Comparison of single dose and three day ciprofloxacin prophylaxis regimen for transrectal ultrasound guided prostate biopsy

Background: Prostate cancer incidence is rising leading to a major health problem globally. Infectious complications in TRUS guided prostate biopsy are very common without antibiotic prophylaxis

Objective: To compare the effect of single dose and three day ciprofloxacin prophylaxis regimen for prevention of urinary tract infection after prostatic biopsy

Methodology: This randomized controlled trial involved 130 patients with Prostate cancer which were randomly allocated into 2 groups. Group-A received two ciprofloxacin 500 mg tablets stat while Group-B received 3 days has of ciprofloxacin treatment. Patients were followed up to 5 days to observe any symptoms of UTI. Written informed consent was taken from all the patients. The data was entered and analyzed using SPSS version 19

Results: The mean age of the patients was 56.84 +/- 7.28 years. The mean age of the patients in Group-A was 56.44 +/- 7.10 years while in Group-B it was 57.23 +/- 7.50 years. However, there was no statistically significant difference between groups in terms of age. On follow up at 5 days, 11 patients has UTI. The rate of presence of UTI was similar across different age groups and treatment regimens. Treatment with one-day antibiotic prophylaxis resulted in UTI in 6[9,2%] associated with in comparison to three days' antibiotic treatment, where 5 [7.6%] has UTI. [P=0.64]

Conclusion: The incidence of UTI with one-day antibiotic prophylaxis with ciprofloxacin was comparable to three antibiotic treatments in patients who are candidates for TRUS guided biopsy

Comparison of Mathieu vs tubularized incised plate [Snodgrass] techniques of urethroplasty in distal penile hypospadias

Background: Hypospadias is a congenital abnormality characterized by opening of external urethral meatus on ventral aspect of the penis with an overall incidence of 1:300. Different treatment modalities have been employed in the treatment of distal penile hypospadias with varying degrees of success and complications. A number of studies have compared Mathieu and Snodgrass Techniques but the existing evidence is doubtful owing to small sample size and great variation in their results

Objective: To compare the outcome of Mathieu repair with that of tubularized incised Plate Urethroplasty [Snodgrass] in distal penile hypospadias

Methodology: 90 patients meeting the inclusion and exclusion criteria's were selected and divided into two equal groups randomly using lottery method. Group-A was treated by Mathieu technique and Group-B underwent Snodgrass repair. Operative time was noted in minutes from the start of procedure till the end. Patients were followed post-operatively at 15[th] day, 1 Month and 2 Months and functional recovery and complications were evaluated

Results: The age of the patient ranged from 1 to 25 years in both groups with mean age of 6.67+/-5.74 years in Group-A and 6.65+/-6.06 years in Group-B [p=0.982]. Snodgrass was better in terms of mean operative time [67.37+/-8.85 minutes versus 87.86+/-8.22; p=0.00] as compared to Mathieu technique. The functional outcome in terms of meatal location at tip was better in Snodgrass [93.7% versus 80.2%; p=0.003] with a lower fistula rate [5.4% versus 21.6%; p=0.00] as compared to Mathieu technique

Conclusion: Tubularized Incised Plate Urethroplasty [Snodgrass] is better than Mathieu technique for the treatment of distal penile hypospadias in terms of operative time, success and complication rate

Perceptions of medical students about educational environment at services institute of medical sciences, Lahore

Objective: the objective of this study was to assess the perceptions of undergraduate medical students of Services Institute of Medical Sciences [SIMS], using DRE EM questionnaire

Material and Methods: all students from the final year MBBS class of the medical college [n=150] were included in the study. The non-parametric chi-square test and Mann Whitney U Test were used to determine the significance of differences [proportion of frequencies] for individual items

Results: the total no of final year students of medical college were 150 with 135 respondents with 43% males and 57% females. DREEM score SIMS medical college in metropolitan city was 118.6 indicating a positive perception

Conclusion: DREEM is a valid instrument for the measurement of students' perceptions worldwide. The students of SIMS have positive perception about educational environment of the institute

