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Introduction: Renal stones have been one of the most commonly encountered diagnosis in patients visiting Urology clinics and Extra-Corporeal Shock Wave Lithotripsy [ESWL] has been an effective method for management of renal stones of certain size [Up to 2.5 cm]
Objective: To determine the complication rates in patients undergoing ESWL to look for safety level of the procedure. Duration And Setting: Study was conducted From December 2015-March 2016 in Kidney Center, DHQ Hospital, Faisalabad
Methodology: First 225 patients undergoing ESWL at Kidney Center, DHQ Hospital, Faisalabad were included in the study and they were observed for short term complications as post procedure pain, hematuria, fever and ureteric obstruction
Results: 225 patients included in the study. Among them 132 [58.7%] were male, 93 [41.3%] were female. Average age of patient was 38.2 years with minimum range as 5 years and maximum as 75 years. Stone size ranged from 7mm to 2.5cm with average size as 1.541cm. Fragmentation was observed in 218 [96.9 %] patients in first two sessions while no fragmentation was observed in 7 [3.1%] patients after two sessions. Out of 225, 37[16.4%] patients developed pain, 19 [8.4%] observed hematuria, 7 [3.11%] have fever and 6 [2.66%] developed ureteric obstruction. Only 3 patients developed two complications simultaneously. No statistical association was found for development of complication after ESWL in our study
Conclusion: Inference drawn from the statistics clearly showed that ESWL is still a very safe and effective modality for renal stone management
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Objectives: To determine the significance of indwelling time for bacterial colonization of DJ stents by measuring the frequency of bacterial colonization in such stents after endoscopic Urological surgery. Place And Duration: Study was done from September 2014 to November 2015 [15 months] in Department of Urology and Kidney Transplantation, Allied Hospital, Faisalabad
Methodology: 68 patient were included in the study who undergone Percutaneous nephrolithotomy [PCNL] and Ureterorenoscopy [URS] for renal and ureteric stones respectively with DJ stenting. Sterile nature of urine was assured in pre-operative circumstances and patients with active urinary tract infection were excluded from the study. Urinary cultures were performed at 2-4 weeks, 5[th] week and more than 6[th] week of indwelling time and lower end of DJ stent cultures were also performed after removal
Results: 68 patients were included in the study with mean age 48.5 years [20-77 years age limits]. Among 68, 38 were male patients and 30 were female. Percutaneous nephrolithotomy [n = 5] and ureterorenoscopy [n =63] were the procedures after which DJ stenting was performed. Out of 68, 36 patients undergone right sided stenting and 32 patients undergone left side ureteric stenting. Urine culture was positive in 1 [1.47%] case and DJ stent cultures were positive for bacterial colonization in 4 [5.8%] cases. We do not found any statistical association between stent culture analysis and variables like gender, age of patient, or laterality. However we find statistical significance between stent indwelling time and colonization as evident by the results that the rate of colonization was 2.7% when indwelling time was less than 4 weeks, 4% colonization when indwelling time was 5 weeks as compared to 28.5% colonization when indwelling time was more than 6 weeks
Conclusion: These results showed that colonization rates increases when indwelling time increases especially when indwelling time exceeds 6 weeks. This study also refers to the fact that DJ stents can be kept safely for maximum duration of 6 weeks and indwelling time greater than 6 weeks will be associated with complication of urinary tract infection. Moreover this study also showed that one may find an infected colonized stents even if urine culture is negative for any growth
ABSTRACT
Background: Penile carcinoma is an uncommon condition, accounting for less than 1% of all male cancers. It typically presents as a superficial lesion involving the Glans and Penile Shaft. Risk factors for penile carcinoma include phimosis, human papilloma virus infection and tobacco smoking. The spread of the tumor to the loco-regional lymph nodes is the most relevant prognostic factor
Case Presentation: The current case report is about a 65 years old male who presented with non-healing ulcer involving glans and shaft of penis for two months. Examination of Perineum revealed an ulcer of size about 3 cm in length involving glans and distal penile shaft, with eaten up most of glans surface. Wedge biopsy histopathology report showed moderately differentiated Squamous cell carcinoma of the penis involving sub-epithelial tissue with lympho-vascular invasion and involvement of corpora cavernosa. CT-Scan abdomen with IV contrast showed no evidence of metastasis or lymphadenopathy. So partial penectomy was planned and carried out subsequently
