Management of lower urinary tract stones in paediatric population. A comparison of endoscopic versus open procedures

To compare the safety and efficiency of endoscopic treatment methodology vs open surgical procedures in pediatric lower tract stone disease. This study was conducted in Department of Urology, Karachi Medical and Dental College and Abbasi Shaheed Hospital, from July 2010 to December 2012. The characteristics of the patients in the two groups, and the outcomes of the two procedures, the endoscopic treatment [Group A] vs. the open surgery procedure [Group B] for lower urinary tract stone disease, were compared. In both groups, age range was 1 to 16 years with male to female ratio was 2:1 and 1.7:1. In group A and B in that order, size of stone was 0.8 to 1.6 cm and 0.7 to 2 cm, average duration of surgery was 39 and 31 minutes. Stone clearance was 98 and 100 percent respectively. Total post operative hospital stay was 18 to 24 hours in group A, and 5 to 10 days in group B patients. The post operative duration of indwelling catheter was 0.8 to 1 day in Group A, and 5 to 15 days in Group B. No drains were placed in group A patients while group B patients had drains for minimum duration of 2 days. Significant wound infection was found in group B patients. Endoscopic management of lower tract stones in paediatric population is the more effective treatment modality with minimum complications, short duration of indwelling urethral catheter and minimum procedure related hospital stay

Elective hemi transurethral resection of prostate: a safe and effective method of treating huge benign prostatic hyperplasia

To evaluate the safety and efficacy of elective hemi-resection of prostate in patients with huge gland, weighing more than 120 grams. Multicentric, analytical comparative study. Department of Urology, Karachi Medical and Dental College, Abbasi Shaheed Hospital and Dr. Ziauddin Hospital, Karachi, from August 2006 to July 2009. All benign cases were included in this study and divided into two groups. In group A, patients having huge prostate [> 120 grams] were placed and hemi TURP was performed. In group B, patients having 60 to 100 grams prostate were placed and conventional Blandy's TURP was performed. Results of both groups were compared in terms of duration of surgery, amount of tissue resected, operative bleeding, postoperative complications, duration of postoperative catheterization, re-admission and re-operations. Effectiveness of procedure was assessed by a simple questionnaire filled by the patients at first month, first year and second year. Patients satisfaction in terms of their ability to void, control urination, frequency, urgency, urge incontinence, haematuria, recurrent UTI, re-admission and re-operations were also assessed. Fisher exact test was applied to compare the safety and efficacy of variables. In group A and B, average age range was 72 and 69 years, average weight of prostate was 148 and 70 grams, average duration of surgery was 102 and 50 minutes respectively. Average weight of resected tissue was 84 and 54 grams and haemoglobin loss was two grams and one gram respectively. Total hospital stay was 5 and 4 days. Total duration of indwelling Foley's catheter [postoperative] was 5 days and 2 days. Patient satisfaction in term of urine flow, urinary control, improvement in frequency and nocturia were comparable in both groups. UTI and re-admission was more in hemi-resection group. At the end of 2 years follow-up, there is no statistical difference between the safety and efficacy of two methods of treatment. In selected population, elective hemi TURP for huge obstructed prostate is a safe treatment. It's safety and short terms efficacy is comparable with the results of conventional TURP

Irrigation free transurethral resection of prostate [TURP]

To assess the safety and feasibility of irrigation free TURP in our routine practice. This study was carried out at Department of Urology, Karachi Medical and Dental College and Abbasi Shaheed Hospital, from March 2009 to February 2010. In this interventional study our inclusion criteria was benign disease and prostate weight up to 70 grams. Patients having more than two systemic medical illness like Diabetes, Hypertension [HTN], Ischemic heart disease [IHD], Cerebro-vascular accident [CVA] and Parkinsonism, were excluded from study. Patients remains on anti coagulant medications, patients with present or persistent urinary tract infections were also excluded. Patients who had surgical trauma, incidentally invent urethral stricture and vesical stones were also excluded. All cases were operated by one qualified, experienced surgeon. The decision of irrigation free TURP was taken on the basis of satisfactory hemostasis and good peri operative blood pressure control. Irrigation free TURP was ordered in post operative notes and such cases were closely observed for next 24 hours. After initial advice of irrigation free group if the patient needed irrigation because of haematuria, different patient's and operative variables were reviewed. There were total 50 patients aged 52-84 years with prostate weight ranging from 35 to 70 grams. Mean weight of prostate was 50.12 grams. Our 27% patients were hypertensive, 20% were diabetic and 17% patients had two comorbid conditions. Out of 50 patients 39 that is 78% cases remained irrigation free and followed the routine post operative course and were discharged. Patients who developed haematuria and had irrigation were 22%, seven had about two liters irrigation fluid over 6 hours and 4 patients had larger amount of fluid for 24 hours. In those patients who needed irrigation, seventy six percent were hypertensive, forty two percent were diabetic and twenty percent had two comorbid conditions. History of urinary infection was positive in ninety percent cases. Size of prostate and duration of surgery had no major impact on post operative period in this study. Seventy percent of the patients who needed irrigation had low blood pressure during surgery and became hypertensive in post operative phase. Post TURP Irrigation is an important step that helps in avoiding clot retention in early post operative phase. It increases the work load and treatment cost. In selected patients who have moderate gland, no major co morbidities and no infection, irrigation free TURP can be practised under close observation