Significance of Charlson co-morbidity index as predictive factor for post-op complications after radical nephrectomy.

The current study planned to explore the correlation between an elevated Charlson Comorbidity Index score and post-operative complications following radical nephrectomy in patients with renal cell carcinoma. A total of 70 patients aged 30-80 years undergoing radical nephrectomy were categorised into low Charlson Comorbidity Index score <4 group A and high score >4 group B. Post-operatively, complications were noted in 21(30%) patients, with higher grades more prevalent in the group B patients (relative risk: 1.96, p=0.004). The finding underscored the importance of considering comorbidities in assessing the risk of complications following radical nephrectomy.

Squamous Cell Carcinoma of the Kidney: A Large Case Series.

OBJECTIVES: We present our experience with and data about a very rare neoplasm of the kidney, squamous cell carcinoma (SCC). METHODS: A total of 14 patients with a diagnosis of SCC were identified on the basis of a retrospective analysis of medical records of patients who underwent surgery for renal cancers between 2015 and 2021 at the Sindh Institute of Urology and Transplantation. IBM SPSS v25 was used to record and analyze data. RESULTS: Most patients found to have SCC of the kidney were male (71.4%). The mean (SD) patient age was 56 (13.7) years. Flank pain was the most common presenting symptom (n = 11; 78.6%) followed by fever (n = 6; 42.9%). Only 4 (28.5%) of the 14 patients had a preoperatively established diagnosis of SCC; the remaining 10 (71.4%) had an incidental finding of SCC on their histopathology specimen. The mean (SD) overall survival was 5 (4.5) months. CONCLUSIONS: SCC of the kidney is a rare upper urinary tract neoplasm reported in the literature. The gradual onset of vague symptoms, lack of pathognomonic signs, and inconclusive radiological features make the disease unsuspected in most cases, therefore delaying diagnosis and treatment. It usually presents at an advanced stage, and the prognosis is often poor. A high index of suspicion is warranted in patients with chronic kidney stone disease.

Incidental Prostate Cancer: A 23-Year Review Of A Tertiary Care Hospital.

Prostate cancer is the second most commonly diagnosed malignancy in men worldwide. The prevalence has been increasing with significant differences between regions. This study assesses the prevalence of incidental prostate cancer detected in specimens removed during bladder outlet obstruction operation. A retrospective analysis of the records of patients who had either endoscopic or open prostatectomy from January 1998 to December 2021 was conducted. The variables analysed were age, procedure, date of surgery, and Gleason score. A total of 2,842 patients underwent surgery on the prostate gland during the study period. Most of the patients, i.e. 2,733 (96.2%), were pathologically diagnosed with benign prostatic hyperplasia, while only 110 (3.9%) had prostate cancer. The frequency of incidental prostate cancer following surgery for bladder outlet obstruction has decreased over the last two decades at our centre, possibly because of an increase in PSA testing.

E-learning in postgraduate urology training: A Covid-19 pandemic experience.

Since the declaration of the Covid-19 pandemic in March 2020, several teaching institutions started the process of adjusting to the new challenge. Medical education could not be imparted the way it used to be and some new methods had to be taken to adapt to the pandemic. At our institute, an online e-teaching approach was adopted to ensure the continuation of post-graduate medical training. Each week two lectures were recorded and uploaded on the YouTube Channel and shared with the students. This was followed by an MCQ based test using Google forms. Ten lectures were delivered in five weeks to 55 participants. The majority of residents agreed that this activity increased their knowledge of the subject and opted to continue it in future. With the help of short online lectures (< 30 minutes) and online tests (5 MCQs), the learning experience of residents can be enhanced. In future, more online resources can be used to incorporate this method of teaching.

Inflammatory myofibroblastic tumour of genitourinary system.

