Use of monopolar electrocautry in transurethral resection of prostate [TURP] in the presence of permanent cardiac pacemaker

A 75 years old man having a permanent pacemaker [PPM] presented to the Department of Urology Allied Hospital Faisalabad, with severe lower urinary tract symptoms. On history he had strangury, burning micturition, dysuria and hematuria. His International Prostate Symptom Score [IPSS] was severe [29 out of 35]. On Digital Rectal Examination [DRE] there was a moderately enlarged prostate with firm consistency. On ultrasonography prostate size was about 40gm. Transurethral resection of prostate [TURP] was planned. Due to PPM it was hazardous to use monopolar electrocautery in TURP. Indifferent electrode plate of diathermy was placed under the gluteal region bypassing the chest [heart and pacemaker] to remain the circuit in limited area. During surgery no fluctuation in blood pressure and no any extra ECG changes were found on cardiac monitor. Peroperative procedure and postoperative recovery was uneventful

Bone mineral density in patients with metastatic prostate cancer with or without androgen deprivation therapy

Prostate cancer commonly metastatize to skeletal sites. Androgen deprivation therapy [ADT], the primary treatment of metastatic prostate cancer, may result in osteoporosis. Bone mineral density evaluation during androgen deprivation therapy can detect patients at risk of osteoporotic fractures

Objectives: 1-To determine BMD [T-score] in patients with metastatic prostate cancer with or without androgen deprivation therapy. 2-To compare BMD in metastatic prostate cancer patients with age matched controls

Study Design: case-control study

Setting: Urology Department, Allied Hospital Faisalabad

Materials and Methods: BMD of patients with metastatic prostate cancer [30 with ADT, 30 without ADT sampled with nonprobability convenience method] were compared with age matched control group of 60 subjects. Inclusion criteria. Group-I: 60-80 years aged consecutive patients of carcinoma prostate who have been taking anti androgen therapy at least six months. Group-II: 60-80 years consecutive patients with metastatic prostate cancer who have not started any antidrogen deprivation therapy. Group-III: 60-80 years aged healthy men from general population [preferably from patient's family] without prostate cancer. Exclusion criteria: From all groups, men taking for any reason, chemotherapy, radiation thyroxin, warfarin, corticosteroids, methrotrexate, anticonvulsants, post organ transplant therapy, chronic heparin, antipsychotic medications, long term lithium therapy and calciuretic diuretics were not included in the study

Results: Out of 120 subjects, 31% had normal BMD, 27% osteopenia, 42% osteoporosis. In metastatic prostate cancer patients taking ADT [n=30], 7% subjects had normal BMD, 37% osteopenia and 56% osteoporosis. In metastatic prostate cancer patients without ADT [n=30], 13% subjects had normal BMD, 63% osteopenia, 24% osteoporosis. In healthy controls [n=60], 52% subjects had normal BMD, 33% osteopenia, 15% osteoporosis

Conclusions: BMD is affected by prostate cancer and its treatment. Bisphosphonates use should be rationalized according to the patients need

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases

Outcome of retrograde ureteroscopy for the management of ureteric calculi: four years experience

To ascertain the efficacy of transurethral Ureteroscopy [URS] and Pneumatic Lithoclasty for the management of ureteral stones. This retrospective study was conducted from December 2005 to December 2009 at the Department of Urology and Renal Transplantation, Allied Hospital/Punjab Medical College, Faisalabad and Hospitals in Private sector. Patients with stones of different sizes and at different levels in the ureter were included in the study. Patients of less than 12 years of age and also patients with ureteric stones more than 3 cm were not included in the study.Such stones were managed by open Ureterolithotomy. A total number of 540 patients with ureteric calculi were included in the study. Cause of ureteric obstruction was stones in all cases. Among these 450 patients, 209 [38.6%] patients presented with lower ureteric stones, 266 [49.20%] patients presented with stones in the mid ureter, 65 [12.2%] patients presented with stones in the upper ureter. Bilateral ureteric calculi were present in 95 [17.5%] cases. Out of 540 cases 57 [10.62%] patients presented with anuria and they were initially treated by Percutaneous Nephrostomy PCN to relieve the obstruction followed by URS and Lithoclasty. Overall, ureteric stones at different levels and of different sizes were treated successfully in 480 [89.0%] patients and in remaining 60 [11.0%] patients stones could not be broken. Stones were successfully fragmented and cleared in the 198 [94.73%] of 209 patients with stones in the lower ureter, in 253 [95.11%] of 266 patients with stones in the mid ureter and in 29 [44.61%] of 65 patients with stones in the upper part of ureter. Stones were successfully fragmented in 347 [98.21%] out of 354, 92 [85.18%] out of 108 and 41 [52.56%] out of 78 patients with stone sizes of <1 cm, 1-2 cm and 2-3 cm respectively. DJ stents were inserted in 426 [78.81%] cases. Procedure was not successful in 60 [11.0%] patients. Stones were migrated up in to renal pelvis in 31 [5.73%] patients, stone fragmentation failure was in 13 [2.40%] patients, failure of URS insertion up to stone was in 6 [1.10%] patients and ureteric avulsion was in 1 [0.18%]. Transurethral rigid Ureteroscopy is still an acceptable procedure in the treatment of ureteric calculi of different sizes at different levels and it can be used safely with very good results in expert hands

