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Background: Renal Trauma is one of the significant causes of deterioration, morbidity, and mortality in the pediatric age group around the globe. Firearm injuries are among one of the essential causes for renal trauma. Overall, trauma is the leading cause of death and accounts for approximately 50% of mortality in children over 1 year of age. Therefore, the current study aims to determine the frequency of morbidity, mortality and renal trauma in blunt and firearm accidents in pediatric population. Methodology: A total of 180 children, aged up to 15 years with blunt and penetrating trauma, including firearm injuries, were enrolled in our study. All patients with in the inclusion criteria of the study, who were presented in the emergency department were evaluated and resuscitated by a pediatric surgeon. Patients indicated with renal trauma were operated and were post-operatively managed in the pediatric surgery ward. All patients included were followed as an outpatient. The data of this descriptive case series were collected prospectively and was analyzed on SPSS version 22.0. Results: Out of 180 patients 110 (61.11%) were male and 70 (38.89%) were female with mean age of 8.5 ± 2.9 years. Majority of the patients had blunt trauma (54.44%) followed by firearm injuries (60, 33.33%). While penetrating trauma were observed in 22 patients (12.22%). Overall Renal trauma was observed in 40 (22.2%) of patients. Out of 40 patients, 20 (50%) patients had blunt, while 14 (35%) had firearm and 05 (12.5%) had penetrating abdominal trauma. Majority of renal injuries were Grade II (60%) followed by Grade III (17.5%), Grade IV (12.5%) and Grade I (10%) injury. The major morbidities noted in firearm injured patients were surgical site infection that was reported in 33.33% patients, limb deformity in 6.66% and neurological deficit in 5% patients. Overall Mortality was observed in 6.6% patients and firearm injuries was responsible for 8.33%. Conclusion: Firearm injuries are one of the significant causes of trauma in children. The renal trauma was observed in 22.2% of cases, and all were managed conservatively. The frequency of morbidity and mortality secondary to firearm injuries was high as compared to other studies.

Background:After the introduction of simulators in urology, urology education has evolved significantly. The development of Transurethral Resection of Prostate (TURP) skills has shifted to simulator-based learning from being directly on patients. We evaluated the outcome of simulation-based teaching of TURP procedural skills on virtual reality simulator and objectively assessed the operative skills on the Global Rating Scale (GRS). Methodology:In this prospective comparative study, high fidelity (VirtaMed | UroSim™) simulator was used. A total of 17 participants were enrolled in this study, 4 were urology faculty members, and 13 were post-graduate urology trainees. All participants performed five attempts of real-time TURP complete procedure and were allowed to resect the maximum possible prostate tissue (goal ≥ 85%). Skills were assessed in terms of resection, bleeding control and safety parameters. Objective assessment of simulative operative skills was done on GRS score sheets by faculty, based on the Global Rating Index for Technical Skills (GRITS) and OSATS. The data from the 1stand 5thattempts of all participants was analyzed on SPSS version 22.0. Results:There was statistically significant difference in the mean resection score at 1stattempt between faculty and trainees i.e. 112±8.6 and 86.69±9.95, respectively (pthattempt. All the enrolled members resected >80% of prostate volume (40 score points). Similarly, for the parameters associated with bleeding control, there was a significant difference in the bleeding control, lost blood and remaining bleeders between trainees and faculty members (pstattempt while on 5thattempt, the outcomes were comparative in both groups. The objective assessment of operative skills of the trainee’s displayed improvement in all 5 parameters including tissue injury, movement and time, instrument application, surgical process and surgical details. Conclusion:Simulation-based TURP teaching significantly improves simulative operative skills in resection, bleeding control and safety parameters. GRS is an effective tool in assessing simulative operative skills and may evaluate endo-urological procedural training in urology trainees periodically. Link: http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/594/679

