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

Comparison between double J [DJ] ureteral stenting and percutaneous nephrostomy [PCN] in obstructive uropathy

To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A and B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy [PCN] was 92.0% [p < 0.0001]. Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications

Frequency of metabolic abnormalities in urinary stones patients

To determine the'frequency of metabolic abnormalities in the serum and urine of patients with urinary stones disease. Two hundred patients with either multiple or recurrent urolithiasis diagnosed on ultrasonography and intravenous urography were included in this study. 24 hour urine sample were collected from each patient and sent for PH, specific gravity, Creatinine, uric acid, calcium, phosphate, oxalate, citrate and magnesium. In addition, blood sample of each patient was also sent for serum levels of urea, creatinine, uric acid, phosphate and calcium. Mean age of patients was 38 +/- 7.75 years with male to female ratio of 2:1. The main presenting complaint was lumber pain and 82.5% patients were found to have calcium oxalate stones on chemical analysis. Metabolic abnormalities were found in 90.5% patients, whereas there were no metabolic abnormalities in 19 [9.5%] patients. Forty patients [21.5%] only had one metabolic abnormality and 157 [78.5%] patients had multiple metabolic abnormalities. Hyperoxaluria was the most commonly observed metabolic abnormality and was found in 64.5% patients. Other significant metabolic abnormalities were hypercalciuria, Hypercalcemia, hypocitraturia and hyperuricemia. This study concludes that frequency of metabolic abnormalities is very high in patients with urolithiasis and hyperoxaluria, hypercalciuria and hypocitraturia are the most important metabolic abnormalities observed in these patients

Ultrasonography, X-ray and intravenous urography [IVU]

To know the sensitivity and specificity of ultrasound with plan abdominal film [X-ray KUB] compared to IVU in evaluation of renal colic. To develop a protocol for investigations of renal colic. Experimental. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur. From July 2010 to December 2011. The number of cases for the study were one hundred and fifty. Patients of either sex of age range from 10 to 50 years with suspected urinary tract stone disease, PUJ obstruction and structure ureterovesical junction were included in this study. While patients of age <10 years, renal failure and with history of hypersensitivity to contrast media were excluded from the study. After routine investigations, ultrasonography, plain X-ray KUB and IVU were performed in every patient at radiology department, Bahawal Victoria hospital, Bahawalpur. The mean age of patients was 41.14 +/- 1.30 years. The ratio of male to female was 2.8:1. Presenting complaints of patients were flank pain. Maximum duration of complaint was 5-6 years. USG + X-ray KUB findings were obstructing renal stone, ureteric stone and PUJO in 97[64.67%], 25[16.67%] and 28 [18.67%] patients respectively. While on IVU, obstructing renal stone, PUJO and ureteric stone was found in 87[58%], 31[20.67%] and 32[21.33%] patients respectively. this study shows that ultrasonography and plain X-ray abdomen [KUB] in sufficient for the diagnosis of renal disease presenting with renal colic

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

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