Two cases of inflammatory myofibroblastic tumour (IMT) involving the genitourinary system are presented. One patient with mass of urinary bladder came in with lower abdominal pain whereas the second patient complained of right flank pain and investigations showed a mass involving the right kidney. At present, no specific guidelines exist for the management of inflammatory myofibroblastic tumours. In this case report, we will discuss the work-up and the management stratégies adopted for each case.

Chondrosarcoma of right big toe with metastases to left orbital and left infra temporal region.

To report a case of chondrosarcoma of right big toe with left orbital and left infra temporal metastases. Chondrosarcoma is the second most frequent primary malignant tumour of the bone. A 56 year old man had history of trauma on his right big toe, which was amputated and the biopsy in 2011 at Sindh Institute of Urology and Transplantation (SIUT) revealed chondrosarcoma with clear margins. Eventually the patient was presented with swelling of the left eye, pain and gradual loss of vision of that eye. Later a CT scan of his chest, brain and orbit showed pulmonary and pleural based nodule, with mediastinal and hilar lymphadenopathy representing metastatic deposit in left orbit, extending to left infra temporal region. A treatment of palliative chemotherapy was started with doxorubicin and ifosfamide, after which he was referred for radiotherapy. At that time he had loss of vision, pain and exopthalamus, and palliative radiotherapy was delivered to the left orbit with the prescribed dose of30 Gy/300cGy×10 fraction. Thereafter his case will be followed up at the oncology OPD after a 03 month interval.

Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients.

OBJECTIVE: To report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18 years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup. PATIENTS AND METHODS: We retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients' age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997-2005 and 2006-2014, to study the differences. RESULTS: Of the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast® master in 524 (15.4%). In the majority of patients (97.4%) a 18-22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4 L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate. CONCLUSIONS: This is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system.

Da Vinci Robotic Surgical System: Early Experience from Pakistan.

OBJECTIVE: To determine the outcomes of robotic surgeries using the Da Vinci robotic surgical system (DVSS) at Pakistan's largest urological tertiary healthcare system. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Minimally Invasive and Robotic Surgery, Division of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from March 2017 to December 2021. METHODOLOGY: Hospital records of patients who underwent robotic urological surgeries were assessed for their outcomes in terms of blood loss, mortality, system malfunction, and conversion to open surgery. Descriptive statistics were determined. RESULTS: A total of 550 procedures were performed. The mean age recorded was 39.58±16.83 years. The mean blood loss recorded was 255.611±353.57 ml; there were 3 cases of malfunction. Forty cases were converted to open surgery, and the mortality rate was 1.1%. CONCLUSION: Minimally invasive surgical techniques have high precision, fewer complications, and lower morbidity rates. Using DVSS for surgical interventions is both effective and safe. KEY WORDS: Minimally invasive surgery, Da Vinci robotic surgical system, Robotic surgery.

Early post-operative outcomes of robot-assisted pyeloplasty in patients with unilateral ureteropelvic junction obstruction.

INTRODUCTION: Ureteropelvic junction obstruction (UPJO) is a commonly encountered abnormality and it can lead to serious consequences such as renal dysplasia eventually resulting in loss of kidney. Hence, early diagnosis and timely management remains the cornerstone of the treatment. The most anticipated technique amongst modern day urologist is the robot-assisted laparoscopic pyeloplasty (RALP). The study aims to determine early post-operative outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedure in patients presenting with unilateral ureteropelvic junction obstruction to establish the local perspective. METHODOLOGY: This is a descriptive study involving patients with ureteropelvic junction obstruction in a tertiary care facility in Karachi; Sindh Institute of Urology and Transplant (SIUT). A total of 46 participants were recruited. Robot-assisted laparoscopic transperitoneal dismembered Hynes-Anderson pyeloplasty was performed by a single surgeon with over 3 years of experience in the presence of the researcher. Early postoperative outcome total operative time, length of hospital stay, console time and blood loss were noted by the researcher as per operational definition. Data were analyzed on SPSS Version 22. RESULTS: Mean age in our study was 46.51 years with the standard deviation of ± 10.87. Whereas, mean length of hospital stay, total operative time, total blood loss, console time, pre-hemoglobin, posthemoglobin, height, weight and BMI in our study was 1.19 ± 0.40 days, 64.58 ± 17.59 min, 9.56 ± 6.13 ml, 30.17 ± 4.99 min, 12.66 ± 1.47 ml, 11.79 ± 1.93 ml, 165.62 ± 8.23 cm, 68.34 ± 8.23 kg and 24.85 ± 3.34 kg/m2, respectively. CONCLUSION: Recent advancements in technology have yielded the latest RALP technique which has been proven significantly better than existing approaches and similar results are reported by this study demonstrating improvement in peri-operative and post-operative outcomes ultimately ameliorating the quality of life of patients with UPJO.

