effect of two weeks preoperative finasteride therapy in reducing prostate vascularity

Objective: To determine the effect of two weeks preoperative finasteride therapy in reducing prostate vascularity in terms of mean microvessel density [MVD] and expression of VEGF in prostate urothelium among patients of BPH by comparing with controls. Study Design: Randomized controlled trial. Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2013 to January 2014

Methodology: A total of 80 patients of Benign Prostatic Hyperplasia [BPH] planned for Trans-Urethral Resection of Prostate [TURP] having prostate size of more than 40 grams on trans-abdominal ultrasonography was randomized into two groups, each group having 40 patients. The finasteride group [Group A] was prescribed oral 5 mg of finasteride daily for 2 weeks before surgery. The control group [Group B] did not receive any agent. After 2 weeks, TURP was performed and prostate samples were sent for histopathological determination of MVD and expression of VEGF

Results: The mean age of patients was 66.21 +/- 10.08 years, ranging from 48 to 86 years. The mean prostate gland size was comparable in both groups [55 +/- 10.7 vs. 58.1 +/- 10.8 grams, p=0.21]. Mean MVD in finasteride group [20.25 +/- 10.3] was significantly lower as compared to control group [48.9 +/- 22.6, p < 0.001]. Similarly expression of VEGF was also significantly lower in finasteride group [30%] as compared to control group [65%] [p= 0.0017]. Mean MVD had a significant weak correlation with the size of prostate gland on Pearson correlation test [2-tailed] with r = 0.222

Conclusion: Finasteride reduces microvessel density and hence prostate vascularity with only 2-week therapy and the mean MVD is clearly correlated with size of prostate

Comparison of outcome of percutaneous nephrolithotomy in adult versus paediatric patients

Objective: To compare the outcome of percutaneous nephrolithotomy [PCNL] in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients

Study Design: Descriptive case series

Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2010 to December 2013

Methodology: A retrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ? 12 years were included in paedriatic group [A] while patients aged > 12 years were included in adult group [B]. The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma

Results: One hundred and twenty-nine [129] patients including 44 [34.10%] females and 85 [65.89%] males with a mean age of 45.00 +/- 1.44 years were adults. Twenty-six palrents with mean age of 9.21 +/- 5.70 years, 17 [65.4%] males and 9 [34.6%] females, were included in the paedriatic group. Mean stone size was 2.12 +/- 1.01 cm in paedriatic group compared to 2.52 +/- 0.77 cm in adult group [p = 0.023]. Mean operative time in paedriatic group was 158.8 +/- 39.63 minutes compared to 119.34 +/- 37.06 minutes in adult group [p < 0.001]. Mean hospital stay in paedriatic group was 2.76 +/- 1.14 days compared to 3.12 +/- 1.27 days in adult group [p=0.1881]. Peroperative stone clearance was in paedriatic group was 93.28 +/- 9.23% compared to 90.81 +/- 12.23% in adult groups [p = 0.331]. One patient in the adult group developed urosepsis

Conclusion: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases

Constipation in pediatric patients with Lower Urinary Tract Symptoms

Objective: To determine the frequency of constipation in patients with pediatric age group presenting with Lower Urinary Tract Symptoms [LUTS]

Study Design: Descriptive study

Place and Duration of Study: Outpatient Department of Urology in Pakistan Kidney Institute at Shifa International Hospital, Islamabad, from November 2012 to February 2014

Methodology: Two hundred pediatric patients presenting with Lower Urinary Tract Symptoms [LUTS] were studied in terms of age, gender, obstructive and irritative types of LUTS along with any associated symptoms. Constipation was assessed by Bristol stool chart in these patients. Patients with exstrophy of bladder were excluded from the study. Descriptive statistics were measured for both qualitative and quantitative variables. For qualitative variables like gender, presenting symptoms, constipation and stool types, percentages and frequencies were calculated. For quantitative variables like age, percentages / mean +/- SD were calculated

Results: Mean age was 6.87 +/- 3.64 years with a range of 2 - 14 years. Constipation was found in 37.5% of the pediatric patients with lower urinary tract symptoms

Conclusion: Constipation is frequent and overlooked problem in pediatric patients having urinary symptoms. Irritative lower urinary tract symptoms are more common. Children up to 5 years of age are the most common sufferers. Knowing the burden of constipation in such patients can help physicians in better treatment of such cases