Role of ureterorenoscopy in bypassing the ureteric obstruction

To ascertain the efficacy of transurethral ureterorenoscopy [URS] in the management of ureteral obstruction. This study was conducted from June 2005 to August 2006 at the Department of Urology and Renal Transplantation, Allied Hospital/Punjab Medical College, Faisalabad. A total number of 198 patients with ureteral obstruction due to any cause were included in the study. Cause of ureteral obstruction was stones in 172 patients, encrusted and upward migrated Double J [DJ] ureteric stent in 06 patients, ureteric tumors 03 patients and ureteric injuries in 10 patients. Ureteral obstruction was relieved by completely clearing the stone in 98% patients; encrusted and upward migrated ureteric stents were removed in 100% patients. latrogenic ureteric obstruction was bypassed in 30% of patients. There was failure to negotiate ureteric orifice by ureterorenoscopy in 07 patients due to oedema at ureteric orifice. There was no significant complication during the procedure. Ureterorenoscopy is superior procedure in the diagnosis and treatment of ureteric obstruction due to any cause at any level except the iatrogenic ureteric obstruction where it has limited role

Evaluation of hospital services by urological patient's home visit

To improve the quality of life of the patients by assessing the level of hospital services and benefits to the patients. 2]. To know the sufferings of the patients and their relatives. Mayo Hospital Lahore. May 16, 1995 - Sep 8, 1995. Case study. 52 patients were visited at their own homes in different localities of Lahore, after their treatment and discharge from the ward to discuss their experiences during their stay in the hospital in a relaxed and homely atmosphere. 60% of the patients belonged to very poor class earning less than Rs.3000/month, 80% were residing in smaller than 5 marla houses. 67% had their own houses and usually stuffed with their relatives. 60% were supporting their whole families. Only 46% of the patients had overall good impression about the services and facilities provided to them. 60% of the doctors and 40% of the nurses were responsive respectively. 60% of the patients had to stay in the hospital for up to 10 days and spend up to Rs. 6000.00 for their treatment. The main objection of the patients was the lack of communication from the staff. Improvement in hospital services will really effect positively the quality of life of the patients

Staging of prostatic carcinoma; comparative role of prostate specific antigen [PSA] and prostatic acid phosphatase [PAP]

OBJECTIVE: 1]. To see the comparative role of serum prostate specific antigen [PSA] and prostatic acid phosphatase [PAP] in the pre-operative staging of prostatic cancer. 2]. Their significance in different grades and different tumor volumes. SETTING: Mayo Hospital Lahore. PERIOD: Sep 1993 to Feb 1995. DESIGN Case study. METHODS We evaluated 50 patients with adenocarcinoma of the prostate [Group A]. Fifty benign prostatic hyperplasia [BPH] patients serum PSA and PAP was done in all the cases. Tumour volume was measured by transrectal ultrasonography [TRUS] and were divided into 3 groups [<5cc, 5-10cc,> 10cc]. Grading of the tumour was done [Grade I, II and III] on histopathological examination according to the degree of differentiation. In stage ABC and D prostatic carcinoma patients 33.3%, 56.0%, 87.5% and 100% patients had serum PSA level even more than 10mg/ml respectively. On the other hand serum PAP level was within the normal [3.7 u/l] limits in stage A and B prostatic carcinoma patients, while it was raised above the normal limits in 43.7% and 95.5% patients of stage C and D prostatic carcinoma patients. Serum PSA level was raised above the normal [5ng/ml] in 4.5% normal subjects but it was less than 10 ng/ml and 28% of BPH patients. Serum PAP level was raised above the normal in 2% of the BPH patients. Statistically significant difference [P<0.05] in serum PSA value was seen in stage C and D prostatic carcinoma patients when compared with stage A and B prostatic carcinoma and control groups. This was true only in stage D prostatic carcinoma in case of PAP. Estimation of serum PSA level can better predict variable contributions from tumour differentiation and tumour volume as well as BPH