effect of two weeks preoperative finasteride therapy in reducing prostate vascularity

Objective: To determine the effect of two weeks preoperative finasteride therapy in reducing prostate vascularity in terms of mean microvessel density [MVD] and expression of VEGF in prostate urothelium among patients of BPH by comparing with controls. Study Design: Randomized controlled trial. Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2013 to January 2014

Methodology: A total of 80 patients of Benign Prostatic Hyperplasia [BPH] planned for Trans-Urethral Resection of Prostate [TURP] having prostate size of more than 40 grams on trans-abdominal ultrasonography was randomized into two groups, each group having 40 patients. The finasteride group [Group A] was prescribed oral 5 mg of finasteride daily for 2 weeks before surgery. The control group [Group B] did not receive any agent. After 2 weeks, TURP was performed and prostate samples were sent for histopathological determination of MVD and expression of VEGF

Results: The mean age of patients was 66.21 +/- 10.08 years, ranging from 48 to 86 years. The mean prostate gland size was comparable in both groups [55 +/- 10.7 vs. 58.1 +/- 10.8 grams, p=0.21]. Mean MVD in finasteride group [20.25 +/- 10.3] was significantly lower as compared to control group [48.9 +/- 22.6, p < 0.001]. Similarly expression of VEGF was also significantly lower in finasteride group [30%] as compared to control group [65%] [p= 0.0017]. Mean MVD had a significant weak correlation with the size of prostate gland on Pearson correlation test [2-tailed] with r = 0.222

Conclusion: Finasteride reduces microvessel density and hence prostate vascularity with only 2-week therapy and the mean MVD is clearly correlated with size of prostate

Stone-free-rate after extracorporeal shockwave lithotripsy in the management of pediatric renal stones in lower pole and other locations - a comparative study

Objective: To determine a difference in the stone-free-rate among different renal locations in children after extracorporeal shockwave lithotripsy [ESWL]

Study Design: A descriptive study

Place and Duration of Study: Urology Department, Shifa International Hospital, Islamabad, Pakistan, from January 2007 to June 2015

Methodology: The study included children who underwent ESWL, divided into three groups based on location of stones in kidney as group A [lower pole stones], group B [upper and mid pole stones] and group C [renal pelvis stone], respectively. ESWL was done by standard technique using Storz Modulith SLX lithotripter 3rd generation. Data was collected by chart review. SPSS version 16 was used for data analysis

Results: Among 76 children with mean age of 7.55 +/- 4.16 years, 55 [72.4%] were males whereas 21 [27.6%] were females. Mean stone size was 1.08 +/- 0.59 cm. There were 34, 17 and 25 cases in groups A, B and C, respectively. Post-ESWL stone-free-rate was 47% in lower pole stones, 70.58% in upper and mid pole stones, and 68% in renal pelvis stones. Hematuria was seen in one patient from each group, sepsis in two patients from each of the mid pole/upper pole and lower pole group, while Steinstrasse in one patient from each group

Conclusion: ESWL is a safe and effective way of treating renal stones in all poles in pediatric population

Constipation in pediatric patients with Lower Urinary Tract Symptoms

Objective: To determine the frequency of constipation in patients with pediatric age group presenting with Lower Urinary Tract Symptoms [LUTS]

Study Design: Descriptive study

Place and Duration of Study: Outpatient Department of Urology in Pakistan Kidney Institute at Shifa International Hospital, Islamabad, from November 2012 to February 2014

Methodology: Two hundred pediatric patients presenting with Lower Urinary Tract Symptoms [LUTS] were studied in terms of age, gender, obstructive and irritative types of LUTS along with any associated symptoms. Constipation was assessed by Bristol stool chart in these patients. Patients with exstrophy of bladder were excluded from the study. Descriptive statistics were measured for both qualitative and quantitative variables. For qualitative variables like gender, presenting symptoms, constipation and stool types, percentages and frequencies were calculated. For quantitative variables like age, percentages / mean +/- SD were calculated

Results: Mean age was 6.87 +/- 3.64 years with a range of 2 - 14 years. Constipation was found in 37.5% of the pediatric patients with lower urinary tract symptoms

Conclusion: Constipation is frequent and overlooked problem in pediatric patients having urinary symptoms. Irritative lower urinary tract symptoms are more common. Children up to 5 years of age are the most common sufferers. Knowing the burden of constipation in such patients can help physicians in better treatment of such cases