Childhood circumcision, indications and complications

Circumcision is the most commonly performed operation in males worldwide and is an integral part of several religions like Islam and Judaism. Medical indications of circumcision are a few. Circumcision is contraindicated in a number of congenital penile disorders, including hypospadias, epispadias, chordee, buried penis and micropenis. Various techniques are available for performing circumcision. Complications include haemorrhage, infection, and meatal injury resulting in stenosis, removal of incorrect amount of skin, penile injury, urethral injury and painful scarring. However many of these complications can be prevented by using precise surgical techniques, meticulous asepsis and haemostasis

Objectives: To note indications, age of children and complications developing after circumcision

Patients and Methods: The study was conducted in the Surgical Department of Ch. Rahmat Ali Memorial Hospital, Township, Lahore, from Jan 2009 to Dec 2011. A total of 1000 cases were included in the study

Results: 860 [86%] children had circumcision performed in the surgical department and 140[14%] were referred to our unit after circumcision performed by quacks, barbers and general practitioners, after developing some complications. Ritual [religious] circumcision was done in 936 [93.6%]. 64 [6.4%] had medical indications. Out of 936, 815 [87%] were Muslims and 121 [13%] were non Muslims. 64 [6.4%] children were circumcised because of medical indications, mainly phimosis and paraphimosis. 140 [14%] children were referred to our unit because of complications, mainly bleeding in 34 [24%], infection in 20 [14.2%], under circumcision in 85 [60.7%] and excessive removal of skin in 1 [0.7%] child. The only complication which occurred in children operated in the hospital was infection in 6 [0.7%]children. Ages of the children were: Less than 1 month- 208 [20.8%] 1 to 12 months- 655 [65.5%] 1to 5 years- 110 [11%] More than 5 years- 27 [2.7%]

Experience with cold knife optical internal urethrotomy

To evaluate the outcome and efficacy of cold knife optical internal urethrotomy. A retrospective analysis of 300 cases. The study was carried out over a period of 3 years [January 2005 to December 2007] in the Department of Urology, Bolan Medical College and Salim Medical Complex, Quetta. Three hundred male patients with urethral strictures were treated with cold knife optical urethrotomy over a period of 3 years. An analysis was carried out of the long-term results of optical internal urethrotomy to determine the outcome and efficacy of the procedure. The mean age was 25 years [range from 15-60 years]. The follow-up period on treated patients ranged from 3 months to 1 year. The results showed that early morbidity was 15.6% with no mortality. The recurrence rate was 6% [18 out of 300]. The results are consistent with other studies and confirm this as the preferred initial procedure in urethral strictures of bulbar, membranous and proximal penile urethra. Optical internal urethrotomy is safe and effective in the management of un-complicated urethral stricture. Urethroplasty should be considered in failed optical urethrotomy and recurrent stricture disease

Impact of drinking water and other causative factors for nephrolithiasis

Impact of drinking water i.e.. its hardness and calcium contents on urolithiasis was studied. Thirty adult patients, both males and females of nephrolithiasis [Group-I] compared with those of 34 age matched control [Group-II] were included in this study. Mean age of Group-I was 30.63 and +/- SD 3.58 and of Group-II was 28.62 +/- SD 2.60. Mean serum calcium level of Goup-I was 9.56 mg/100ml and +/- SD 0.7 and of Group-II was 8.8mg/100ml +/- SD 1.30, which was significant [p<0.05]. Mean 24 hours urinary excretion of calcium in Group-I had 287.79 [ +/- SD181.29] and in Group-II had 187mg [ +/- SD 88.91], which is significant. Mean serum uric acid was 5.37mg/dl [ +/- SD 1.66] in Group-I and 5.40mg/dl [ +/- SD1.52] in Group-I 1 which is non significant. Mean 24 hour urinary excretion of uric acid in stone patients was 424.31mg +/- SD 142.16 and in normal subjects was 314.29mg +/- SD173.49 [significant at p<0.05]. Stone formers had a mean 24-hour urinary out put of 1336.7ml +/- SD 773.83, while non-stone formers had a mean out put of 1129.41ml +/- SD 512.36, which is not significant. Mean pH of freshly voided urine of Group-I had 6.24 +/- SD 0.78, while in Group-II had 6.12 +/- SD 0.38 and was not significant. Economic status and family history of both group was also analysed. Mean +/- SE Comparison of various variables of drinking water was also analysed