Objectives: To compare ureterovesical jet frequency in non-obstructed versus obstructed ureter secondary to ureteric stone using ultrasonography in patients presenting with ureteral stones.Study design: Cross-sectional prospective study.

Background: Simple nephrectomy is a technique of removing the kidney from within the gerota’s fascia and is usually for a non-functioning kidney. While for renal tumors, radical nephrectomy is done, which involves the removal of the kidney with gerota’s fascia along with the ureter. Histopathology of patients who undergo simple nephrectomy sometime reveals renal malignancy. Such patients often need further treatment as simple nephrectomy in such cases is mostly suboptimal. The number of studies reporting tumors in simple nephrectomy specimens is limited. We aim to report single-center pathological findings in nephrectomy specimens from patients treated for non-functioning kidneys due to renal stone disease. Methodology: The medical record of patients (n=210) who underwent simple nephrectomy between 2014 and 2021 at the Kidney Centre Postgraduate Training Institute due to renal stone disease was reviewed retrospectively. Results: The total number of patients undergoing simple nephrectomy for non-functioning kidneys due to stone disease was 210. Of those patients, 117 were males, and 93 were females. The mean age was 45.33 ± 17.65 years. The histopathology report of specimens revealed renal malignancy in 10 patients (4.76%), xanthogranulomatous pyelonephritis in 11 patients, tuberculosis of the kidney in 7 patients, and chronic pyelonephritis in 182 patients. Conclusion: In conclusion, the prevalence of renal malignancy in patients undergoing simple nephrectomy is significantly high.

Aim: To assess the role of Intraprostatic injection of epinephrine intra-operatively in patients undergoing TURP in decreasing blood loss and the need for subsequent blood transfusions. Design: A double-blind, randomized controlled trial. Place and duration of study: The Kidney Centre Postgraduate Training Institute, Karachi, from March till August 2020. Methodology: A total of 40 patients were chosen at random and divided into two groups of equal size. One group got an intra-prostatic injection of epinephrine, whereas the other received a standard saline injection. Both groups were evaluated in terms of prostate volume (ml), resected tissue (gms), surgical resection time (minutes), pre and post-operative Hemoglobin (HB), and Hematocrit (HCT) levels. Intra-operative blood loss was then quantified using the last two variables. Transfusion requirement in both groups was also recorded. Results: Mean +Age of patients in Group A and Group B was 66.30+9.24years and 65.65+7.43years, respectively, with no significant difference between both groups (p=0.808). Median and IQR Prostatic volume in Group A and Group B was 68.0, 15, and 64.0,21, suggesting no statistically significant difference between the two groups (p=0.372). Mean + S.D Loss of HB of patients in Group A and Group B was 1.15 + 0.42 and 1.87+1.04, respectively, with a significant difference between both groups (p=0.007). Mean + S.D of post-op HCT patients in Group A and Group B was 3.16+1.50 and 4.81+2.79, revealing a significant difference between the two groups (p=0.026). No patients in Group A needed blood transfusions, whereas six patients in Group B had blood transfusions, indicating a statistical distinction between the two groups (p=0.001). Conclusion: The use of intra-prostatic injection of epinephrine leads to reduced blood loss and subsequently reduced operative time, irrigation fluid usage, and blood transfusion during TURP. It also allows a greater amount of prostatic tissue to be resected. Keywords: Transurethral resection of Prostate, Epinephrine, Blood transfusion, Hemoglobin, Hematocrit.

Aim: To find out the role of listening to music during extracorporeal shockwave lithotripsy to reduce pain and anxiety during the procedure. Design: A randomised controlled trial. Place and Duration of Study: Lithotripsy department at The Kidney Centre Postgraduate Training Institute, Karachi, from January to July 2021. Methodology: One hundred ten patients were randomly assigned into two groups of fifty-five patients each; Group-M (first session of ESWL with music and second session without music) and Group-X (first session of ESWL without music and second session with music). Patients with the music group were provided headphones with soothing music throughout their procedure. Routine analgesic (intravenous nalbuphine 0.1mg/kg) was administered to patients as per treatment guidelines. Each patient received a total of 4000 shockwaves with energy levels varying from 11.45 to 13.1 kilovolts and frequency ranging between 2 to 3 Hertz. Patients filled out two questionnaires, Visual Analogue Scale (VAS) and State-Trait Anxiety Inventory (STAI). Baseline data for all patients was calculated and compared between the two groups. Data were analysed using IBM SPSS ver. 20. Results: Ninety-eight were males while twelve were females. Gender distribution between groups does not differ significantly (p = 0.862). The mean age in Group-M was 36.22 + 9.78 while in Group-X was 36.13 + 9.89 without any significant difference between groups (p = 0.422). BMI of Group-M patients (25.34 + 4.64) was not significantly different from Group-X (25.41 + 4.80) (p = 0.327). Median stone size of Group-M was 1.0 ; 0.30 while that of Group-X was 1.1; 0.40 (p=0.997). Stone laterality was not significantly different among the two groups (p = 0.961). The distribution of stone location among both groups was not significantly different from each other (p=0.949). In Group-M, first session patients (with music) had significantly lower median VAS score (2; 1) as compared to second session patients without music (4; 2), (p < 0.001). In Group-X, first session patients (without music) had significantly higher median VAS score (6; 1) as compared to second session patients with music (4; 2), (p < 0.001). Conclusion: Music therapy during ESWL sessions reduces both pain and anxiety and also improves overall compliance of stone disease patients by eradicating the fear of the procedure. Keywords: ESWL, Lithotripsy, Visual Analogue Scale, Renal calculi.