Comparison of morbidity of three flank approaches for open renal surgery

The aim of this study was to compare the morbidity of three flank incisions, subcostal, transcostal and supracostal for open renal surgery in terms of incision times, postoperative pain, postoperative hospital stay and long term complications. Prospective comparative and analytic study. This study was conducted at Department of Urology, Nishtar Hospital Multan and Department of Urology, Ghulam Mohamed Maher Medical College/Teaching Hospital Sukkur from January 2007 to December 2011. In this study twelve hundred sixty [n-1260] patients who underwent open surgical procedures over a period of five years are analyzed. Patients were studied in three groups. Group A, subcostal,[n-407] 32.3%. Group B transcostal [n-526] 41.7% and Group C, supracostal, included [n-327] 25.9%. Mean incision time in Groups A, B and C was 17.3 min, 21.08 min and 23.81 min respectively. Mean amount of injectable analgesic required in first three post operative days in Groups-A, B and C was 41.36 mg, 46.87 mg and 49.40 mg of Nalbin respectively. Mean Post operative hospital stay in Group A Band C was 4.63, 5 days and 4.64 days respectively. Pleural injury was none in Group A, thirty five [n- 35] cases [6.61%] in Group B and thirty nine [n-39] cases [11.9%] in Group C. Incisional hernia was noted in Group A 12 cases 3%, Group B 6 cases 1.1 % and none in group C. With subcostal approach, incision time, dose of analgesia and pleural injury is minimum but high incidence of incisional hernia is there. In transcostal and supracostal approach the incision time, dose of analgesia and incisional hernia is minimum but incidence of pleural injury is relatively high

Role of alpha blockers in the management of lower ureteric stones

To study the role of Alpha-blockers in the management of patients with lower ureteric stones. Single blind experimental study. Department of Urology Nishtar Hospital and Medical College, Multan from 1st January 2002 to 30 December 2003. Eighty patients of lower ureteric stones were included in the study. They patients were divided into two equal groups. Basic data of all patients was collected including history, examination, age, sex, stone size, location, number and duration of symptoms. In group I forty patients [Experimental group], Doxazocin 4mg was given OD for four weeks, along with routine analgesics while the group II were performed weekly for eight weeks. The results were collected regarding stone passage rate, time, analgesic use, hospitalization and endoscopical intervention if needed. Statistical analysis was performed. In all paitents the mean size of stones was 5.68mm [range 5-8mm], average number one [range 1-3] and located in the lower five centimeters of ureter. In experimental group, 36 patients [90%] passed their stones in average three weeks; rest of the four patients [10%] needed ureterorenoscopy. While in Control group, only eighteen patients [45%] passed their stones spontaneously in average five weeks, eighteen patients [45%] needed ureterorenoscopy and in four patients [10%] ureterolithotomy was done. Alpha-blockers when, used as a spasmolytic drug for treatment of lower ureteric stones of size less than one centimeter, increased the stone expulsion rate and decreased expulsion time. It also decreased the need for hospitalization and endoscopic intervention, and provided particularly good control of colic pain

Role of Peritoneum as interposition tissue in the management of vesico vaginal fistula

To study the relative efficacy and results of the use of peritoneum as interposition tissue between vesical and vaginal repair in the management of VVF and compare the results with omentum pedicle flap. Design: It is a comparative study. Place and Duration: The study included twenty patient of VVF, who were operated in the Dept of Urology Nishtar Hospital Multan, from 301 June 2003 to 30, July 2004. Subject And In 10 patients [Group I], omentum was used as interposition tissue between the vesical and vaginal suture lines and in 10 patients; [Group II] peritoneum was used as interposition tissue between the two repairs. The study included 20 patients of VVF with mean age of 27 years. The leading cause of hysterectomy was the dysfunctional uterine bleeding in 8 patients [40%]. Fifteen patients [75%] came from rural areas and 5 patients [25%] were referred from gynecological units of Nishtar Hospital Multan. In group I patients, with omentum as interposition tissue, two patients [20%] developed high-grade fever three patients [30%] developed persistent vomiting, two patients [20%] needed blood transfusion, four patients [40%0] developed UTI. One patient [10%] developed leakage of urine per vagina on 18t postoperative day and one patient [10%] developed intestinal obstruction. In group II patients, one patient [10%] developed high-grade fever one patient [10%] developed persistent vomiting, three patients [30%] needed blood transfusion, three patients [30%] developed UTI. None of the patients developed any leakage of urine or intestinal obstruction. The study showed that peritoneum is equally good as omentum for use as interposition tissue in transabdominal repair of VVE It is also easy to mobilize with a comparable complication rate