Conclusion: Although squamous cell carcinoma of the penis a rare disease, mainly affecting the elderly population but all the penile ulcers not responding to medial therapy must be evaluated for malignancy. Most of these cases remain neglected because of inadequate evaluation and investigation by the local doctors which leads to late presentation. Due to these circumstances the patients have already metastatic disease at presentation. So, it is required to educate local doctors as well as general population to create proper awareness of this disease
ABSTRACT
Ureteric stents are being used for the last 25 years to relieve the renal obstruction. Ureteric stents are made of different biomaterials which can be retained in the human urinary system up to six months when properly indicated. Indwelling period of Double J ureteric stent in the case repot is 14 years, which is possibly the longest period ever reported. It was removed without any complication endoscopically. The stents of proper biomaterial should be used with judicious indication and should be removed or replaced according to the quality of biomaterial. Indwelling period will prolong with quality of biomaterial used
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Objective: to access the level of awareness regarding HIV/AIDS among surgical trainees of Pakistan and the fear associated of getting transmitted while working in a healthcare setup
Materials and Methods: a cross sectional study was conducted at 10 hospitals in Sindh. The study was conducted on surgical trainees in those hospitals and a self-administered questionnaire was administered during the period of Jan-August 2015. Chi Square test was applied and P-values were commuted to find the significance. The data was analyzed by SPSS 17
Results: the questionnaire was administered to 400 surgical trainees of whom 310 opted to participate. The level of awareness regarding HIV was significantly high in both male and female surgical trainees, however in comparison females had a greater level of awareness about the treatment [30%], modes of transmission [100%], and knowledge regarding dealing with needle prick injuries [96%] as compared to male trainees. However lack of knowledge about the HAART therapy was seen among both male [26%] and female surgical residents [30%]. Moreover majority of both male [58%] and females [87%] surgical trainees had the point of view that government is not taking affective steps to counter the fight against HIV/AIDS
Conclusion: in spite of significant general knowledge about HIV and its prevention yet lack of knowledge was seen about HIV treatment i.e. HAART therapy in surgical trainees of Pakistan. Furthermore the Pakistani government needs to take proper initiatives to increase the awareness and to counter the fight against this fatal disease
ABSTRACT
Background: DJ Stents have been in use since long for the management of ureteral obstruction. The obstruction may be due to stone, stricture, PUJ Obstruction etc. DJ Stents if kept for long time are associated with different complications like, blockage, break, migration, encrustation, stone formation etc. These long stayed DJ Stents need additional procedures for their removal like, URS, PCNL, and Pyelolithotomy etc
Objectives: i] to analyze the data retrospectively to see the number of patients having forgotten DJ Stents. ii] to see the level of awareness of patients regarding their DJ removal
Study Design: retrospective study
Place and duration of study: Urology Department, Allied Hospital, Faisalabad from Jan 2011 to Dec 2014
Materials and Methods: record of patients of forgotten DJ Stents for 4 years
Results: during 4 years period 35 patients were found to have forgotten DJ Stents and maximum duration of forgotten DJ Stents was 14 years. 41.66% patients in first group [indwell time 3- 12months] were having encrustations. Overall 11/35 [31.42%] needed litholopaxy for their DJ removal and 24/35 [68.57%] needed URS and it was successful in 22/24 patients. One patient needed PCNL and one had pyelolithotomy for their removal
Conclusion: patients should be stressed / counseled properly regarding its removal by telling its complication. Thread attached to the DJ stent may be left outside external urethral meatus. It must be properly documented in discharge slip. A register must be maintained to keep record of these patients and it should have their address and phone number so that they should be reminded of about their DJ removal well in time
ABSTRACT
Objective: Pakistan has a dual burden of communicable and non-communicable diseases. The major indication of renal transplantation is end stage renal disease due Diabetes and hypertension, which is also a cost effective treatment significantly decreasing mortality and morbidity in these patients
