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APMC-Annals of Punjab Medical College. 2016; 10 (2): 85-91
in English | IMEMR | ID: emr-185523


Introduction: Renal stones have been one of the most commonly encountered diagnosis in patients visiting Urology clinics and Extra-Corporeal Shock Wave Lithotripsy [ESWL] has been an effective method for management of renal stones of certain size [Up to 2.5 cm]

Objective: To determine the complication rates in patients undergoing ESWL to look for safety level of the procedure. Duration And Setting: Study was conducted From December 2015-March 2016 in Kidney Center, DHQ Hospital, Faisalabad

Methodology: First 225 patients undergoing ESWL at Kidney Center, DHQ Hospital, Faisalabad were included in the study and they were observed for short term complications as post procedure pain, hematuria, fever and ureteric obstruction

Results: 225 patients included in the study. Among them 132 [58.7%] were male, 93 [41.3%] were female. Average age of patient was 38.2 years with minimum range as 5 years and maximum as 75 years. Stone size ranged from 7mm to 2.5cm with average size as 1.541cm. Fragmentation was observed in 218 [96.9 %] patients in first two sessions while no fragmentation was observed in 7 [3.1%] patients after two sessions. Out of 225, 37[16.4%] patients developed pain, 19 [8.4%] observed hematuria, 7 [3.11%] have fever and 6 [2.66%] developed ureteric obstruction. Only 3 patients developed two complications simultaneously. No statistical association was found for development of complication after ESWL in our study

Conclusion: Inference drawn from the statistics clearly showed that ESWL is still a very safe and effective modality for renal stone management

APMC-Annals of Punjab Medical College. 2016; 10 (1): 36-40
in English | IMEMR | ID: emr-185534


Objectives: To determine the significance of indwelling time for bacterial colonization of DJ stents by measuring the frequency of bacterial colonization in such stents after endoscopic Urological surgery. Place And Duration: Study was done from September 2014 to November 2015 [15 months] in Department of Urology and Kidney Transplantation, Allied Hospital, Faisalabad

Methodology: 68 patient were included in the study who undergone Percutaneous nephrolithotomy [PCNL] and Ureterorenoscopy [URS] for renal and ureteric stones respectively with DJ stenting. Sterile nature of urine was assured in pre-operative circumstances and patients with active urinary tract infection were excluded from the study. Urinary cultures were performed at 2-4 weeks, 5[th] week and more than 6[th] week of indwelling time and lower end of DJ stent cultures were also performed after removal

Results: 68 patients were included in the study with mean age 48.5 years [20-77 years age limits]. Among 68, 38 were male patients and 30 were female. Percutaneous nephrolithotomy [n = 5] and ureterorenoscopy [n =63] were the procedures after which DJ stenting was performed. Out of 68, 36 patients undergone right sided stenting and 32 patients undergone left side ureteric stenting. Urine culture was positive in 1 [1.47%] case and DJ stent cultures were positive for bacterial colonization in 4 [5.8%] cases. We do not found any statistical association between stent culture analysis and variables like gender, age of patient, or laterality. However we find statistical significance between stent indwelling time and colonization as evident by the results that the rate of colonization was 2.7% when indwelling time was less than 4 weeks, 4% colonization when indwelling time was 5 weeks as compared to 28.5% colonization when indwelling time was more than 6 weeks

Conclusion: These results showed that colonization rates increases when indwelling time increases especially when indwelling time exceeds 6 weeks. This study also refers to the fact that DJ stents can be kept safely for maximum duration of 6 weeks and indwelling time greater than 6 weeks will be associated with complication of urinary tract infection. Moreover this study also showed that one may find an infected colonized stents even if urine culture is negative for any growth

APMC-Annals of Punjab Medical College. 2016; 10 (3): 166-169
in English | IMEMR | ID: emr-185644


Background: Penile carcinoma is an uncommon condition, accounting for less than 1% of all male cancers. It typically presents as a superficial lesion involving the Glans and Penile Shaft. Risk factors for penile carcinoma include phimosis, human papilloma virus infection and tobacco smoking. The spread of the tumor to the loco-regional lymph nodes is the most relevant prognostic factor

Case Presentation: The current case report is about a 65 years old male who presented with non-healing ulcer involving glans and shaft of penis for two months. Examination of Perineum revealed an ulcer of size about 3 cm in length involving glans and distal penile shaft, with eaten up most of glans surface. Wedge biopsy histopathology report showed moderately differentiated Squamous cell carcinoma of the penis involving sub-epithelial tissue with lympho-vascular invasion and involvement of corpora cavernosa. CT-Scan abdomen with IV contrast showed no evidence of metastasis or lymphadenopathy. So partial penectomy was planned and carried out subsequently

