Urology Commons^™

Sexual Dysfunction In Men After High Energy Pelvic Fractures: Narrative Review Of Targeted Literature, Obada Hussein Hasan, Muhammad Atif, Naveed Baloch, Imran K. Jalbani, Masood Umer

Section of Orthopaedic Surgery

Pelvic fractures represents high energy trauma with associated other organ injuries including intra-abdominal injuries, haemorrhage and extremity injuries. Anatomical location of genitourinary structures makes them vulnerable to injury with pelvic fracture. Incidence of sexual dysfunction varies in literature with 5% incidence of dysfunction in patients without urethral injury and 42% with urethral injuries. Hence in pelvic fracture, erectile dysfunction may be due to neurogenic, vascular, corporal and psychogenic injury. In this narrative review of targeted English literature from all level of evidences, which is written and supervised by experienced specialized orthopaedic, trauma and urology surgeons who were among the pioneers …

Kidney Stone Analysis And Spiritual Guides (Pir Faqir): The Known-Unknowns, Lena Jafri, Aysha Habib Khan, Humaira Asif

Department of Pathology and Laboratory Medicine

No abstract provided.

Antimicrobial Sensitivity Pattern, Demographic Findings And Risk Factors Amongst Meningitis And Non-Meningitis Invasive Streptococcus Pneumoniae At Aga Khan University Hospital Clinical Laboratory, Karachi, Pakistan, Seema Irfan, Joveria Farooqi, Afia Zafar, Haresh Kumar

Department of Pathology and Laboratory Medicine

Objective: To determine the resistance rate of penicillin and ceftriaxone amongst invasive meningitis and nonmeningitis isolates of streptococcus pneumoniae. Methods: The prospective cross-sectional study was conducted from January 2011 to March 2014 at the Clinical Microbiology Laboratory of Aga Khan University, Karachi, and comprised all invasive strains of streptococcus pneumoniae. Penicillin and ceftriaxone susceptibilities were performed and interpreted based on minimum inhibitory concentration breakpoints recommended by Clinical and Laboratory Standards Institute guidelines. Data was analysed using Stata 12.
Result: There were 163 strains isolated from sterile body fluids of 109 patients. Of the total, 46(28%) samples were meningitic while 117(72%) …

Unique Classification Of Parathyroid Dysfunction In Patients With Transfusion Dependent Thalassemia Major Using Nomogram: A Cross Sectional Study, Hafsa Majid, Lena Jafri, Jamsheer Jehangir Talati, Sibtain Ahmed, Bushra Moiz, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Introduction: Hypoparathyroidism is a rare complication of iron overload in patients with transfusion dependent β thalassemia major (β-TM). We aim to determine the prevalence of parathyroid dysfunction in patients with β-TM.
Methods:Diagnosed cases of transfusion dependent β-TM between 5 and 17 years of age were recruited from outpatient clinics of a non-profit organization in Karachi, Pakistan. Blood and urine samples were collected in fasting to determine Ca, P, Alb, Mg, Cr 25OHD and iPTH. Patients were grouped on the basis of upper and lower levels of Ca, 25OHD and iPTH for assessing parathyroid dysfunction into primary hypoparathyroidism [low calcium …

Urdu Translation And Validation Of The Urogenital Distress Inventory (Udi-6) In Women With Urinary Incontinence, Nuzhat Faruqui, Novera G. Chughtai, Jamil Ahmed

Section of Urology

Objective: To provide an Urdu translation of the six-item version of the Urogenital Distress Inventory (UDI-6) and its validation in patients with urinary incontinence (UI), as the UDI-6 is a recognised, useful disease-specific questionnaire for the evaluation of UI in women.
Patients and Methods: We used a multi-step linguistic translation of the UDI-6, which comprised backward and forward translations coordinated by clinical investigators, followed by a pre-test in 10 patients. The final version was completed by a larger sample of women (n = 200), of which 100 had UI for the last 3 months and 100 had no UI. …

