EFFICACY OF ENDOSCOPIC TREATMENT FOR PRIMARY VESICOURETERIC REFLUX IN CHILDREN.

BACKGROUND: Vesicoureteral reflux (VUR) is a common anomaly affecting 1-3% of all children and 30-50% of those with urinary tract infection (UTI). In the past febrile vesicoureteric reflux on chronic antibiotic prophylaxis were treated by open surgery. Now a day's endoscopic injection of a bulking material has replaced open surgical procedure in cases of primary VUR. Our objective was to assess the efficacy of endoscopic treatment for primary vesico-ureteric reflux in children. METHODS: This was a descriptive case series. One hundred and five patients with either unilateral or bilateral VUR (181 ureters) underwent endoscopic treatment for primary VUR between January 2011 and January 2014. Children from 1 to 12 years of age with grade-II to IV reflux on preoperative voiding cystourethrogram (VCUG) were enrolled through consecutive non-probability sampling. Efficacy of treatment was evaluated at three months post injection by a standard VCUG. Ureters with no or grade-I reflux were considered successful treatment. RESULTS: Out of 105 patients 76 had bilateral while 29 had unilateral reflux. Mean age was 5.7 years (SD ± .7). Among 181 refluxing ureters, 116 (64%) were free of reflux, while 49 (27%) showed down gradation and 16 (8.8%) showed no response to treatment on postoperative VCUG. CONCLUSION: Endoscopic treatment for VUR is a viable option for patients with primary VUR and may be considered in management of such cases.

Neuroblastoma in horseshoe kidney.

Neuroblastoma is one of the commonest malignancy of childhood. Neuroblatoma in horseshoe kidney is an extremely rare condition. There is only one case of this tumour occurring in horseshoe kidney described in the literature. Recently we successfully treated a boy with neuroblastoma in horseshoe kidney.

Primary Renal Epithelioid Angiosarcoma.

Primary renal angiosarcoma is a rare tumor. Epithelioid variant of primary renal angiosarcoma is extremely rare and aggressive entity described in literature as a few case reports. It presents as solid looking renal mass as other renal cell carcinomas. Management is not well described due to scarcity of cases and aggressiveness of disease. We hereby report a case of epithelioid renal angiosarcoma in a 62-year female who presented with features of infected perinephric collection. Histopathological and immunohistochemical examinations of the renal specimen revealed lower polar renal tumor with atypical epithelioid cells having eccentric nuclei with coarse chromatin and eosinophilic cytoplasm, which were positive for vascular endothelial (FLI-1, CD 34, CD31 and factor VII) as well as epithelial (CKAE1/AE3) immune markers. Based on the histopathological and immunohistochemical findings, the patient was diagnosed with primary renal epithelioid angiosarcoma.

Partial Nephrectomy in Adults - A Single-Centre Experience.

Partial nephrectomy is the preferred procedure in benign renal lesions requiring surgical removal. It has also been accepted procedure for malignant renal conditions of smaller size. The aim of this observational study was to determine the outcome of partial nephrectomy in terms of complications and recurrence rates. Twenty patients with renal mass underwent this procedure from January 2010 till June 2014 at our Department, with mean age of 46.51 ±1.53 years. There were 14 males and 6 females. Renal mass on CT scan had the mean size of 3.80 ±1.15cm. The mean hospital stay in this series was 5.11 ±1.42 days, while mean operative time was 247 ±79.71 minutes. Twelve patients had malignant histology. They were followed using CT scan abdomen and pelvis with contrast at six and 12 months. Out of these, 10 (83.3%) patients were found to have no recurrence after six months.

Outcome Of Trans Rectal Ultrasound Guided Twelve Core Biopsy Of Prostate For The Detection Of Prostate Cancer- A Single Centre Experience.

