Prevalence of Hypogonadism in males of different age groups: is it a lack of awareness?

Introduction: Hypogonadism in aging male is defined as [Syndrome caused by androgen deficiency which affect multiple organ functions and qualityof life]. Patients present with different symptoms like male erectile dysfunction, decreased sexual desire, anemia etc.

Objectives: To demonstrate the serum testosterone levels and prevalence of hypogonadism in different age groups and their correlation with symptoms of hypogonadism

Study Design: Cross sectional comparative study

Settings: Allied Hospital Faisalabad. Duration: 3 years and 6 months, from Dec 1, 2015 to May 30, 2018

Methodology: 180 healthy looking males were randomly taken from attendants of patients of Urology Department from indoor or from OPD and categorized into six groups according to their age decades: starting from Group-I [20-29 years] and ending at Group 6 [70 years and above]. Informed consent was taken. Symptoms of every person were recorded on Aging male symptoms scale [AMS]proforma/questionnaire. BMI, testicular volume,serum testosterone, Albumin, estradiol, SHBG, HbA1c and Blood Sugar were recorded. Results were recorded and put in SPSS version 10 for statistical analysis

Results: Average serum testosterone of different groups was 9.43+/-2.7ng/ml. The study shows a decrease in average serum testosterone level by 28.95 percent with advancing age. This difference is statistically not significant [chi square test, p-value 0.554]. The prevalence of hypogonadism was 10 percent in advanced age groups of our study population and all persons having low testosterone were symptomatic. Study showed93.44percentincrease in the severity of symptoms with advancing age

Conclusion: Serum testosterone falls with advancing age leading to differentsymptoms of hypogonadism but it is under reported as none of the persons was aware of this problem

Penile squamous cell carcinoma involving corpus cavernosum in a circumcised male - a case report

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

Complications of ventriculopeitoneal shunts in paediatric patients with hydrocephalus

Objective: to assess the pattern, causes and frequency of Complication of Ventriculoperitoneal Shunt surgery in Paediatric patients

Material and Method: 404 patients with hydrocephalus were operated between the period of 2004 to 2013 in the Departments of Neurosurgery and Paediatric Surgery at Allied Hospital, Punjab Medical College, Faisalabad. All patients with provisional diagnosis of Hydrocephalus were admitted in the hospital, detailed history was recorded and general physical examination with special emphases on neurological examination. Diagnosis was confirmed on the basis of investigations like Cranial Ultrasonography, CT and MRI scanning. Data analysis was carried using Statistical package of social Sciences [SPSS]

Results: of the 404 patients 176[81.48%] were male and 40[18.51%] female. Shunt infection was the commonest complication [12.9%] followed by Blockage [8.3%]. Shunt related mortality was [1.8%]. The mean age among the patients showing disconnection was 20.7 months compared to mean age of 7.8 months for not having this complication[p<0.04]

Conclusion: infection remains the most significant complication of VP Shunt surgery. Ventriculoperitoneal Shunt operation should be considered a major surgical procedure. Children with VP shunt should receive follow-up through the transition the adult hood

Forgotten DJ stents; a misery to the patients

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

Surgical outcome of tethered cord syndrome

Objective: surgical outcome of tethered cord syndrome

Study Design: retrospective descriptive

Period and Place of study: Neurosurgery Department Allied Hospital Faisalabad over 6 months from October 1, 2014 to March 28, 2015

Materials and Methods: forty patients were selected at Neurosurgical Department, Allied Hospital, Faisalabad with age ranging from 2 months to 27 years[average 2.58 years]. These were assessed clinically and their orthopedic and urological aspects were also assessed. MRI of relevant area was advised. Counselling was done regarding surgery under general anesthesia and its outcome. Laminectomy or laminotomy was done. Cord was detethered from its attachments from dura, and, in case of lipomeningocele, from its extradural component. In case of diastometomyelia, bony spur was extirpated and dura- plasty was done. Tight filum terminale was divided. Surgery was done using microsurgery techniques. Postoperative assessment was done immediately at the time of discharge, at 6 and 12 months

Results: a total of 40 patients, M:F ratio was5:3. Average age was 2.58 years.Age was ranging from 2 months to 27 years. Power improved in 44 % to grade 5/5 and 37% in grade 4/5 at one year. There was 65 % improvement in anal sphincters and 71% improvement in urinary sphincters at one year

