Prostatic carcinoma; association between serum prostatic specific antigen [PSA] and gleason grade

During the past many years the availability of serum PSA as a screening marker, has encouraged its use to diagnose both prostatic cancer and its recurrence. Patients with high S/PSA are at increased risk of advanced carcinoma prostate and screening at an earlier stage would help to manage it accordingly. The aim of this study was to determine association between serum prostatic specific antigen [PSA] levels and Gleason grade in prostatic carcinoma patients. Descriptive, case series study. Department of Urology and Renal Transplantation in collaboration with Institutional laboratory of Bahawal Victoria Hospital, Bahawalpur. June 2012 to June 2014. Total 160 patients of age 50-80 years with biopsy proven prostatic carcinoma were included. Patients with h/o radiotherapy for prostatic carcinoma and anti-androgen therapy were excluded. Histological slides of each patient were reviewed by using the Gleason grading system. Gleason grade of each patient was correlated with his serum prostatic specific antigen [PSA] report which was done before surgery or biopsy. In our study, mean age was 66.89 +/- 9.28 years. Mean serum PSA was 21.41 +/- 13.67 ng/ml. Intermediate grade cancer was found in 38.75% patients followed by moderate to poorly differentiated cancer in 31.86% patients. Gleason score >/= 7 was significantly higher in patients with serum PSA >20 ng/mL than those with serum PSA

Frequency of carcinoma of prostate in clinically benign prostatic hyperplasia and role of different screening tests

To assess the frequency of carcinoma in clinically benign prostatic hyperplasia and role of digital rectal examination [DRE] and prostatic specific antigen [PSA] in assessment of these patients. Patients admitted to the Department of Urology and Renal Transplantation with lower urinary tract symptoms [LUTS] due to enlarged prostate. Descriptive Study. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College /Bahawal Victoria Hospital, Bahawalpur, from January 2007 to December 2010. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal ultrasonography. The selection criteria were; Refractory retention of urine, Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 300 patients were selected. Patient's blood sample was sent to laboratory to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transurethral resection of prostate [TURP] or transvesical prostatectomy [TVP] and prostatic tissue was sent for histopathology. In this study, 13.33% patients were found to have carcinoma of prostate inspite of being clinically benign prostates in all patients, irrespective of PSA range. The PSA value was found < 4ng/ml in 211 [20.33%] patients and remaining 89 [29.67%] patients had PSA value > 4ng/ml. In this study, 9.95% patients had carcinoma prostate inspite having normal PSA and benign prostate on DRE while with rising PSA levels and normal DRE, chances of malignancy detection increases [66.67%]. We conclude that although frequency is low the possibility of malignancy in clinically benign enlarged prostate should be borne in mind whenever subjecting the patient for screening, assessment and treatment. DRE alone is insufficient to detect malignancy. PSA in combination with DRE is beneficial in predicting prevalence of carcinoma prostate.

Hypospadias repair

The Departments of Urology, Pediatric Surgery and Plastic Surgery, Quaid-e-Azam Medical College, Bahawal Victoria Hospital, Bahawalpur. Jan 1999 to Dec 2004. Prospective. Patients admitted with hypospadias in these departments were included in this study except patients with multiple failed repairs previously. Standard procedures were practiced for every type of defect i.e. MAGPI and Mathieu's repair for coronal hypospadias, Snodgrass urethroplasty for proximal and distal penile hypospadias. The age range observed during this study was 1.5 to 25 years while 64% of patients were less than 10 years of age. The type of defect was coronal in 25%, penile in 60%, penoscrotal and perineal in 15% of the patients. Initial success rate was 78% and overall success rate was 92%. Complications observed were fistula formation 7%, stenosis of anastomotic site 7% and dehiscence of repair 3%. Thorough evaluation of urethral and penile malformation brings best outcome of surgery for hypospadias. Hypospadias repair should be offered to the child before school going age so as to prevent psychological impacts of genital malformations

Pyelopalsty; Comparison of results of repair with and without stents

To evaluate the outcome of pyeloplasty for congenital pelviureteric junction obstruction and comparison of results between repair with stents and without stents. Patients admitted to the department of Urology with congenital pelviureteric junction obstruction regardless of age were entered in this study. Prospective. Department of Urology, Quaid-l-Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur. From April 1999 to December 2002. A total of 30 patients were grouped into A and B. Either dismembered or non-dismembered pyeloplasty were performed in either group, both with and without D.J. Stents. The results in our study show that there is no gross difference of outcome in pyeloplasty whether done over D.J. Stent or without stents. Dismembered pyeloplasty resulted in better outcome. Open pyeloplasty is the "Gold Standard" treatment option for congenital pelviureteric junction obstruction. The use of D.J. Stents is not necessary in every repair

Treatment modalities of urethral stricture

To find out etiology, site of urethral stricture and evaluation of various operative procedures used. Design: Prospective study. Place and Duration of Study: Department of Urology, Bahawal Victoria Hospital, Bahawalpur from January 1998 to June 2000. Subjects and Patients diagnosed as stricture urethra at the Department of Urology. After all investigations, patients were subjected to various operative procedures. We have found trauma as the leading cause of stricture urethra and bulbomembranous urethra being the most commonly affected site. Internal urethrotomy has best results in uncomplicated strictures of < 1cm length. Stricture urethra has very high morbidity. No procedure is 100% curative. Internal urethrotomy should be the procedure of choice

Transurethral resection of prostate versus transvesical prostatectomy

To compare the results of transurethral resection of prostate [TURP] and transvesical prostatectomy [TVP]. DESIGN: Retrospective study. SETTING: Department of Urology, Bahawal Victoria Hospital, Bahawalpur. PERIOD: January 1995 to December 1998. MATERIAL AND METHODS: A total of 300 cases of BPH were included in the study. Out of 150 cases underwent TURP and in 150 cases TVP was done. The age of patients ranged from 48 to 85 years with maximum incidence [87.67%] between 51-70 years of age. Two hundred and thirty [76.66%] cases presented with urinary retention. Transient incontinence seen in 4[2.66%] cases of TURP and 10[6.66%] cases of TVP and clot retention in 2[1.33%] cases of TURP] and 8 [5.33%] cases of TVP, were the most common complications. Wound infection in 12 [8%] cases and suprapubic urinary fistula in 4[2.66%] cases were only seen in TVP. Mean hospital stay with TURP was 9.4 days as compared to 22.6 days with TVP. TURP is a better procedure than TVP because of its low complication rate and shorter hospital stay