Efficacy of pneumatic Lithoclast in the management of ureteric calculi

Background: To assess the efficacy and safety of pneumatic lithoclast in the management of ureteric calculi

Methods: One hundred and four patients with ureteric calculi were treated by pneumatic lithoclast at department of Urology Services Hospital Lahore from Jan 2005 to December 2006. Record of the patients was analyzed retrospectively. Patients above 15 years from both sexes with calculi measuring more than 0.5cm [in the largest diameter] were treated in upper, middle, and lower ureter. Calculi were approached with 8fr ureteroscope and fragmented with Swiss lithoclast. After the completion of the procedure, ureter was stented. Patients were followed up till they became stone free. Following parameters were assessed: stone size, site, laterallity, degree of fragmentation, success rate, stone migration, type and duration of stenting, post operative hospital stay and complications. Requirement of another procedure or inability to enter the ureter were considered failure

Results: One hundred and six ureteric calculi were treated in 104 patients. Amongst those, 22 stones were in upper ureter, 16 in the middle ureter and 68 stones were in lower ureter. Mean stone size was 11.2mm [largest diameter]. Overall success rate was 89.2%. Whereas success rate in upper, middle and lower ureter was 63.6 %, 87.5% and 95.6% respectively. Mean postoperative hospital stay was 26.5 hours. There were no major complications

Conclusions: Pneumatic lithoclast with URS is effective and safe in the management of the ureteric calculi. However, success is limited in the upper ureter

Percutaneous Nephrolthotomy [PCNL]

Background: SIMS/Services Hospital Urology department presented its initial experience of Percutaneous Nephrolithotomy [PCNL] with promising results

Aim: To assess the efficacy and safety of PCNL in the management of Renal stones

Methods: Prospective study of 40 patients who underwent PCNL. Procedure performed in General Anasthesia. Placement of ureteric catheter in Lithotomy position to visualize the collecting system. Ureteric catheter and Foley catheter retained in a sterilized bag. Patient shifted to prone position with C-Arm at 0[degree]. Nephrostomy needle placed over desired calyx and tract dilated with metallic dilators. Stone crushed with swiss lithoclast and fragments removed with stone graspers. Foley catheter placed at the end of procedure percutaneously. X-Ray KUB done post operatively and both Foley and ureter removed subsequently

Results: In total 40 patient 27 [67.5%] male and 13 [32.5%] female the success rate with PCNL as monotherapy was 72.5%. It was 82.5% when combined with ESWL

Conclusion: Percutaneous Nephrolithotomy [PCNL] is effective monotherapy for renal stones and gives excellent results when combined with ESWL

Calculus related acute renal failure; management strategies

Background: Urolothises is one of the most common and oldest diseases of urinary tract. It is endemic Pakistan and the incidence of calculus renal failure is high. This is due to poor initial management

Methods: it is an observational study conducted at the Department of Urology, Services Hospital, Lahore from April 2001 to March 2003. In this study we evaluated the patients with calculus renal failure regard“; their preoperative, operative, postoperative management and improvement in renal function after the removal of stones. Twenty patients, 13 male and 7 female were included in this study. The chief presenting symptom was anuria in 20 [100%] of patients. Ultrasonography, X-ray KUB and Ante-grade pyeiogrqahy were the main investigations regarding the site, size of stone, degree of hydronephrosis and echogenicty of the kidneys. Percuta-neous Nephrostomy alone, Acute Peritoneal Dialysis alone and Pereutaneous Nephrostomy with Acute Peritoneal Dialysis were the emergency procedures performed to save the lite ot the patients and to plan for a definite surgical procedure. After the stabilization of the renal function. definite surgical procedure in the tom of pyelo-lithotomy and ureterolithotomy were performed

Results: Results were analyzed by considering the duration of anuria, degree of obstruction [hydrawephmsis] and duration of maximum improvement. Overall thirteen [65%] patients had good result five [25%] patients had satisfactory results and two [10%] patients had poor results. Anuria due to stones in the unnary tract is a urological emergency

Conclusion: Prompt and early interventions can save the patient from developing irreversible renal damage