Comparison of recurrence of low risk superficial bladder cancer in patients with and without single dose intravesical doxorubicin instillation

Introduction: Urinary bladder Cancer [UC] is second most common cancer among patients with genitourinary malignancies. Because of high recurrence rate the patients with Non-muscle-invasive bladder cancer [NMIBC] requires a lifelong surveillance. Doxorubicin has been shown to decrease recurrence rate on long term follow up. However, evidence on its efficacy on short term follow-up is limited. The purpose of the current study was to find out early recurrence rate after Doxorubicin treatment. If found low, this study will reduce the costs and hospital burden for patients needing Re-TURBT

Objective: The study objective was to compare the frequency of recurrence in patients with low risk superficial bladder cancer receiving a single dose intravesical Doxorubicin instillation with placebo

Study Design: Randomized Controlled Trial

Setting: Department of Urology, Khawaja M Safdar Medical College, Sialkot

Duration: One year from 10-03-16 to 09-03-2017

Methodology: 70 patients with Non-muscle-invasive bladder cancer were randomly allocated into 2 groups. Group-A received Doxorubicin treatment while Group-B received Placebo. Patients were followed after 3 months on cystoscopy. All the patients were informed about the procedure

Results: The mean age of the patients was 56.84+/-7.28 years and majority [n=58, 82.85%] of the patients were male and only 12 [17.14%] patients were female giving a male to female ratio of 4.38:1. The mean age of the patients in Group-A was 56.44+/-7.10 years while in Group-B it was 57.23+/-7.50 years. Among Group-A 80% patients were male and 20% were female while in Group-B 82.9% were male and 17.1% were female. However, the difference in term of age and gender was not significant statistically. On follow up at 3 months, 19 [27.14%] patients had recurrence while 51[72.85%] patients were clear of disease. The rate of recurrence was similar across different age groups and gender. Doxorubicin treatment was associated with decreased frequency of recurrence [18.6% vs. 35.7%; p=.023] as compared to Placebo

Conclusion: This comparative randomized control trial showed that intravesical Doxorubicin instillation within 6 hours of TURBT is effective in reducing recurrence in patients with NMIBC

Transurethral cystolithotripsy for large vesical calculi

To assess efficacy and safety of transurethral cystolithotripsy in the management of large vesical calculi. Adult patients with large vesical calculi [>2.5cm] were selected for this prospective study. Patients with associated urethral stricture and big adenomas were excluded. Stone size was measured on ultrasound in the largest diameter. Patients were operated under spinal or general anaesthesia. Nephroscope with 28 fr sheath was used transurethrally along with 2 cm lithoclast probe. Initial fragmentation was achieved with Swiss lithoclast. Later bigger fragments were dealt with stone punch. In the end all fragments were evacuated with Ellick evacuator. Bladder was drained with Foley's catheter for 24 hours. TURP [transurethral resection of prostate] was done if required. Patients with bigger glands were excluded to restrict operating time. Patients were followed up for two weeks. Forty patients were selected. Mean age of the patients was 55 years [range 18-73 years]. There were 32 males [80%] and 8 females [20%]. Stone size was 4.72 +/- 2.52 cm with range of 2.5-7.0 cm. Five patients had multiple stones, four of them had associated neurogenic bladder. Procedure time ranged from 20-90 minutes [mean 45.8 minutes]. Complete fragmentation of calculi was achieved in all patients. Twelve patients underwent TURP under same anaesthesia. Time consumed on resection of prostate was not included in procedure time. There were no major complications. Transurethral cystolithotripsy is very effective and safe for large vesical calculi [>2.5cm]. It is time consuming but saves patients from hazards of open surgery.

Penile fracture: role of early surgical intervention on postoperative outcome

Fracture of penis is relatively uncommon but grave urological emergency, which needs urgent surgical intervention to achieve good postoperative outcome

Objective: To determine the outcome of early surgical repair in patients presenting with fracture of penis

Patients and Methods: This retrospective study comprises 13 patients with fracture of penis, presenting in emergency of Services Hospital, Lahore from 2000-2007. Diagnosis was made clinically. No radiological investigation was carried out. All patients had primary suturing of the tunica tear and were followed up for 2-6 months postoperatively

Results: Mean time interval between accident and arrival to hospital was recorded. Eight patients [61.5%] had fracture due to sexual intercourse. Three patients [23.08%] bending of penis. Masturbation and fall on to an erect penis each accounted for 1 [7.70%] of the total cases. There were no significant complications except necrosis of penile skin in one patient. Erectile function was preserved in all patients postoperatively

Conclusion: Early surgical intervention for penile fracture has good postoperative outcome with acceptable complication rate. Early diagnosis and surgical repair are instrumental in ensuring good outcome and minimal complications