Assessing Clinical Reasoning Skills Using Script Concordance Test (Sct) And Extended Matching Questions (Emqs): A Pilot For Urology Trainees, Syed Muhammad Nazim, Jamsheer Jehangir Talati, Sheila Pinjani, Syed Raziuddin Biyabani, Muhammad Hammad Ather, John J. Norcini

Section of Urology

Introduction: Clinical reasoning skill is the core of medical competence. Commonly used assessment methods for medical competence have limited ability to evaluate critical thinking and reasoning skills. Script Concordance Test (SCT) and Extended Matching Questions(EMQs) are the evolving tests which are considered to be valid and reliable tools for assessing clinical reasoning and judgment. We performed this pilot study to determine whether SCT and EMQs can differentiate clinical reasoning ability among urology residents, interns and medical students.
Methods: This was a cross-sectional study in which an examination with 48 SCT-based items on eleven clinical scenarios and four themed EMQs with …

Incidentally Found Metastatic Prostatic Carcinoma In A Therapeutic Orchiectomy Specimen, Zeeshan Uddin, Muhammad Bilal, Mohammad Ayaz Khan

Department of Pathology and Laboratory Medicine

Metastatic tumour involving the testis is a rare event. Incidental discovery of metastatic cancer in a therapeutic orchiectomy is even rarer. We report a case of metastatic adenocarcinoma prostate found incidentally in one of the bilateral therapeutic orchiectomy specimens. The patient was a 55-year-old man presenting with back ache and generalized body aches. Clinical examination showed malignant feel of prostate. Bone scan revealed metastatic disease and a serum PSA level of >100 ng/ml. Clinical diagnosis of carcinoma prostate was established and subsequent bilateral orchiectomy for hormonal deprivation was performed. On gross examination of left testis, there was a small 0.7 …

Role Of Multi-Parametric (Mp) Mri In Prostate Cancer, Syed Muhammad Nazim, Ather Enam, Basit Salam

Section of Urology

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer and for the …

Fibrous Pseudotumor Of Tunica Albuginea Testis Mimicking Testicular Neoplasm In A Young Man, Nazim Syed Muhammad, Ayesha Nusrat, Zehra Kazmi

Section of Urology

ntrascrotal lesions are common findings with a majority occurring in paratesticular tissue. Fibrous pseudotumors are rare, benign lesions of the testicular tunics and present with mass lesion(s) in the scrotum. Preoperative clinical and radiological diagnosis is challenging. We report a case of a 34-year-old man who presented with a 3-year history of left testicular swelling and was advised left radical orchidectomy by another surgeon. Physical examination revealed a firm, nontender mass attached to the lower pole of the testis. Testicular tumor markers were all negative, and ultrasound scan showed a relatively hypoechoic lesion closely associated with the left testis and …

Successful Use Of Balloon Tamponade In The Management Of Postpartum Hemorrhage In A Case Of Bicornuate Uterus, Erum Saleem, Ayesha Basharat

Department of Obstetrics & Gynaecology

Worldwide 50%–70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Bladder Distension As A Cause Of Abdominal Compartment Syndrome, Muhammad Yasir, Muhammad Qamarul Hoda, Tauseef Ahmed

Department of Anaesthesia

Abdominal compartment syndrome (ACS) is increasingly identified in critically ill patient and its harmful effects are well documented. The disparity among the pressure, volume in abdominal cavity and its contents, results in ACS. The actual incidence of ACS is not known. However, it has been observed predominantly in patients with severe blunt and penetrating abdominal trauma, ruptured abdominal aortic aneurysms, retro- and intra-peritoneal hemorrhage, pneumoperitoneum, neoplasm, pancreatitis, ascites and multiple bone fracture. We present a case of 40-year female who underwent emergency cesarean section and developed abdominal compartment syndrome due to urinary bladder distension secondary to blockade of urinary catheter …

