study of renal tumours in tertiary care hospitals

Renal cell carcinomas [RCC] comprise 90% of all renal tumours and are presage of poor outcome. Very little data has been published in Pakistan regarding the clinical and pathological manifestations of the disease. A total 0/50 cases presenting with different subtypes of RCC were selected from Allied Hospital Faisalabad and Sheikh Zayed Hospital, Lahore. Clinical details were obtained from the hospital records. The fresh nephrectomy specimens were further processed according to College of American Pathologists guidelines. Mean age of the study population was 50.16 +/- 11.982 years. Male to female ratio was 2.57:1. Left to right ratio was 1:1. Most tumours [n = 36, 72%] were located in the upper pole. Most common symptom was heamaturia [n = 38, 76%]. Mean of the greatest dimension was 10.41 +/- 4.22 cm. The most common stage of presentation was stage II [n = 21, 42%] and histological subtype was clear cell carcinoma [n = 37, 74%]. Renal cell carcinoma, including its chromophobe variant, is a growing malignancy in Pakistan. Delay in seeking medical care on the part of patient and inadequate facilities account for the tumour growing to a larger size and more advanced stage of malignancy in our country

Optical internal urethrotomy for the treatment of urethral strictures

Aims and Objectives: To study the outcome of optical internal urethrotomy in the treatment of urethral strictures. Study Design: Prospective. Setting: Allied Hospital, Faisalabad. Period: April 1996 to Dec. 1998

Patients and Methods: A total of 70 consecutive male patients ranging from 5-80 years treated with optical internal urethrotomy for stricture urethra were included in the study. Follow up ranged from 12 to 30 months

Results: Trauma was the most common cause of urethral stricture. Fracture pelvis alone was responsible for 43% of the strictures while straddle injury accounted for another 23%. The incidence of iatrogenic and infective stricture was found to be 26% and 8% respectively. The results of optical internal urethrotomy were excellent in 61% patients who were treated with single internal urethrotomy. Internal urethrotomy was to be repeated in 21% patients and urethroplasty was performed in 9% patients. Clean Intermittent Self Catheterization and active urethral dilatation was applied as adjuvant treatment to prevent the recurrence of stricture

Conclusions: Internal Urethrotomy is safe and reliable procedure for simple urethral strictures while urethroplasty should be considered for complex strictures. Active urethral dilatation at repeated intervals still has a role in preventing recurrence of stricture after initial treatment with internal urethrotomy or urethroplasty

Cystectomy and urterosigmoidostomy; treatment of carcinoma urinary bladder

Objective: To audit experience of cystectomy and ureterosigmoidostomy as treatment of carcinoma bladder. [2] To assess the complications of ureterosigmoidostomy. [3] To assess the quality of life after the procedure. Design: Prospective. Setting: Department of Urology Allied Hospital Faisalabad. Period: December 2000 to January 2004

Material and Methods: Twenty two cases were included in the study. All patients had muscle invasive transitional cell carcinoma, demonstrated histopathologically by TUR biopsies. CT abdomen and pelvis and sphincter assessment was performed besides other routine investigations. All patents were treated by cystectomy and ureterosigmoidostomy Prophylactic alkalinization of urine was done by Na citrate tablets

Results: All patients presented with total painless haematuria. 19 patients were male and 03 females. Age ranged from 38-75 years. 18 [82%] had T2 and 04 [18%] had T3, transitional cell carcinoma. Two patients had rectal injury. One repaired Primarily and 2[nd] patient was managed by colostomy and delayed repair. Immediate post-operative complications were urine leak wound [13.6%], wound infections in 8 patients [36%], pyelonephritis in 04 patients [18%]. No patients suffered metabolic acidosis. 03 [13%] patients expired

Conclusion: We consider that cystectomy and ureterosigmoidostomy is the right option for patients with localized carcinoma urinary bladder

Revival of estrogen therapy in advanced prostate cancer; a prospective study

Objectives: to study the efficacy and safety of oestrogens in advanced prostate cancer

Methods: 15 consecutive patients irrespective of age with advanced prostate cancer were included in the study. Fosfestrol tetrasodium [1200 mg infusion daily for 05 days] was administered to each patient. Efficacy of the therapy was identified by subjective [improvement judged by the patient] as well as objective [reduction in serum PSA] response at week 1 and 4 postchemotherapy

Results: these were available in only 13 cases. Mean +/- S.D. of age was 72.23 +/- 08.21 years. All patients had presented with urinary retention. Associated symptoms were backache, bilateral ureteric obsturction, paraplegia, lymphoedema of legs and bilateral deep venous thrombosis [DVT]. Subjective response was noted in 76% of patients at week 1 and in 92% of patients at week 4. Objective response was noted as 84% at week 4. No significant complication was identified except in one patient who did not tolerate the drug due to excessive nausea and vomiting

Conclusion: the present study demonstrated that intravenous fosfestrol is effective, well tolerated drug therapy in advanced prostate cancer particularly in patients who have bulk abdomino-pelvic disease