Conclusion: our clinical and neurological evaluation showed satisfactory outcome after surgery, particularly when performed before the onset of irreversible deficit. Neurological status prior to surgery has profound impact on the outcome

Role of intravenous urography and ultrasonography in the management of vesicovaginal fistula [VVF]

Background: It has been a matter of great controversy whether the sonography [USG] and intravenous urography [IVU] both are mandatory for the evaluation of hydronephrosis and hydro ureter in female patients having urinary fistulae. So we planned to conduct a study on this subject

Objectives: To compare the sensitivity of IVU and USG in showing the degree of Hydro nephrosis and hydro ureter in the patients having VVF

Study Design: Prospective study

Place and Duration of Study: Department of Urology Punjab Medical College /Allied Hospital Faisalabad from January 2013 to October 2014

Methodology: Thirty consecutive female patients suffering from urinary incontinence who presented in outpatient department and were diagnosed to have VVF were taken for study. Patients with urge incontinence, patients with malignancy, patients who underwent surgery or received radiation were excluded from this study. Informed consent for study purpose and surgery were taken. USG and IVU were done in every patients to find the hydronephrosis or hydro ureter

Results: Twenty seven out of thirty patients who had not hydronephrosis on USG, they also had not hydronephrosis or hydro ureter on IVU, while only three patients had hydronephrosis on USG had also hydronephrosis on IVU

Conclusion: This study concluded that USG and IVU have almost equal sensitivity in finding hydro nephrosis or hydro ureter in patients having VVF. Therefore, any one of them can suffice to find out hydronephrosis. IVU is an invasive procedure and have the risk of reaction to contrast material and exposure to radiations. USG is cost effective, non-invasive and hence can be used in place of IVU

Abnormal Lipid levels as a risk factor of eclampsia, study conducted in tertiary care Hospitals of Khyber Pakhtunkhwa Province - Pakistan

To evaluate abnormal lipid metabolism as a risk factor of eclampsia in pregnant women. This cross sectional study was conducted in three tertiary care hospitals of Peshawar. Serum total cholesterol [TC], high density lipoprotein cholesterol [HDL-C], low density lipoprotein cholesterol [LDL-C], very low density lipoprotein cholesterol [VLDL-C], triglyceride [TG], apolipoprotein A1 [APO-A1], APO-B100, lipoprotein-a [Lpa] were measured in 110 women with eclampsia and compared with 90 healthy pregnant women. Mean lipid levels in cases and controls were compared using student's t test. Mean systolic/diastolic blood pressure, TC, TG, VLDL-C and Lpa levels were significantly higher [p < 0.001] in patients compared to control women. Similarly TC: HDL-C, LDL-C: HDL-C and TG: HDL-C ratio in the patients group were significantly higher [p < 0.001] and HDL-C: VLDL-C ratio was significantly lower [p < 0.001] in the patients as compared to control group. Undesirable cholesterol were noted in 35.8% patients, HDL-C in 50.5%, borderline high concentration of LDL-C in 23.6%, high triglycerides levels in 73.2%, undesirable cholesterol ratio in 52.3% and undesirable LDL-C ratio were noted in 82.1% patients of eclampsia. Serum lipids were found significantly higher thus early assessment may be helpful in prevention of complications in the eclampsia patients

Comparison of the impact of powerpoint and chalkboard in undergraduate medical teaching: an evidence based study

To compare the impact of the PowerPoint multimedia presentation and chalkboard in teaching by assessing the knowledge based on the marks obtained. Cross-sectional study. Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, from December 2007 - June 2009. Three-hundred male medical students were divided into three groups and a selected content-based lecture in physiology was delivered. For one group lecture was delivered using PowerPoint presentation, for second group using chalkboard and for third group the lecture was delivered by using both PowerPoint as well as chalkboard. Single-best Multiple Choice Questions [MCQs] paper was used for assessing the knowledge gained. The same exercise was repeated in another medical science school for the confirmation of validity and reliability of the results. Students who attended the class on both PowerPoint and chalkboard obtained significantly higher score in single best MCQ examination compared to those students who attended the same content based lecture on the PowerPoint or chalkboard alone [p = 0.05]. The integrated [PowerPoint and chalkboard] method of teaching was found more suitable tool of teaching and learning than PowerPoint or chalkboard alone

