Effect of Tamsulosin on stent related symptoms; a prospective study

Introduction: Cystoscopic intraluminal placement of ureteral stents has become a routine practice in urology. Ureteral stents preserve urine flow from the kidney to the bladder in cases of ureteral obstruction [intrinsic or extrinsic]. In patients with obvious ureteral obstruction, the placement of a ureteral stent will restart urine transport and protect the kidney from possible risks. Ureteral stents are troublesome in some patients and causes LUTS. Study Design: Prospective randomized controlled trial. Setting: Urology Department, Sheikh Zayed Hospital Lahore. Period: Six month started from August 2015 to December 2015

Material and Methods: 100 patients who were randomly divided into two equal groups. The patients were between 18 to 50 years of age of both gender undergo retrograde double-J ureteral stent placement. Before the double-J stent will be applied, all patients completed an International Prostate Symptom Score [IPSS] questionnaire for evaluation of lower urinary tract symptoms. Patients were divided in two groups on the basis of lottery method tamsolusin group [1] and placebo group [2]. Tamsulosin group patients was given tamsulosin post operatively and placebo group was given a placebo postoperatively

Results: There were total 100 patients who were enrolled in this study with a mean age of 42.63 +/- 6.24. There were 75[75%] were male while 25[25%] were female. The mean IPSS sore at presentation was 2.47 +/- 1.43 and post treatment was 5.20 +/- 1.65. There was significant difference in IPSS score in control group with mean 5.28 +/- 1.69 versus study as mean 2.22 +/- 1.05 group, p-value= 0.010

Conclusion: There is difference in lowering of IPSS score in the patients who are given tamsolusin versus those who were retained on placebo

Single centre experience of transperitoneal radical tumour nephrectomy

Objective: To share the experience of radical nephrectomy through transperitoneal approach

Material and methods: After approval from ethical committee and the consent from patients a retrospective study vas conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal ell carcinomas, staging, per operative and early post operative complications. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history nd physical examination was performed. Haematological and radiological investigations including ibdominopelvic ultrasonography and CT scan abdomen and pelvis were performed to stage the renal umour. High resolution CT chest was performed where indicated. Radical nephrectomy performed hrough transabdominal approach and outcomes measured in terms of per-operative and early postoperative complications

Results: There were total of 50 cases. The male to female ratio was 3:2. Vlean age of patients was 52.38 [18-93] years. Most common clinical presentation was gross haematuria [66%]. The mean tumour size was 8.34 [3-24] cm. Operative findings were suggestive of tumor limited to Gerota's fascia in 40 patients [80%] and in 6 [12%] tumor was extending into renal vein or inferior vena cava. In these cases, venacavatomy had to be performed. Lymphadenectomy was performed in 2 patients [4%] who were having enlarged hilar lymph nodes. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 [4%], while aortic injury was observed in one [2%] patient. Post operatively one [2%] developed pulmonary embolism, 2 [4%] chest infection while 2 [4%] developed wound infection and 3 patients [6%] required blood transfusion. Tumour histology was clear cell in [84%], papillary transitional cell carcinoma [12%] and oncosytoma contributed 4%

Conclusion: We observed that large number of the patients presented with haematuria and most of them were male. Radical nephrectomy along-with removal of tumour thrombus is a valuable method for the treatment of renal cell carcinoma having tumour thrombus either in renal vein or inferior vena cava. Common pathological type was clear cell carcinoma

Tubeless percutaneous nephrolithotomy; analgesia requirement in conventional and tubeless percutaneous nephrolithotomy: a comparison

