A Randomised Prospective Analysis of Effectivness of ESWL vs PCNL in Renal Stone Size 1-2 cm and Review of Literature

Introduction: Majority of renal stones diagnosed todayare below 2 cm. The preferred treatment of <1cm stone isextracorporeal shockwave lithotripsy (ESWL) while standardof care for renal stone >2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1-2 cm renalstones is still a subject of debate. This study was undertakento formulate a better understanding of management of renalstones of size 1-2cm in this patient populationMaterial and methods: A prospective study was carried outto evaluate clearance of ESWL vs PCNL in patients with renalstones of size 1-2 cm. Complete follow up data were availablefor 281 patients 140 in PCNL and 141 in ESWL group, 12patients were lost to follow up.Results: Both the groups were well matched with regards toage and sex distribution. 141 patients underwent ESWL and103/141(73%) patients had stone clearance in 1-3 months. 140patients underwent PCNL out of which 133 (95%) patientshad stone clearance. Complications were mostly minor andfound in 9.7% in patients undergoing ESWL while same wereseen in 30% of those undergoing PCNL.Conclusion: The primary objective in stone management istotal stone clearance. Considering this as priority PCNL hasproved superior to ESWL in our study for renal stones 1-2 cmin size. It has also got lower auxiliary and retreatment rates buthas its own share of complications and longer hospital stay areother important factors in PCNL.

A Study of Normal Female Uroflowmetry for Development of Flow Volume Nomogram in an Indian Population

Introduction: Uroflowmetry is a common urological toolto diagnose bladder outlet obstruction in males but it is notappropriate to use the same for females as female uroflowmetrynomograms are not universally acceptable. By conducting thisstudy we aim to create a nomogram for our population andcompare our findings with other investigators. Study aimed toestablish maximum flowrate and average flowrate in womenand develop its NomogramMaterial and Methods: A total of 445 patients meetinginclusion criteria were enrolled and uroflowmetry performed.Peak flow rate (Qmax), average flow rate (Qave),time topeak flow rate (TQmax),voided volume(VV), post voidresidue(PVR) and total voiding time (TVV) were recorded.Corrected Qmax, Corrected Qave and Body Mass Index (BMIwere calculated. statistical analysis was done.Result: Both peak flow rate and average flow rate correlatespositively with voided volume while they correlates negativelywith age and BMI. Both corrected Qmax and corrected Qavewere not having significant negative correlation with age andBMI. Multivariate regression analysis revealed only voidedvolume to significantly affect PFR independently. Univariatelinear regression analysis revealed that only voided volumeaffects the Average flow rate.Conclusion: This study gives a reference value of peak andaverage flow rates of normal women in the form of confidencelimit to help clinicians diagnose poor flow rates taking intoaccount voided volumes (flow–volume nomograms) as wellas age (corrected flow–age nomogram).

A Randomised Controlled Study to Compare the Efficacy and Safety of Intracorpospongiosal Anesthesia alone Versus Transperineal Urethrosphincteric Block and Intracorpos Spongiosal Anesthesia Combined in Direct Vision Internal Urethrotomy in Urethral Strictures

Introduction:DVIU is a common urological procedure forshort segment urethral stricture ≤2cm and is generally doneunder spinal anesthesia. The study was performed to accessthe feasibility to perform DVIU under local anesthesia toreduce the cost, hospital stay and the morbidity of anaesthesia.Material and Methods: A prospective randomized study wasconducted in 168 patients who were divided in two groups.Group ‘a’ received only ICS block intra corporospongiosalblock) and group ‘b’ received both ICS with USblock(urethrosphincteric block).VAS pain score was obtainedat the end and one hour after the procedure.Results: The visual analogue score (VAS) at the time ofprocedure were significantly lower for Group ‘b’ (Groupa =3.46, Group b=2.55 p value=0.0053), and was alsolower at the end of one hour (Group a=3.1, Group b=2.01 pvalue=0.0001). The change in blood pressure and pulse rateas a measure of hemodynamic variability were recorded inboth groups and significant differences were noted at the timeof procedure Group ‘a’ 6.43±1.08, Group ‘b’ 3.95±1.46, p <0.0001 value.Conclusion: DVIU is a common urological procedure whichcan be safely performed under local anaesthetic blocks insteadof spinal anaesthesia. A combination of ICS with US blockincreases the safety and tolerability of the procedure.