ObjectiveTo analyse the advanced systems of urology residency in the developed world, to compare them to a system in the developing world, and thereby identify the shortcomings and make recommendations to improve residency programmes for urology in the Kurdistan Region of Iraq.MethodsA survey was conducted amongst the urology Residents (55) in the three governorates of the Kurdistan Region of Iraq, to assess the accessibility of the training programme, the types of the residency programmes, skills acquisition, the use of modern technology for teaching and assessment, the environment of the settings of practice, and the status of research in their training.ResultsAn overwhelming majority (88%) of trainees reported difficulty in securing a training position. A high proportion (43%) felt disappointed at the beginning of their training. There is no unified curriculum of training, and more than two-thirds of the respondents reported a lack of a proper evidence-based medical education. There is no formal subspecialty training programme. Of the respondents, 65% referred to the difficulties in the environment for training, and that there was a low level of research involvement (12%).ConclusionsUrology training is not easily accessible, there is no unified programme of residency, there are limited facilities, and a minimal assessment of practical skills. The environment for practice needs enormous improvements and a strong foundation for research should be created.
Background: Urinary incontinence (UI) is generally defined as the involuntary loss of urine from the bladder through the urethral meatus. Filling cystometry is the method by which the pressure/ volume relationship of the bladder is measured during bladder filling. Purpose: To determine the value of diagnostic cystoscopy in addition to Urodynamic study (UDS) in patients with primary urinary incontinence. Material and Methods: 200 patients with primary incontinence studied prospectively from January 2013 to June 2014. Their age ranges from (14-93 years), 86.5% were female, and 13.5% of them were male. In addition to physical, neurological examination and biochemical investigations, urine analysis and urine culture with Ultra-sound and Post void residual volume (PVRV), all patients underwent diagnosticflexible cystoscopy under local anesthesia, and urodynamic study. Result: 43.5% of patients age were between (34-53 years), (39%) between (54-73 years), (9%) between (14-33 years) and (8.5%) were between (74-93 years). Atonic bladder on UDS were (40.5%), Detrusor over activity (29%), patients with normal UDS were (22%) and patients that had DSD (Detrusor Sphincter Dyssynergia) were (8.5%). Eighty-four cases (42%) were found to have normal cystoscopy, those with grade-I-II bladder wall trabeculations were (49%) and patients with grade-III were (8.5%). Sixty-one patients (30.5%) with normal diagnostic cystoscopy have abnormal UDS (Atonic bladder, over-active bladder and DSD) while twenty-one (10.5%) patients with normal UDS had bladder wall trabeculations (grade-I-III) on diagnostic cystoscopy. Conclusion: Diagnostic cystoscopy in addition to urodynamic study will put in further knowledge in the assessment of patients with urinary incontinence. To some extent, it can predict the diagnosis.
Background Overactive bladder syndrome (OAB) is a highly prevalent condition. Urodynamics have long been the only option, and still remain the gold standard, for examining people with OAB complaints and composing an appropriate treatment plan. Alternatives for this invasive, expensive, and time-consuming examination have been explored Objectives To review if bladder wall thickness (BWT) and bladder trabeculations could be a more objective and easier measurement that potentially could diagnose overactive bladder. Patients and Methods Twenty six patients with overactive bladder underwent an urodynamic study for assessing detrusor muscle activity in Department of Urology at Sulaimaniya Teaching Hospital, from July 2009 to October 2009. Further investigations were performed including ultrasonography of the bladder to determine mean bladder wall thickness and cystourethroscopy for detecting the grade of the bladder trabeculation. Results There is no significant correlation between mean bladder wall thickness and bladder trabculations with detrusor action analysis (in filling or voiding phase) of urodynamic study. Conclusion We cannot depend on increased mean bladder wall thickness or bladder trabeculations for diagnosis of overactive bladder without urodynamic study.
Removal of all stone and fragments is an important goal of every operations of renal stone. In spite of using modern techniques for stone manage still residual calculi (retained calculi) is an ever existing problem. Of a total 1059 patients with renal stone seen between 1994-2004, 557 patient under went operation, of these 117 showed false recurrent calculi with a total incidence of 21% false recurrent rate. The reasons for incomplete removal of renal calculi are discussed, methods of decreasing the incidence are mentioned. Accurate intra-operative localization of stones is the most important factor.
Background Urinary tract infection (UTI) is amongst the most common bacterial infections that prompt patients to seek medical advice. Approximately 10% of human populations get urinary tract infection at some stage of their live. Objectives The study was carried out to determine the types of micro-organisms causing UTI and their sensitivity to antibiotics in Sulaimani Teaching Hospital. Methods Records of patients admitted in Sulaimani Teaching Hospital, who had complicated UTI, were studied for a period of five years, from 1st December 2006 to 1st December 2010. All study subjects who had positive records of urine sample cultures inoculated on MacConkey and blood agar media were included in the study. The isolated bacteria were identified using biochemical tests. Disk diffusion susceptibility test was used to determine susceptibility of bacterial agents to antibiotics. Results A total of 2055 urine samples were found to be positive. The main isolated organism was Escherichia coli (E coli) 67.69%, followed by Pseudomonus aeruginosa 11.24%, then Proteus Species 7.15%, Gram negative bacilli 4.53%, Staphylococcus aureus 4.23%, Klebsiella species 3.55% and lastly Salmonella species represented 1.61%. Conclusion The commonest microorganism for UTI in this study was E. coli, followed by Pseudomonas, Proteus. Resistance of organisms to antibiotics is high probably due to misuse and overuse of antibiotics.
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