Flexible cystoscopy a valuable diagnostic tool for lower urinary tract pathology.

OBJECTIVE: To assess the role of flexible cystoscopy in the diagnosis of lower urinary tract pathologies and its suitability as a routine diagnostic protocol in outdoor patients. METHODS: The quasi-experimental study was conducted at the Urology Department, Pakistan Ordinance Factory Hospital, Wah Cantt., from June 2009 to June 2010. All adult patients presenting with lower urinary tract symptoms to outdoor department were included on the basis of universal non-probability sampling technique. Cystoscopy was performed as a clinic-based procedure without sedation. SPSS 17 was used for data analysis. RESULTS: Of the 1500 patients in the study, 810(54%) were females and 690(46%) were male. Lower urinary tract pathologies were found in 480(32%) patients. The most common pathology among males was enlarged prostate in 127(8.4%) patients. Among females, urethral stenosis was the most common pathology in 57(3.8%) patients. Transitional cell carcinoma was seen in 57(3.8%) patients having haematuria with inconclusive ultrasound and intravenous urography. All patients tolerated the procedure well. CONCLUSIONS: Flexible cystoscopy is an effective, well-tolerated and easy way of detecting lower urinary tract pathologies among outpatients.

Acute appendicitis in the elderly; Pakistan Ordnance Factories Hospital, Wah Cantt. experience.

OBJECTIVE: To review the clinical experience in diagnosis, management and outcome of elderly patients presenting with acute appendicitis at the Pakistan Ordnance Factories Hospital, Wah Cantt. METHODS: All patients of age 60 years and above presenting with abdominal pain were prospectively reviewed. Patients who were diagnosed as acute appendicitis were included in this case series which was conducted at Pakistan Ordnance Factories Hospital, Wah Cantt, from December 2006 to May 2008. Detailed history and clinical examination, co-morbid conditions, clinical manifestations and post-operative outcome were recorded. The diagnosis was made on the basis of history and clinical examination. The diagnosis was also confirmed on histopathology. All the details were recorded on a questionnaire. Approval from our own ethical committee was taken. SPSS 16 was used for statistical analysis. RESULTS: A total of 75 patients presented with acute abdominal pain. Of them 42 were admitted with tenderness in right iliac fossa and lower abdomen. Finally, 36 (48%) were diagnosed as acute appendicitis and were included in the study. There were 20(56%) men and 16(44%) women with age range of 60 to 78 years and a mean age of 65.5 +/- 4.2 years. Associated illness occurred in 25(70%) patients. Symptoms included abdominal pain in 32(90%), nausea in 17(48%), and emesis in 9(25%) patients. Signs included right lower quadrant tenderness in 26(74%) patients, leukocytosis in 17(47.2%), and fever (>99'F) in 11(30.5%). Laparoscopy was used as an important diagnostic as well as therapeutic modality. Of the patients, 9 (25%) had gangrenous appendix, while 12 (33.3%) had perforated appendix. A total of 12 (33.4%) patients developed complications. Hospital stay was considerably increased in patients with a delayed diagnosis (5-7 days), perforations (5-9 days) and postoperative complications (5-15 days). One patient, a known case of ischaemic heart disease, died of cardiopulmonary arrest. CONCLUSION: Acute appendicitis needs to be considered in the differential diagnosis of all patients with abdominal pain. A high index of suspicion is necessary to guard against mis-diagnosis, especially in the elderly. Delays in presentation and diagnosis are associated with higher rates of perforation and, hence, higher morbidity. Repeated clinical examination, a high index of suspicion and urgent investigations are necessary for a correct and rapid diagnosis.