Conclusion: Although squamous cell carcinoma of the penis a rare disease, mainly affecting the elderly population but all the penile ulcers not responding to medial therapy must be evaluated for malignancy. Most of these cases remain neglected because of inadequate evaluation and investigation by the local doctors which leads to late presentation. Due to these circumstances the patients have already metastatic disease at presentation. So, it is required to educate local doctors as well as general population to create proper awareness of this disease

APMC-Annals of Punjab Medical College. 2015; 9 (1): 45-47
in English | IMEMR | ID: emr-186175


Ureteric stents are being used for the last 25 years to relieve the renal obstruction. Ureteric stents are made of different biomaterials which can be retained in the human urinary system up to six months when properly indicated. Indwelling period of Double J ureteric stent in the case repot is 14 years, which is possibly the longest period ever reported. It was removed without any complication endoscopically. The stents of proper biomaterial should be used with judicious indication and should be removed or replaced according to the quality of biomaterial. Indwelling period will prolong with quality of biomaterial used

APMC-Annals of Punjab Medical College. 2015; 9 (3): 136-139
in English | IMEMR | ID: emr-186190


Background: DJ Stents have been in use since long for the management of ureteral obstruction. The obstruction may be due to stone, stricture, PUJ Obstruction etc. DJ Stents if kept for long time are associated with different complications like, blockage, break, migration, encrustation, stone formation etc. These long stayed DJ Stents need additional procedures for their removal like, URS, PCNL, and Pyelolithotomy etc

Objectives: i] to analyze the data retrospectively to see the number of patients having forgotten DJ Stents. ii] to see the level of awareness of patients regarding their DJ removal

Study Design: retrospective study

Place and duration of study: Urology Department, Allied Hospital, Faisalabad from Jan 2011 to Dec 2014

Materials and Methods: record of patients of forgotten DJ Stents for 4 years

Results: during 4 years period 35 patients were found to have forgotten DJ Stents and maximum duration of forgotten DJ Stents was 14 years. 41.66% patients in first group [indwell time 3- 12months] were having encrustations. Overall 11/35 [31.42%] needed litholopaxy for their DJ removal and 24/35 [68.57%] needed URS and it was successful in 22/24 patients. One patient needed PCNL and one had pyelolithotomy for their removal

Conclusion: patients should be stressed / counseled properly regarding its removal by telling its complication. Thread attached to the DJ stent may be left outside external urethral meatus. It must be properly documented in discharge slip. A register must be maintained to keep record of these patients and it should have their address and phone number so that they should be reminded of about their DJ removal well in time

Journal of Sheikh Zayed Medical College [JSZMC]. 2014; 5 (1): 569-574
in English | IMEMR | ID: emr-174472
APMC-Annals of Punjab Medical College. 2014; 8 (2): 121-125
in English | IMEMR | ID: emr-175337


Background: It has been a matter of great controversy whether the sonography [USG] and intravenous urography [IVU] both are mandatory for the evaluation of hydronephrosis and hydro ureter in female patients having urinary fistulae. So we planned to conduct a study on this subject

Objectives: To compare the sensitivity of IVU and USG in showing the degree of Hydro nephrosis and hydro ureter in the patients having VVF

Study Design: Prospective study

Place and Duration of Study: Department of Urology Punjab Medical College /Allied Hospital Faisalabad from January 2013 to October 2014

Methodology: Thirty consecutive female patients suffering from urinary incontinence who presented in outpatient department and were diagnosed to have VVF were taken for study. Patients with urge incontinence, patients with malignancy, patients who underwent surgery or received radiation were excluded from this study. Informed consent for study purpose and surgery were taken. USG and IVU were done in every patients to find the hydronephrosis or hydro ureter

Results: Twenty seven out of thirty patients who had not hydronephrosis on USG, they also had not hydronephrosis or hydro ureter on IVU, while only three patients had hydronephrosis on USG had also hydronephrosis on IVU

Conclusion: This study concluded that USG and IVU have almost equal sensitivity in finding hydro nephrosis or hydro ureter in patients having VVF. Therefore, any one of them can suffice to find out hydronephrosis. IVU is an invasive procedure and have the risk of reaction to contrast material and exposure to radiations. USG is cost effective, non-invasive and hence can be used in place of IVU