Percutaneous nephrolithotomy [PCNL]: comparison of tubeless versus conventional method in terms of hospital stay and duration of operation

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

Inverted papilloma of ureter: a rare cause of hydronephrosis

A case of hydronephrosis with a rare underlying cause in a 35 years old male is described. He reported with pain in the left lumbar region with a past history of left ureterolithotomy. The ultrasound and IVU studies were suggestive of left hydronephroureter. CT Scan showed left hydronephroureter with narrowing at the lower end of left ureter. Ureterorenoscopy [URS] confirmed polypoidal lesions in the left lower ureter, completely obliterating the lumen and involving the whole circumferential wall of the lower ureter. The biopsy of the lesion revealed an inflammatory polyp. Accordingly open surgical intervention was planned. Excision of the lower third of left ureter with ureteric reimplantation was done with a Boari flap. The histopathology report of the lower third of ureter confirmed inverted papilloma of ureter. The patient made a smooth postoperative recovery

Pattern of malignant renal tumours using 2004 who classification of renal tumours on radical nephrectomy

Objective: To determine the type of malignant renal tumours subjected to radical nephrectomy at a tertiary care urology unit using the 2004 WHO classification for renal tumours. Methods: It was an observational study conducted at Department of Urology, AFIU Rawalpindi, from October 2008 to September 2010. The study included 92 patients with malignant renal tumours of both genders aged above 15 years. The histopathological types and grades were recorded along with the gross tumour presentation. The data was entered in structured proforma and analysed for descriptive statistics using SPSS-14. Results: Over the span of 24 months study, 92 cases of malignant renal tumours were subjected to radical nephrectomy. The age was 16–82 [57.23 +/- 14.61] Years and male to female ratio was 2.1:1. The lesions were mostly unifocal [96.7%] and 58.6% affecting the right side. The commonest malignant renal tumour encountered was the conventional clear cell renal carcinoma [78.2%]. The other tumours in descending order were the transitional cell carcinoma [7.6%], papillary [chromphilic] renal cell carcinoma [6.5%], renal cell carcinoma unclassified [3.2%], chromophobe renal cell carcinoma [2.1%], Wilm's tumour and oncocytoma [1.7%]. T1 lesions were found in 42 cases [45.6%], T2 lesions in 25 cases [27.1%], T3a lesions in 17 cases [18.4%] each, while 8 cases [8.6%] had T3b lesions. Four cases had high and 3 had low grade lesions in transitional cell carcinoma. Wilm's tumour had favourable prognosis, 1 case had oncocytoma limited to kidney. Among the rest, 26 [28.2%] were G1, 35 [38%] were G2, 16 [17.3%] were G3, and 6 [6.5] were G4. Conclusion: The commonest type of the malignant renal neoplasm remains the clear cell [conventional] renal cell carcinoma. The lesions from T1 to T3 are amenable to radical nephrectomy and may not include the ipsilateral adrenalectomy as well. The grade may range from G1 to G4

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

Bladder outlet obstruction in a 5 years boy

We report a 5 years old boy with bladder outlet obstruction secondary to a fibroepithelial polyp of prostatic urethra. The micturating cystourethrogram showed a filling defect in the posterior urethra. Cystourethroscopy revealed a polyp in the prostatic urethra proximal to the verumontanum. Transurethral resection was done and histopathology confirmed fibroepithelial polyp of the urethra

rare complication of forgotten ureteral stent

A 35 years old lady presented with history of something coming out of the genitalia for the last 5 days. She also had history of pain in the left lumbar region which was initially investigated but the patient did not follow-up. About 15 years ago she also underwent left ureteric reimplantation. On examination, a stick like tube was protruding out of the urethral meatus which was fixed to the underlying vesical calculus. The calculus was evident radiologically and on ultrasound. The projecting portion of the stick like tube was cut and the vesical calculus with the inner portion of the tube was removed by open procedure. On evaluation of the specimen, it was found that the vesical calculus was fixed to the plastic tube which had concretions around it. This plastic tube had been placed after the ureteric reimplantation done 15 years age and the patients was not aware of it

