Worm infestation in children of Skardu

To determine the frequency of parasitic infestation among children of district Skardu. Cross-sectional study. Combined Military Hospital, Skardu, from September 2010 to January 2011. Two hundred and fifty children of 1-15 years of age. were selected from out patient department through non probability convenience sampling. Demographic information included gender, hygienic condition, source of drinking water, defecation site and maternal education. This information was recorded on a questionnaire. Parents were interviewed, while stool samples of children were collected for examination of ova and cysts. Ova and cysts of various parasites were found in 192[76.8%] children. Intestinal helminths were more frequent 167[87%] than protozoa 25[13%]. Mixed infestation seen in 24[12.5%] cases and single parasite was seen in 168[87.5%] cases. Water from streams, use of traditional defecation sites, poor personal hygiene, illiteracy of mothers and rural living proved to be significant risk factors in predicting the intestinal helminth infection [p<0.05]. Parasitic infestation is very common in children belonging to Skardu region. Ascaris lumbricoides was the most common helminth infestation found compared to protozoa. Poor hygiene, use of stream water, rural living, and low level of maternal education have appeared as major contributors towards parasitic infestation.

Role of clean intermittent self catheterisation [CISC] in the prevention of recurrent urethral strictures after internal optical urethrotomy

Background: Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy, were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean Intermittent Self Catheterisation [CISC] in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure. Methods: A randomised controlled study conducted in the department of urology and renal transplantation, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean age 48 years [range 20–73] were selected and randomly divided into Treatment Group [30 patients] and Control Group [30 Patients]. Eight "drop out" occurred in the treatment group and four "drop out" occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter [No. 16 or 18] twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then every 2 months for the next 6 months. Results: Total of 48 patients completed the study, 22 in the treatment group and 26 in the control group. Within the first year, 4 patients [22%] in the treatment group developed urethral stricture. In the control group, 12 patients [46%] developed urethral stricture within the first year, showing a significant difference [p<0.01]. In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs, one with concomitant epididymitis. No other complications were noted up to one year follow up. Conclusion: Clean Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after Internal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is an important modality for maintaining the normal urethral calibre. Keywords: Urethral Strictures, Optical Urethrotomy, Clean Intermittent Self Catheterisation, Recurrence, Complications

Percutaneous nephrolithotomy for the treatment of renal stones larger than 2.5 CM

To share our experience regarding the safety and efficacy of Percutaneous Nephrolithotomy for the treatment of renal stones of larger than 2.5 cm and to study the frequency of any postoperative complications associated with this procedure. This is a descriptive study conducted during the period from June 2007 to December 2009. Using non-probability convenient sampling, total 88 patients with renal stones of more than 2.5 cm were selected for PCNL. Data was analyzed on SPSS version 10 for windows XP. In a cohort of 88 patients [57 male and, 31 female] PCNL was performed for renal stone treatment. The mean age was 33.5 [9 - 65] years. The mean operative time was 85 [60 - 180] minutes and the mean stone size was 3.2 cm range [2.5-4.8] cm. There were 37 staghorn and 51 non staghorn stone. PCNL via a single access tract was accomplished in 86% [76/88] of procedures, with upper pole calyx in 30, middle calyx in 27 and lower pole calyx in 19 procedures, while multiple tracts were used in 14% of procedures [12/88] with 09 procedures using the upper and middle calyxes and 05 procedures using lower and middle calyxes. The stone-free rates for staghorn stone at discharge and at 3 months were 83.7% and 90.8% respectively, while for non staghorn stone the figures were 85.8% and 92.5% respectively. Postoperative complications were observed in 9% of the procedures [8/88], the commonest of which was bleeding necessitating blood transfusion in 4 patients. PCNL is safe and Effective treatment for renal calculi associated with less morbidity, shorter hospital stay and is cost effective

Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters

Transurethral resection versus transurethral incision of the prostate: a subjective and objective analysis

To assess and compare the outcome and complications of transurethral prostatectomy [TURP] versus transurethral incision of the prostate [TUIP] in patients having bladder outlet obstruction. Fifty patients suffering form benign prostatic hyperplasia [BPH] with prostate size of <30 gms were included in this study. Group a [25 patients] underwent TURP while in group B [25 patients] TUIP was performed. The patients were assessed using International Prostatic Symptoms Scoring System [IPSS], uroflownetry, TRUS and postvoid residual urine volume. Follow up was done at 1,3,6 and 9 months intervals. There was no statistically significant difference in the mean age among the two groups. IPSS score dropped by 81.55% for group A and 85.71% for group B at 9 months postoperatively from baseline. The overall improvement in maximum flow rates as recorded for both groups was 172.60% and 249% respectively while it was 182.8% and 279% for group A and B in average flow rates. The mean drop in postvoid residual urine volume for group A was -88.50% and -99.02% for group B. Overall 84% of patients in group A and 92% of patients in group B were well satisfied with the outcome of procedures. TUIP is an effective and comparable treatment modality for BPH with gland size of < 30 grams. Results of TURP and TUIP were comparable, but TUIP was simple and easier to perform, with less morbidity and shorter operation time than TURP

efficacy of percutaneous nephrolithotomy in renal and upper ureteric calculi

To determine the efficacy of Percutaneous Nephro-Lithotomy [PCNL] in clearance of symptomatic renal and upper ureteric calculi and study the frequency of postoperative complications associated with it. A descriptive study conducted in the Department of Urology at Pakistan Institute of Medical Sciences [P.I.M.S] Islamabad from 1990 to 2001. Two hundred patients with symptomatic renal and upper ureteric calculi were selected with the technique of non-probability convenient sampling. All Patients were subjected to PCNL. The data was analyzed on SPSS version 10. The mean age of patients was 37 years with a range of 18-75 years. The mean size of the stone was 2.7cm with a range of 1.5 to 3.5cm. The mean operation time was 90 minutes with range of 40 to 120 minutes. The stone clearance was successfully achieved in 194 patients [97%]. Failure was noted in 6 patients [3%]. Majority [189] of patients required only a single session for the complete clearance. Postoperative complications were recorded in 24 patients [12%]. Only 8 patients [4%] required blood transfusion, 8 patients [4%] had bacteriemia, 4 patients [2%] had prolonged ileus of more than 72 hours and 4 patients [2%] developed urinary fistula. No mortality was recorded. PCNL is a minimally invasive, effective and safe modality for the removal of renal and upper Ureteric calculi