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

Transurethral resection; a critical evaluation of the results

To establish the current usage and results of transurethral resection of prostate in patients of benign prostatic obstruction [BPO] who presented with severe irritative and obstructive prostatic symptoms. Saleem Medical Complex Hospital Quetta. Period: From April 1997 to December 2004. Transurethral resections for BPO were performed with 5% dextrose water in 500 consecutive patients. All these patients were followed for early and late complications and followed up to 6 months after TURP. Significant symptomatic improvement has been observed with minimal morbidity [14%]. None of the patient had significant hematuria and TURP syndrome. Mean operative time was 45.0 minutes. Mean interval to catheter removal was 26 hours. Only 15 patients [3%] revealed neoplastic changes in resected tissues. Incidence of secondary hemorrhage, stricture urethra, epididymo-orchitis, retrograde ejaculation and impotence were observed in 10 [2%], 20 [4%], 10 [2%], 5 [1%] and 20 [4%] patients respectively. Only 15 patients [3%] who developed post-operative retention and Re-TURP were performed in two patients for the residual prostatic tissue. None of the patient developed incontinence of urine. Pre operative and postoperative history of libido and sexual behavior was also assessed

Efficacy of extracorporeal shockwave lithotripsy for urolithiasis in adults

The aim of this study is to prove or disprove any statistically significant difference in the stone-free status and retreatment rates according to stone location i.e. Renal [R], upper third ureter [UTU], middle third ureter [MTU], lower third ureter [LTU] and surface area.. Hundred adult patients, who were treated by ESWL. between 2005 and 2006, were studied according to the above-mentioned protocols. The results of the study showed a very high stone-free rate [95.00%] regardless of stone location and surface area. Except for the best stone-free rate in [UTU], there was no difference in success rates in [R], [MTU], [LTU], as far as size and location are concerned; however, there was a statistically significant difference in treatment rates regarding stone location and surface. At present, ESWL, as first line of single therapy, is equally effective for most urinary stones including lower third ureteral stones thus obviating the need for secondary endoscopic interventions

Benign prostatic obstruction successfully treated by transurethral reselection

To evaluate the results of transurethral resection of prostate [TURP] in patients having benign prostatic obstruction [BPO]. Five hundred patients were operated in 7 years using 5% dextrose in water and 26 French Storz resectoscope. All patients were followed for early and late complications up to 12 months. Significant symptomatic improvement was observed in majority of the cases with a morbidity of 15 %. None of the patient experienced significant hematuria or TURP syndrome. Mean operative time was 45.0 minutes with a mean interval to catheter removal of 26 hours. Twenty patients [4 %] developed post-operative retention due to residual clots. Re-TURP was performed in 10 patients for residual prostatic tissue. Histology revealed neoplastic changes in 15 patients [3%]. Secondary hemorrhage and erectile dysfunction were seen in 20 cases each [4%] while 10 cases each [2%],had epididymo-orchitis and retrograde ejaculation,5 cases had stricture urethra. TUR [P] is an effective procedure for benign prostatic hypertrophy which has minimum morbidity and low mortality. It has replaced open prostatectomy in majority of cases

Evaluation of low ligation and high ligation procedures of varicocele

To describe the mode of presentation of varicocele and to compare the low ligation [Inguinal approach/Ivanissevich's procedure] and high ligation [Retroperitoneal approach / modified Palomo's procedure] of varicocele repair regarding efficacy and postoperative complications. Design: Institutional-based randomized comparative clinical trial. Place and Duration of Study: This study was conducted at the Urology Department, Bolan Medical College and Sandeman Provincial Teaching Hospital, Quetta from December 1996 to November 2001 [5 years]. Subjects and A total of 213 patients of varicocele who underwent treatment in the department and completed 6 months follow-up were included in the study. The mode of presentation of varicocele was recorded for all patients. For treatment purpose patients were randomly divided into two groups: in group I [n: 115] varicocele was ligated by inguinal approach [Ivanissevich's procedure] while in group II [n: 98] by retroperitoneal approach [modified Palomo's procedure]. The efficacy and postoperative complications of the two procedures were carefully recorded and compared between the two groups. The mean age of the patients of group-I and group-II was 27.2 and 27.5 years respectively. More than 50% patients of both groups presented with feeling of heaviness/ dragging sensation on ipsilateral side. Presentation with infertility/sub fertility in group-I and group-II was 16.5% and 15.3% respectively. Majority of patients of both groups had grade III varicocele with visible deformity. The rate of postoperative complications was very low in both groups of patients. Recurrence of varicocele and postoperative hydrocele formation were slightly more common in group-II as compared to group-I but the difference was statistically not significant [p>0.05]. An extremely significant improvement occurred postoperatively in both sperms density and motility in infertile /sub fertile patients of both groups. Both procedures of varicocele repair are equally effective and have a low rate of complications. There is no significant difference in postoperative complications. An extremely significant improvement occurs in semen parameters of infertile/sub fertile patients postoperatively, irrespective of method / technique of varicocelectomy

Dietary risk factors and impact of drinking water on urolithiasis at Quetta

This study was conducted at PCSIR Laboratories, Lahore and Department of Pathology, Bolan Medical College, Quetta from January 1991 to December 1991. Impact of drinking water i.e. its hardness and calcium contents on urolithiasis was studied. Thirty adult patients, both males and females of upper urinary tract stones [Group-1] compared with those of 17 age matched control [Group-11] from Quetta city were included in this study. Mean age of Group-1 was 30.63 and +/- SD 3.58 and of Group-11 was 28.62 +/- SD 2.60. Mean serum calcium level of Goup-1 was 9.56 mg/100ml and +/- SD 0.7 and of Group-11 was 8.8mg/100ml +/- SD 1.30, which was significant [p<0.05]. Mean 24 hours urinary excretion of calcium in Group-1 was 287.79 [ +/- SD 181.29] and in Group-11 187mg [ +/- SD 88.91], which is significant. Mean serum uric acid was 5.37mg/dl [ +/- SD 1.66] in Group-1 and 5.40mg/dl [ +/- SD 1.52] in Group-11 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 it was 314.29mg +/- SD 173.49 [significant at p<0.05]. Stone formers had a mean 24-hour urinary out put of 1336.7 ml +/- 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-1 had 6.24 +/- SD 0.78, while in Group-11 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 of Quetta were also analysed