Complication of open transvesical prostatectomy vs. TURP: a comparative study

To assess the outcome, complications and frequency of re-operation of BPH in Transversical Prostatectomy and TURP, a ten years single centre study. A retrospective comparative study. This study was conducted at the Department of Surgery and Allied, SOM Fauji foundation Hospital, Karachi, Pakistan from January 2001 to May 2010. All cases which underwent Open Transversical Prostatectomy or TURP from January 2001 to May 2010 were reviewed. Total of 360 cases were included, out of which 250 were done by open method and 110 by TURP. Outcome, complications and frequency of re-operation of both the techniques were noted. Data entered into SPSS v.15 and analyzed statistically. Age ranged from 48 to 77 years with a mean age of 57 +/- 6 years. Hospital stay and catheter removal times were longer in open surgery. Symptom score improvement of 6 points noted in TURP group while 10 points in open surgery group. Four point five percent cases of TURP while 2.8% cases of open surgery needed transfusion. TUR Syndrome was seen in 1.8% of TURP, while no case of open surgery. Stricture urethra developed in 3.6% cases of TURP, while in 0.4% case of open surgery. Urinary Incontinence was seen in 2.7% cases of TURP while nil in open surgery. Re-operation to relieve obstruction needed in 11.8% cases of TUR, while only 1.2% cases of open surgery needed re-operation. There is no statistically significant difference in complications between TURP and open surgery methods, whereas outcome of operation in terms of symptom score improvement was better in open surgery group and no need of re-operation. Disadvantages of open surgery included longer hospital stay and catheter removal time and a scar

impact of renal lower pole radiographic anatomy on the clearance of stone fragments after extracorporeal shock wave lithotripsy

1. To determine the frequency of clearance of stone fragments after extracorporeal shock wave lithotripsy [ESWL] for isolated lower pole renal calculi. 2. To compare the average Lower Infundibular diameter and lower infundibulo-pelvic angle [L-IPA] between patients with residual stone fragments and those who become stone free after extracorporeal lithotripsy [ESWL] for isolated lower pole renal calculi. Descriptive Study. This study was conducted at Department of Urology, Liaquat National Postgraduate Medical Centre, Karachi from June 2006 to June 2010. One Hundred patients of either sex, aged > 14 years with isolated lower pole calculi [LPC] of <20mm undergoing ESWL were included in the study, while patients with lower pole calculi > 20mm, multiple renal calculi, congenitally distorted pelvi-calyceal anatomy, with concomitant Ureteric calculi, with decreased urine output due to renal insufficiency, with Hydronephrosis, with previous pyelo-uretral surgery, who required ancillary procedures e.g. Ureteroscopy, DJ Stent insertion were excluded from the study. The confirmation of stone in lower pole and LPC anatomy [width of the infundibulum and lower infundibulo-pelvic angle] were viewed on the IVU. The Infundibular width was measured as the narrowest point of the infundibulum. The L-IPA was determined in two axes, the ureteropelvic axis and the infundibulo-pelvic axis. Frequency of clearance of stone fragments after ESWL for lower pole renal calculi was 82%. Average L-IPA was significantly higher in those who become stone free after ESWL than patients with residual stone fragments [79.34 +/- 8.33 vs. 64.56 +/- 5.53, p<0.001]. Average Lower Infundibular diameter was slightly higher in stone free patients after ESWL but not statistically significant [5.02 +/- 0.76 vs. 4.89 +/- 0.78, p=0.631]. Successful ESWL is sensitive to lower pole anatomical variables especially lower Infundibulo-pelvic angle and preferably first line treatment in patient with a lower pole stone has L-IPA >80 degrees and lower infundibular diameter of >5mm

Veress needle versus direct trocar insertion techniques for inducing pneumoperitoneum in laparoscopic procedures

To compare the safety and complications of veress needle [VN] versus direct trocar insertion [DTI] techniques in laparoscopic procedures. Comparative study. The study was conducted at three different hospitals in Karachi from October 2005 to May 2011. A total of 1050 consecutive laparoscopic surgeries were done during the study period. Female to male ratio was 2.5:1. In 73% of the cases direct trocar placement was done while in 27% pneumoperitoneum was achieved with Veress needle. Variables noted included technique, complications, and duration of surgery. Data was analyzed statistically using SPSS version 16. Female to male ratio was 2.5:1.Complications were more in direct trocar insertion method. Overall total complications were 3.4%. One percent in group I [VN technique] and 4% in group II [DTI technique] had complications [p=0.017]. No visceral injuries were noted in either group, but pre-peritoneal insufflations found in 2 patients [0.25%] in group II. Late complications were more in group II. This include wound infection [1.5%], late wound bleeding [0.9%], port site hernia formation [0.9%] and chronic sinus formation [0.38%].All these were statistically insignificant except wound infection [p 0.036]. Veress needle method is as safe as direct trocar insertion method in expert hands