Objective: To compare the outcome of single oral dose of ciprofloxacin verses no prophylaxis before minor cystoscopic procedures (diagnostic cystoscopy, check cystoscopy and removal of double J stent) in female patients. Methodology: A total of 180 female patients were prospectively assessed. All patients had documented “no growth” on pre-procedure urine culture. Ninety female patients were randomized as Group A (No prophylactic antibiotics) and Group B (single oral dose of ciprofloxacin). Postoperatively all patients were observed for 4 hours in-hospital and then on telephone for first 3 days of procedure. Parameters including, burning micturition, fever, hematuria flank pain and urinary retention were recorded. Results: Overall the median age was 52.4 years (23-74 years), the mean age in group A was 52+6.1 years and in group B was 49.2+7.4 years. There was no statistically significant difference in both groups. In terms of co-morbidities, there was no statistical significant difference in both groups. Majority of our cystoscopy indications were ureteral stent removal, diagnostic cystoscopy and check cystoscopy for surveillance of bladder tumor, both groups were statistically comparable (p=0.09). Post-procedure, majority of patients from both groups remained asymptomatic (group A = 80%, group B =83%). Dysuria was reported by 17.7% of group A patients and 15.5% of group B patients, statistically it was comparable in both groups. Only 3 patients had culture proven urinary tract infections. Conclusion: There is no difference in patients proceeding for day care cystoscopy procedures with or without taking prophylaxis. Double J stents removal, diagnostic cystoscopy and check cystoscopy can safely be performed without antibiotic prophylaxis. Dysuria can happen up to 17% of patients without prophylaxis. Key Words: Antibiotic Prophylaxis, Cystoscopy.

Urethral stricture disease has significant economic impact throughout world. The bulbar urethra is the commonest site for urethral strictures (Approx 50%) followed by penile urethra in most of the published literature. In developing countries trauma (road traffic accident and iatrogenic) is the leading cause of urethral stricture disease. Younger patients have usually idiopathic type as compare to old age group, which present more frequently with iatrogenic and trauma related urethral strictures.This Qausi Experimental study was conducted from May2012-June2016 of duration at Liaquat National Hospital Karachi. All the patients diagnosed with short urethral strictures related to bulbar urethra were included in this study. All the patients underwent non transecting bulbar urethroplasty. All patients were assessed preoperatively, peri-operatively and postoperatively and on follow-up visits as; on 2nd, 8th and 24th week. All the data regarding outcome was recorded on the Performa and analyzed on SPSS V20.Total of 179patients were included, mean age was 38±SD15.3years (range 20- 65years). Anatomically bulbar urethra was affected in 52% of the cases followed by bulbopenile, bulbomembranous region. Etiologically idiopathic type was found in 40% cases, while trauma 21%, iatrogenic injury 26% and UTI 13% were also reasons. Stricture length was mean1.1±SD 1.4 cm (range 0.5-2.5cm). Preoperative Uroflowmetry revealed mean Qmax of 10.5±SD 5.3 ml/sec. Mean operative time was 35±SD 4.6 minutes, 7 patients had conversion to other procedures (3.91%), Postoperative complications were minimal. Mean follow up was 12±SD 21 months (range 6 months to 3 years). On initial follow up at 8th week and 24th week, Qmax was significantly improved. Only 3 patients required DVIU after the 24th week. Initial success rate after 24th week was 98.3% and eventually 100% at the long-term follow-up.non-transecting anastomotic bulbar urethroplasty (NTABU) is a new standard of care for the short bulbar urethral stricture up to 2.5cm. Idiopathic aetiology, iatrogenic and posttraumatic urethral strictures in selective patients can safely be operated with this technique.

Objective: To determine the pulmonary hypertension in chronic kidney diseases Patients And Methods: The one year cross sectional study was conducted at tertiary care hospital. All the patients either gender who were diagnosed as chronic kidney disease were included in the study. These patients were allowed to undergo necessary investigations and treatment. PH was defined as a mean pulmonary artery pressure ≥ 25 mmHg. All the specific patients had thorough clinical history, relevant clinical examination and important investigations to explore the pulmonary hypertension while the frequency / percentages (%) and means ±SD computed for study variables. Results: During one year study period total fifty patients with chronic kidney disease were explored and studied. The frequency for male and female population was 28 (56%) and 22 (44%) with mean ± SD for age of male and female individuals was 55.82±7.83 and 53.72±8.75 respectively while the mean value for pap (mmHg) was 37.72 ± 9.95. gender male 28 (56%) and female 22 (44%), diabetes mellitus 30 (60%), hypertension 32 (64%) and pulmonary hypertension 29 (58%). Conclusion: We presume that PH is a noteworthy issue in ESRD patients. Keywords: Pulmonary hypertension, Renal and Lung.

