Comparison Of Solifenacin And Mirabegron For The Treatment Of Overactive Bladder.

BACKGROUND: Overactive bladder is mostly treated with a combination of behavioural interventions and commonly prescribed anti-muscarinic medication therapy, including solifenacin, which has considerable side effects and lowers the quality of life. Mirabegron relaxes the detrusor muscle and is a recently approved drug for the treatment of OAB. This study examined the effectiveness and safety of two medications, solifenacin and mirabegron. METHODS: This study was a comparative cross-sectional study conducted at Sami Medical Center, Abbottabad for a period of 6 months from August 2022 to January 2023. Female patients of aged ≥18 years with symptoms of OAB were enrolled. RESULTS: Current study showed that the average age of patients was 37.47±12.48 years in Group S and 39.93±7.93 in Group M. The population consists of 60 (100%) females. After 4 weeks of follow up dizziness, dry mouth, constipation hypertension and blurred vision were found insignificant between both groups with p-values of 0.312, 0.161, 0.076, 0.076, and 0.313 respectively. OABSS score improved significantly and after therapy 4.20±1.32 in Group S and 3.43±1.13 in Group M. There was no significant difference in frequency of treatment withdrawal p-value 0.150. CONCLUSIONS: When it comes to relieving symptoms of OAB, both solifenacin and mirabegron are effective. The OABSS improved with both drugs; however, mirabegron was associated with fewer treatment-related adverse events. We advocate using mirabegron as the first-line treatment. Solifenacin can be utilized if patients are no longer getting the desired effects from Mirabegron.

Post Operative Complications Of Open Partial Nephrectomy With Respect To Tumour Location.

BACKGROUND: Partial Nephrectomy has been the go-to approach for the treatment of small sized renal tumours for years now. Like any other surgical procedure, it is associated with post-operative complications. The study was aimed at determining the post-operative complications of open partial nephrectomy concerning tumour location. METHODS: This descriptive cross-sectional study was done on 45 patients as per inclusion criteria. The patients were managed as per department protocols and were observed for the development of immediate post-operative complications during hospital stays. RESULTS: Post-operative complications were observed in 4 (8.9%) patients and included haemorrhage (n=1; 2.2%) and urine leak (n=3; 6.7%). There was a statistically significant association between post-operative complications of partial nephrectomy and central tumour location (p=0.008, OR=14.52 and LR=5.70) and increased age (p=0.04, LR=5.40 and OR=8.90). Discussion: Increased age and tumour location may play a significant role in determining the likelihood of post-operative complications in patients who have undergone surgery for renal tumours.

Comparison Between Supine Position Versus Prone Position In Percutaneous Nephrolithotomy: A Single Centered Analysis Of 623 Cases.

Background: The ideal urological method for treating complex, large renal calculi is Percutaneous nephrolithotomy (PCNL). Its instruments, surgical techniques, and positions have all been adjusted as a result of its ever-changing nature. In PCNL, the supine position is advantageous compared to the prone position due to its several advantages, including the absence of cardiopulmonary risks, fewer post operative complications and shorter operative time. This study was designed for comparison of PCNL in prone and supine positions. Methods: After receiving ethical and research committee approval, this retrospective review from secondary data was conducted from April 2015 to December 2021. Out of 623 patients, PCNL in prone position was performed on 258 patients and365 patients inmodifiedsupine position. The patients' demographics, stone size and location, number of tracts, operating time, hospital stay, stone clearance rate, and post-operative complications were all compared. Results: The gender and age of the patients, the size and number of tracts, and location of the stones were all comparable (p>0.05). Operative time for prone position was 82 min ±2.49 SD VS 65 min ±2.95 SD, for modified supine position, p<0.001), hospital stay was 58 hrs. ±1.66 SD for prone VS 51 Hrs. ±1.65 SD, for modified supine position, p<0.01) and analgesia requirements for prone position was 41% VS 23% for modified supine position, p<0.001). The stone clearance rate was 87% in supine position and 89% in the prone positioning group (p=0.47). Urinary leakage from tract site was 0.38% in prone vs. 0% in supine position and temperature >99 °F was 12.4% in prone vs. 11.3% in supine position were the most common post-operative complications. Angioembolization was not observed in either group. Blood transfusions were given to 4.26% in prone position and in 3.58% of cases in supine PCNL. Conclusion: Percutaneous nephrolithotomy in the supine position had a short operating time, short hospital stays, and less analgesia requirements than PCNL in the prone position. In view of the above findings, supine PCNL is easy, quick to perform and having less complications rate as compare to Prone PCNL.

Anatomic Patterns Of Right Renal Vein.

