2019) Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial, Arab Journal of Urology, 17:4, 279-284, ABSTRACT Objective: To assess the effect of diuretics (furosemide) administered before extracorporeal shockwave lithotripsy (ESWL) followed by continuous infusion of 0.9% NaCl during the ESWL in patients with renal stones. Patients and methods: A tertiary care teaching hospital-based prospective randomised controlled trial was conducted from July 2015 to June 2017, including 714 patients who underwent ESWL. The patients were randomised in two groups: in Group-A, patients received 40 mg furosemide 30 min before each ESWL session and 1000 mL 0.9% NaCl intravenous hydration during the procedure. In Group-B, the patients only received 0.9% NaCl. All patients were followed-up every 2 weeks for 3 months with X-ray and ultrasonography of the kidney, ureter and bladder. Patients without a radio-opaque stone at follow-up were classified as successes. Results: After 2 months, the stone-free rate (SFR) was much higher in Group-A, at 77.0% vs 65.3% (P < 0.001). Further, for patients aged ≤40 years, the SFR was significantly higher in Group-A than Group-B, at 89.2% vs 71.4% (P < 0.001). The mean (SD) age of the patients was 34.4 (8.23) years. Amongst them, 441 (61.8%) were male and 273 (38.2%) were female. The mean (SD) stone size was 1.42 (0.21) cm in Group-A and 1.40 (0.20) cm in Group-B. Conclusion: We conclude that the efficacy of diuretics (furosemide) along with hydration is superior to hydration alone during ESWL for renal stone clearance.Abbreviations: BMI: body mass index; KUB: kidney, ureter and bladder; OPD: Outpatient Department; ESWL: extracorporeal shockwave lithotripsy; SFR, stone-free rate. ARTICLE HISTORY
Objective: To assess the mean change in outcomes of sildenafil in the treatment of lower urinary tract symptoms and erectile dysfunction due to benign prostatic hyperplasia. Study Design: This is a quasi experimental study. Setting: The study was carried out at OPD of Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 26, 2018 to July 26, 2018. Materials and Methods: 50 patients fulfilling selection criteria were included in the study through OPD of Department of Urology, Jinnah Postgraduate Medical Centre, Karachi Informed consents were obtained. Demographics (name, age and contact) were also be obtained. All patients were subjected to detailed history and clinical examination for BPH and ED according to the IPSS and IIEF. Mean change in urine flow rate assessed through uroflowmetry and Mean change in post-void residual (PVR) urine was assessed through an ultrasound on the same day and on follow-up after 10th weeks in OPD before and after the tablet sildenafil 50 mg OD at night to every patient. Results: Mean age of patients was 58.42±9.76 (45-80) years. pre and post treatment International prostate symptom score (IPSS) score mean 17.78±2.91 and 12.94±2.79 (p-value=0.0001) respectively, erectile function score (IIEF) score mean 17.64±2.69 and 21.86±4.47 (p-value=0.0001) respectively, Urinary flow rate (UFR) pre and post treatment mean 8.32±1.62 and 12.46±1.83 (p-value=0.0001) respectively, Post-void residual (PVR) urine pre and post treatment mean 62.64±6.29 and 54.72±5.04 (p-value=0.0001) respectively. Conclusion: Improvement of erectile dysfunction and reduction of urinary tract symptoms in men with sildenafil was associated with improved quality of life and satisfaction with treatment. Daily doses of sildenafil can improve lower urinary tract symptoms.
Objectives: To correlate the clinically diagnosed prostatic lesion with histopathological evaluation, Gleason scoring andserum prostate specific antigen (PSA) levels in a tertiary care centre. Study Design: Observational Study. Setting: The current study was conducted in multiple centers of Sindh like Department of Surgery Unit-III, Peoples University of Medical and Health Sciences, Nawabshah CMCH Larkana, Jinnah Sindh Medical University and Al-Tibri Medical College and Hospital Karachi. Period: January 2018 to December 2019. Material & Methods: on 112 consecutive cases of clinically diagnosed prostatic disease, all the relevant demographic and clinical details including digital rectal examination (DRE) findings and serum PSA levels were recorded on a proforma designed for the study. PSA values of all these cases were recorded before the surgical procedure. The tissue sample of prostate was collected after surgery and histologically analysed for the confirmation of diagnosis and the Gleason scoring was made. All the results obtained were statistically analysed and tabulated. Results: The age of patients ranged 34-81 years, with mean age of 58+3.4 years. The adenocarcinoma was detected in 05 cases, hyperplasia in 92 cases and hyperplasia with prostatitis in 07 cases. The carcinoma was clinically diagnosed in 17 cases but after histological evaluation, the carcinoma was confirmed in 03 cases and 02 cases of cancer were confirmed among clinically diagnosed cases of hyperplasia. Majority of cases of hyperplasia were having the PSA level < 4ng/ml No any case of adenocarcinoma have PSA level below 4ng/ml, and majority of the cases of denocarcinoma were having PSA level above 20ng/ml. majority of malignant lesions were having PSA level above 20ng/ml and the Gleason score above 6. No any case of malignancy was detected in those patients having PSA level below 4ng/ml. Conclusion: The histopathological evaluation with serum PSA levels is necessary in all cases of prostatic disease to rule out the possibility of malignant pathology.
