Tuberous sclerosis with bilateral angiomyolipomas

A case of a 30-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease is described in the present case report. Clinical symptoms were unexplained fever, pain in lumber areas and gross hematuria. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts in the lungs characteristic for pulmonary lymphangioleiomyomatosis. CT scan of the brain revealed subependymal calcifications. These three diagnostic features are rarely exhibited in a single patient. Bilateral renal angiomyolipomas and pulmonary lymphangioleiomyomatosis are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality

Lymphocele incidence following renal transplantation our experience in sims/services hospital Lahore

To determine the incidence of lymphocele in patients who under went renal transplantation, as well as potential factors responsible or associated to its development. All records of 25 patients who were operated for renal transplant in SIMS/SHL between March 2006 to December 2007 were reviewed for lymphocele. The surgical technique was the standard one. All lymphatic vessels were either ligated or diathermized. Baseline post operative ultrasound after one week done or whenever indicated for lymphocele. 10% povidone iodine instilated in case of lymphocele. Patients were followed for an average of six months with history, physical examination and ultrasound on each visit. 25 patients [20 male and 5 female] have received renal allograft from live donors. There was 1[4%] instance of lymphocele; encountered at two weeks after renal transplantation. Careful ligation of lymphatic vessels both during graft preparation and during implantation can significantly contribute to reducing incidence of lymphocele following renal transplantation. Instillation of 10% povidone iodine in the lymphpcele can cure and prevent its recurrence

Clinical outcome of modified thiersch duplay urethroplasty for proximal hypospadias

To report the functional results, complications and cosmesis by using Thiersch Duplay urethroplasty repair for hypospadias. Between years 2006 to 2007, 30 patients underwent repair of proximal hypospadias [penoscrotal] with chordee. Two stage repair was performed in all cases. 1[st] stage consisted of chordee correction by excising fibrous cord between ectopic meatus and corona along with incision of glans. The grafting of the dorsal hood skin was made on ventral aspect of tunica albuginea. In second stage repair U shaped incision was made around hypospadiac meatus and a ventral skin flap was dissected superficially to allow tubularization around a suitable size silicon Foley catheter [5 -8 Fr in children, 10-12 Fr adolescence and 14-16 Fr in adults] without tension. The Thiersch Duplay tube was constructed using 5/0 vicryl. A subcutaneous fascial layer was closed over tube to support neourthra. The Foley catheter was left for 10-12 days. Age range was 3-25 years with mean +/- SD of 12.7 +/- 5.09. Total hospital stay was 10-12 days with mean +/- SD of 11.9 +/- SD 0.85. Twenty five patients [80.2%] could void on standing and had a good caliber straight single stream of urine in forward direction. The cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans achieved in twenty five patients. Period of follow up was 4-8 month mean with mean +/- SD of 6 +/- 1.43. Main complications seen were urethrocutaneous fistulae in three [9.9%], meatal stenosis in three [9.9%], hematoma in one [3.3%], complete disruption in one [3.3%] infection in two [6.6%] and painful bladder spasm in two [6.6%]. These seen in five [16.5%] patients. Staged urethroplasty for proximal hypospadias results in a normal penis with good functional, minimum complications and excellent cosmesis, with short hospital stay

Significance of uroflowmetry in small voided volume

Uroflowmetry is a useful diagnostic tool for the evaluation of bladder outlet obstruction. Significance of uroflowmetry was studied in small voided volumes as many of the patients with bladder outlet obstruction, are unable to void required volumes i.e. > 150 ml were included. The patients above the age of 50, having IPSS >20, post void residual urine less than 100 ml and voided volumes less than 150 ml. Study parameters were; patients' age, residual urine, traces of uroflowmetry, maximum flow rate [Qmax], average flow rate [Qave], flow time, voiding time and voided volume. Out of 77 patients 23 voided less than 150 ml. 12 patients proved to be obstructed [5 developed retention and 7 were operated due to bothersome score]. Out of 23 patients 12 [52%] proved to be obstructed and 10 [43.45%] were diagnosed by uroflowmetry. Pearson correlation coefficient between voiding time and voided volume was 0.432 [p<.05]. There was no correlation between voided volume and Qmax among these patients who voided less than 150ml. It has been concluded that in some of the cases even with small voided volumes, uroflowmetry can be helpful in diagnosing bladder outlet obstruction

Tissue damage following extracorporeal shockwave lithotripsy

To assess acute tissue damage following ESWL fifty patients were studied at Department of Urology, Mayo Hospital, Lahore between April 1991 to May 1992. Tissue damage was assessed by haematuria, proteinuria, changes in serum and urinary concentrations of glutamate oxaloacetate transaminase [GOT], lactate dehydrogenase [LDH] and renal ultrasonography. This study revealed that all patients suffered from acute tissue damage following ESWL which was transient and completely reversible. All parameters returned to the base line within four weeks

role of multiple mucosal biopsies in the evaluation of bladder cancer

A prospective study was conducted on 50 patients with superficial transitional cell carcinoma of urinary bladder to determine the incidence of atypia and carcinoma in situ in selected site biopsies from apparently non-tumour bearing bladder mucosa. 48% of the biopsies from cystoscopically normal mucosa revealed histological abnormalities including 20% atypia and 28% carcinoma of the urinary bladder. It is recommended that every patient with a neoplastic lesion of the bladder should have the benefit of multiple biopsies in order to ascertain the status of the bladder epithelium outside the area of visible tumour. It shall help in contemplating aggressive therapeutic measures in patients with diffuse and marked peripheral urothelial abnormalities