Introduction and Objective: Laparoscopic surgery is increasingly exercised in urology due to improvements in technical capabilities and experience. It comes with many advantages compared to open surgery such as lesser degree of pain and haemorrhage, shorter hospital stay and better cosmetic results. This study is carried out to evaluate the outcomes and complications of urological laparoscopic surgery cases performed Chittagong Medical College Hospital, Chattogram, Bangladesh. Methods: This was a hospital based prospective observational study of total 29 patients, who received laparoscopic surgery of different kinds between January 2017 and September 2019 for urological causes with a minimum one month follow-up. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications after surgery and need for conversion to open surgery. Results: The mean age was 45.03 years where 12 patients were women and 17 were male. All patients underwent trans-peritoneal procedures where2 patients received renal cyst excision, 4 simple nephrectomy, 5 ureterolithotomy, 9 radical nephrectomy, 1 radical cystectomy, 2 adrenalectomy, 3 pyelolithotomy and 3 pyeloplasty. Three of the 29 patients required conversion to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 87.5 (70-105) min, simple nephrectomy 141.25 (120-170) min, ureterolithotomy 120 (100-140) min, radical nephrectomy 215.56 (180-260) min, pyelolithotomy 120 (100-140) min, and pyeloplasty 156.67 (130-190) min. The mean hospital stay was 4.59±1.7 (2-8) days. Conclusions: The success and complications rate of the laparoscopic urological surgeries performed in our hospital were consistent with those reported in the literature. In the light of technological advances and increasing experience, we believe that laparoscopic surgery is an effective technique with excellent outcome along with a safe and feasible alternative to open surgery in the field of urology. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.17-23

Introduction: Gallstone disease occurs in 3%-20% of the world population and about 15% of people with gallstone disease develop stones in the common bile duct (CBD). Smaller stones are amenable to be removed by endoscopic retrograde cholangio-pancreatography (ERCP) while larger stones require surgery-either open or by laparoscopic. Materials and Methods: This was a prospective study between January 2010 and December 2012 in two hospitals in Chittagong, Bangladesh, on ultrasonography upper abdomen. And where ultrasonography was not able to diagnose the location and cause of obstruction than magnetic resonance cholangio-pancreatography (MRCP) was done. To rule out malignancy, contrast enhanced computerized tomography was done in selected cases. The patients were divided into two groups on the basis of management-Group A: CBD exploration with insertion of T-tube and Group B: CBD exploration with primary closure. All operated patients underwent a longitudinal choledochotomy. Then the stones were removed and CBD was flushed with normal saline ensuring no distal obstruction. Initially we used T-tube cholangiogram to see distal clearance which was replaced by choledochoscope later on. Primary closure was done in 37 (53%) cases where T tube drainage was given in 34 (47%) cases and T-tubes were kept in situ for 9-10 days. Bile duct was closed with interrupted absorbable catgut 3-0 suture and a sub hepatic drain was kept for 48 hours. All patients were given pre-operative and post-operative antibiotics and follow up was taken for next 6 months. Results: Out of 71 patients, 46 (61%) were females and 29 (39%) males. In all patients cholecystectomy was done along with CBD exploration. Three patients who were planned for primary closure without T-tube, T-tubes were inserted due to CBD trauma, oozing, and gross swelling. Complication like biliary leakage was seen in only one patient with primary closure which was managed by keeping subhepatic drain for 5 days. Two patients in the T tube group developed wound infection while only one developed this complication in the primary closure group. No patient in the study developed cholangitis. No patient was expired in the study. Conclusions: Primary closure without external drainage after choledochotomy is feasible, safe, and cost-effective.

Objective: Now a days, percutaneous nephrolithotomy (PCNL) is the treatment of choice for retrieval of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study was to compare the safety and efficacy of PCNL using different tract size. Patients and Methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Mini or by Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chattogram from July 2016 to October 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, access time, fluoroscopy time for access, total operative time, need for blood transfusion, postoperative hospital stay, postoperative pain, fever, urinary leakage and other complications between two groups. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 78 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini-PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.59±0.89 cm, and 2.66±0.97 cm in standard-PCNL group (p=0.7). Mean tract size was 18.53 ± 1.29 F (16-20) and 26.11 ± 4.61 F (24-30) respectively with P value <0.001. In mini-PCNL operative time was significantly longer than that of standard PCNL with 112.11 ± 20.29 vs. 98.68± 19.75 minutes respectively with p=.004. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.26 vs. 0.83 ± 0.32 gm%, p value 0.001) and hospital stay (2.18 ± 0.77 vs. 3.39 ± 1.10 days, p value= 0.001), respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.84% vs. 92.11%, p=0.45). There was no statistical difference in terms of visual analogue scale (VAS) score (5.55±1.54 vs. 6.24±1.6) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10.52% vs 12.50%, p=0.72). No statistical difference was recorded in terms of postoperative fever (eŠ38C) between two groups (2 in each group, 5.2%, p=1 Blood transfusion requirement was much less in mini PCNL group (10.52% vs. 34.2%, p=0.01). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct tostandard PCNL, URS, and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.11-16

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study is to compare the safety and efficacy of PCNL using different tract size. Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 64 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini- PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct to standard PCNL, URS and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

Introduction: Bladder cancer is the ninth most common cancer in the world, with 430,000 new cases diagnosed in 2012. Carcinoma bladder occurs with an overall incidence of 2.25% (10,000 annually), 3.67% among males and 0.83% for females. Metabolic syndrome (MS) is characterized by overweight, hypertension, elevated blood glucose, and dyslipidaemia. Cigarette smoking and occupational exposure are the main risk factors for upper tract urothelial carcinoma and urinary bladder cancer. Objective: To elucidate the relationship between metabolic syndrome on grade and stage of urothelial carcinoma of bladder. Methods: We retrospectively analyzed study was carried out at Dept. of Urology, Sir Salimullah Medical College Hospital, Dhaka, Bangladesh from January to December 2021. One hundred (100) patients who were first time detected cases of carcinoma bladder and were operated. Consent was required for surgical procedure as mandatory for the procedure. Patient related factors (Age, height and weight), histopathological analysis (stage and grade,) and comorbid conditions (the presence of hypertension, diabetes mellitus, and triglyceride level and body mass index) were evaluated. Non-invasive papillary urothelial neoplasms of low malignant potential (PUNLMP), Ta and T1 tumors were classified as lower stage and T2, T3, and T4 tumors as higher stage bladder cancers. Stasticial Analyses was done using chi-square tests and logistic regression analysis. Results: Total 100 patients 82 (82%) were males and 18(18%) were females with mean age of 65.5±4.8 years. MS was found in 32 (32%) patients. Hypertriglyceridemia, Hypertension, Diabetes mellitus (DM) and BMI ≥25 kg/m2 were present in 25%, 32%, 25%, and 40% of patients respectively. The pathological characteristic between patients with or without MS is demonstrated. Metabolic syndrome was significantly associated with histologic grade (p<0.05) and stage (p=0.04) of bladder cancer. Components such as diabetes (p=0.005, OR=1.92) and ....