Outcome of traumatic subarachnoid hemorrhage

Objectives: Traumatic Subarachnoid Hemorrhage [Tr SAH] is a part of traumatic brain injury [TBI]. Traumatic brain injury has worst impact on society converting useful citizens to severely disabled and vegetative patients. Traumatic subarachnoid hemorrhage is a negative prognostic factor. We have tried to study the contribution of traumatic subarachnoid hemorrhage to this lethal entity

Methods: Thirty patients with head injury with traumatic subarachnoid hemorrhage, diagnosed in emergency ward, were included and managed. They were assessed by GCS and Fissure grading at admission. Outcome was assessed by Glasgow outcome scale at the time of discharge and at thirty days after discharge

Results: Traumatic subarachnoid hemorrhage is a negative prognostic factor. Outcome depends upon clinical condition at time of admission [mild head injury and severe head injury p<0.05], distribution of the blood in the brain [F2 and F4, F2 and F3 p <0.05] and associated brain injury [p<0.05]

Colloid cyst of the third ventricle; endoscopic excision

Cerebrospinal fluid shunting or microsurgical resection of the colloid cysts of the third ventricle have long been a standard treatment. The emergence of neuroendoscopy has lead to its application in various neurosurgical problems. Colloid cyst of the third ventricle is one such pathology where endoscopic treatment has been performed with great clinical success during the past decade. We now Although considered less efficacious than microsurgical excision endoscopic excision is less invasive and much simpler. [1] to assess the extent of excision [2] to assess the morbid anatomy of the colloid cyst [3] to assess the risk of complications [4] to assess the functional outcome. Eight years [Jul 2001-June 2009]. Endoscopic resections of 15 colloid cysts of the third ventricle with obstruction of Foramina of Monroe in all cases. Total removal was achieved in 10 [66.7%] cases. In 5 [33.3%] patients the colloid material was evacuated completely while the remnant of the capsule adherent to its origin was left behind. Two [13.3%] patients developed meningitis one week postoperatively and one died subsequently. Nine [60%] patients had excellent recovery as the symptoms were relieved during a period of 3 to 24 months. Five [33.3%] of the total patients required ventriculoperitoneal shunt for obstructive hydrocephalus which developed with in 2 weeks after surgery. One out of the total number of patients deteriorated postoperatively on the existing neurological deficit. There has not been any recurrence until now with subtotal excision of the capsule. Keyhole surgery under endoscopic visual control offers an alternative, very effective minimally invasive approach for the excision of colloid cyst of the third ventricle and is likely to replace microsurgical resection as a standard procedure

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

Hypospadias repair; Seven years experience at Allied Hospital Faisalabad

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

Hypospadias repair; four years experience at Allied Hospital, Faisalabad

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

Mass Casualty management after a suicidal terrorist attack on a religious procession in Quetta, Pakistan

To determine the effectiveness of hospital management, considering triage system, hospital staff response, medical resources availability, and surgical management depending upon the nature and pattern of injuries in a mass casualty incident. Descriptive. Combined Military Hospital, Quetta, Pakistan in March 2004. All injured by gunshot or blast in a terrorist attack and reported to the hospital were included in this study. Patients were triaged by the triage team using "triage sieve" into priority I, II, III, and IV. Priority I patients were further triaged by using "trauma index" to prioritize for surgery. Phase I included life saving, Phase II limb saving surgery and Phase III for debridement. All data was recorded and analyzed. Hospital received 161 casualties among whom 20 were brought in dead, and 141 patients were admitted to the hospital. Mean age was 26.63 +/- 13.97.The cases were categorized as Priority-I 22.7%, Priority-II 14.72%, Priority-III 50.31% and Priority-IV 12.27%. Maximum casualties reached within the first 2 hours. Eighty-eight patients had pre-dominantly splinter injuries and 53 patients had dominantly gunshot wound injuries. In priority I, the trauma index was 15.55 +/- 5.74. Six patients having trauma index 20 or above could not even be resuscitated. Seventyfive percent of staff reported to the hospital within 15 minutes. Only 30% of reserve medical store was consumed. Total management cost to the hospital was Rs. 362,1856/- [British Pounds approx 32,052/-.] calculated by the hospital rates for treatment of non-entitled patients. Death rate in hospital survivors was 4%. Mass casualty management in a terrorist act requires prompt hospital response, appropriate triage, efficient surgical approach, and dedicated postoperative care. A good response can help to decrease mortality rate in salvageable injuries