Stages Of Chronic Kidney Disease And Soluble Transferrin Receptor (Stfr), Ferritin, Ratio, Faiza Alam Faiza Alam, Syeda Sadia Fatima, Sabeela Noor Sabeela Noor, Ahmed Bilal, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: To assess the ratio of soluble transferrin receptor to ferritin in different stages of chronic kidney disease.
Methods: This case-control study was conducted at the Aga Khan University Hospital and the Jinnah Postgraduate Medical Centre, Karachi, from January to September 2014, and comprised chronic kidney disease patients and healthy controls. Group 1 comprised controls, whereas groups 2, 3 and 4 had patients based on their mean glomerular filtration rate. SPSS 19 was used for data analysis.
Results: Of the 170 participants, 126(74.1%) were cases and 44(25.9%) were controls. The overall mean age was 55.87±3.48 years and the mean body …

Frequency And Predictors Of Recurrence Of Bladder Tumour On First Check Cystoscopy - A Tertiary Care Hospital Experience, Muhammad Farhan, Nazim Syed Muhammad, Jibran Ahmed, Hammad Ather

Department of Surgery Docs

Abstract

OBJECTIVE:

To determine the frequency and predictors of non-muscle invasive bladder tumour recurrence on first-check cystoscopy after transurethral resection of bladder tumour.

METHODS:

This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from April to November 2014, and comprised patients with a suspected newly-diagnosed urothelial cancer. Patients with non-muscle invasive disease with complete resection of all visible lesions along with deep biopsy from the tumour base were included. Patients received standard adjuvant intravesical therapy according to their risk stratification and underwent a white-light check cystoscopy at 3 months to look for tumour recurrence. Association between clinico-pathological …

Intravesical Foreign Body: Tertiary Care Center Experience From Pakistan., Hussam Uddin Soomro,, Imran K. Jalbani, Nuzhat Faruqui

Department of Surgery Docs

Foreign body in bladder is relatively uncommon condition with variable presentations. Literature is limited to case reports and small series from region. Therefore, we planned this study to review our experience regarding intravesical foreign body. This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised 14 patients having intravesical foreign bodies from March 1989 to March 2013. Demographics, presentation, mode of insertion, type of foreign body and management were noted. Of the 11(78.6%) patients included in the study, 10(90.9%) patients were male and 1(9.1%) was female. The mean age was 51± 20 years. In 5(45.5%) patients, …

Adrenalectomy For Solitary Metastasis Of Hepatocellular Carcinoma Post Liver Transplantation: Case Report And Literature Review, Imran K. Jalbani, Nazim Syed Muhammad, Usman Tariq Siddiqui, Farahat Abbas

Department of Surgery Docs

Abstract

Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is …

Comparison Of Ureteric Stone Size, On Bone Window Versus Standard Soft-Tissue Window Settings, On Multi-Detector Non-Contrast Computed Tomography., Hussam Uddin Soomro, Hammad Ather, Basit Salam

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the difference in mean stone size, as measured on bone window vs standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone.

PATIENTS AND METHODS:

In all, 60 patients presenting to the emergency and outpatient departments of a University Hospital from May 2015 to October 2015 and fulfilling the inclusion criteria were included in the study. A 64-slice MDCT was used to assess the locations and size of the ureteric stones. A consultant radiologist independently analysed the MDCT scans of all the patients. The mean difference in stone size was …

Severity Of Lower Urinary Tract Symptoms Among Middle Aged And Elderly Nigerian Men: Impact On Quality Of Life, Patrick Temi Adegun, Philip Adebayo, Peter Olufemi Areo

Internal Medicine, East Africa

Objectives. To compare the severity of LUTS among middle aged and elderly Nigerian men and determine the influence of LUTS severity on QoL.

Methods. This cross-sectional study was conducted among new patients presenting with LUTS attending Urology clinic between 2011 and 2015. Assessment of symptoms was based on IPSS and bother score completed by the eligible subjects on the same day of their clinic visits.

