Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy

PURPOSE: To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). MATERIALS AND METHODS: This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. RESULTS: The mean age of the patients in group A was 37.31+/-10.1 years and that in group B was 40.1+/-11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). CONCLUSIONS: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.

audit of patients satisfaction after adult day - case surgery at Ayub teaching hospital, Abbottabad

Day-case surgery has become an important component in the provision of surgical care in the Western countries. This study was done to introduce the concept of day-case surgery and assess the patients' satisfaction after day case general surgery in our set up with vast rural communities lacking medical facilities and no day-case surgery units in the hospitals. All those patients suitable for day-case surgery and who accepted day-case surgery for general surgical procedures in General Surgical 'A' unit of Ayub Teaching Hospital, Abbottabad were interviewed after the operation on follow up visits. Questions were asked about their satisfaction with day-case surgery. If they were not satisfied, the reasons for dissatisfaction were noted. Direct admissions and re-admissions after day-case surgery were recorded. Any complications in the postoperative period were also noted. The patient's preference for a similar procedure as day-case in future was also recorded. There were 122 patients in this study. 60[49%] were operated under general anesthesia and 62[51%] under local anesthesia. Fourty Nine [40%] patients were satisfied while 73[60%] were not satisfied with day-case surgery. Six [5%] patients were admitted directly after day-case surgery while 7[5.7%] patients were admitted after discharge. Complications occurred in 41[33.6%] patients at home. Wound complications and pain were the most common morbidity encountered by the patients. Twenty eight [23%] patients contacted a hospital or a doctor in the early postoperative period. Sixty two [51%] patients would prefer operation as in-patient while 74 [60.6%] would prefer an overnight stay after the operation next time. Conclusions: Patients satisfaction with day-case surgery in Ayub Teaching Hospital is not high. Short-stay surgery would be more appropriate in our set up

Screening for biochemical abnormalities in urolithiasis patients

The significance of biochemical screening in stone formers has been a debated topic. This study was conducted to investigate the frequency of biochemical abnormalities in our urolithiasis patients and to compare the abnormality between the first time and recurrent stone formers so that this information would help in assessing the value of biochemical screening in our practice. Over a twenty-one month period, new and recurrent stone disease patients had one random blood specimen and two random 24-hour urine collections analysed for biochemical abnormalities. Serum was checked for calcium, urate, phosphate and creatinine. The urines were measured for volumes, calcium, oxalate, urate, citrate, cystine and pH. Out of total of 113 patients, 83 [73%] had some urinary or blood abnormality. Highest number of abnormalities were in urine. Low volume 33 [39.76%], hypercalciuria 33 [39.76%] and hyperoxaluria 20 [24.1%] were the main urinary abnormalities. Elevated serum creatinine in 10 [12.05%] was commonest blood abnormality. Females had significantly higher frequencies of low urinary volume [48% vs 21%, p=0.001], hyperoxaluria [38% vs 11%, p=0.002] and hypocitraturia [37% vs 0%, p<0.001]. There was no significant difference of abnormality rate between first time and recurrent stone formers. A high frequency of urinary biochemical abnormality and equal abnormality frequencies among first time and recurrent stone formers highlights the significance of biochemical screening even in cases of initial stone presentation. We feel such diagnostic evaluation would help in providing precise treatment and efficient prophylaxis