Low-dose thalidomide in patients with metastatic renal cell carcinoma.

OBJECTIVE: To evaluate the role of thalidomide in patients with metastic renal cell carcinoma and the efficacy, toxicity and response rates to thalidomide. METHODS: The phase-II clinical trial study was conducted at the Sindh Institute of Urology and Transplantation (SIUT), Karachi between November 2008, and April 2009, comprising 80 patients with metastic renal cell carcinoma who had either progressed on or were not suitable for immunotherapy/biologic therapy. After institutional approval and informed consent, the patients received thalidomide 400mg daily. Thalidomide was continued until the time of disease progression or documented severe toxicity. Primary endpoints were the safety, response, progression free survival (PFS) and overall survival (OS). SPSS version 16.0 was used for statistical analysis. RESULTS: The median follow-up was 18 months (15-20); median age was 51.11 years (range 23-73). Three were 59 (73.8%) males. The bone (n=83; 47.5%), lungs (n=26; 32.5%) and lymph nodes (n=8; 10%) were frequent sites of distant metastases. Of the patients, 32 (40%) had previous different systemic treatments. Grade 3 and 4 toxicities were; fatigue (n=34; 42.5%), sensory neuropathy (n=8; 10%), deep venous thrombosis (n=7; 8.8%) and gastrointestinal upset (n=6; 7.5%). Response rates were available for 75 patients: partial 48 (60%); stable disease 12 (15%); progression 15 (18.8%); while 5 (6.2%) were not evaluated. Median progression free survival and overall survival rates were 7 months and 19 months respectively. CONCLUSION: Low-dose thalidomide resulted in manageable toxicity, better response rates, progression free survival and overall survival in the study population. Further large randomised trials are warranted.

Capecitabine induced cardiotoxicity: a case report and review of literature.

Capecitabine is an oral prodrug of 5-fluorouracil (5-FU) which is converted in tumor cells to 5-FU by the enzyme thymidine phosphorylase. Nowadays, it is being widely used into the management of colorectal, breast and head and neck cancers because of its oral route and its comparable efficacy with 5-FU. 5-FU induced cardiotoxicity (angina and myocardial infarction) has been reported the literature, but capecitabine induced cardiotoxicity is less reported event. We report a patient with diagnosis of locally advanced adenocarcinoma of rectum who developed symptomatic bradycardia and acute ischemia while receiving oral capecitabine 825mg/m(2) twice daily with preoperative radiation.

Outcomes of Nephron-sparing Surgery in T1 vs T2 Renal Tumours.