Material and Methods: this cross-sectional study was carried out in Pakistan to determine the level of awareness among the general population regarding kidney donation and their willingness to donate. The total number of participants who completed a questionnaire was three thousand five-hundred and twenty. 56% were male while 44% female. The sample included people of all ages from all educational and ethnic backgrounds
Results: among participants 63.5% were found to be aware regarding kidney donation and 46.6% showed a willingness to donate to a first degree relative [FDR]. Only 11.5% were willing to donate to someone other than a FDR. Females were found to be more willing to donate to both a FDR and a non-FDR with a male to female ratio of 0.7 [95% C.I]. A small percentage [16.7%] albeit important believed organ donation should be declared illegal
Conclusion: awareness regarding kidney donation and educational status were found to be linked, with people educated at a higher level having greater knowledge about the topic. All stakeholders need to develop a comprehensive strategy to decrease the overall health burden of end stage renal disease and promote legal renal transplantation
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Background: Urinary incontinence leaves the sufferer with physical and psychological stresses. Majority of the cases are caused by an underlying treatable condition however the it is under reported to medical care providers. The objective of this study was to explore the psychosocial impacts of urinary incontinence and assess quality of life in patients with urinary incontinence in Pakistan
Methods: This study was conducted at five tertiary care hospitals in the city of Karachi during January 2013 to December 2013. Self-administered questionnaire was prepared and adjusted according to the local social dynamics of the community based on 'Incontinence Impact Questionnaire' and 'The Kings Health questionnaire'. Inclusion criteria included urinary incontinent patients visiting outpatient departments
Results: The study comprised of 280 participants with a response rate of 80%. Overall 89 males and 191 females participated. Majority of the sample population [40.7%] believed that the weak anatomy was the etiology of their Urinary Incontinence. More than 40% of the participants declared that they would rate 'the fear that an embarrassing condition could arise in result of their disease' as 'Moderate' followed by 38.2% as 'Highly'. 39.64% stated that their social life including interaction with people was 'Moderately' affected and 21.7% believed that they their social interaction was 'highly' limited. Regarding travel, majority of the participants asserted that their travel has been restricted to a great extent and rated as Highly [30.7%] or Moderate [29.6%]. In total 28.5% patients stated that their exercise schedule had been 'Moderately' affected as a consequence of their disease
Conclusion: Patients with urinary incontinence should be heard comprehensively by the care providers. Coping techniques for patients and education regarding Urinary incontinence should be provided by the medical practitioner to the sufferers
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Background: Surgery is a competitive specialty and requires a lengthy and rigorous residency training which necessitates one's passion and commitment. A number of medical students experience their surgical rotation as demanding with extended period of work hours as compared to other medical specialties
Methods: This cross sectional study was conducted at four medical colleges located in Karachi, Pakistan during September 2013 to January 2014. A self administered questionnaire was made to gain insight regarding students' views of advantages and disadvantages associated with surgical profession. Medical students who have completed at least one rotation of surgery were included in the study
Results: Overall 810 respondents participated in the study, with a response rate of 90.% Amongst the participants 72.8%were females and 27.2% were males. 62.7% of the students thought that surgery is a stressful profession, while 80.8% believed that a surgeon's family life is adversely compromised at some time during their carrier [86.7% females, 65% males]. Majority of the students [55.3%] asserted that surgery is more respectful than other medical field, however 52.7% of the respondents believed that a surgeon's income is higher than any other medical specialty. Overall 17.9% students strongly considered to become surgeon in future [Male/Female OR: 2.0]
Conclusion: Workload, family life, length of residency, income, respect and stress level associated with surgery are some important factors influencing student's choice for profession
