Objective- To evaluate the usefulness of measuring stone density in Hounsfield Unit by Low-dose Non Contrast Computed Tomography scan in predicting the outcome of extracorporeal shockwave lithotripsy for renal stone clearance. Materials & Methods - A total of 96 patients with renal stone size d” 20 mm attending at the OPD of BSMMU were included in this study. The outcome measures were complete clearance of stone, number of ESWL sessions and number of shock waves required to become stone free. Result- The mean size of the stone was 1.8 ± 0.3 cm. The mean stone density was 663.7 ± 69.8 HU. 25% of the patients underwent 2 sessions of ESWL, 52.1% three sessions and 22.9% more than 3 sessions. Of the patients 83.3 % were successfully cleared of their stone. The mean number of shock waves 6689.2±268.4 required for stone fragmentation of d” 750 HU and 9945±375.7 required > 750 HU stone density respectively. 85.5% of the patients with stone density d” 750 HU needed d” 3 sessions to become stone-free; whereas only 55.5% of the patients with stone density > 750 HU became stone-free in d” 3 sessions. 14.5% patients needed > 3 sessions of ESWL with stone density of e” 750 HU. 78.8% of the patients with stone density d” 750 HU exhibited complete clearance of stone as opposed to 37.5% of those with stone density > 750 HU. The chance of having complete stone clearance is 6-fold (95% CI = 1.9-19.4) higher in patients with low density stone (d” 750 HU) than that in patients with high density stone (d” 750 HU) (p = 0.002). Conclusion-In conclusion a stone density less than 750 HU should be treated with ESWL as first choice of treatment. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.90-97
A 28 years old male with well developed secondary sexual characteristics was admitted in BSMMU with a grossly swollen, malformed phallus and passage of urine mostly through an opening in the perineum. After birth, his parents noticed that when the baby micturates the phallus is swollen and few drops of urine comes out through the external urethral meatus but most of the urine comes out through an opening in the perineum. No treatment was taken by his parents for this complaint. At puberty his secondary sexual characteristics developed normally. He felt sexual urge towards females but his penis was not erected. At the peak of his sexual excitement, orgasm occurs with release of whitish seminal fluid which comes mostly through perineal opening. His general physical examination was unremarkable & examination of the genitalia revealed well developed scrotum. Both of the testes were normal in size, shape and consistency but the penile shaft was large and flabby, and the ventral aspect of the penis appeared as a sac with mild pseudo phimosis. Careful palpation suggested the absence of the corpus spongiosum & corpora cavernosa. Both these findings were subsequently confirmed by a duplex colour doppler study. The penis distended ventrally when he tried to micturate and the urinary stream was narrow. About 75% of urine flow evacuates through perineal opening which was located about 2 cm from anal opening in the midline ventrally. A voiding cystourethrogram revealed that whole of the anterior urethra was grossly dilated with narrowing at the bulbar part & external urerthral meatus. There was another passage (about 5 cm) from the scrotal margin up to proximal posterior urethra. Cystogram showed a bladder diverticulum at left lateral wall. An urethrocystoscopic examination revealed that just proximal to the stenosed external urethral meatus the urethra is widely dilated which seemed like a transparent fusiform sac with irrigating fluid. Whole of the anterior urethra was very thin walled with transmitting lights through it. Proximal part of the urethra near the external sphincter was grossly narrowed. Urethrocystoscope was also introduced through the abnormal urethral opening into the perineum which was located in the midline raphe of the perineal region about 2 cm from the anal verge. This urethra joined with the penile urethra distal to the external sphincter. Prostatic part of the common urethral channel was normal containing verrumontanum and a normal bladder neck. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.53-56
Objective- To determine the changes in free to total serum prostate specific antigen (PSA) ratio level after transurethral resection of prostate (TURP) in BPH patients at different interval of time. Materials & Methods- A total of 93 patients undergoing TURP for benign enlargement of prostate were included in the study. Serum total PSA and free PSA were assessed before operation and on the Ist and 7th postoperative day and at month 3 to determine the changes in total PSA, free PSA and free to total PSA ratio following TURP. Result- The preoperative mean total PSA, free PSA and free to total PSA ratio were 3.5 :L 1.7 ng/ml, 0.781 0.21 ng/ml and 0.28 + 0.07. In terms of IPSS, 75(80.7%) patients had severe lower urinary tract obstruction and 18(19.3%) moderate obstruction. Histopathological examination of the resected prostatic tissue revealed that all the 93 patients had benign prostatic lesion. Conclusion-The free and total PSA in first few days increases and thereafter it decreases in 3 months period following transurethral resection of prostate in men with BPH. As both these parameters decrease proportionately, the free to total PSA ratio remains consistent. If free to total PSA ratio decreases it raises suspicision about the early changes in malignancy. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.83-87
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