Comparative evaluation of upper versus lower calyceal approach in percutaneous nephrolithotomy (PCNL) for managing renal calculi.

OBJECTIVE: To compare upper versus lower calyceal approaches in percutaneous nephrolithotomy for managing renal calculi. METHODS: The retrospective study was conducted in the Department of Urology, The Kidney Centre Post-Graduate Training Institute, Karachi, and comprised data of patients who underwent percutaneous nephrolithotomy from January 2014 to January 2015. Patients were divided into upper pole puncture group A and lower pole puncture group B. Data was analysed using SPSS 17. RESULTS: Of the 198 patients, 147(74.2%) were males and 51(25.8%) were females. The overall mean age was 40.64±14.02 years. Of the total, 69(34.84%) were in group A and 129(65.15%) were in group B. Inter-group difference was significant in pre- and post-operative haemoglobin (p<0.05). Post-operative outcomes showed that blood transfusion, stone clearance and complication like tube thoracostomy had significant association with both the groups (p<0.05). Complete clearance was seen in 152(76.8%) patients; 40(74.1%) in group A and 102(81.6%) in group B. CONCLUSIONS: The success rate was found to be better in lower calyceal puncture group than upper calyceal puncture group for the management of renal calculi.

Outcome of 980 nm diode laser vaporization for benign prostatic hyperplasia: A prospective study.

Purpose: To evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser. Materials and Methods: A prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery. Results: The mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS 7.04±1.69 (-18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (-112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs. Conclusions: PVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.

Postoperative Pain Score of Bupivacaine versus Placebo in Patients Undergoing Percutaneous Nephrolithotomy.

OBJECTIVE: To compare postoperative mean pain score of bupivacaine versus placebo in patients undergoing percutaneous nephrolithotomy. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Urology, The Kidney Centre, Postgraduate Training Institute (PGTI), Karachi, from November 2014 to December 2015. METHODOLOGY: A total of 94 patients who underwent standard percutaneous nephrolithotomy, clinically diagnosed renal stone by CT scan, KUB, X-ray or ultrasound were included in the study. Patients were randomly divided into two groups. Forty-seven patients in group A were treated with 20ml/50mg of 0.25% bupivacaine; and 47 patients in group B were treated with normal saline. Postoperatively, visual analog score was used to assess the pain at 6, 12 and 24 hours. Data was analysed using SPSS version 20.0 and student t-test was applied for comparison between the groups. RESULTS: The average age of the patients was 37.23 ±11.31 years. Mean pain score in 24 hours was low in group A as compared to group B (5.22 ±0.76 vs. 7.85 ±0.78; p<0.001). CONCLUSION: Bupivacaine infiltration into the nephrostomy tract is a highly effective and safe in postoperative pain management for patients undergoing standard PCNL.

Predictive Factors for Intraoperative Blood Loss during Percutaneous Nephrolithotomy.

OBJECTIVE: To evaluate the factors that may increase bleeding during Percutaneous nephrolithotomy (PCNL) and correlate them with outcome. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: The Kidney Centre postgraduate Training Institute, Karachi, Pakistan, from July to December 2016. METHODOLOGY: Consecutive patients who underwent PCNL from July to December 2016 were prospectively enrolled. Drop in hemoglobin was divided into three groups: mild <1 gm/dl, moderate 1-2 gm/dl and major >2 gm/dl. Factors such as age, gender, comorbidities, body mass index (BMI), operative time, creatinine levels, renal cortical thickness, stone size, its characteristics and location, puncture type and site, and need for blood transfusion were assessed by Chi-square/ Fisher exact test and Kruskal Wallis test. Predictive factors were assessed by multinomial logistic-regression analyses. RESULTS: Total 305 patients were enrolled in the study. Median age was 37 (27.5-49.1) years with predominantly males (n=217, 71.8%). Median BMI was 27.3 (24.6-31.4) Kg/m2 and mean stone size was 2.7 (2.1-3.4) cm. Two hundred and ninety-seven (97.7%) stones were radio-opaque. Operative time was 95 (60-127) minutes. There were 50.8% patients who had moderate drop in hemoglobin (1-2 gm/dl). Stone size, BMI and operative time were strongly associated with significant drop in hemoglobin. Complete stone clearance was achieved in 256 (84%) patients. Thirty (9.8%) patients needed blood transfusion. None of the patients required angioembolisation. CONCLUSION: BMI, stone size, and operative time were strongly associated with intraoperative blood loss during PCNL.

Awareness of risk factors and fallacies associated with urinary bladder cancer in our population: A prospective survey.

OBJECTIVE: To determine the awareness of risk factors for bladder cancer and false beliefs associated with this disease. METHODS: This cross-sectional study was conducted at the Kidney Centre, Karachi, from January to February 2015, and comprised subjects who presented to the various in-house clinics. The subjects were interviewed using a questionnaire comprising demographic parameters, level of education and awareness of smoking hazards, knowledge and false beliefs associated with bladder cancer. A pilot study was performed prior to the main study and the questionnaire was redesigned accordingly. SPSS 20 was used for data analysis. RESULTS: Of the 1,000 respondents, 593(59.3%) were males and 407(40.7%) were females. Moreover, 229(22.9%) respondents were aware of the association between smoking and bladder cancer compared to 858(85.8%) who knew that there is an association between smoking and lung cancer. Besides, 479(47.9%) respondents said that smoking caused tuberculosis. Patients with a higher level of education were statistically more likely to be aware of the association between smoking and bladder cancer, i.e. 91(9.1%) uneducated, 208(20.8%) primary, 182(18.2%) secondary, 222(22.2%) intermediate and 352(35.2%) graduates (p=0.0001). Most common fallacy associated with bladder cancer was low intake of water 504(50.4%), followed by multiple sexual partners 362(36.2%). CONCLUSIONS: Most patients were unaware of the relationship between bladder cancer and tobacco smoking.