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Background: Tuberculosis [TB] can be traced back to the beginning of the mankind. It is a bacterial infectious communicable disease. Globally, TB is the second major cause of death from infectious diseases. MDR-TB is a type of tuberculosis that is resistance to at least two first line anti-tuberculosis drugs Isoniazid [INH] and Rifampicin [RMP] with or without resistance to other drugs. Multidrug resistant TB [MDR-TB] caught attention, when it emerged in the USA in 1990. Globally 425,000 new cases emerge annually, which is almost 5% of the annual global TB burden. Pakistan is included in 27 high burden MDR-TB countries, with almost 2% to 3.2% for newly diagnosed and 35% for previously treated patients. The overall aim of this study was to assess the burden and the distribution of resistance for four anti-tuberculosis medications
Method: A cross sectional study design was used. Data was collected from the hospital records of microbiology department, for the patients between the duration of January 2008 to December 2011. Forms of 300 patients were collected and analyzed. Epi-data and SPSS software were used for analysis. An outcome variable was developed and analysed. Correlation of resistance was analysed with different independent variables such as age, sex, residence [rural/urban], duration of disease, TB treatment history, smear reports and sensitivity results
Results: The results of this study showed the variation of resistance to four different drugs, but most resistance was found for rifampicin and lowest for Ethambutol. The resistance was found Isoniazid [49%], Streptomycin [52%], Rifampicin [68%], and Ethambutol [25%]. Resistance between male/female and rural/urban was not prominently different. Among the different TB types, MDR-TB patients were found to be more resistant, with the highest resistance for Rifampicin [80%] and the lowest resistance for Ethambutol [31%]. The extent of the lesion had no association with the resistance prevalence. Age was significantly associated with resistance. Previous ZN smear negative reported cases appeared to be more resistant
Conclusion: This study suggests for improvements in the early detection and treatment. Old test techniques such as ZN smear should also be replaced by more reliable and efficient laboratory techniques. There is also a need to improve the record keeping system in order to have complete information about the diseases and patients
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Introduction: Percutaneous Nephrolithotomy [PCNL] is an effective treatment for large renal calculi and usually a nephrostomy tube is placed in the kidney at the end of PCNL
Objective: To compare the outcome of conventional percutaneous nephrolithotomy with postoperative PCN tube versus tubeless Percutaneous Nephrolithotomy, in terms of duration of surgery and postoperative hospital stay
Study Design: Randomized control trial
Setting: Urology Department Punjab Medical College / Allied Hospital Faisalabad
Materials and Methods: Sixty patients were taken with non probability consecutive sampling technique. They were divided into group A[n=30] with conventional PCNL having postoperative nephrostomy tube and group B[n=30] with tubeless PCNL by computer generated random number table. They were compared in terms of duration of surgery and post operative hospital stay
Results: Age distribution of total patients ranged from 15 to 77 years, mean age was 35.07 +/- 15.89. Mean duration of postoperative hospital stay was 6.2 +/- 0.81and 4.07 +/- 1.2 days [p-value=00001] in group A and group B respectively. The operating time was 80 to 145, minutes, mean time 110.17 +/- 15.87 in group A. In group B, operating time was between 65 to 140 minutes mean time 95.18 +/- 22.43
Conclusion: Tubeless PCNL reduces duration of surgery and postoperative hospital stay significantly as compared to conventional PCNL with postoperative nephrostomy tube
ABSTRACT
Objectives: To evaluate the success and complications of intracorporeal cystolithotripsy in children
Design: It was prospective and descriptive study
Place and duration of study: Study was conducted in Department of Urology Allied Hospital, [PMC] Faisalabad from January 2011 to December 2012
Patients and Methods: Total number of 40 patients with vesical stone
Results: Children with average age of 7.23 years were included in study. Stones were completely removed in [90%] patients. Perforation occurred in 2.5% patients, 5% patients required redo intracorporeal cystolithotripsy due to stone impaction in urethra. 2.5% Patients needed open vesicolithotomy due to bleeding
Conclusion: Intracorporeal cystolithotripsy with pneumatic lithoclast is a safe and valid procedure for management of vesical calculi in children
ABSTRACT
Foetal hydronephrosis is commonly caused bycongenital pelviureteric Junction [PUJ] obstruction.It is either due to nerve deficiency or due to intrinsicmuscular defect at PUJ or it may be due to lowerpolar aberrant crossing vessel just compressing thePUJ. The purpose of this study is to see thecontribution of crossing vessels in causing the PUJobstruction
Aims and objectives: [1] to find thecontribution of crossing vessels in causing PUJobstruction on naked eye examinationperoperatively, [2] To histologicaly verify the causeof PUJ obstruction in cases of crossing vesselscompressing the pelvi-ureteric junction [PUJ]
Patients and methods: 27 cases of Congenital PUJobstruction were taken during four year period whowere candidatesfor operation. All underwent Anderson HynesPyeloplasty and specimen of PUJ with narrowsegment below it was taken and preserved in 10%formalin. The specimen was sent to histopathologistalong with other specimens where PUJ obstructionwas not caused by crossing vessels for nervedetection by S-100 immunohistochemistry and forhistopathological examination
Results: Five out of27 cases of PUJ obstruction were caused by crossingvessels and in these five cases, four [80%] werehaving normal histology showing that crossingvessels were the cause of PUJ obstruction merelycompressing the PUJ mechanically
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Objectives: To assess the causative factors and outcome of surgical management of Vesicovaginal fistula [VVF] in our set up
Duration and Design of Study: Retrospective descriptional study from January 2008 to June 2012 conducted at Department of Urology PMC/Allied Hospital Faisalabad
Methodology: All patients with VVF who presented in our out patient department and underwent surgical repair in our department were included in this study. The records of patients were reviewed and data was entered in a structured proforma and analyzed. After history, physical examination, relevant investigations, IVU, Cystoscopy and vaginoscopy, patients were divided into two groups. Patients with supratrigonal fistula were operated through abdominal approach and those with infratrigonal fistula were operated through vaginal approach. The outcome of surgical procedures and post operative complications were noted
Results: This study included 68 patients. In 42 [61.76%] patients, cause of VVF was iatrogenic injury during hysterectomy, and 26 [38.24%] patients developed VVF due to obstetric causes. Fifty patients [73.53%] had supratrigonal fistula and eighteen patients [26.47%] were having trigonal or subtrigonal fistula. We achieved 90% and 83.33% success rate with abdominal and vaginal repair respectively
Conclusion: The most common cause of VVF is iatrogenic injury during hysterectomy. Both approaches of surgical repair had almost equally good results
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To evaluate the outcome of end-to-end urethroplasty for stricture urethra and need for ancillary procedures. Prospective, study was carried out in Department of Urology Allied Hospital Faisalabad from Oct, 2007 to April, 2010 to see the outcome for anastomotic urethroplasty in 40 patients. Simple perineal urethroplasty was done in 30 patients. Perineal urethroplasty with separation of corporal bodies was done in 06 patients and inferior pubectomy was required in 02 patients according to indication. Age, length of stricture and ancillary techniques required during reconstruction were combined. Success was considered when there was no need for redo anastmosis, IOU or patient was cured by dilatation. Out of 40 patients that underwent end-to-end urethroplasty, 35 [87.5%] were successful. Simple perineal urethroplasty showed a success rate of 93.75%. Perineal urethroplasty with separation of corporal bodies had a success rate of 66.66%. Patients in which inferior pubectomy was required had success rate of 50%. End-to-end urethroplasty is an excellent option for treatment of stricture urethra and majority of failures occurs in children and those having very proximal membranoprostatic urethral strictures
Subject(s)
Humans , Anastomosis, Surgical , Prospective Studies , Treatment Outcome , Urologic Surgical Procedures/methodsABSTRACT
To compare the success and complications of the side-to-side and end-to-side techniques of AV fistula formation. A prospective randomized comparative analysis of 344 cases. The study was carried out from February 2006 to July 2010 in the Department of Urology, Punjab Medical College and Al-Noor Hospital Faisalabad. A total number of 344 patients with end stage renal disease [ESRD] were included in the study for AV. fistula formation for hemodialysis access. 304 patients completed their follow up. AV fistula was made by end-to-side and side-to-side techniques. Patients were followed after 24 Hours, 1 week, 1 month and 6 months after the operation. These 304 patients were divided into 2 groups. Group 1 comprises of 154 patients and group 2 comprises of 150 patients. AV fistula worked successfully in 88.3%, 70.78%, 68.18% and 61.04% of 154 group 1 patients after 24 hours, one week, one month and six months followup respectively. AV fistula worked successfully in 76%, 65.33%, 63.33% and 58% of 150 group 2 patients after 24 hours, one followup respectively. Hemorrhage from fistula site was among 9.09%patients in group 1 and in 7.33% in group 2 patients after 24 hours of surgery while it was 2.6% and 1.33% patients in group 1 and group 2 patients respectively after one moth follow up. Aneurysm was seen in 1.3% patients at one month and six months follow up respectively in group 1. It was seen in 0.67 and 1.33% patients at one month and six months follow up in group 2 patients. Ischemia was seen among 1.3% patients in group 1 and 8% in group 2 patients. No limb edema was present up to 1 week in any group. Odema was in 9.74% and 13% patients of group 1 patients at one month and six months follow up and 14.67% and 17.33% of group 2 patients at one month and six months follow up respectively. Both operative techniques for AV fistula formation are equally good for hemodialysis access but complication rate with end-to-side technique is lower as compared to side-to-side technique
Subject(s)
Humans , Male , Female , Renal Dialysis , Kidney Failure, Chronic/surgery , Arteriovenous Shunt, Surgical/adverse effects , Anastomosis, Surgical , Vascular Patency , Graft Occlusion, Vascular , Treatment OutcomeABSTRACT
To compare the results of Tubularized Incised Plate Urethroplasty with Mathieu repair and transverse inner perpuitual skin flap [Asopa's repair]: For Distal Hypospadias repair 30 patients were treated with Tubularized Incised Plate Urethroplasty and 30 were managed with Mathieu repair. For proximal hypospadias repair 20 patients were treated by Tubularized Incised Plate Urethroplasty and 20 patients were managed by Asopa's repair. The mean age at presentation was 7 years. Good cosmetic and functional results were achieved by all techniques. The overall success rate of Tubularized Incised Plate Urethroplasty was 86.6% and that of Mathieu repair 83.3% for the management of distal hypospadias. Success rate of Tubularized Incised Plate Urethroplasty was 85% and that of Asopas repair was 75% for the management of proximal hypospadias. Regarding Distal Hypospadias. In Mathieu repair; Urethrocutaneous fistula developed in 04 patients and total disruption in 01 patient. Meatal stenosis occurred in 02 cases who responded well to regular dilatation. In Tubularized Incised Plate urethroplasty 03 patients developed urethrocutaneous fistula. Total disruption in 01 patient and meatal stenosis was seen in 03 cases which responded well to regular dilatation. Regading proximal Hypospadias. In Tubularized incised plate Urethroplasty; 03 patients developed urethrocutaneous fistula and 01 patient presented with total disruption. Meatal stenosis was seen in 01 patient that needed meatatomy. In Asopas repair 03 patients developed urethrocutaneous fistula and 02 presented with total disruption. All the techniques are good for hypospadias repair. However Tubularized incised plate Urethroplasty proved to be the better technique for management of all type of hypospadias
Subject(s)
Humans , Male , Adult , Child, Preschool , Child , Adolescent , Urethra/surgery , Surgery, Plastic/methods , Treatment Outcome , Postoperative ComplicationsABSTRACT
To compare the results of Tubularized Incised Plate Urethroplasty with Mathieu repair. Prospective Randomized comparative study. Department of Urology Allied Hospital, Faisalabad from May 2001 to April 2005.Patients: 48 patients with distal hypospadias were included in the study. Twenty four patients were treated with Tubularized Incised Plate Urethroplasty [TIPU] and 24 were managed with Mathieu repair. The mean age at presentation was 7 years. Good cosmetic and functional results were achieved by all techniques. The overall success rate of TIPU was 83.33% and that of Mathieu repair 79.16% for the management of distal hypospadias. In Mathieu repair, urethrocutaneous fistula developed in 04 patients and total disruption in 01 patient. Meatal stenosis occurred in 02 cases who responded well to regular dilatation. In TIPU, 03 patients developed urethrocutaneous fistula. Total disruption was seen in 01 patient and meatal stenosis in 03 cases which responded well to regular dilatation. All the techniques are good for hypospadias repair. However TIPU proved to be the best technique for management of all type of hypospadias
ABSTRACT
This randomised control study was conducted at a teaching hospital to study, the comparative rise of serum prostate specific antigen [PSA] and serum prostatic acid phosphatase [PAP] levels is prostatic cancer pate and to observe any relationship between these levels with stage, grade and volume of the tumor. One hundred and thirty seven patients above the age of fifty years were studied in three batches of carcinoma prostate, benign prostatic hyperplasia and normal control. Serum PSA and serum PAP levels were estimated alongwith digital rectal examination, transrectal ultrasonography and biopsies in group A and B. Results showed correlation in sernm PSA level rise and stage of carcinoma prostate as well as tumor volume. Serum PAP level rise was only in higher graft and bigger tumor volume. No correlation of both with tumor grade. So it is concluded that the role of serum PAP level as tumor marker for prostate cancer cannot be supported. In spite of limitations, serum PSA level is a far better although not ideal tumor marker for carcinoma of the prostate