Hepatic hemangioma is mostly asymptomatic and incidental finding on imaging. Fever of unknown origin as a sole presentation is rare. We present an interesting case report of a 49-year-old female, who presented with fever for three months. Extensive blood investigations and infectious workup failed to reveal the cause. Contrast computed tomography of abdomen revealed a giant (15 × 11 cm) hemangioma arising from left lateral segment of liver, and was attributed as a cause for fever. Surgical excision of hemangioma completely ameliorated the fever.
Background: Vesical calculus means urolith in bladder. Cystolithotomy is the traditional treatment, but a percutaneous approach has been advocated. The objective was to compare open cystolithotomy with perurethral cystolithotripsy and suprapubic percutaneous cystolithotripsyused in the treatment of bladder stones.Methods: A retrospective study was conducted among 100 patients of bladder stone treated at a tertiary centre in Eastern Nepal from January 2014 to December 2019 who underwent open cystolithotomy and endoscopic procedures (perurethral cystolithotripsy and suprapubic percutaneous cystolithotripsy). Data were analysed using SPSS version 11.5 at p value less than 0.05 taken as significant.Results: Statistical significant difference was observed in operating time, duration of catheterization and duration of hospital stay in both open and endoscopic management of vesical calculus (p value=0.0001). General complications were observed in 90% cases of open cystolithotomy and 33.9% cases of endoscopic procedure respectively.Conclusions: Endoscopic procedure is safe and efficacious method of urinary bladder stone removal with low incidence of complications.
Background: Percutaneous nephrolithotomy (PCNL) is considered as the standard treatment for renal tract stones. It is a successful procedure with low complication rate. Objective was to evaluate the outcome measures in large renal stone including stone free rates and complications in patients underwent PCNL. Methods: A retrospective study was conducted in 120 patients who underwent PCNL for renal stone size 2 to 2.5 cm, between 2019 and 2021. Ethical clearance was obtained from the institutional review committee (IRC/2430/022). The data were collected from the records available in the medical record section. The data were analyzed for patient demographics, investigations, site of puncture, stone-free rates (SFRs), type of nephroscope, use of nephrostomy tube, blood transfusion, hospital stay and complications. Results: Out of 120 cases, 64 (53.3%) were males and 67 (55.8%) presented with renal stone on the right kidney. Renal stone was in pelvis in 47 (39.2%) patients. In 47 (39.2%) cases puncture was made in the lower pole. Stone free clearance rate was 92.5% and 4.2% patients required blood transfusion. There was no statistical difference in intraoperative complication like bleeding in supracostal puncture group and subcostal puncture group [25% vs 13.2%; p=0.13] and in tube group and tubeless group (43.9% vs 3.8%; p<0.001). There was significant difference in length of hospital stay and duration of Foley’s catheter removal between supracostal group vs subcostal group and tube group vs tubeless group (p<0.05). Postoperative complications like fever were seen in 14 (23.0%) and four (6.8%) patients with standard nephroscope group and mini nephroscope group respectively and it was statistically significant (p<0.05). Conclusions: Mini and tubeless PCNL had a good success rate with minimal complication. The total stone clearance rate in our study was 92.5%.
Background: Urethral stricture leads to obstructive voiding dysfunction. We report an audit of surgical management of urethral stricture in adult males. Methods: The records of all patients diagnosed with urethral stricture from December 2017 to March 2019 at B. P. Koirala Institute of Health Sciences, Nepal were retrieved. Preoperative, surgical, and postoperative follows-up data were evaluated. The American Urological Association International Prostatic Symptom Score (AUA-IPSS) and Uroflowmetry (voided volume and peak urinary flow rate (Qmax)) were used to assess the outcome of the surgery. Results: Among 50 patients, the majority (46%) belonged to 40 - 59 years. Twenty-five patients (78.1%) with traumatic anterior urethral stricture underwent excision and primary end to end anastomotic (EPA) urethroplasty; seven patients (21.9%) with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty (PPU) with EPA; eight patients with inflammatory urethral stricture underwent Kulkarni urethroplasty; four patients with iatrogenic urethral stricture underwent EPA; six patients with idiopathic urethral stricture underwent Barbagli dorsal onlay urethroplasty. All patients had preoperative voided volume < 150ml, Qmax < 15ml/s. Thirty patients had complete obliteration; the remaining patients had severe storage and voiding symptoms (AUA-IPSS ≥ 20) before surgery. Except for two patients who underwent redo surgery, outcome of urethroplasty was successful in terms of storage and voiding symptoms (AUA-IPSS < 7) and uroflometry findings (voided volume > 150ml and Qmax >15ml/s). Conclusion: Urethreal stricture was most common in the age group of 40 - 59 years and traumatic stricture was the most common cause.
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