BACKGROUND: This study was conducted to determine the outcome of trans-rectal ultrasound (TRUS) guided biopsy of prostate for the detection of prostatic carcinoma in a single tertiary care hospital in Pakistan. METHODS: This is a retrospective study including three hundred and eightythree patients who underwent trans rectal ultrasound guided biopsy of prostate in a single tertiary care hospital. Indications for biopsy were raised prostate specific antigen (PSA), abnormal digital rectal examination (DRE) and/or both. Twelve core biopsy of prostate was done.. RESULTS: The overall detection rate of prostate cancer was 59%. Prostate cancer detection in various PSA ranges of 0-3.99, 4-9.99, 10-19.99 and >20 ng/ml are 22.22%, 37.88%, 50.0% and 89.9%. PSA density >0.15ng/ml2 can diagnose 74.5% of patients with cancer. Prostate cancer detection rate based on abnormal DRE is 64.6% compared to 60.8% detected by PSA>4 ng/ml. CONCLUSIONS: In conclusion raised PSA, smaller prostate volume, abnormal DRE and raised PSA density are associated with greater chances of detection of prostate carcinoma.

Clinicopathological Characteristics of Prostate Cancer in Patients Presenting to a Tertiary Care Private Sector Hospital.

Prostate cancer (PCa) is one of the leading cancers in older males. The aim of this study was to evaluate the clinico-pathological characteristics of prostate cancer and rate of detection of prostate cancer by DRE (digital rectal exam) in patients presenting to a tertiary care private sector hospital in Islamabad, and determine the awareness about PCa in these patients. There were 226 patients who presented from December 2009 to December 2015 having mean age of 68.63 ±8.76 years and median Prostate Specific Antigen (PSA) value of 19.12 ng/mL (IQR=35.8). Median prostatic volume was 49 (IQR=22) gram/cc in the subjects. DRE was abnormal in 164 (72.56%) patients and normal in 62 (27.43%) patients only. Majority of patients presented relatively late, which may be due to lack of screening programme or public awareness.

Vaginal Yolk Sac Tumor in an Infant.

Yolk sac tumors are most common tumors among the germ cell tumors (GCTs) in children, mostly involving the gonads. But yolk sac tumors involving the vagina are very rare. These usually present with per vaginal bleeding and vaginal mass. Presentation with discharged tumor fragments is very unusual. We present a rare case of yolk sac tumor of vagina in an infant with very unusual presentation of per vaginal tumor tissue discharge, histopathological examination of which was diagnostic.

Comparison of Outcome of Percutaneous Nephrolithotomy in Adult Versus Paediatric Patients.

OBJECTIVE: To compare the outcome of percutaneous nephrolithotomy (PCNL) in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. STUDY DESIGN: Descriptive case series. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from January 2010 to December 2013. METHODOLOGY: Aretrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ≤12 years were included in paedriatic group (A) while patients aged > 12 years were included in adult group (B). The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma. RESULTS: One hundred and twenty-nine (129) patients including 44 (34.10%) females and 85 (65.89%) males with a mean age of 45.00 ±1.44 years were adults. Twenty-six palrents with mean age of 9.21 ±5.70 years, 17 (65.4%) males and 9 (34.6%) females, were included in the paedriatic group. Mean stone size was 2.12 ±1.01 cm in paedriatic group compared to 2.52 ±0.77 cm in adult group (p = 0.023). Mean operative time in paedriatic group was 158.8 ±39.63 minutes compared to 119.34 ±37.06 minutes in adult group (p < 0.001). Mean hospital stay in paedriatic group was 2.76 ±1.14 days compared to 3.12 ±1.27 days in adult group (p=0.1881). Peroperative stone clearance was in paedriatic group was 93.28 ±9.23% compared to 90.81 ±12.23% in adult groups (p = 0.331). One patient in the adult group developed urosepsis. CONCLUSION: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases.

Effect of body mass index on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy.