OBJECTIVE:  To compare the drop in eGFR after nephron-sparing surgery in T1 and T2 renal tumours. STUDY DESIGN:  Descriptive study. PLACE AND DURATION OF STUDY:  Department of Uro-oncology, Sindh Institute of Urology, and Transplantation Karachi, from March 2020 to March 2021. METHODOLOGY:  Retrospective data were collected for all patients who underwent nephron-sparing surgery between 2014 to 2019. Eighty-seven patients were divided into two groups based on the T stage of renal tumours (T1 ≤7 cm and T2 >7 cm). The outcomes of the two groups were compared such as eGFR, blood transfusion, hospital stay and complications. RESULTS:  There was a higher drop in eGFR in T2 tumours when compared to T1 tumours at 1 year of follow-up. There were more perioperative complications, higher blood transfusions and longer hospital stays for T2 tumours. CONCLUSION:  Nephron sparing surgery for T2 renal tumours carries lower eGFR preservation, higher blood transfusions and complications when compared to T1 tumours. The indication for such extensive surgery should be individualized to specific contexts only. KEY WORDS: Adenocarcinoma kidney, Nephrectomy, Glomerular filtration rate, Length of hospital stay, Blood transfusion.

Excision of Postchemotherapy Residual Retroperitoneal Mass in Testicular Cancer.

In this study, patients, who underwent excision of retroperitoneal mass following chemotherapy for testicular cancers from 2006 to 2016, were studied and followed till 2021. The clinical and oncological outcomes were measured. Among 338 patients, who were treated for TC during the entire study period, 38 (11.2%) underwent excision of the residual retroperitoneal mass. The mean age of these patients was 26.9±6.3 years. The majority were stage 3 testicular cancer. Complete resection with negative microscopic margins was achieved in the majority of cases i.e. 31 (81.6%). Damage to the collateral structures was seen in 12 (31.6%) cases. On histopathological examination, teratoma was seen in 18 (47.4%) of the cases followed by necrosis in 10 (26.3%). Complications were recorded in 12 (31.5%) cases, most were low grades. At five years of follow-up, 19 (50%) were disease-free, 25 (65.8%) were alive, and 9 (23.6%) were lost to follow-up. Five-year survival rates are lower than standard template-based retroperitoneal dissection, however, complications rates are comparable. Such complex surgeries should only be performed in high-volume centres. Key Words: Testicular neoplasms, Lymph node excision, Seminoma, Germ cell and embryonal.

Bladder preservation by neoadjuvant chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer: experience at Sindh Institute of Urology & Transplantation (SIUT).

OBJECTIVE: To identify any additional benefit and note the safety profile of neoadjuvant chemotherapy prior to concurrent chemoradiation in muscle-invasive bladder cancer. METHODS: Forty three patients with T2b-T4N0M0 bladder cancer underwent maximal TURBT followed by neoadjuvant chemotherapy cisplatinum 75 mg/m[2] D1+ gemcitabine 1000 mg/m[2] D1, D8 & D15 repeated every 28 days for three cycles followed by concurrent radiation 65Gy and weekly cisplatinum 30 mg/m[2] or gemcitabine 100 mg/m[2]. Complete response (CR) was defined as no tumour seen on cystoscopy and biopsy. The disease control and overall survival were determined by Kaplan and Meier method and statistical inferences with the log-rank test. Cox regression analysis was used to find different prognostic factors. RESULTS: Out of 43, thirty two patients (78.04%) achieved CR at time of cystoscopic evaluation. Six patients who did not achieve CR (14.63%) underwent salvage cystectomies, remaining were not operable. At the median follow up of 36 months, overall survival was 61%. Local recurrences were seen in 3 patients (10%) (2 pT1, 1pT2), distant metastases were seen in 2 patients (6.6%); 27/41 were alive, of whom 23 (56.1%) were retaining intact disease free bladders. The Tumour stage, incomplete TURBT and presence of hydronephrosis were important prognostic factors (log-rank p values 0.0001, 0.0001 and 0.001 respectively). CONCLUSION: Neoadjuvant chemotherapy followed by concurrent chemoradiation was tolerable with better bladder preservation and overall survival.

Outcome of trimodality protocol for invasive bladder cancer patients at Karachi, Pakistan.

