Objective: To compare the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter versus Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper ureteric stones. Materials and methods: Patients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper ureteric stones were reviewed. Patients with urinary tract infection, ,loss of follow-up, concurrent middle or lower third ureteral stones or acute renall failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups. Results: There were 70 patients with upper ureteric stones (35 in pneumatic group and 35 in laser group) meeting the study criteria. Patients’ age, gender, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less upward migration and secondary intervention rate, sepsis as compared with pneumatic lithotripsy (94.2% vs. 60%; 85% vs. 100%; 5.7% vs 40%; 5.7% vs 34.2%; 2.8 vs 2.8 respectively, all p < 0.05). In patients with stones sizes 8-10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate. Conclusions: Ho:YAG laser lithotripsy is better and much effective than pneumatic lithotripsy in the management of upper ureteric stones in terms of, stone free rate and secondary intervention rate for stones of sizes about 8 to 10 mm.Although the access of upper ureter is difficult but our small calibre (4.5 fr) ureteoscope and gentle manuevre have made the procedures safe and successful. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.188-192
Objective: In standard PCNL usually placement of a double J stent and a nephrostomy tube is required.Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PCNL). Postoperatively,In standard PCNL patients have an indwelling ureteric stent placed, which is often associated with stent-related morbidity. We performed totally tubeless(without any stent or nephrostomy tube) PCNL.This study was conducted in the urology centre of Combined military Hospital,Dhaka, to evaluate the safety, effectiveness, and feasibility of totally tubeless PCNL and to compare with standard PCNL where both nephrostomy tube and double J stent were placed. Materials and Methods: From January 2018 to June 2019 , total 57 selected patients underwent standard or totally tubeless PCNL.In standard PCNL group, both D-J stent and nephrostomy tube were placed and Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PCNL group. We compared patient demographics and stone characteristics, operation time, length of hospital stay, analgesia requirements, stonefree rate, blood loss, change in creatinine, and postoperative complications between the standard and totally tubeless PCNL groups. Results: There were no significant differences in preoperative patient characteristics, postoperative complications, and the stone-free rate between the two groups, but the totally tubeless PCNL group showed a shorter hospital stay and a lesser analgesic requirement compared with the standard PCNL group. Blood loss and change in serum creatinine level were not significantly different between the two groups. Conclusions: Totally tubeless PCNL appears to be a safe and effective alternative for the management of renal stone in selected patients and is associated with a shorter length of hospital stay and less analgesic requirement. Bangladesh J. Urol. 2021; 24(1): 53-57
Objectives : The Objectives of this study is to determine the outcome and effectiveness of Ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal stone without placement of any stent and nephrostomy tube as a supplement to the conventional PCNL. Material and methods: The Patients who underwent ultra-mini PCNL bwtween July 2018 to December 2018. were studied.This was a prospective study of 14 patients.This study was carried out in urology centre of CMH Dhaka.Before the study ethical clearance was taken from hospital ethical committee. All these patients had their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 1.5 cm in its maximal dimension. The mean stone size was 10.8+_4.2(5-15mm). An 6 Fr operating nephroscope was used. The patients were placed in prone position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed.The stone free rate was assessed on the 1st day and at three month after surgery by X-ray KUB and ultrasonography. Results: The study includes a series of 14 patients (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=7; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40–65) and the stone-free rate was 93.3% at first day and 97% after three month follow up.. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. Conclusion: Ultra-mini PCNL in prone position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume stone disease. A long term large scale multicentre study may be required to validate this technique. Bangladesh J. Urol. 2021; 24(2): 118-123
Objective: To-evaluate the outcome of bipolar Versus conventional monopolar transurethral resection of the prostate (TURP) on urinary function. Material and Methods: A total of 300 patients with benign prostatic hyperplasia (BPH) were randomized to bipolar or monopolar conventional TURP treatment groups. Operative and early postoperative variables and complications were recorded and all patients were re-evaluated at 1, 3, 6 and 12 months after surgery using the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR). Results: The operating time was shorter in the monopolar TURP group. Postoperative bleeding and blood transfusion requirements did not significantly differ between the two groups. Sodium levels were significantly lower in the monopolar group than in the bipolar group. Transuretheral resection syndrome developed in two (1.4%) patients in the monopolar group. Both groups had similar and significantly improved IPSS values, maximum urinary flow rate values and PVRmeasurement. Conclusion: Bipolar TURP is a safe and effective procedure that is associated with a relatively longer operating time, a smaller reduction in serum sodium levels and a similar efficacy compared with conventional monopolar TURP. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 66-70
Glomus tumors are rare, vascular,benign, painfulneoplasm, originating from glomus bodies and comprise just 1% of tumors arising in the hand, with fewer than 10% in the volar pulp of digits. Hallmark symptoms of glomus tumors include hypersensitivity to cold, heightened pinprick sensitivity and paroxysmal pain. We report this case due to its rarity and it’s potentialto be included among the differential diagnosis if the lesion is painful. We report here a rare case of a 59-years male presenting with08-years history of pain in the palmer surface of distal phalanx of right little finger. The fingertip was incredibly sensitive to touchand the pain increased at night. He could not recollect any history of trauma. Palpation of the finger revealed tenderness with feeling of no lump. Magnetic resonance imaging(MRI) of the right little finger revealed a small altered signal intensity lesion measuring about 8.0x4.0mm at the ventral aspect of distal phalanx ofright little finger. After I/V contrast- moderate enhancement of the lesion is seen. An incision was made in the mid-axial plane. A circumscribed mass removed with careful &blunt dissection. It was a tan-yellow, soft tissue nodule of about 1- cm in diameter without stalk or adherences to joint capsule or bone. Histopathological examination revealed the mass as a glomus tumor. Symptoms improved on removal and the wound healed without complications. Glomus tumors in the volar digital pulp can be difficult to diagnose. Complete surgical excision of the tumor is the only effective treatment to achieve pain relief and low recurrence.We also emphasize the importance of keeping this tumor in mind among the possibilities of differential diagnosis of painful digital nodules. J Bangladesh Coll Phys Surg 2022; 40: 306-309
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