Objective: To compare the first 30-day outcomes of Trans-peritoneal and Extra-peritoneal Radical cysto-prostatectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2015 to Mar 2019.Methodology: A total of 100 patients who underwent Radical cystoprostatectomy were observed in two groups either by extra or trans-peritoneal approach. Patients diagnosed with carcinoma urinary bladder (both muscle and non-muscle invasive) vetted through multidisciplinary meeting, with or without neo-adjuvant chemotherapy were included. Patients undergoing salvage cystectomy or any previous open abdomino-pelvic surgery were excluded. The standard techniques were used for both approaches. Variables under study were recorded for first 30-day-followup period. Results: The mean age was 59.9 ± 7.231 years (range=34-80). In extra-peritoneal group the mean duration of surgery was 5.6 ± 1.16 hours comparing to 7.2 ± 1.34 hours in the trans-peritoneal group. Statistically significant trend was also noted in the favour of extra-peritoneal group for stay in Intensive care in post-operative period (3.00 ± 1.19 days/4.77 ± 1.20, p<0.001) as well total stay in the hospital (6.06 ± 2.8 days/ 11.74 ± 4.17, p<0.001). Overall comparison of total number of complications as per Clavien-Dindo system in both groups was insignificant (p=0.136), however a significant trend in favour of extraperitoneal group was noted with respect to major wound dehiscence as well rate of blood transfusion (p<0.001). Conclusion: Extra-peritoneal approach showed a favourable trend in terms of operative time and early recovery after radical cysto-prostatectomy.

Objective: To determine the efficacy of alpha keto-analogues in the management of chronic kidney disease at a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Nephrology Department, Armed Forces Institute of Urology, Rawalpindi from Jul to Dec 2020. Methodology: A total of 300 patients of chronic kidney disease stage 3 and 4, not dependent on hemodialysis were included in the study. They were divided into two groups with matched age, gender and duration of chronic kidney disease. Group-I received the routine treatment of chronic kidney disease with low protein diet while group-II received alpha keto-analogue in standard dose in addition to routine treatment of chronic kidney disease with low protein diet. Estimated glomerular filtration rate was assessed at the baseline and after six months. Results: Out of 300 patients 151 (50.3%) were males while 149 (49.7%) were female patients. 110 (36.7%) patients had stage-3 disease while 190 (63.3%) had stage-4 chronic kidney disease. Mean difference of eGFR in group-I was 3.17 ± 3.19 mL/min/ 1.73m2 while mean difference of eGFR in group-II was 1.16 ± 1.52 mL/min/1.73m2 (p-value<0.001). Conclusion: Alpha keto-analogues emerged as an efficacious short-term option in reducing the progression of chronic kidney disease in our study. Use of this option in addition to routine treatment and low protein diet was related to significant improvement in renal functions.

Objective: To compare the estimated glomerular filtration rate (eGFR) assessed through the CKD-EPI equations based on creatinine, Cystatin C and creatinine-Cystatin C levels for estimating kidney function among patients with diabetes. Study Design: Cross-sectional analytical study. Duration and Place of Study: Nephrology Department, Armed Forces Institute of Urology, Rawalpindi Pakistan, from Aug 2020 to Mar 2021. Methodology: A total of 70 patients were recruited. Serum samples were collected for creatinine and Cystatin C levels and 24 hours of urine for creatinine clearance. The eGFR values were calculated using the creatinine, Cystatin C and combined creatinine-Cystatin C CKD-EPI equations and compared with 24 hours of urinary creatinine clearance. Results: A total of 22 (31.4%) patients had early stage, while 48 (68.6%) had late-stage chronic kidney disease (CKD). The highest Spearman correlation coefficient was found for eGFR CKD-EPIcr-cys (rho=0.844), followed by CKD-EPIcys (rho= 0.835) and CKD-EPIcr (rho=0.709). Conclusion: CKD-EPIcr-cys is the most accurate, recommended method of calculating eGFR.

Objective: To evaluate outcome of diagnostic kidney biopsy in patients with renal allograft dysfunction at a tertiary care hospital. Study Design: Retrospective observational study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2014 to Jan 2020. Methodology: A consolidate registry review was carried to formulate this study. The registry data exists at our center containing information about the graft dysfunction (manifesting as proteinuria, deranged urea and creatinine or urine sediment abnormalities) and other major indications which warrant probing with biopsy. The histopathological diagnosis of these biopsies is confirmed from the nephro-pathology registry before finalization of diagnosis. Results: A total of 94 diagnostic kidney biopsies were performed in patients with graft dysfunction. Out of 94 biopsies, 80 (85.1%) patients were male while 14 (14.9%) were female patients. The most frequent single cause for graft dysfunction was Cell Mediated Rejection (n 12, 24.5%) followed by Interstitial Fibrosis and Tubular Atrophy/Acute Tubular Injury. The most common cause among the glomerulonephritis was Membranoproliferative Glomerulonephritis (n 3, 6.1%) followed by others. The most common cause for mixed pathology remainedcell mediated rejection with Interstitial fibrosis and tubular atrophy (n 8, 17.8%). Conclusion: Cell mediated rejection is thecommonest pathology responsible for renal allograft dysfunction both as a single lesion as well as part of mixed pathology.

Renal failure affects up to 18% of hospitalized patients and is associated with significant morbidity, mortality, and resource utilization. Hemodialysis is used mostly as renal replacement therapy method all over the world. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Objective: The objective of this study was to determine the outcome of all tunneled catheters placed in a single center for dialysis access over a period of six months. Study Design: Descriptive case series study Setting: Study was conducted in Dialysis Department, Combined Military Hospital, Lahore. Duration of Study: Present research was conducted from 6th May 2019 to 5th Nov 2019. Methodlogy: A total of 145 patients were enrolled after informed consent. Demographic information with duration of hemodialysis was also noted. In all patients tunneled catheter was placed for dialysis, by primary investigator. Then patients were followed-up for 2 months and were assessed for catheter in next visit. If there was redness, pain, and pus present then infection labeled. On assessment of catheter condition, if it was found damaged, fell out, exposed cuff, or fractures, blocked then catheter failure was noted. All this information was recorded through proforma. Results: Mean age was 45.72 ± 15.31 years; Mean duration of dialysis was 7.66 ± 2.93 months. Male were 53.8% and female were 46.2%. Placement of catheter was at internal jugular 116 (80%) patients, at subclavian 21 (14.5%) and at femoral 8 (5.5%). Infection was present in 13.1% patients while it was absent in 86.9% patients. Catheter failure was seen in 4.1% patients, there was no significant association between presence of catheter failure and age group, gender, BMI, duration of dialysis and site of catheter having p-value = 0.322, 0.849, 0.741, 0.716 and 0.457 respectively. Significant association was not found between presence of infection and age group, gender, BMI, duration of dialysis and site of catheter having p-value = 0.591, 0.380, 0.081, 0.538 and 0.540 respectively. Conclusion: Presence of Infection was observed in 13.1% patients and catheter failure was present in 4.1% patients with chronic kidney disease on maintenance hemodialysis. Effect modifiers like age group, gender, BMI, duration of dialysis and site of catheter did not show significant association. Keywords: Chronic Kidney Disease, Infection, Catheter Failure, Hemodialysis.