BACKGROUND: Preoperative surgical planning assumes a central role in avoiding catastrophic outcomes of a surgery in the field of renal transplantation, and other urological procedures. This study was aimed to study the different anatomic patterns of human renal venous system. METHODS: It is a descriptive cross-sectional study including 50 adult male cadavers with well-preserved kidneys, renal vasculature and the inferior vena cava. Cadavers with deformed or congenitally anomalous kidney, evidence of surgery, solitary kidney, tumours of kidneys or injured renal vessels / inferior vena cava were excluded from the study. The kidneys, renal veins and the inferior vena cava were exposed. After securing inferior vena cava fifty ml mixture of Indian ink and gelatine was injected into renal veins via inferior vena cava and was allowed to solidify. Following this, the renal venous anatomy was studied. RESULTS: Twenty-eight cadavers had their right renal vein formed by 2 tributaries (56%), 13 (26%) had 3 tributaries, 5 (10%) had 4 tributaries, 1 cadaver had a posterior tributary (2%), while 3 cadavers had other numbers of tributaries (6%). Out of total 50 cadavers 40 (80%) had normal distribution of right renal vein. Additional renal veins were found in 14 (7%) cadavers, double renal veins in 1 (2%) and proximally double renal veins in 2 cadavers (4%).. CONCLUSIONS: There is considerable variation in renal venous anatomy. Knowledge of common venous patterns is necessary for minimizing intraoperative damage to renal anatomy and to prevent intra- and post-operative complications..

Initial Experience Of Percutaneous Nephrolithotomy In Hazara Region.

BACKGROUND: Renal stone disease affects a large population of the world and surgical management is the main stay treatment for larger stones. In comparison to open procedures, percutaneous nephrolithotomy (PCNL) has been known to offer almost similar stone clearance with least patient morbidity. The study was done with the objectives to evaluate our initial experience of PCNL in the management of nephrolithiasis in Abbottabad. METHODS: A case series study was carried out at a private hospital, Valley Medical Complex, Abbottabad, including the 35 patients undergoing PCNL from January 2015 to February 2016. RESULTS: Thirty-five patients (23 male (65.7%) and 12 female (34.3%) underwent PCNL with a mean age of 35.57 years±6.701 and mean renal stones size of 24.49 mm±7.098. 28.6% stones (n=10) were located in the renal pelvis, 28.6% (n=10) in the lower pole of kidney and 42.9% (n=15) had stones in other sites of kidney. 25.7% patients (n=9) had mild, 57.1% (n=20) moderate and 17.1% (n=6) had gross hydronephrosis. 28.6% patients (n=10) had a single renal stone, 61.4% (n=18) had ≥2 stones whereas 7 patients (20%) had partial stag horn stone. Tract access was gained through upper pole in 8.6% patients (n=3), middle pole in 11.4% (n=2), and lower pole in 85.7% (n=30). Complete stone clearance was achieved in 30 patients (85.7%) whereas partial clearance accomplished in 3 patients (8.6%). Two patients had PCNL failure due to failed tract access. Postoperatively 10 patients (28.6%) had significant pain, 06 patients (17.1%) had fever and 1 patients (2.9%) required blood transfusion. CONCLUSIONS: PCNL is a safe procedure for management of upper urinary tract stones and is still in evolution stages in Hazara region.

Role Of Symptomatic Treatment In Comparison To Antibiotics In Uncomplicated Urinary Tract Infections.

BACKGROUND: Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores. METHODS: A randomized control trial (RCT) in 100 women (15-50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test. RESULTS: There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004. CONCLUSIONS: Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use.

CLINICAL PRESENTATION OF RENAL CELL CARCINOMA.

BACKGROUND: Most common malignant tumour of the kidney is Renal Cell Carcinoma (RCC) and is known for its unpredictable clinical behaviour. Aetiology and risk factors are not completely understood. Extensive workup is being done in the understanding of the disease, especially to diagnose early and to treat promptly. The objective of this study was to determine the clinical presentation and pathological pattern of RCC. METHODS: After approval from ethical committee a retrospective review of records was conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal cell carcinomas. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. The data was retrieved regarding, history, physical examination and necessary investigations such as ultrasonsgraphy of abdomen and pelvis and CT scan of abdomen and pelvis. RESULTS: There were total of 50 cases. The male to female ratio was 3:2. Mean age of patients were 52.38 (18-93) years old. Most common clinical presentation was gross haematuria (66%).The mean tumour size was 8.34 (3-24) cm. Tumour histology were clear cell (84%), papillary transitional cell carcinoma (12%) and oncosytoma contributed 4%. CONCLUSION: We observed that large number of the patients with RCC presented with haematuria and most of them were male. Common pathological type was clear cell carcinoma.