This is hospital based prospective study done in the urology unit of Chitwan Medical College, Bharatpur. All patients who were subjected for ureteroscopy and lithotripsy were included in the study between January 01, 2018 to May 31, 2018. Hundred patients with 116 stones were treated with the Holmium laser Versa Pulse P20 Laser Lithotripter. Overall stone clearance rate was 97%. The more the stone burden less was the stone clearance rate. The major complications were perforation and postoperative fever which occurred in 11% of each case. This procedure is a safe and effective treatment for ureteric calculi and is associated with a low complication rate and a high clearance rate. Laser lithotripsy is the optimum ureteroscopic method of treating ureteric.
INTRODUCTION: Acute appendicitis is the most common surgical condition presented to the emergency department. Clinical scoring systems such as the Alvarado and modified Alvarado scoring system were developed with the goal of reducing the negative appendectomy rate to 5%–10%. In the other hand the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian population. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in the Nepalese population. METHODS: This study included 125 patients who had undergone appendectomies from March of 2017 to January 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 125 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 68.64% and a specificity of 28.57%. The PPV was 95% and the NPV was 5.12%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded 88.13% sensitivity and 28.57% specificity. The PPV was 95.41% and the NPV was 12.5%. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity similar to the modified Alvarado scoring system. KEYWORDS: Acute appendicitis, Modified Alvarado Score, RIPASA score.
Background: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent indicate that these affect 73-90% of patients. Aim of this study is to evaluate the effect of tamsulosin on the DJ related complications to improve the quality of life and render symptom free life. Material and Methods: Quasi experimental study was carried out in the department of urology in College of Medical Science, teaching hospital Chitwan, Nepal from 15th March 2017 to 15th March 2018. A total of 80 post operative patients were included in this study and were randomized into Group A and B with 40 patient in each group. Stent related symptoms, quality of life and IPSS (International prostate symptom score) were evaluated at the time of discharge and at the time of DJ removal. Pain was evaluated with the help of VAS at the time of discharge and at the time of DJ removal. Data were entered in MS-Excel and were imported to EZR software Version 3.4.1 for analysis. A p-value of less than 0.05 was considered significant. Results: Median age was 30.5 in Tamsulosingroup and24years in placebo group. (p=0.68).At the time of discharge significant difference was noted in IPSS (p<0.001), butno significant difference wasnoted with QoL index (p=0.932) and VAS (p=0.68). At the time of DJ stent removal, significant difference was noted with IPSS (p<0.001), QoL index (p<0.001), VAS (p=0.004) in Tamsulosin group than in Placebo group. Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patientswith indwelling DJ stent. Key words: DJ stent; IPSS; Tamsulosin; VAS.
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