Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone.

Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL) by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001). Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05). In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A than in Group B and Group C. Multiple logistic regression analyses revealed that slow delivery rate (60 SW/min) as well as age (younger), symptom (painful) at onset, stone location (upper and middle calyx) and size (small) were independent prognostic factors determining stone clearance after ESWL of renal stone. Conclusion: Slow rate shock wave delivery improves efficacy of ESWL treatments of renal stone and decreased number of sessions, shock waves and treatment time.

Role of free to total prostate specific antigen ratio in serum in the diagnosis of prostatic enlargement.

This study was aimed to demonstrate the significance of free/total Prostate Specific Antigen (PSA) ratio in the diagnosis of prostatic enlargement. The study was carried out in a total number of 100 subjects, of which 58 had benign prostatic hyperplasia (BPH), 42 had carcinoma prostate and 50 were age matched control. The subjects were collected from Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU). Venous blood (5ml) was drawn from each subject before digital rectal examination or pre-urethral manipulation for estimation of PSA. Final diagnosis was made by histopathological examination, specimen being obtained by transurethral resection of prostate (TURP), open prostatectomy and per rectal tru-cut biopsy with biopsy gun. The study showed a highly significant difference of serum PSA and free/total PSA ratio in differentiating BPH from carcinoma prostate. Free/total PSA ratio was highly significant in differentiating between BPH and carcinoma prostate (p<0.001) and carcinoma prostate and control (p<0.001). In the marginally elevated PSA, free/total PSA ratio reduced biopsy by 81-85% in BPH and carcinoma prostate respectively. The overall specificity, positive predictive value and efficiency of free/total PSA was much higher than that of total PSA in differentiating BPH from carcinoma prostate.

Incidence of malignancy in microscopic haematuria: a study of 100 cases.

During June, 1998 to April, 2000, one hundred cases of microscopic haematuria were evaluated. All were symptomatic patient with age ranging from 24-68 years. 70 (70%) cases were male and 30 (30%) cases were female. Commonest presentation was dysurea 70 (70%). Urinary stone disease was the commonest cause found to be present in 25 (25%) cases. Malignant lesion was found in 16 (16%) cases of which bladder tumour was found in 10 (10%) cases.