Urdu Translation and Linguistic Validation of the Bladder Cancer Index Questionnaire.

Background This study aimed to translate the Bladder Cancer Index (BCI) questionnaire to Urdu and validate it to assess the quality of life of patients with bladder cancer. Material and methods After forward and backward translation of the BCI questionnaire into Urdu, content validity was calculated using the content validity index (CVI) based on input from five health experts regarding the clarity and relevance of the questionnaire. Construct validity was measured by comparing the inter-scale domains and subdomains of BCI and by comparing BCI with Short Form 36 (SF-36) using correlations. For assessment of reliability, Cronbach's alpha was calculated to measure internal consistency and for test-retest reliability, the questionnaire was re-administered four weeks later and the correlation of responses at baseline and at a four-week time point was evaluated. Results The questionnaire has good content validity for clarity (0.91) and relevance (0.87). The construct validity of BCI was also adequately displayed by moderate to high correlation between different subdomains of BCI (Pearson's r: urinary - 0.62, bowel - 0.78, sexual function - 0.43) and low to moderate correlation between responses of BCI compared with SF-36 (Pearson's r mostly >0.45). Test-retest reliability was excellent (Pearson's r 0.90-0.98), and there was good internal consistency (Cronbach's alpha 0.79-0.92) in the different domains of the questionnaire. Conclusion The Urdu-translated BCI is a valid and reliable tool to measure the impact of bladder cancer on the quality of life of patients.

Access and Fluoroscopy Time Difference in Patients Undergoing Prone Percutaneous Nephrolithotomy (PCNL) With Ureteric Catheter Placement in Supine Versus Lithotomy Position.

OBJECTIVE: To compare the operative and fluoroscopy time in two different methods of ureteral stent insertion before prone percutaneous nephrolithotomy (PCNL). MATERIALS AND METHOD: Over 12 months, 124 patients with urolithiasis who went through prone PCNL were included in our study. All the patients had kidney stones and were divided into two groups based on the method of ureteral catheter insertion. This was done with the help of flexible or rigid cystoscopy in to group A and group B, respectively. Both groups had an equal number of patients, i.e., 62. The main outcome variables assessed were access time (from intubation to placement of access sheath) and fluoroscopy time during access. RESULTS: The categorical variables (age, gender, site of the stone) between the two groups were comparable. The access time in groups A and B were 48±4.30 and 77±10 minutes, respectively. The fluoroscopy times in groups A and B were 52±14.63 and 116±47.77 seconds, respectively. A statistically significant difference (p-value < 0.05) was observed for both the access and fluoroscopy time. None of the patients in either of the groups had a misplaced ureteral catheter requiring repositioning. CONCLUSION: Flexible cystoscope-assisted insertion of ureteral catheter prior to PCNL significantly reduces operative time, fluoroscopy time, and consequently radiation exposure during PCNL.

Comparison of efficacy three-site versus single-site steroid injections for the treatment of adhesive capsulitis.

Background: Frozen shoulder or adhesion capsulitis is a frequent ailment that causes pain and progressively restricts both active and passive shoulder motions. It is estimated that it affects 2%-5% of the general population and up to 20% of diabetes mellitus patients.We aimed to compare the effectiveness of three-site steroid injections against one-site injections in the treatment of adhesive capsulitis. Methodology: The Rheumatology Department of Pakistan Institute of Medical Sciences in Islamabad conducted this cross-sectional study. Between August 2021 to December 2021. The study comprised a total of 98 patients. This study included patients of both genders with shoulder pain between the ages of 40 and 70.Patients were divided into two groups & dosage was given at Sub-coracoid, Subacromial, and Posterior Capsule.The CONSTANT score was used to assess patients three times (Initial, 3months & 6 months later). Results: The average age, gender distribution, and dominant/non-dominant side ratio of the participants were nearly identical between the two groups. More patients in group B (77.22 8.17) had a higher mean CONSTANT score than those in group A (72.73 7.05). Patients were checked in on again after three and six months. Conclusion: The three-site injection technique is a safe and effective method for frozen shoulder. It provides an early recovery and improved shoulder function with a reduced frequency of relapse as compared to single-site injection techniques.

Relationship of spot urine oxalate to creatinine ratio and 24 hours urinary oxalate excretion in patients with urolithiasis.