OBJECTIVE: To compare the effect of body mass index (BMI) on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy (PCNL) by comparing three BMI groups. MATERIAL AND METHODS: This is a retrospective analysis of 129 patients who underwent PCNL from January 2010 to August 2013. All the patients underwent PCNL by a standard technique. The patients were divided into three groups: patients having a BMI ≤24 kg/m(2) were included in the normal group, those having a BMI of 24.1-30.0 kg/m(2) were included in the overweight group, and those having a BMI >30 kg/m(2) were included in the obese group. Three groups were compared for operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement. RESULTS: A total of 129 patients including 44 females and 85 males were included with a mean age of 45.00±1.44 years. The mean age in the normal group was 43.29±1.69 years, 47.08±1.29 years in the overweight group, and 43.61±1.25 years in the obese group. The mean stone size in the normal group was 25.46±8.92 mm, 28.01±8.40 mm in the overweight group, and 26.84±7.41 mm in the obese group. Our results showed no statistically significant difference with respect to mean operative time, mean hospital stay, and stone clearance in the normal, obese, and overweight patients undergoing PCNL. Postoperative complications and analgesia requirement were also similar in all the three groups. CONCLUSION: There was no effect of BMI on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing PCNL. PCNL is a safe and effective procedure for the removal of renal stones in obese patients.

Paediatric Percutaneous Nephrolithotomy (PCNL).

OBJECTIVE: To describe Paediatric Percutaneous Nephrolithotomy (PCNL) in terms of safety and efficacy in a group of 26 children. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from January 2011 to June 2013. METHODOLOGY: PCNL of 26 children was done by standard technique. The patients were analyzed for age, gender, presenting symptoms, stone size, site, PCNL approach, operative time, stone clearance, hospital stay and per-operative and postoperative complications. Descriptive statistics were obtained. RESULTS: The mean age was 9.21 ±5.70 years. Seventeen (65.4%) patients were male whereas 9 (34.6%) patients were female. Flank pain was the most common presenting symptom. Mean stone size was 2.21 ±1.04 cm. Mean operative time was 158.8 ±39.63 minutes and mean hospital stay was 2.84 ±1.14 days. Postoperative transfusion was required in only one case (4%). There was no episode of sepsis or perinephric collection. Per-operative stone clearance was 93.28% ± 9.23%. Conversion to open was seen in one (4%) case. DJ stent was placed in 7 (27%) cases. CONCLUSION: PCNL is a safe and effective way of treating renal stones in paediatric age group.

Frequency of occurrence of urinary tract infection in double j stented versus non-stented renal transplant recipients.

Prophylactic ureteric stenting in renal transplant recipients prevents major surgical complications such as ureteric leak and obstruction on the one hand while, on the other hand, it is associated with complications like urinary tract infections (UTI), hematuria, stent migration, stent encrustation and forgotten stents. UTI is documented to be most common complication associated with double J (DJ) stent. In this retrospective observational study involving 157 patients, we compared the frequency of occurrence of UTI in DJ-stented versus non-stented renal transplant recipients. The study patients had undergone renal transplantation, with or without DJ-stenting, between January 2007 and June 2012. The mean age of the study subjects was 34.01 ± 14.63 years. The patients were followed-up for one year post-transplantation with regular evaluation, including detailed assessment, complete blood picture, renal function tests, routine urine examination and cultures. Data were collected through chart and electronic record review. Of a total of 157 patients, 61 (38.85%) developed UTI, including 30 of 74 stented patients (40.54%) and 31 of 83 non-stented renal transplant recipients (37.34%). Relative risk was calculated to be 1.08. The mean serum creatinine at the end of one year was 1.47 mg/dL in DJ-stented patients and 1.36 mg/dL in nonstented patients. Our study suggests that there is no significant difference in the frequency of UTI between DJ-stented and non-stented renal transplant recipients.

Primary renal aspergillosis and xanthogranulomatous pyelonephritis in an immuno-competent toddler.

Aspergillosis is primarily a pulmonary disease so that renal aspergillosis is usually secondary to hematogenous spread from lungs. Primary renal aspergillosis, though a rare entity, is still seen in immuno-compromised individuals. Renal aspergillosis may lead to formation of focal abscesses, fungal bezoars and may cause ureteric obstruction. Treatment involves stabilization of patient and removal of fungal bezoars along with administration of anti-fungal agents. This report describes the case of localized primary renal aspergillosis with fungal bezoar formation in 2 years old immuno-competent child who presented in sepsis and acute renal failure and was successfully managed by nephroscopic removal of fungal bezoar and intravenous voriconazole. The other kidney required nephrectomy for xanthogranulomatous pyelonephritis.