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OBJECTIVE: To compare the efficacy of expulsive medical therapy for treating ureteric stones with or without mirabegron as an add-on to Diclofenac. METHODOLOGY: A prospective randomized controlled trial was undertaken between April 2018 to March 2019 at the Asian Institute of Medical Sciences, Hyderabad, Sindh. A total of two hundred participants who had ureteric stones were enrolled using non-probability convenience sampling. Diclofenac Only 100 mg/day (group A, n=100), and Mirabegron 50 milligrams/day + diclofenac 100 milligrams/day (group B, n=100) were administered to patients, adjunctively. Age, sex, site, size of the stone, and laterality were noted. The stone expulsion time for each patient was evaluated. SPSS version 24 was used for analysis. A p-value of 0.05 or less was set as the cut-off value for significance. RESULTS: Age, sex, site of stone, and laterality were not significantly different between the two groups (p=0.886, p=0.755, p=0.168, p=0.321, & p=0.889, respectively). Spontaneous stone expulsion ratios were observed as 43% and 71% in group A and group B (p4mm (p=0.04). The SER for middle and distally localized stones was higher in group B with a statistically significant p=0.02. CONCLUSION: The present study indicated that combined therapy with both mirabegron and Diclofenac is more effective than monotherapy with Diclofenac only. Mirabegron is a safe drug that improves the stone expulsion ratio in ureteric stones by > 4mm.

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.

OBJECTIVE: To determine the correlation of serum sodium and potassium levels before and after transurethral resection of the prostate with weight of resected tissue in BPH patients. METHODOLOGY: A prospective observational study was conducted on 75 male patients aged 40-70 years, presenting with benign prostatic hyperplasia and undergoing transurethral resection of the prostate at Department of Urology, Liaquat University of Medical and Health Sciences, Jamshoro. Ethical permission was taken before conducting this study from the university. Blood samples were obtained before and 24 hours after surgery for assessment of sodium and potassium levels. SPSS version 20.0 was used for data analysis. Pearson Correlation was applied for inferential analysis whereas p-value of < 0.05 was taken as significant. RESULTS: No correlation exist between baseline sodium level before resection(r=0.116 p=0.304) and 24 hours after the resection of prostate (r=0.219, p=0.051) and between baseline potassium level before resection (r=0.059, p=0.604) and 24 hours after the resection of prostate (r=-0.058, p=0.611) whereas moderate negative correlation (r=-0.310, p=0.005) exist between changes in potassium level with respect to weight of resected tissue. No correlation exist between exist between pre-operative hemoglobin level with respect to weight of resected tissue. (r=0.182, p=0.106). Moderate negative correlation (r=-0.309, p=0.005) exist between post-operative hemoglobin level whereas strong positive correlation (r=0.690, p=0.001) exist in operative time with weight of tissue resected. CONCLUSION: The results of the study showed that moderate negative correlation exists between changes in potassium level and post-operative hemoglobin level and strong positive correlation exists in operative time with respect to weight of resected tissue.

OBJECTIVE: To assess the effectiveness of honey dressing in Fournier’s Gangrene against conventional Edinburgh University solution of lime (EUSOL) dressing. METHODOLOGY: This was a prospective experimental study conducted in Liaquat National Medical College and Hospital Karachi for duration of 5 and half years. Total 44 patients having gangrene and no co morbid conditions were included in this study. Patients who had co-morbid conditions like deranged coagulation profile and CVA, who were not willing to participate or loss to follow up were excluded from the study. After getting baseline blood workup (i.e. CBC, S. Creatinine, S. Electrolytes, Urine D/R, C/S and Diabetic workup) done and taking consent, the patients were immediately shifted to operation theatre, the incision and drainage was performed, and the necrotic tissues were debrided. Pus cultures were sent, and patients were started on routine intravenous antibiotics (3rd generation Cephalosporin and metronidazole). A Dressing of wound was done randomly by honey in Group A and by Eusol in Group B. Patients were discharged after wound was completely healed. The data were obtained and analyzed by using SPSS version 20. Mann-Whitney U-test and chi-square test was applied to find out the significance. RESUTS: The patients in Group A got slough cleared in4.82±0.96 days, on average requiring 3.22±0.75 number of debridement’s, complete wound healing and duration of hospital stay being 9.54±0.74 days. The patients in Group B got slough cleared in 8±0.87 days, requiring 5.32±0.72 number of debridement’s, complete wound healing and duration of hospital stay 13.68±1.09 days.There was a significant difference in slough clearance, number of debridement’s required, time taken for complete wound healing and hospital stay between Group A and Group B (P-value

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 1st and 5th attempts of all participants was analyzed on SPSS version 22.0. Results: There was statistically significant difference in the mean resection score at 1st attempt between faculty and trainees i.e. 112±8.6 and 86.69±9.95, respectively (p80% 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 (p