Results. Four hundred patients were studied comprising 229 middle aged and 171 elderly men. Interquartile range (IQR) of IPSS scores for men < 65 years and those ≥65 years was 14.0 (16.0) and 19 (15.0), respectively (p < 0.001). Mild LUTS was significantly associated with best, good, and poor quality of life while moderate LUTS was associated with poor QoL. Severe LUTS was significantly associated with all the categories of QoL (Best-Worst). Among the cohort of subjects with poor QoL, elderly patients had a significantly higher median IPSS score (p < 0.05).

Conclusions. There is no level of severity of LUTS in which patients’ QoL …

Is Laparoscopic Pyeloplasty A Comparable Option To Treat Ureteropelvic Junction Obstruction (Upjo)? A Comparative Study, Mazhar Ali, Syed Raziuddin Biyabani, Rajab Ghirano, Wajahat Aziz, Khurram Mutahir Siddiqui

Department of Surgery Docs

Objective: To compare laparoscopic with open pyeloplasty.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent surgical correction of ureteropelvic junction obstruction between during January 2008 and December 2012. Patients with laparoscopic pyeloplasty were placed in group 1 and those with open pyeloplasty in group 2.The groups were compared for operative time, hospital stay, perioperative complications, blood loss, duration of surgery, outcome and follow-up. Data was analysed using SPSS 19.
Results: Of the 73 patients, 29(40%) were in group 1, and 44(60%) in group 2. A crossing vessel could be …

Is Laparoscopic Pyeloplasty A Comparable Option To Treat Ureteropelvic Junction Obstruction (Upjo)? A Comparative Study, Mazhar Ali Memon, Syed Raziuddin Biyabani, Rajab Ghirano, Wajahat Aziz, Khurram Mutahir Siddiqui

Department of Surgery Docs

Objective: To compare laparoscopic with open pyeloplasty.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent surgical correction of ureteropelvic junction obstruction between during January 2008 and December 2012. Patients with laparoscopic pyeloplasty were placed in group 1 and those with open pyeloplasty in group 2.The groups were compared for operative time, hospital stay, perioperative complications, blood loss, duration of surgery, outcome and follow-up. Data was analysed using SPSS 19.
Results: Of the 73 patients, 29(40%) were in group 1, and 44(60%) in group 2. A crossing vessel could be …

Pheochromocytoma Associated With Von Hippel-Lindau Disease In A Pakistani Family, Imran K. Jalbani, Nazim Syed Muhammad, Farhat Abbas

Section of Urology

Objectives: The aim was to study the presentation, disease characteristics, operative outcome, and prognosis in patients with familial Pheochromocytoma associated with von Hippel-Lindau (VHL) disease.
Materials and Methods: There were six patients belonging to two generations of a single family who developed features of VHL over a period of 13 years and were treated at our institute. Patients' characteristics, that is, age, gender, presenting complaints and clinical signs, laboratory and biochemical evaluation, and the presence of associated conditions was gathered from medical records. The preoperative and postoperative radiological imaging and histopathological results were also collected.
Results: Out of six cases, …

Prospective Evaluation Of Outcome Of Percutaneous Nephrolithotomy Using The ‘Stone’ Nephrolithometry Score: A Single-Centre Experience, Muhammad Farhan, Syed M. Nazim, Basit Salam, Hammad Ather

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the 'STONE' nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density).

PATIENTS AND METHODS:

This was a prospective study of patients undergoing single-tract PCNL while prone, conducted at a university hospital. All patients had non-contrast-enhanced computed tomography within 3 weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with …

“Looks Can Be Deceiving”: Adrenal Teratoma Causing Diagnostic Difficulty, Mehwash Nadeem, Muhammad Hammad Ather, M Nasir Sulaiman, Shahid Pervez

Department of Surgery Docs

Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcification in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of soft consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological …

Doctor! Will I Be Dry? Factors Determining Recurrence After Vesicovaginal Fistula Repair, Atif Ajaved

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate various prognostic factors which determine outcome after surgical repair of vesicovaginal fistula.

