Background: Urethral stricture (post-scarring contraction in the urethral mucosa) is among the most challenging clinical conditions in urology. In Pakistan, Urethral stricture is a high-volume disease and constitutes 4-5% of urology workload (majority of them being in the 3rd to 5th decade of life). Different urethral strictures have different management option depending upon site, size and number of recurrences. OIU is indicated for urethral stricture for small (1.5 cm) bulbar and membranous urethral stricture. However, recurrence of strictures after OIU is quite common                (4 to 5%). It has been proposed that duration and size of catheter after OIU effects the recurrence rate. The foremost management choice is internal urethrotomy, but recurrences are common, and many believe that the duration and size of catheterization post internal urethrotomy may affect the recurrence rate. Objective: To determine the factors affecting recurrence rates of urethral stricture after internal urethrotomy. Methodology: It was Quasi Experimental Study conducted in Urology ward of Dr. Ziauddin University Hospital, Karachi from 10th March 2020 to 31 december 2021. Total 60 patients were included; all of the patients were divided into four equal groups. All the patients were followed quarterly for 12 months and data was recorded for urinary flow, retention, burning sensation during urination. UFM, Cystoscopy and urethrogram were done once indicated. Symptomatic patients or patients with UFM 15ml/sec were checked for recurrence followed by cystoscopy if needed. The data analysis was obtained using SPSS v. 21.0. Results: The mean age of the sample stood at 27 (SD ± 4) years (range: 20 to 40) years were enrolled in the study. Urethral stricture disease recurred cumulatively in 24 (40%) patients within 12 months. Mean duration of catheterization was 8.71 ± 1.1 and 2.97 ± 0.91 days in patients with and without recurrences, respectively (p=0.001). Catheter dwell times for ≥7 days was associated with increased recurrence (p=0.039). Of the patients with recurrent strictures, increased catheter diameter was also associated with higher recurrence rates (p=0.041). Conclusion: After careful consideration, it can be concluded that longer catheter in-dwell time and greater catheter diameter lead to a greater probability of stricture recurrence and hence the indwell time should be limited to ≤ 3 days and the catheter size chosen to be no more than 16Fr.

Background: The worldwide prevalence of developing renal stones is as high as 15% with an estimated 1 in every 5 persons being affected with the condition in Pakistan. Among the many treatment options available for renal calculi, extracorporeal shockwave lithotripsy (ESWL) is among the commonest owing to its non-invasive nature, however, it has its drawbacks; one being limitation against dense stones.   Objective: To assess association between stone density (detected on CT KUB) and ESWL outcome among patients with renal calculi. Methodology: This clinical trial was conducted upon a sample of 150 patients (of either gender, aged 16 to 70 years) presenting to the Urology out-patient, emergency and lithotripsy department of Ziauddin University Hospital with renal calculi from 30th August 2017 to 30th September 2019. After taking written informed consent, data was recorded onto a prestructured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, and disease history, inferences obtained from C.T KUB, operative notes and the eventual treatment outcome. The data obtained was analyzed using SPSS v. 21.0.  Results: The mean age of the sample stood at 36.7 (SD ± 3.1). 104 (69.3%) patients had multiple calculi and 46(30.7%) have single calculi with mean density of 812 (SD ± 219) HU. A (having stone density <500-HU) group B (having stone density 501 to 1000-HU) and group C (having stone density >1000-HU). The success of group A was 95.34% group B was 88.5% and group C was 80.3%. Major proportion of the sample (39.3%) required up to 3 ESWL sessions. The stone density was observed to be inversely proportional to the success of ESWL.  Conclusion: After careful consideration, it can be concluded that higher stone density is associated with a poor ESWL outcome and thus other treatment modalities may be considered among patients with a stone density of more than 900 HU.

Background: A common indication in urological pathologies and especially in instances of ureteric calculi/obstruction, is the placement of ureteric catheter such as the double J stent. 76% of patient with double J stent may encounter adverse outcome owing to bacterial colonization of their stents. Though antibiotic administration may help counter the situation, the implicated microorganisms are hard to determine. One may suggest that a urine culture may offer insight into the matter, however, little is known how bacteriology of the urine and stent culture resemble and thus a comparative analysis is much needed. Objective: To compare the bacteriologic profile of urine and stent culture to determine the incidence and etiology of bacteriuria among patients with ureteric double J stent. Methodology: This cross-sectional analysis, was conducted upon a sample of 219 patients (of either gender, aged 10 to 70 years) presenting for ureteric double J stent removal from June 2021 to February 2022 at Ziauddin University Hospital, Karachi. After taking written informed consent, data was recorded onto a pre-structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, bacteriological profiles of the urine and ureteric double J stent culture. The data obtained was analyzed using SPSS v. 21.0. Results: Among the sample 51.6% of the patients were males, while the remaining 48.4% were females. The mean age of the sample stood at 38 (SD ± 9.1). The total incidence of bacterial colonization was seen in 61.64% and 19.6% of stent and urine cultures respectively, with Enterococci being the commonest (54.8%) organism in stent culture and Pseudomonas Aeruginosa being the commonest (32.6%) in urine culture. Conclusion: After careful consideration, it can be concluded that the incidence of bacterial colonization among both cultures, in addition to the detailed bacteriological profiles of urine and ureteric double J stent culture differ considerably and urine culture may not serve as an ideal indicator of stent colonization and antibiotic prophylaxis should continue to be practiced among symptomatic patients despite a sterile urine culture.  

Objective: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. Method: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. Results: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8+14.4 years, and 659(51%) were females with a mean age of 38.3+13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). Conclusion: The prevalence of overactive bladder was found to be low when assessed with strict application of the three classical symptoms of the condition. Continuous...

Background: Urethral stricture disease has always been a challenge for urologists. Different treatment modalities that are used for treatment of urethral stricture disease, however recurrence has been a persistent problem. Agents such as triamcinolone and mitomycin-C offer hope but merit to be researched. Objective: To test the combination of triamcinolone and mitomycin in direct vision internal urethrotomy (DVIU). Methods: This quasi-experimental analysis was conducted in Ziauddin Hospital North Nazimabad upon a sample of 116 patients (selected using non-probability, consecutive sampling) in two groups (A: Experimental and B: Control) of 58 each. Data was recorded onto a structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, disease history, operative notes and post0operative follow-up. The data obtained was analyzed using SPSS 21.0 and MS. Excel 365. Results: The mean age of the sample stood at 47 (SD ± 05) years, with the age ranging from 19 to 80 years. The etiology was idiopathic in most (55.2%) of the cases and the primary urethral strictures were the commonest (67.2%). Most strictures appeared between 6 to 9 months after the procedure and the incidence decreased with passage of time till no new cases were reported at 1 year. The outcome of the treatment in group A bi-inject given was regarded as success in 49 (84.5%) and in group B bi-inject not given was 32 (55.2%) of the cases. Among those that experienced a recurrence, majority (63%) of the patients experienced bulbar urethral stricture, while the remaining (37%) faced membranous urethral strictures. Few complications were seen in both groups, predominant among which was bleeding. Conclusion: After careful consideration, it is concluded administration of triamcinolone and mitomycin in direct vision internal urethrotomy (DVIU) yields a successful outcome significantly (<0.05) more frequently (84.5%) than the control group (52.5%).