Urethral Strictures and its Management at Tertiary Hospital of Nepal.

BACKGROUND: Urethral stricture can occur from urethral meatus to bladder neck. Treatment of urethral stricture include dilatation, endoscopic incision and anastomotic urethroplasty. The aim of this study is to report our experience in the management of different types of urethral strictures. METHODS: We retrospectively reviewed the chart of all the patients of urethral stricture who received treatment at Kathmandu model hospital between January 2015 and October 2019. Different types of urethral stricture along with various modalities of treatment given were recorded. RESULTS: Fifty patients were included in this study, all were males. Mean age was 49 (16-82) years. Bulbar urethra was the most common site in 54% of cases and bulbomembranous least common, only 10% of cases. Depending on sites and size of stricture, different types of surgery performed were meatoplasty, dviu and anastomotic urethroplasty. CONCLUSIONS: Urethral stricture is a troublesome disease and can occur anywhere from meatus to the bladder neck. Different surgical techniques are present and the treatment should be individualized, depending on location and length of the stricture.

Semi-rigid Ureteroscopy for the Management of Ureteric Calculi: Our Experience and Complication Encountered.

BACKGROUND: Semi-rigid ureteroscopy lithotripsy have become standard of treatment for ureteral calculi. The aim of this study isto review outcome of Semi-rigidureteroscopy lithotripsy and to report the complications encountered. METHODS: After approval from institutional committee of Public Health Concern Trust Nepal,we retrospectively reviewed the chart of all patients of ureteral stone who underwent ureteroscopy and pneumatic lithotripsy at Kathmandu Model Hospital between January 2013 and September 2017. Patient characteristics, stone size, success rate and complications were assessed. Intraoperative complications were graded using modified Satava classification system and the postoperative complications graded according to modified Clavien classification system. The success rate was based on stone free status after primary semi-rigid ureteroscopy lithotripsy, without the need of any other secondary procedures. RESULTS: Total 232 patients underwent semi-rigidureteroscopy lithotripsy. Mean age was 46 (16-76) years, with 128 males and 104 females. Size of the stone ranges from 5-18mm. The success rate of primary semi-rigidureteroscopy lithotripsy was in218 (93.9%) cases.Most intraoperative complications were modified Satava grade I (41.7%) andII(3.87%).Four(1.7%) patient had grade III complication, requiring conversion to open surgery. Ureteral avulsion was seen in 1(0.43%) patient, requiring ureteral reimplantation.The postoperative complication were modified Clavien grade I(10.7%), grade II(5.17%), grade III (4.6%) and grade IV(0.43%). Double J stents were inserted in all the patients postoperatively.The mean hospital stay was 2.2(1-14)days. CONCLUSIONS: Semi-rigid ureteroscopy lithotripsy for the management of ureteral stones is efficacious and have a lesser major complications.

Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: A Randomized control trial.

OBJECTIVE: The objective of this study is to evaluate if gonadotropin-releasing hormone agonist (GnRHa) trigger is a better alternative to human chorionic gonadotropin (hCG) in polycystic ovary syndrome (PCOS) of Indian origin undergoing in vitro fertilization (IVF) cycles with GnRH antagonist for the prevention of ovarian hyperstimulation syndrome (OHSS). DESIGN: Prospective randomized control trial. SETTING: Tertiary care center. MATERIALS AND METHODS: A total of 227 patients diagnosed with PCOS, undergoing IVF in an antagonist protocol were recruited and randomly assigned into two groups: Group A (study group): GnRHa trigger 0.2 mg (n = 92) and Group B (control group): 250 µg of recombinant hCG as trigger (n = 101) 35 h before oocyte retrieval. We chose segmentation strategy, freezing all embryos in both the groups. STATISTICAL ANALYSIS: Continuous variables were expressed as mean ± standard deviation independent sample t-test and Kolmogorov-Smirnov test were used for continuous variables which were normally distributed and Mann-Whitney U-test for data not normally distributed. MAIN OUTCOME MEASURES: Primary outcome: OHSS (mild, moderate, and severe) rates. Secondary outcomes: Maturity rate of the oocytes, fertilization rate, availability of top quality embryos on day 3 (Grade 1 and Grade 2). RESULTS: The incidence of moderate to severe OHSS in the hCG group was 37.6% and 0% in the GnRHa group with P < 0.001. The GnRHa group had significantly more mature oocytes retrieved (19.1 ± 11.7 vs. 14.1 ± 4.3), more fertilized oocytes (15.6 ± 5.6 vs. 11.7 ± 3.6), and a higher number of top quality cleavage embryos on day 3 (12.9 ± 4.7 vs. 7.5 ± 4.3) than the hCG group. CONCLUSIONS: The most effective strategy which significantly eliminates the occurrence of OHSS in PCOS following ovarian stimulation in antagonist IVF cycles is the use of GnRHa trigger yielding more mature oocytes and good quality embryos when compared with hCG trigger.