Objective: To determine the spectrum of pleural effusion due to renal pathologies at tertiary care hospital. Patients And Methods: The one year cross sectional study was conducted at tertiary care hospital. All the patients either gender who were diagnosed as chronic kidney disease (on haemodialysis) were included in the study. These patients were allowed to undergo necessary investigations and treatment. All the specific patients had thorough clinical history, relevant clinical examination and important investigations to explore the pulmonary pathology (pleural effusion) while the frequency / percentages (%) and means ±SD computed for study variables. Results: During one year study period total fifty patients with pleural effusion were explored and studied. The frequency for male and female population was 32 (64%) and 18 (36%) with mean ± sd for age of male and female individuals was 59.82±7.83 and 53.85±6.94 respectively. Gender male 30 (60%), female 20 (40%), pleural effusion 32 (64%). The cause includes idiopathic (unknown) 05 (10%), over hydration 15 (30%), heart failure 06 (12%), parapneumonic effusion 08 (16%), uremic pleuritis 05 (10%), tuberculous pleurisy 06 (12%), malignancy (prostate cancer) 05 (10%). Conclusion: Pleural effusion is regular in hospitalized patients getting long haul hemodialysis due to chronic kidney disorders. Keywords: Pleural effusion, Kidney, Lung and Renal disease.

Objective: To determine the efficacy of Alpha blocker as adjunctive medical therapy , which increases the stone clearance afterextracorporeal shock wave lithotripsy (ESWL) to treat renal stones. Design: Quasi Experimental study. Setting: Department of Urology,Liaquat National Hospital, Karachi. Period: September 2010 to March 2011. Materials & Method: Ultrasound guided Dornier Alpha Impactlithotripter was used for shock wave lithotripsy. Study was carried out on 60 patients who underwent single session of ESWL for renal calculus.Patients were divided in two groups, Group A (n=30) received conventional treatment and Group B (n=30) received Alpha-1 Blocker in additionto conventional treatment. All patients were evaluated with X-ray and Ultrasound (KUB) after 2 weeks and repeated at the end of month. Failureis defined as unsuccessful expulsion after 4 weeks and patient desire to remove the stone before day 30. Result: Out of 60 patients, 45(75%)were males and 15(257%) were females with male to female ratio was 3:1. The average age of the patients was found 36.32 ± 14.8 (Rangingfrom 15 to 75) years. Complete clearance was achieved in 76.7% of those receiving Alpha-1 Blocker and in 46.7% of controls at 1 month (P =0.001). This difference was statistically significant. Conclusions: The results of my study demonstrate that Alpha-1 Blocker therapy, as anadjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equallysafe.

To compare the stone clearance of upper with middle and lower ureteric stones by using ureteroscopic pneumatic lithotripsy.The study was conducted in the Department of Urology, Liaquat National Hospital, Karachi, from February 2009 to February 2010. A total of 90 patients were selected and divided into three groups of 30, each according to the location of stone in the ureter. All patients underwent ureteroscopic pneumatic lithotripsy with 8.5 Fr Wolf rigid ureteroscope and Wolf 2mm probe used for stone fragmentation. All patients were evaluated with X-ray KUB, ultrasound KUB and IVU. Follow-up studies included X-ray and ultrasound KUB performed on 1st postoperative day, after 1 week and at the end of 2nd week. Presence of stone after last follow-up was considered as failure of the procedure.Total number of patients were 90 and mean age was 27.47 +/- 5.8 years. Male female ratio was 2.1:1. Mean stone size was 11.44 +/- 1.41mm. According to the location of the stones, the success rate of pneumatic lithotripsy for upper, middle, and lower ureteral stones was 86.7%, 93.3%, and 96.7% respectively. Completely fragmented stones cleared spontaneously within two weeks in 83 of 90 cases so the overall stone-free rate was 92.2%.Ureteroscopic Pneumatic Lithotripsy is an acceptable form of treatment for upper ureteric calculi in addition to middle and lower ureteric calculi. It is a simple, reliable, effective, rapid and safe procedure.