Objectives: To determine the outcome of extracorporporeal shock waves lithotripsy for high density renal stone on non-contrast computed tomography. Study Design: Descriptive study. Setting: Urology Department of Sindh Institute of Urology and Transplantation, Karachi. Period: 1st November 2017 to 31st October 2018. Material & Method: Patients in the age range of 25-75 years were selected, irrespective of their gender. After 12 weeks final outcome of ESWL was measured by performing plain X-ray KUB films before and after procedure. Satisfactory outcome was defined as stone clearance in <3 sessions of the procedure. Results: According to our inclusion and exclusion criteria 122 patients were selected for ESWL. Among them there were 41.8 (n=51) females and 58.1% (n=71) males. The mean age of the patients was found to be 34.08+ 9.53 years. Approximately more than half of the patients 57.4% (n=70) patients were present in the age group of in ≤35 years. The mean size of the stone was 1.51+ 0.5 cm whereas mean stone density as scan was 772 + 22.2HU. Patients were having renal or ureteric stones for mean duration of 2.07 + 0.31 months. Around 69.7% of patients had renal stones and 30.3% of patients had ureteric stones. Stone clearance was found in 58.2% (n=71) of the patients. Conclusion: Non-contrast enhanced CT scan is the most frequently used investigation to diagnose kidney stones and decide its treatment modality. Outcome of ESWL also depends on various factors as mentioned in the study.
Aim: To detect usefulness of triple D score in ESWL (extracorporeal shock wave lithotripsy) for management of renal stone. Methodology: Retrospective Study was conducted at Urology department, CMCTH) at SMBBMedical University Larkana. 50 patients underwent ESWL from 2018 to 2020. All the related data were taken as well as demographic details, history and risk factor from the patients. Routine investigation carried out including Blood CP ESR, Urine DR, Blood sugar, Renal profile, urine culture sensitivity and CT KUB. The stone density, skin-to-stone distance, and stone size were calculated by a radiologist. Results: ESWL was performed on 50 patients with average age of 30± 8 years and a sex ratio (male female) of 1:0.3. The stone-free percentage after the first treatment session was 40 percent and 90 percent on 2nd sitting, based on the triple D score, which included stone size, skin to stone distance, and stone density (HU). The mean stone size was 15.8 mm, the Skin to Stone Distance was 6.4 cm, and the stone density was 594 HU were established respectively. Conclusion: The Triple D Score is easy to compute and reported by radiologist. The use of the Triple D Score in ESWL patients has been shown to improve overall ESWL success rates. Keywords: Extracorporeal, Shock, Wave, Lithotripsy, Renal stone and Triple D score
Introduction: Hematuria is a common urologic finding in young adults, reported in 0.3–38.7% of adults in population-based studies. Objectives: The main objective of the study is to find the role of CT urography in investigating hematuria among local population of Pakistan. Material and methods: This descriptive cross-sectional study was conducted in Ganga Ram Hospital, Lahore during June 2020 to July 2021. Fifty patients with hematuria from the hospital OPD provided the data for this study. Results: Most common age group for hematuria was 31-45 years which constituted 41% of the study group and least common age group was 61-75 years constitutes 16%. Thirty-eight women and twelve men took part. Urinary obstruction was caused most frequently by renal, ureteric or both stone disease, which was found in 75.0% of group A patients and 65.0% of those in group B, as shown in table 01. Conclusion: It is concluded that CT urography is useful in detecting urolithiasis, nephrographic phase mostly useful for upper urinary tract pathologies and pyelographic phases are useful for detecting lower urinary tract pathologies. Keywords: Patients, Hematuria, Urolithiasis, Urography
Objective: To evaluate the efficacy of tamsulosin in reducing post operative flank pain during voiding, in patients with ureteric stent. Study Design: This is a Randomized control trial (RCT) study. Place and Duration: Study carried out at Department of Urology, Jinnah Post Graduate Medical Centre, Hospital, Karachi, Pakistan, from June 2016 to November 2016. Methodology: 60 patients aged between 15 – 45years, undergone placement of ureteric stent to treat ureteric and renal calculi and have pain score >4, were included in the study. Divided into two groups ‘group A’ and ‘group B’. In group ‘A’ and group ‘B’ Tamsulosin and Placebo was given respectively in patients with ureteric stent and reduction in post-operative flank pain was measured and compared. Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours. Patients having uretral trauma, patients having BPH, patient underwent TURP or TURBT, patent having urinary tract infection and patients with pregnancy or lactating females were excluded. All patients were received intravenous antibiotic (Ceftrixone 1gr). Also all patients were receive oral analgesic (diclofenic sodium 50mg BID) and antispasmodics (Drotaverine 80mg BID). Patients were discharged after 24 hours. Postoperatively stent related flank pain during voiding was assessed via Pain Scale. Results: 60 Patients who got operated for ureteric stent. In group ‘A’ there were 21 males (70%) and 9 females (30%), the mean age of group A was 35.67±5.99 as In group ‘B’ there were of 21 males (70%) and 9 females (30%) and mean age of group B was 35.04±6.42 (Table 1). Mean Pain score in ‘Group A’ (Tamsulosin) in week 1, 2, 3, 4, 5, 6 was 4.1, 3.5, 2.9, 2.3, 1.9, 1.3 respectively as shown in Table 2. Mean Pain score in ‘group B’ (Placebo) in week1, 2, 3, 4, 5, 6 was 6.9, 6.3, 5.9, 5.6, 5, 4.2 respectively as shown in Table 2. Average pain score in ‘group A’ and ‘group B’ came out to be 2.67 and 5.64 respectively (P value 0.005). Conclusion: Alpha blockers reduces the post-operative flank pain and voiding complaints in patients with ureteric stent. Our study shows that the efficacy of Tamsulosin in reducing post-operatice flank pain in patients with uretercic stent is better than placebo.
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