Objective: To compare open testicular biopsy and testicular fine needle aspiration (TEFNA) for spermatogenesis in terms of Johnsen’s scoring in patients with suspicion of obstructive azoospermia. Study Design: Comparative study. Place and Duration of Study: Department of Urology, Services Hospital, Lahore from 24th December 2018 to 23rd December 2019. Methodology: Forty males with primary infertility and azoospermia (in 3 consecutive reports) were enrolled. Males with normal testicular size and bilaterally palpable vas deference were investigated further regarding their hormone profile (serum FSH, LH, and Testosterone) and scrotal color Doppler ultrasound (CDUS). When hormones and scrotal ultrasound were found normal, appointment was given to patients for procedure, after complete discussion about their diagnosis and plan of management with possible complications. Both procedures; open testicular biopsy and testicular fine needle aspiration (TEFNA) were done simultaneously under local anesthesia. Specimen obtained from both procedures was sent for analysis of spermatogenesis in terms of Johnsen scoring. Patients were discharged after four hours with advice of daily dressing for five days and scrotal support for two weeks and oral Diclofenac Sodium 50mg twice daily after meals for three days. Results: The mean values of Johnsen scores were 7.7±2.8 in open biopsy while in TEFNA 9.9±0.95 and statistically significant (<0.05) results were found. Among 40 patients, 33(82.5%) patients showed spermatogenesis on open biopsy and 39(97.5%) on TEFNA. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy of TEFNA in diagnosing spermatogenesis was 100%, 14.2%, 84.6, 100.0% and 85.0% respectively. Conclusion: Testicular fine needle aspiration is found to be a simple, reliable, and least invasive mode of diagnosing and management of azoospermia in adult males with minimal complications. Keywords: Open testicular biopsy, TEFNA, Infertility, Johnsen score
Introduction: During this modern era of surgery, where miniaturization has taken a front row seat, endo-urology is flourishing like never before. PCNL has become the chosen tool for treating Staghorn stones, large renal calculi and complex upper ureteric calculi. The renal collecting system can be accessed by upper or lower pole puncture. Lower pole access is considered safer with fewer complications; however the benefits of upper pole access for PCNL also stands tall due to direct access to the most of renal calyxes system, renal pelvis and upper ureter. A lot of debate and confusion is recorded worldwide with respect to both methods. Aims & Objectives: To determine the outcome of upper pole access for removal of renal stones in patients undergoing Percutaneous Nephrolithotomy. Place and duration of study: A descriptive study, conducted in Department of Urology, SIMS/SHL, in 2 year period i.e. 1-02-2018 to 31-01-2020. Material & Methods: A Total of 62 patients fulfilling selection criteria were included in the study. All of these cases were operated under general anesthesia. Post-operatively, patients X-ray K.U.B were performed for presence or absence of stone. If there was no stone found in x-ray, then efficacy was labeled as high. Regarding complications, patients were evaluated for presence of hydrothorax and bleeding. If there was no complication, then safety was labeled as adequate. All this information was recorded on proforma. Results: The mean age of patients was 32.58±9.41 years. There were 29 (46.8%) males and 33 (53.2%) females. The mean size of stone was 2.50±0.50mm. In this study, 20 (32.3%) patients had one stone, 25 (40.3%) had two stones and 17 (27.4%) had three stones. High Efficacy of PCNL was achieved in 50 (80.6%) patients while PCNL was adequately safe in 45 (72.6%) cases while 17 (27.4%) patients had complications. Conclusion: This study showed that PCNL with upper pole approach was found to be highly effective in renal stone removal and is also safe in more than 70 % of cases.
Objective: To find the frequency of patients of renal calculi with different stone densities and to evaluate the success rate of ESWL treatment in selected groups of patients i.e. low, medium and high stone density. Methodology: In this descriptive case series, at Department of Urology, Services Hospital, Lahore was conducted and enrolled a 100 cases with single, radiopaque renal stone of 1-2 cm (10 to 20 mm), between 15-80 years of either gender whereas those with calculus in nonfunctioning kidney (GFR less than 15 ml/min), calculus in Pyonephrotic kidney, presence of JJ stent and having previous surgery for stone on same side or radiolucent stones were excluded from this study. All sessions of ESWL were performed following departmental protocol. 3 weeks after the ESWL session, the outcome was evaluated by plain X-ray KUB and USG KUB. In this analysis, ESWL success was defined as either total stone clearance or the presence of clinically insignificant residual fragments (CIRFs) (4 mm, peripheral, not producing renal colic, with no infection or extensive hematuria). Results: Stone density was in the range of 335-1900 HU with a mean density of 851.1 (±418) HU. Patients with medium density group (500-1000HU) were significantly greater than other two groups. MDG had frequency of 51% followed by LDG (25%) and HDG (24%). Overall, ESWL success rate was 82% in all the 100 patients of renal calculi. Success rate was greatest in LDG i.e. 100%. MDG had a success rate of 90% and only 45.8% of the patients in HDG had succees after ESWL treatment. Success rate decreased as the stone density increased. Conclusion: the stone density has a significant impact on success of ESWL. NCCT stone characteristics like mean density in HU and demographic characteristics are potential predictors for evaluation of success of ESWL. Keywords: Kidney stones, ESWL, Stone density
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