APMC-Annals of Punjab Medical College. 2013; 7 (2): 154-160
in English | IMEMR | ID: emr-175303


Introduction: Percutaneous Nephrolithotomy [PCNL] is an effective treatment for large renal calculi and usually a nephrostomy tube is placed in the kidney at the end of PCNL

Objective: To compare the outcome of conventional percutaneous nephrolithotomy with postoperative PCN tube versus tubeless Percutaneous Nephrolithotomy, in terms of duration of surgery and postoperative hospital stay

Study Design: Randomized control trial

Setting: Urology Department Punjab Medical College / Allied Hospital Faisalabad

Materials and Methods: Sixty patients were taken with non probability consecutive sampling technique. They were divided into group A[n=30] with conventional PCNL having postoperative nephrostomy tube and group B[n=30] with tubeless PCNL by computer generated random number table. They were compared in terms of duration of surgery and post operative hospital stay

Results: Age distribution of total patients ranged from 15 to 77 years, mean age was 35.07 +/- 15.89. Mean duration of postoperative hospital stay was 6.2 +/- 0.81and 4.07 +/- 1.2 days [p-value=00001] in group A and group B respectively. The operating time was 80 to 145, minutes, mean time 110.17 +/- 15.87 in group A. In group B, operating time was between 65 to 140 minutes mean time 95.18 +/- 22.43

Conclusion: Tubeless PCNL reduces duration of surgery and postoperative hospital stay significantly as compared to conventional PCNL with postoperative nephrostomy tube

APMC-Annals of Punjab Medical College. 2013; 7 (1): 10-16
in English | IMEMR | ID: emr-175317


Background: Hepatitis C is a worldwide public health problem nowadays. World Health Organization [WHO] estimates that 3 percent of the world population is infected with HCV. Voluntary blood donors have a very high prevalence of HCV infection especially in the developing world. The blood and blood components can be obtained from volunteer donors, direct donors, paid donors, or through autologous donation, hence the donors should be carefully interviewed and tested before blood donation

Objectives: To assess the incidence of false sero-negative Hepatitis-C blood donors and evaluate the costs, benefits and effectiveness of specific Tests of Hepatitis-C in public and private hospitals of city district, Faisalabad

Study Design: It was a cross-sectional hospital based study

Setting and Duration: The study was conducted in 3 public sector and 3 Private sector Hospitals of City district of Faisalabad. The study was conducted for one Year during 2010-2011

Sampling procedure: Non-probability Convenient sampling technique was employed

Sample size: The study included 600 blood donors who deposited their blood in the blood banks of the above hospitals for transfusion purposes

Results: The majority of the blood donors 70.83% were between the age of 18-25 years. Despite the fact that all the donors, in government and private hospitals groups respectively were found initially negative for hepatitis C on routine diagnostic test, yet considerable number of individuals, 14 [4.60%] and 46 [15.33%] in government and private hospitals groups, respectively were found unexpectedly positive for hepatitis C when scrutinized on ELISA diagnostic test. The results were found to be statistically significant when the P value was less than 0.05 [P<0.05]

Conclusion: All the individuals irrespective of their group were screened to be sero-negative for hepatitis -C, when tested on the routine laboratory test. But when their blood serum was tested by ELISA method, a sizeable number of individuals in both government and private hospital groups were screened as sero-positive for HCV. This state of uncertain performance of the routine laboratory test has given rise to unreliability of the diagnosis of hepatitis C by the routine test. It is, therefore, strongly recommended that only ELISA method should be ordered for authentic diagnosis of hepatitis C

APMC-Annals of Punjab Medical College. 2013; 7 (1): 21-23
in English | IMEMR | ID: emr-175319


Objectives: To evaluate the success and complications of intracorporeal cystolithotripsy in children

Design: It was prospective and descriptive study

Place and duration of study: Study was conducted in Department of Urology Allied Hospital, [PMC] Faisalabad from January 2011 to December 2012

Patients and Methods: Total number of 40 patients with vesical stone

Results: Children with average age of 7.23 years were included in study. Stones were completely removed in [90%] patients. Perforation occurred in 2.5% patients, 5% patients required redo intracorporeal cystolithotripsy due to stone impaction in urethra. 2.5% Patients needed open vesicolithotomy due to bleeding

Conclusion: Intracorporeal cystolithotripsy with pneumatic lithoclast is a safe and valid procedure for management of vesical calculi in children

APMC-Annals of Punjab Medical College. 2012; 6 (2): 126-130
in English | IMEMR | ID: emr-175253