OBJECTIVES: To evaluate the outcomes of patients with muscle invasive bladder cancer managed by trimodality protocol with assessment of factors that may predict treatment response, risk of recurrences and survival of such patients in our population. METHODS: A prospective, single arm study was conducted between July 2006 and December 2009 at the Sindh Institute of Urology and Transplantion, Karachi. One hundred and sixteen patients with muscle invasive bladder cancer T2-T3N0M0 were treated with concurrent chemoradiation (total dose 6500 cGy) after maximal transurethral resection. Complete response was defined as no tumour seen on check cystoscopy and biopsy. The disease control and overall survival were determined by Kaplan and Meier method and statistical inferences with the log-rank test. Cox regression analysis was used to find different prognostic factors. RESULTS: At the median follow up of 36 months (14-43), out of total 116, 62(51.6%) surviving patients the bladder was functioning well, while 18(15%) had local recurrence; in 9 patients superficial tumour recurred and required further transurethral resection and intravesical drug therapy and nine patients who had muscle invasive recurrence; underwent radical cystectomies. Concurrent chemoradiation was well tolerated. The overall survival at 3 years was 54%. Initial complete response, primary tumour stage and absence of hydronephrosis were the most important prognostic factors for survival (all p=<0.0001). CONCLUSION: Trimodality treatment was found to be an effective therapy in patients with invasive bladder cancer and complete TURBT, tumour stage and no hydronephrosis at time of presentation were found important prognostic factors for treatment response, disease free and over all survival rates.

Holmium laser urethrotomy for treatment of traumatic stricture urethra: a review of 78 patients.

OBJECTIVE: To evaluate the efficacy and long-term results of laser urethrotomy as minimally invasive treatment for traumatic stricture urethra. METHODS: Between January 2006 and June 2008, 78 male patients were treated with Holmium Laser urethrotomy. 16 Fr urethroscope was used through which 600um laser fiber was introduced through side channel. Stricture was visualized and incised at 12 o'clock position with energy set at 1500-2000 MJ at pulse rate of 10-12. Two other incisions were given at 2 and 10 o'clock positions. Further ablation was done till 16Fr Foley's catheter was passed. Patients were followed in a stricture clinic. RESULTS: Patients age ranged from 15-73 years. All strictures were due to trauma, Road traffic accident in 40 (52%) post catheter trauma 4 (5%), fall as ride 27 (35%) and failed urethroplasty 7 (8%). Site of stricture was bulbar 57 (73%), bulbomembranous 16 (20%) and membranoprostatic 5 (2.5%). Length of stricture ranged from 0.8-2.5 cms. At 3 months follow-up, 60 (77%) patients remained catheter and symptoms free while 18 (23%) developed recurrence of stricture but at the end of 36 months follow-up success rate decreased to 47 (60%). Among those who developed re-strictures, 6 ( 7.6%) had 2nd sitting laser while 4 (5.1%) had urethroplasty, and others were on intermittent dilatation. Immediate complications were sepsis 10 (13%), extravasation 2 (4%), failed urethrotomy 2 (4%) and mild haematuria 3 (5.8%). Hospital stay ranged from day care to 3 days. CONCLUSION: Laser urethrotomy is minimally invasive and an effective treatment for short strictures in bulbarurethra. The recurrence rate is 40% in the long-term follow-up and is more commonly seen in completely obliterated strictures.

Stricture of Urethra: Patterns and Outcomes of Management from a Single Centre in Pakistan Over 7 Years.