Revolutionary advances in the minimally invasive and non invasive management of stone disease over the past two decades have greatly facilitated the removal of stones. Renal stone management moved from open surgery to minimally invasive procedures with the aim of achieving maximum stone clearance with the least morbidity and mortality. Percutaneous nephrolithotomy [PCNL] remains the most efficient procedure in all patient groups. Tubeless PCNL is increasing in popularity and the technique of percutaneous nephrolithotomy is in constant evolution. Nephrostomy tube has been implicated in causing postoperative discomfort or pain and morbidity. Nephrostomy-free or tubeless PCNL reduces postoperative pain and analgesia related to the drainage tube. To compare mean analgesia requirement with tubeless PCNL and standard PCNL in renal stone patients Randomized controlled trial conducted at Shaikh Zayed Hospital Lahore from July 2010 to January 2011. 100 patients were divided into two groups randomly by using random numbertables i.e. 50 patients in group A and 50 patients in group B. Group A patients were operated by standard PCNL method i.e. with Placement of nephrostomy tube and ureteric catheter and group B were operated by tubeless PCNL i.e. without nephrostomy tube but with ureteric catheter. The data was collected on attached predesigned computer based proforma. The analgesic dose requirement in Group A was 116.50 +/- 26.55mg and analgesic dose requirement in Group B was 73.00 +/- 30.24mg of pethidine. So, analgesia requirement in both groups showed a significant difference [p<0.05]. Tubeless PCNL can be used with a favorable outcome in renal stone patients, with the potential advantage of decreased analgesia requirement

Percutaneous nephrolithotomy; randomized comparison of large bore, small bore and tubeless

We compared postoperative outcome of conventional large bore percutaneous nephrolithotomy [PCNL] with small bore and tubeless percutaneous ephrolithotomy [PCNL]. prospective randomized trial. August 2008-2009 Setting: Shaikh Zayed Hospital Lahore. The study included 90 patients randomized in three groups. Group. 1 included 30 patients who underwent conventional PCNL with large bore 16 fr nephrostomy tube, Group2 included 30 patients, PCNL with small bore 10 fr nephrostomy tube, and Group3 included 30 patients who had tubeless PCNL. Comparison was made in the terms of analgesia requirement, fever, duration of urinary leak and hospital stay. In Group 1 analgesia requirement ranged from 40-70mg mean 50mg, in Group II, it was 30-60mg with mean 47.3mg while in Group III, The requirement of analgesia was 10-50mg with mean 21.1mg, p<0.005. Hospital stay was between 4 to 7days, mean 5.7days in group I while in group II, stay was between 3 to 5 days, mean 4.3days and in group III, it was between 1 to 4 days, mean 3.17days, p<0.005. Twelve patients had fever in group I, In group II, eleven patients while in group III, five patients developed fever, p<0.005. Leakage of urine from site of wound in group I was observed between 0 to 5 days while in group II leakage was between 0 to 4 days, and the leakage period reduced in group III from 0 to 2 days p<0.005. Tubeless PCNL is associated with the least postoperative pain, urinary leakage, fever and hospital stay, it's a good option after an uncomplicated percutaneous renal procedure

Extracorporeal shockwave lithotripsy; impact of diuresis on the clearance of lower pole renal calculi

Treatment of renal stone is always a challenge. High incidence of recurrence of renal stone compels the treating physician to opt for minimally invasive treatment. With the advent of extra corporeal shock wave lithotripsy the treatment has been completely revolutionized. The treatment of lower polar stone is always tiring, and usually involves multiple modalities, the low lie of the stone, difficult clearance, narrow infundibulum, and higher incidence of regrowth make it difficult to treat. We assessed the role of diuretic in the clearance of lower polar stone after shock wave lithotrispsy, [SWL]. 60 patients were selected from both sexes and divide them in two equal groups, with age 20-75 Y for group 1, and 5-72 Y for group II. Stone size from 5- 20mm were included in our study. The patients underwent ESWL. The group I was offered inj Frusemide 20 mg intravenously after shock wave lithotripsy, while patients in group II were kept as control. The stone clearance in group I was 73.3, and 60% in group II. Which is quite significant. The use of diuresis after ESWL significantly increases the clearance rate for lower polar stones