Foetal hydronephrosis is commonly caused bycongenital pelviureteric Junction [PUJ] obstruction.It is either due to nerve deficiency or due to intrinsicmuscular defect at PUJ or it may be due to lowerpolar aberrant crossing vessel just compressing thePUJ. The purpose of this study is to see thecontribution of crossing vessels in causing the PUJobstruction

Aims and objectives: [1] to find thecontribution of crossing vessels in causing PUJobstruction on naked eye examinationperoperatively, [2] To histologicaly verify the causeof PUJ obstruction in cases of crossing vesselscompressing the pelvi-ureteric junction [PUJ]

Patients and methods: 27 cases of Congenital PUJobstruction were taken during four year period whowere candidatesfor operation. All underwent Anderson HynesPyeloplasty and specimen of PUJ with narrowsegment below it was taken and preserved in 10%formalin. The specimen was sent to histopathologistalong with other specimens where PUJ obstructionwas not caused by crossing vessels for nervedetection by S-100 immunohistochemistry and forhistopathological examination

Results: Five out of27 cases of PUJ obstruction were caused by crossingvessels and in these five cases, four [80%] werehaving normal histology showing that crossingvessels were the cause of PUJ obstruction merelycompressing the PUJ mechanically

APMC-Annals of Punjab Medical College. 2012; 6 (2): 150-155
in English | IMEMR | ID: emr-175257


Objectives: To assess the causative factors and outcome of surgical management of Vesicovaginal fistula [VVF] in our set up

Duration and Design of Study: Retrospective descriptional study from January 2008 to June 2012 conducted at Department of Urology PMC/Allied Hospital Faisalabad

Methodology: All patients with VVF who presented in our out patient department and underwent surgical repair in our department were included in this study. The records of patients were reviewed and data was entered in a structured proforma and analyzed. After history, physical examination, relevant investigations, IVU, Cystoscopy and vaginoscopy, patients were divided into two groups. Patients with supratrigonal fistula were operated through abdominal approach and those with infratrigonal fistula were operated through vaginal approach. The outcome of surgical procedures and post operative complications were noted

Results: This study included 68 patients. In 42 [61.76%] patients, cause of VVF was iatrogenic injury during hysterectomy, and 26 [38.24%] patients developed VVF due to obstetric causes. Fifty patients [73.53%] had supratrigonal fistula and eighteen patients [26.47%] were having trigonal or subtrigonal fistula. We achieved 90% and 83.33% success rate with abdominal and vaginal repair respectively

Conclusion: The most common cause of VVF is iatrogenic injury during hysterectomy. Both approaches of surgical repair had almost equally good results

APMC-Annals of Punjab Medical College. 2011; 5 (2): 159-161
in English | IMEMR | ID: emr-175232


A 75 years old man having a permanent pacemaker [PPM] presented to the Department of Urology Allied Hospital Faisalabad, with severe lower urinary tract symptoms. On history he had strangury, burning micturition, dysuria and hematuria. His International Prostate Symptom Score [IPSS] was severe [29 out of 35]. On Digital Rectal Examination [DRE] there was a moderately enlarged prostate with firm consistency. On ultrasonography prostate size was about 40gm. Transurethral resection of prostate [TURP] was planned. Due to PPM it was hazardous to use monopolar electrocautery in TURP. Indifferent electrode plate of diathermy was placed under the gluteal region bypassing the chest [heart and pacemaker] to remain the circuit in limited area. During surgery no fluctuation in blood pressure and no any extra ECG changes were found on cardiac monitor. Peroperative procedure and postoperative recovery was uneventful

APMC-Annals of Punjab Medical College. 2010; 4 (2): 101-106
in English | IMEMR | ID: emr-175199


Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases

APMC-Annals of Punjab Medical College. 2009; 3 (2): 86-89
in English | IMEMR | ID: emr-104436
APMC-Annals of Punjab Medical College. 2009; 3 (1): 8-12
in English | IMEMR | ID: emr-104454


