectional analytical study

Place and Duration of Study: Pathology Department, King Edward Medical University, Lahore, from January to December 2016

Methodology: Data of transurethral resection/radical cystesctomy urinary bladder biopsies was collected. Clinical, radiological and cystoscopic findings of patients were noted from patients' charts in the Urology Ward. Biopsies were graded histologically according to WHO 2004 grading system. TNM system was used for pathological staging. On selected slides, immunoshistochemistry for p53 was applied. Nuclear immunoreactivity was considered positive if present in >10% of tumor cells and negative if <10% of tumor cells. Intensity was considered weak [less than 15% cells] and strong [more than 15% cells]. Data was analyzed by SPSS version 21. Linear-by-linear association was calculated between p53 expression and stage of urothelial tumors, Chi-Square test was used to see association between grade and intensity of p53. Qualitative variables, like grade and stage of carcinoma along with p53 expression, were calculated in terms of frequencies and percentages. P

Results: Out of the 70 patients, 61 [87%] were males and 9 [13%] females. Out of 25 low grade lesions, 4 [16%] cases were p53 positive; and out of 45 high grade lesions, 41 [91%] cases were p53 positive. There was 33% [2/6 cases] positivity in Tis, 55% [16/29 cases] in T1, 72% in T2 [21/29], and 100% in T3a [5/5 cases] and T3b [1/1 case]. Strong intensity of p53 staining was noted to be 5.4% [n=25] of low grade and 94.6% [n=45] of high grade tumors

Conclusion: p53 expression was greater and more frequently strong in higher grade and stage of urothelial carcinoma. It can be used as a prognostic marker in predicting higher grade and stage of bladder cancer

Comparison of pain score after giving diclofenac sodium versus nalbuphine in patients undergoing ESWL: our experience in SIMS/ SHL

Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques

Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013

Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated

Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05

Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain

Giant vesical stone - a case report

Background: urinary stones disease is a global problem with a declining incidence since 19[th] century. Commonly seen in Middle East and China, bladder stones are however rare in the western world. Giant vesical calculi especially those weighing more than 100 grams, are even rare in today's urologic practice due to early sought medical attention and prompt treatment

Case Presentation: the current case report is about a 40 years old Asian male who presented with dysuria, suprapubic pain, difficulty in micturition and intermittent pyrexia and hematuria for the last 1 year. Investigations revealed severe anemia, raised white blood cell count, serum urea and creatinine. Radiological investigations confirmed the presence of a large vesical stone. Initial management included Percutaneous Nephrostomy along with pre-operative preparation of the patient followed by open vesicolithotomy. Clearance of the obstruction resulted in improvement of renal function and patient was discharged home in satisfactory condition

Conclusion: despite the overall decline in the incidence of urinary stones and development in the diagnostic and interventional urology, neglected cases are still seen in the outdoors due to lack of knowledge and awareness at the patient level and inadequate availability of investigation facilities in the developing countries. This sufficiently delays the treatment and results in severe complications which at times may be permanent and un compensate able

Vesical calculus: a complication of intravesical migration of intrauterine device [IUD]

Introduction: Migration of intrauterine contraceptive device [IUD] into urinary bladder is not very common. Secondary stone formation is a rare complication. It occurs as a result of complete migration of the IUD into urinary bladder. To date, more than 80 cases of IUD migration to the bladder have been reported in the literature with varying stone sizes. A series of 15 cases to whom an IUD migrated from the uterus to the bladder and resulted in formation of a stone over it

Methods: A cohort of fifteen women was treated for bladder stones over migrated IUD within June 2004 to May 2012. Detailed history was maintained, diagnosis was established by pelvic ultrasonography and/or X-rays pelvis. All cases were managed by endoscopy. All cases undergo Cystoscopy and litholapexy

Results: The mean age of participants was 39.7+5.29 years [28-49]. Major objection in almost all cases was lower urinary tract symptoms; which were not responding to medical treatment, six patients had few episodes of macroscopic hematuria. The interval between insertion of IUD and onset of symptoms ranged from 2 to 5 years. In twelve cases IUD was embedded in urinary bladder wall and an entire intravesical IUD in rest 3 with calculus formation in all of them. Stones were crushed along with retrieval of IUD as a result of which mild hematuria was reported in 4 cases. Patients remained with Foley catheter from 7 - 14 days. Postoperative recovery was uneventful

Conclusion: Intrauterine contraceptive device [IUD] perforation to the bladder, with stone formation, is an uncommon event. Clinically it is difficult to reach its diagnosis but persistence of lower urinary tract symptoms in women with IUD should raise the suspicion of intravesical migration. Sonologist can define intravesical migrated IUD. Endoscopy proved a better and safe procedure with a very low complication rate

Patients preference in the management of urinary stone disease

To assess patients' preference in choosing modality of treatment for the urinary stone disease. 100 consecutive patients with urinary stone disease were interviewed through self designed questionnaire. Following parameters were evaluated: presentation, biochemical and radiological investigations, previous treatment, patient's preference in choosing modality of treatment [hakeem, homeopathy, allopathy and spiritual treatment], duration of treatment and cost. Ultimate management of patients was also assessed. Mean age of the patients were 38.43 years. There were 61 males and 39 females. Mean duration of illness was 4.3 years. Mean stone size was 3.83 cm. Seventy six patients had kidney stones, four patients were with ureteric stones, eleven patients had bladder stones and twelve patients had bilateral renal stones. Seven patients were in renal failure due to stones. First priority was hakeem/ quacks in 45%, allopathic in 39%, homeopathic in 17% and spiritual treatment in 03% patients. Mean cost of treatment of different modalities was as follows: Allopathic Rs 4,530/-, Homeopathic Rs 2,747/-, Hakeem Rs 2,427- and Spiritual Rs 907/-. Fifty five patients underwent pyelolithotomy, 10 patients percutaneous nephrolithitomy [PNL], eleven patients Nephrectomy, 4 patients ureteroscopic removal of stone [URS], 11 patients Vesicolithotmy/Litholapaxy and 4 patients extracorporeal shock wave lithotripsy [ESWL]. Mean post-op stay was 10.5 days. In spite of recent advances in medical science, allopathy is not the first choice for vast majority of the patients in the management of urinary calculi. Our population is still under the influence of hakeems, quacks and homeopaths. Reasons are illiteracy, poverty, fear of surgery and negative propaganda through media. Patients with small stones requiring ESWL end up with major surgical procedures, like pyelolithotmies and nephrectomies. Some of them develop renal failure because of inappropriate management