BACKGROUND: The evaluation of 24 h urinary oxalate excretion is the gold standard for diagnosing hyperoxaluria in patients with recurrent urolithiasis. However, 24 h urine sample collection is cumbersome. Therefore we aim to see if oxalate to creatinine ratio in random urine sample can be used as an alternative. MATERIALS AND METHODS: A cross-sectional study was conducted at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine Aga Khan University Karachi from 1st February to December 31, 2019. A total of 62 adult patients, 18-60 years of age with history of kidney stones presenting to the clinical laboratory for 24 h urine oxalate estimation were invited to participate in the study after informed consent. Clinical details were recorded on a structured questionnaire and patients were guided to submit 24 h urine and a random spot urine sample. Urinary oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle by Trinity Biotech plc, Wicklow, Ireland following standard operating procedures. Urinary creatinine was measured on ADVIA 1800 by Siemens, US using kinetic Jaffe reaction according to the manufacturer's instructions. The data was analyzed on SPSS. RESULTS: In a period of ten months, a total of 62 subjects were recruited; mean age was 32.4 ± 2.6 years. Males were 49 (79.0%) and females were 13 (20.9%). Correlation was found to be (r = 0.289) by Spearman correlation (p value < 0.005). Taking 24 h urinary oxalate as gold standard the sensitivity, specificity, positive predictive value and negative predictive value of spot oxalate to creatinine ratio was 83.3%, 17.8%, 9.8% and 90.9% respectively. CONCLUSION: The random spot urine test cannot replace the 24 h urinary oxalate estimation in patients with urolithiasis.

Association Of Tumour Necrosis Factor-Alpha -308 G/A Promoter Polymorphism With Susceptibility And Disease Profile Of Rheumatoid Arthritis.

BACKGROUND: Single nucleotide polymorphism underlying the auto-immune process governing the pathologic manifestations of rheumatoid arthritis has been the focus of study for quite a while. TNF-alpha -308 G/A promoter polymorphism have been reported to be responsible for a number of manifestations of rheumatoid arthritis. METHODS: This case-control study was conducted at the department of Rheumatology at Pakistan Institute of Medical Sciences Islamabad from 9th May to 9th August 2019 with a focus to determine the Association of tumour necrosis factor-alpha -308 G/A promoter polymorphism with susceptibility and disease profile of rheumatoid arthritis. One hundred and fifty cases with diagnosed rheumatoid arthritis and 150 age and gender matched controls were enrolled in the study. Their genotyping was done for tumour necrosis factor-alpha - 308 G/A promoter polymorphism. RESULTS: The genotypic analysis showed that GG genotype was the most common genotype found in 118 cases (78.66%) followed by GA (18.66%) and AA genotype (2.6%) p=0.0096 in both cases and controls. Overall, G allele was more common than A in both cases and controls pointing towards the preponderance of G genotype in our population. (p=0.003). However, the GA genotype and A allelotype was more common among cases with rheumatoid arthritis (p <0.05). No significant association of G/A polymorphism with smoking and gender, however, within gender, males had a significantly more expression of the GA genotype and A allelotype (p <0.05). CONCLUSIONS: There is a significantly more expression of the GA genotype and the A allelotype of the TNF-alpha -308 G/A promoter gene in rheumatoid arthritis patients in our population. Similarly, more males, compared to females have increased expression of the GA genotype as well as the A allelotype.

Construct validity of UroSim® simulator for learning transurethral resection of bladder tumor.

OBJECTIVE: There is an increasing trend to incorporate Simulator-based training in urology residency programs. The study was designed to determine the construct validity of UroSim® for that we compared the performance of transurethral resection of bladder tumor (TURBT) between experts and novices. MATERIAL AND METHODS: We conducted a cross sectional study at a university hospital to determine the construct validity of UroSim® for TURBT. We compared the outcome measures between experts (urology consultants) and novices (residents) to determine relationship between clinical experience and performance on simulator. Primary outcome measure was resection time and secondary outcome measures were safety, bleeding, and visualization during TURBT on UroSim. We requested participant to resect three tumors to assess the test content of the simulator. Comparison of continuous variables such as resection time, resection, bleeding control, and visualization and blood loss using student t test. Comparison of categorical variable, i.e. perforation of bladder, using Fischer exact test. RESULTS: We included 30 experts and 30 novices. There was a statistically significant difference in the mean resection time between the groups (196±67.4 sec versus 374.6±179.7 sec; p=0.01), suggesting a positive relationship between clinical experience and performance on simulator. Additionally, safety parameters, namely, bleeding control, inadvertent cuts into bladder wall, ureteric orifices, and bladder perforations varied between the two groups. CONCLUSION: We observed significant differences of parameters in performance between experts and novices. Simulator is a useful tool for teaching TURBT as it demonstrates good construct validity and recommended in urology training for teaching psychomotor skills.

Foreign Body in Kidney Presenting as Renal Stone.