To ascertain the efficacy of transurethral Ureteroscopy [URS] and Pneumatic Lithoclasty for the management of ureteral stones. This retrospective study was conducted from December 2005 to December 2009 at the Department of Urology and Renal Transplantation, Allied Hospital/Punjab Medical College, Faisalabad and Hospitals in Private sector. Patients with stones of different sizes and at different levels in the ureter were included in the study. Patients of less than 12 years of age and also patients with ureteric stones more than 3 cm were not included in the study.Such stones were managed by open Ureterolithotomy. A total number of 540 patients with ureteric calculi were included in the study. Cause of ureteric obstruction was stones in all cases. Among these 450 patients, 209 [38.6%] patients presented with lower ureteric stones, 266 [49.20%] patients presented with stones in the mid ureter, 65 [12.2%] patients presented with stones in the upper ureter. Bilateral ureteric calculi were present in 95 [17.5%] cases. Out of 540 cases 57 [10.62%] patients presented with anuria and they were initially treated by Percutaneous Nephrostomy PCN to relieve the obstruction followed by URS and Lithoclasty. Overall, ureteric stones at different levels and of different sizes were treated successfully in 480 [89.0%] patients and in remaining 60 [11.0%] patients stones could not be broken. Stones were successfully fragmented and cleared in the 198 [94.73%] of 209 patients with stones in the lower ureter, in 253 [95.11%] of 266 patients with stones in the mid ureter and in 29 [44.61%] of 65 patients with stones in the upper part of ureter. Stones were successfully fragmented in 347 [98.21%] out of 354, 92 [85.18%] out of 108 and 41 [52.56%] out of 78 patients with stone sizes of <1 cm, 1-2 cm and 2-3 cm respectively. DJ stents were inserted in 426 [78.81%] cases. Procedure was not successful in 60 [11.0%] patients. Stones were migrated up in to renal pelvis in 31 [5.73%] patients, stone fragmentation failure was in 13 [2.40%] patients, failure of URS insertion up to stone was in 6 [1.10%] patients and ureteric avulsion was in 1 [0.18%]. Transurethral rigid Ureteroscopy is still an acceptable procedure in the treatment of ureteric calculi of different sizes at different levels and it can be used safely with very good results in expert hands

APMC-Annals of Punjab Medical College. 2008; 2 (2): 80-86
in English | IMEMR | ID: emr-108397


To compare the results of Tubularized Incised Plate Urethroplasty with Mathieu repair and transverse inner perpuitual skin flap [Asopa's repair]: For Distal Hypospadias repair 30 patients were treated with Tubularized Incised Plate Urethroplasty and 30 were managed with Mathieu repair. For proximal hypospadias repair 20 patients were treated by Tubularized Incised Plate Urethroplasty and 20 patients were managed by Asopa's repair. The mean age at presentation was 7 years. Good cosmetic and functional results were achieved by all techniques. The overall success rate of Tubularized Incised Plate Urethroplasty was 86.6% and that of Mathieu repair 83.3% for the management of distal hypospadias. Success rate of Tubularized Incised Plate Urethroplasty was 85% and that of Asopas repair was 75% for the management of proximal hypospadias. Regarding Distal Hypospadias. In Mathieu repair; Urethrocutaneous fistula developed in 04 patients and total disruption in 01 patient. Meatal stenosis occurred in 02 cases who responded well to regular dilatation. In Tubularized Incised Plate urethroplasty 03 patients developed urethrocutaneous fistula. Total disruption in 01 patient and meatal stenosis was seen in 03 cases which responded well to regular dilatation. Regading proximal Hypospadias. In Tubularized incised plate Urethroplasty; 03 patients developed urethrocutaneous fistula and 01 patient presented with total disruption. Meatal stenosis was seen in 01 patient that needed meatatomy. In Asopas repair 03 patients developed urethrocutaneous fistula and 02 presented with total disruption. All the techniques are good for hypospadias repair. However Tubularized incised plate Urethroplasty proved to be the better technique for management of all type of hypospadias

Humans , Male , Adult , Child, Preschool , Child , Adolescent , Urethra/surgery , Surgery, Plastic/methods , Treatment Outcome , Postoperative Complications
APMC-Annals of Punjab Medical College. 2007; 1 (2): 3-8
in English | IMEMR | ID: emr-118818


Pakistan's image as civilized society has been tarnished in recent years because of several factors. One of the factor had been human organ ["Kidneys"] trade which has shifted from India to Pakistan. Media, in particular had gone to the extent of labeling it as shifting of "Kidney Bazar", "Bombay Bazar" from India to Lahore and Islamabad. We as a nation have failed to promulgate cadaveric law. Even the medical community is not aware of the curse of non-related renal Transplantation in Pakistan. You discuss the dilemma of Kidney trade even with medical students and young doctors, they may have opposite opinion and perceive it as a "life saving" procedure. They may not be able to differentiate between "Altruistic" and "Commercial interests" involved in the "trade" of renal transplantation. This review will highlight some of the ethical aspects of this important topic concerning our nation at this time of actual implementation of Cadaveric Law