Efficacy of percutaneous nephrostomy for management of pyonephrosis

To evaluate the efficacy of Percutaneous Nephrostomy [PCN] for the management of pyonephrosis. This descriptive study of 78 cases of pyonephrosis was conducted at Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar Pakistan from July 2010 to December 2011. Ultrasound guided percutaneous nephrostomy was performed and pus was sent for culture and sensitivity. Urine output in the PCN was monitored. Patients were clinically observed. Blood chemistry was analyzed. Patients were put on antibiotics based on culture and sensitivity. Efficacy was defined as the symptomatic relief of a patient in respect to pain and fever and biochemical improvement in terms of decreased TLC count and improved RFTs in early post PCN period. Data was collected on a structured proforma and was analyzed on SPSS version 10. Out of 78 patients who underwent percutaneous nephrostomy for pyonephrosis, 42[53.84%] were male and 36[46.15%] were female. The majority, 69[88.46%] patients had underlying obstructing urinary calculi. Other causes of obstruction included, benign strictures 5[6.41%]; pelviureteric junction obstruction 3[3.84%] and malignant stricture 1[1.2%]. Culture of the drained pus was positive in 73[93.58%] patients. After 2 to 3 weeks of PCN, 53[69%] patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion whereas 23[31%] patients required major surgery after 4 to 6 weeks. Percutaneous drainage for pyonephrosis is an effective diagnostic and therapeutic method, decompressing the obstructed and infected pelvicaliceal system and rapidly stabilizes the patient's clinical condition and makes him fit for definitive treatment

Role of clean intermittent self catheterisation [CISC] in the prevention of recurrent urethral strictures after internal optical urethrotomy

Background: Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy, were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean Intermittent Self Catheterisation [CISC] in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure. Methods: A randomised controlled study conducted in the department of urology and renal transplantation, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean age 48 years [range 20–73] were selected and randomly divided into Treatment Group [30 patients] and Control Group [30 Patients]. Eight "drop out" occurred in the treatment group and four "drop out" occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter [No. 16 or 18] twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then every 2 months for the next 6 months. Results: Total of 48 patients completed the study, 22 in the treatment group and 26 in the control group. Within the first year, 4 patients [22%] in the treatment group developed urethral stricture. In the control group, 12 patients [46%] developed urethral stricture within the first year, showing a significant difference [p<0.01]. In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs, one with concomitant epididymitis. No other complications were noted up to one year follow up. Conclusion: Clean Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after Internal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is an important modality for maintaining the normal urethral calibre. Keywords: Urethral Strictures, Optical Urethrotomy, Clean Intermittent Self Catheterisation, Recurrence, Complications

Percutaneous nephrolithotomy for the treatment of renal stones larger than 2.5 CM

To share our experience regarding the safety and efficacy of Percutaneous Nephrolithotomy for the treatment of renal stones of larger than 2.5 cm and to study the frequency of any postoperative complications associated with this procedure. This is a descriptive study conducted during the period from June 2007 to December 2009. Using non-probability convenient sampling, total 88 patients with renal stones of more than 2.5 cm were selected for PCNL. Data was analyzed on SPSS version 10 for windows XP. In a cohort of 88 patients [57 male and, 31 female] PCNL was performed for renal stone treatment. The mean age was 33.5 [9 - 65] years. The mean operative time was 85 [60 - 180] minutes and the mean stone size was 3.2 cm range [2.5-4.8] cm. There were 37 staghorn and 51 non staghorn stone. PCNL via a single access tract was accomplished in 86% [76/88] of procedures, with upper pole calyx in 30, middle calyx in 27 and lower pole calyx in 19 procedures, while multiple tracts were used in 14% of procedures [12/88] with 09 procedures using the upper and middle calyxes and 05 procedures using lower and middle calyxes. The stone-free rates for staghorn stone at discharge and at 3 months were 83.7% and 90.8% respectively, while for non staghorn stone the figures were 85.8% and 92.5% respectively. Postoperative complications were observed in 9% of the procedures [8/88], the commonest of which was bleeding necessitating blood transfusion in 4 patients. PCNL is safe and Effective treatment for renal calculi associated with less morbidity, shorter hospital stay and is cost effective

Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters