ABSTRACT
To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Descriptive case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patient's age was 26.25 +/- 7.9 years. On follow-up, 7 patients [23.3%] experienced recurrent stricture during first 10 months. Five [16.6%] patients were treated successfully with single direct visual internal urethrotomy. Two patients [6.6%] had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3% with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures
ABSTRACT
To report our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction. Retrospective study was conducted in the Department of Urology, Jinnah Postgraduate Medical Centre, Karachi for a period of five and half years from May, 2006 to December, 2011. All patients with uretero-pelvic junction obstruction were entered into a database to record patients clinical features, diagnostic tools, operative and post-operative details and follow-up. Over a five-years period, 13 procedures were performed. After clinical evaluation all patient had extensive haematological and radiological workup for diagnosis of uretero-pelvic junction obstruction. All were subjected to open pyeloplasties, out of these 13 patients; one had an aberrant lower pole vessel compressing uretero-pelvic-junction. All procedures were stented. Repair was done with 3/0 vicryl sutures all patients were catheterized and wound drained. Mean operating time was 60 - 100 minutes with about 100cc blood loss requiring no transfusion. The mean follow up was one year. One patient developed post-operative haematuria and was managed conservatively. Two patients developed fever secondary to urinary tract infection despite adequate treatment of urinary tract infection according to culture and sensitivity pre-operatively. One patient developed surgical emphysema detected post-operatively, which required tube thoracostomy. Neither patient developed recurrent symptoms nor had any evidence of obstruction on the renogram on follow-up. Objectively all patients were followed up by intravenous urogram, stress renogram, Urine C/S. Subjective and objective follow-up revealed success in 100% of patients whereas success is defined as no or minimal holder on DTPA renogram, improving renal function and decreasing dilatation on successive intravenous urogram. All patients had a mean post-operative hospital stay of 02 - 04 days Folley catheter was removed after 10-days, double-j- stents were removed after two to three weeks. Our success rate following open pyeloplasty with limited follow-up was 100%. It is comparable with International data. Recent international trend is toward Uretro-pelvic Junction Obstruction [UPJO] repair with laparoscopic approach, they are claiming success rate of 95%
ABSTRACT
To determine various presentations of superficial bladder cancer, its management, recurrence and progression rates. Case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, From January 2002 to December 2009. Patients with pathologically proven superficial transitional cell carcinoma [TCC] with minimal 2 years of follow-up were included. Their clinical presentations and management was recorded. Complete transurethral resection of bladder tumour [TURBT] was attempted in all patients. Tumour grading and staging was performed. Intra-vesical single instillation of mityomycin-C was given postoperatively in selected patients. Cystoscopic surveillance was used to assess recurrence in all patients according to standard protocol. Metastatic work-up and biopsy record of follow-up TURBT was used to document progression in high risk patients. Results were described as simple descriptive statistics. A total of 92 patients were studied. The median age of patient was 62 years, with male preponderance [88%]. Hematuria with lower urinary tract symptoms [LUTS] was most common presentation [47.8%], followed by hematruia alone [25.7%], LUTS alone [9.2%] and upper tract symptom in 1.8% of patients. Complete TURBT in first attempt was possible in 72 patients [78.3%]. Multiple tumours were seen in 34 patients [39.6%]. Intravesical mitomycin was given in 70% patients. Over-all recurrence rate of 68.4% was noted. Patients with TaG2-3 showed recurrence rate of 58.8% which occurred late with good recurrence free interval. T1G2-3 patients have more and early recurrences [80.4%]. Progression seen in 13 patients [14%], 6 patients have up-grading, four showed stage progression, one developed pelvic lymphadenopathy and another one had bone metastasis. One female patient [TaG2] developed right renal pelvic recurrence and progression while her bladder disease was well controlled. The number of patients with T1 disease was 45% in this study which is comparatively higher than other studies. Early recurrences and progression were observed with T1G2-3, while late recurrence were seen with Ta disease, having tumour free interval between 6 months to 2 years. Early radical cystectomy was advised to T1G3 disease and with multiple recurrences, but patient's compliance was poor