OBJECTIVE: To determine the outcomes of urethroplasty and its complications from a large cohort of patients managed in a single centre. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, from January 2010 to December 2016. METHODOLOGY: A total of 546 patients with stricture urethra at different locations underwent urethroplasty from January 2010 to December 2016 were included. All patients had an ascending urethrogram followed by retrograde ± antegrade urethroscopy to assess the location and length of the stricture. Technique of urethroplasty was chosen according to the site, length and etiology. Following appropriate procedure, patients were followed up in the dedicated urethral stricture clinic. Procedure was considered successful if either no further therapeutic intervention was required and the maximum flow rate (Qmax) was >20 ml/sec with a voided volume of at least 200 mls. The procedure was regarded as unsuccessful, if further treatment was required or Qmax was <10ml/sec. RESULTS: A total of 546 patients with mean age of 32.3 +13.1 years (range: 12-74) involving anterior (n=323, 59.2%) or posterior (n=223, 40.8%) urethra were treated. Mean follow-up was 43.6 months (range: 3-84). The success rates of bulbar urethral strictures after excision and primary anastomosis (EPA) was 93. 3%, non-transecting urethroplasty 84.6% and oral mucosal graft (OMG), 81.8%. In penile urethral strictures, OMG, Orandi procedure and Johanson's techniques yielded success rates of 88.4%, 66.6% and 57.1%, respectively. In posterior urethral strictures, after excision and bulboprostatic anastomosis, good results were seen in 88.3%. In pan-urethral strictures, abdominal skin graft repair, combined tissue transfer and OMG urethroplasty yielded success rates of 74%, 78.5% and 75%, respectively. The complications/ adverse events were encountered in 251 / 546 (45.9%) patients in this series. CONCLUSION: Anastomotic urethroplasty yielded best outcomes followed by OMG urethroplasty. In the long-term follow-up, erectile dysfunction (ED), infertility and recurrence of stricture are the main complications which need individualised management.

Adrenal myelolipoma: a report of three cases and review of literature.

Adrenal myelolipoma is a rare and benign tumour composed of mature adipose tissue and haematopoietic elements that resemble bone marrow. It is mostly discovered incidentally on imaging of abdomen done for non adrenal related reasons or at autopsy. Usually asymptomatic, but has been reported to present with symptoms such as flank pain resulting from tumour bulk, necrosis or spontaneous retroperitoneal haemorrhage. Symptomatic tumours, growing tumours or tumours larger than 10 cm should be excised surgically. We report cases of 3 male patients presenting with flank pain and upper pole renal masses. All three were treated surgically with adrenalectomy. Myelolipoma was confirmed in all three on histology.

The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

OBJECTIVE: To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. METHODS: A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. RESULTS: Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. CONCLUSION: Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly high in the patients having a JJ stent. The cost of the treatment doubled in the stented group which is an important factor in our country. JJ stenting does not prove to be a cost effective procedure when compared to the reduction in complications.

Laparoscopic Donor Nephrectomy: Early Experience at a Single Center in Pakistan.

OBJECTIVES: Laparoscopic donor nephrectomy has become the criterion standard for kidney retrieval from living donors. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Pakistan. The objective of the study was to identify benefits and harms of using laparoscopic compared with open nephrectomy techniques for renal allograft retrieval. MATERIALS AND METHODS: In this a retrospective study, patient files from May 2014 to September 2015 were analyzed. Patients were divided into 2 groups: those with open donor nephrectomy and those with laparoscopic donor nephrectomy. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time, perioperative and postoperative complications, surgery time, and length of hospital stay. Finally, serum creatinine patterns of both donors and recipients were analyzed. Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, USA). RESULTS: Of 388 total donors, 190 (49%) had open donor nephrectomy and 198 (51%) had laparoscopic donor nephrectomy. For both groups, most donors were older than 25 years with male preponderance. Left-to-right kidney donation ratio was markedly higher in the laparoscopic group than in the open donor nephrectomy group, with 6 cases of double renal artery also included in this study. There were no significant differences in surgery times between the 2 groups, whereas the laparoscopic donor nephrectomy group had shorter hospital stay. Analgesic requirements were markedly shorter in the laparoscopic donor nephrectomy group. The 1-year graft function was not significantly different between the 2 groups. CONCLUSIONS: The results for laparoscopic donor nephrectomy were comparable to those for open donor nephrectomy, and its acceptability was high. Laparoscopic donor nephrectomy should be the preferred approach for procuring the kidney graft.