METHODS:

The retrospective study was conducted at Koohi Goth Fistula Hospital, Karachi, and comprised data related to patients having undergone vesicovaginal fistula repair from January 2007 to June 2012. Multivariate analysis of the record was done using SPSS 19 software determining odds ratio with 95% confidence interval.

RESULTS:

Record of 640 patients were analysed with an overall success in 558(87.2%) cases. Multivariate analysis determined that the recurrence of vesicovaginal fistula was significantly related to multiplicity (9-fold recurrence risk), pre-operative size (10-fold recurrence risk for …

Frequency Of Electrolyte Derangement After Transurethral Resection Of Prostate: Need For Postoperative Electrolyte Monitoring, Wajahat Aziz, Hammad Ather

Department of Surgery Docs

Abstract

Objective. To determine the electrolyte derangement following transurethral resection of prostate (TURP). Methods. All patients undergoing TURP from June 2012 to April 2013 were included. Preoperative electrolytes were performed within a week of procedures. Monopolar TURP using 1.5% glycine was performed. Serum Na(+) and K(+) were assessed within 1 hour postoperatively and subsequently if clinically indicated. Results. The study included 280 patients. Sixty-six patients (23.6%) had electrolyte derangement after TURP. Patients with deranged electrolytes were older (mean age of 73.41 ± 4.08 yrs. versus 68.93 yrs. ± 10.34) and had a longer mean resection time (42.5 ± 20.04 min …

Role Of Surgery In Locally Advanced Prostate Cancer, Nazim Syed Muhammad, Farhat Abbas

Section of Urology

A significant proportion of patients present with locally advanced prostate cancer with inherent higher risk of local recurrence and systemic relapse after initial treatment. Recent literature favors combination of radiation therapy and extended hormonal therapy for this subset of patients. The effectiveness of Radical prostatectomy (RP) alone for locally advanced prostate cancer is controversial and is a focus of debate. However, it can decrease the tumor burden and allows the accurate and precise pathological staging with the need for subsequent treatment. Comparison of RP and other treatment modalities is difficult and incorrect because of inherent selection bias. RP as a …

“Looks Can Be Deceiving”: Adrenal Teratoma Causing Diagnostic Difficulty, Mehwash Nadeem, Muhammad Hammad Ather, M Nasir Sulaiman, Shahid Pervez

Department of Pathology and Laboratory Medicine

Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcification in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of soft consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological …

Hiv-1 Subtype A Gag Variability And Epitope Evolution, Syed Hani Abidi, Marcia L. Kalish, Farhat Abbas, Sarah Rowland-Jones, Syed Ali

Section of Urology

Objective: The aim of this study was to examine the course of time-dependent evolution of HIV-1 subtype A on a global level, especially with respect to the dynamics of immunogenic HIV gag epitopes.
Methods: We used a total of 1,893 HIV-1 subtype A gag sequences representing a timeline from 1985 through 2010, and 19 different countries in Africa, Europe and Asia. The phylogenetic relationship of subtype A gag and its epidemic dynamics was analysed through a Maximum Likelihood tree and Bayesian Skyline plot, genomic variability was measured in terms of G → A substitutions and Shannon entropy, and the time-dependent …

Surgical Management Of Pheochromocytoma In A 13-Week Pregnant Woman, Mazhar Ali Memon, Wajahat Aziz, Farhat Abbas

Section of Urology

A 34-year-old 13-week pregnant woman presented with hypertension refractory to medical therapy and on workup was found to have a right adrenal mass. Due to her persistent increased blood pressure she was advised urinary vanillylmandelic acid (VMA) and its level was raised. MRI of the abdomen showed a well-circumcised lesion in the right adrenal of 3.0×2.5 cm suggestive of pheochromocytoma. The patient was started on antihypertensives including α-blockers and β-blockers and planned for right open adrenalectomy. Intraoperatively, blood pressure was raised up to 180/110 mm Hg on slight manipulation of adrenal gland which was controlled with glyceryl-trinitrate and volatile agents. …