Fournier's gangrene and its management

To find out major causes of Fournier's gangrene and evaluate its management. A retrospective study was done at Department of Urology JPMC, Karachi, and records of all 32 patients with Fournier's Gangrene over 4 years' period i.e. from December 2001 till 2005 were reviewed. Mean age was 48 years, all being male. All presented with an average delay of 2-10 days. Involvement was typical, with 70% extending to lower abdominal wall, and 10% to perianal region. 37.5% presented with septic shock. Cause being urological in most of the cases [78.13%], followed by anorectal in 6.2% and idiopathic in 15.6%. Associated diseases were diabetes mellitus in 37.5%, uraemia in 12.5% and hepatic failure in 6.25%. 25% patients died due to multiorgan failure in our study. Aggressive surgical debridment with supportive measures remained the key to success

An experience of percutaneous nephrolithotomy

Percutaneous nephrolithotomy [PCNL] as monetherapy and especially in combination with extracorporeal lithotripsy [ESWL] has almost diminished the need for open surgery and offers an excellent modality for large renal calculi with very little morbidity. The objective of this study was to share our initial experience of Jirst fifty cases. The study was conducted at Department of Urology, Jinnah Postgraduate Medical Center Karachi from August 2002 to March 2004, Fifty adult patients with mean age 35+15 years, [34 male and 16 females] having stone size >2.5cm causing some hydronephrosis were included in this study. General anesthesia was given in all cases and after insertion of retrograde ureteric catheter, access to a suitable calyx was gained using fluoroscopic antegrade approach. In 32 [72%] patients stones were completely removed and in 12 [27%] patients ESWL was done for residual fragments. There were three conversions to open two due to excessive bleeding and one because of tract access failure. Mean operating time was 1 hour 25 minutes and average hospital stay was 3 days. Minimal complications occurred Le. urosepsis in 3 [6%], urinary fistula wound infection and ureteric stone in one each