Retained foreign bodies in the urinary system are commonly found in the urinary bladder but are a rare finding in the renal pelvis. Foreign objects can reach the renal pelvis via different pathways. The presence of a foreign body could be iatrogenic, or via direct penetration from the gastrointestinal tract. Presentation could mimic tumor, abscess, hematoma, or even renal stone. We report an unusual case of intrarenal foreign body presenting as renal stone. The patient presented with flank pain and symptoms suggestive of renal stone and a non-contrast CT scan was also indicative of stone, however on endoscopy a foreign body was identified and retrieved.

Surgical Interventions for Renal Cell Carcinoma with Thrombus Extending into the Inferior Vena Cava: A Multidisciplinary Approach.

Objective: To assess surgical strategies and the impact of a multidisciplinary approach on patients undergoing inferior vena caval thrombectomy for renal cell carcinoma and to evaluate perioperative morbidity and mortality associated with these procedures. Methodology: A retrospective audit for all adults who underwent nephrectomy and inferior vena caval thrombectomy from January 2008 till November 2018 at a University hospital. Patients with incomplete records were excluded from the study. Results: During the study period, 21 patients underwent inferior vena caval thrombectomy as a completion of radical nephrectomy. Most were males (19 : 2) with a mean age of 54±11.3 years. The most common surgical approach was the 11th rib flank approach (n=8) followed by midline abdominal (n=6) and Mercedes-Benz (n=5). Eight patients had level 1, 10 patients had level 2, and three patients had level 3 tumour thrombus. The cavotomy was closed primarily in 20 patients; one required inferior vena cava (IVC) reconstruction with a pericardial patch. The proximal clamp was applied below the hepatic veins for most patients. Two patients required suprahepatic clamping before thrombectomy. There was no intraoperative mortality. Five patients (24%) developed complications: two required cardiopulmonary resuscitation due to severe hypotension and were revived; one developed acute renal failure; and one patient required a damage control laparotomy for excessive oozing. There was no thirty-day mortality. Conclusion: The IVC thrombectomy, along with radical nephrectomy for renal cell carcinoma for 1-3 level thrombus, can be performed with acceptable morbidity in a multidisciplinary team approach.

Is laparoscopic pyeloplasty a comparable option to treat Ureteropelvic junction obstruction (UPJO)? A comparative study.

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 identified in 25(86.2%) in group 1 and in 33(75 %) in group 2. Laparoscopic procedures were associated with a longer mean operating time (p=0.04), median estimated blood loss (p<0.001) and a shorter mean hospital stay (p<0.001). Follow-up mercaptoacetyltriglycinescan was done in 21(74.5%) patients in group 1 and 23(52.2%) in group 2. Only 2(7%) patients in group 1 and 2(4.5%) in group 2 had poor response on mercaptoacetyltriglycine scan. Mean follow-up was 2.71±1.2 months. Postoperative complications were 5(13%) in group 1 and 9(20%) in group 2(p=0.141). CONCLUSIONS: Laparoscopic pyeloplasty was associated with shorter hospital stay, less pain and less blood loss. The efficacy in term of success rate and perioperative complications of laparoscopic pyeloplasty was comparable to that of open pyeloplasty.

Surgical management of pheochromocytoma in a 13-week pregnant woman.

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 ß-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. Postoperatively urinary VMA decreased to normal range and all antihypertensives were gradually stopped. She had uneventful pregnancy and delivered vaginally. This case report highlights the importance of surgical management of pheochromocytoma in second trimester of pregnancy to avoid catastrophic complications later in pregnancy.

Renal arteriovenous malformation: an unusual cause of recurrent haematuria.

A 54-year-old woman presented with gross painless haematuria. Initial workup showed no abnormality except mild hydronephrosis on CT scan. Cystoscopy and retrograde pyelography did not find any gross lesion and her urine cytology was also negative. She had recurrent haematuria so her CT was reviewed with the radiologist with clinical suspicion of arteriovenous malformation (AVM) which was suggested by relatively increased contrast density in the hemiazygous vein and renal vein in the arterial phase. She underwent angioembiolisation of left renal AVM after which her haematuria settled.

An unusual combination of extra-adrenal pheochromocytoma and arteriovenous malformation of the ureter in a young adult.

We present a case of a 24-year-old gentleman who presented with painless pan haematuria for 2 weeks. During the workup, he was diagnosed to have a retrocaval mass after a CT scan while cystoscopy revealed a polypoidal pulsating lesion in the left ureter. After surgical manipulation of the retrocaval mass, the blood pressure of the patient raised to 260/130 mm Hg. It was completely resected and diagnosed as extra-adrenal pheochromocytoma (paraganglioma) after histopathology. The lesion in the ureter was completely excised and fulgurated and diagnosed as an arteriovenous malformation. To the best of our knowledge, this is the first patient to be presented in the literature with this unusual combination.