Objective: The aim of the present study was to calculate the mean differences in serum sodium and potassium concentration levels in  patients  with  Benign  Prostatic  Hyperplasia  undergoing  TURP  pre  and post-operation. Methods: A cross-sectional and observational study was conducted at the  Department  of  Urology,  Liaquat National Medical College and Hospital, Karachi, Pakistan. Purposive, convenience sampling technique was used. A total of 75  male  patients  undergoing  transurethral  resection  of  the  prostate  were included in the study. Data was analysed using SPSS version 20.0. A p-value of less than 0.05 was considered to be significant. Results: Out of a total of seventy-five patients, the mean age was 59.59 ± 7.02 years. After surgery,      1.3% (1) patient had hyponatremia (<135 mmol/L), 97.3% (73) patients had normal sodium level (135-145 mmol/L) and 1.3% (1) patient had hypernatremia (>145 mmol/L). In contrast, only 1 (1.3%)  patient had hypokalaemia, 66.7% (50) patients  had  normal  potassium  levels  and  32%  (24)  patients  had hyperkalaemia (p-value 0.001). Conclusion: We reported a significant increase in serum levels  of  potassium  in  post-surgery  evaluation. Therefore, the monitoring of  serum  electrolyte  concentration  following  transurethral  resection  of  the prostate (TURP) is highly recommended.

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 compare the frequency of patients with successful Trial of voiding without catheter (TWOC) after acute urinary retention secondary to benign prostatic hyperplasia in patients taking ketoconazole and tamsulosin vs tamsulosin alone. Study Design: A randomized controlled trial.  Place and Duration: The current study was conducted at Urology Ward, Liaquat National Hospital, Pakistan for a period of six months. Methodology: A total of 162 patients presenting with acute urinary retention were divided into two groups. Group A received tamsulosin 0.4mg OD and ketoconazole 200mg while Group B received tamsulosin and placebo. Trial of voiding without a catheter was induced after one week of medication. SPSS version 20 was used for data compilation and analysis. Results: In Group-A, 85.2% of patients were able to void as compared to group B, where only 74.1% of patients were able to void (p<0.05). Successful trial of voiding without catheter was observed in 79.0% and 60.5% in patients of Group-A and Group-B respectively. The association of successful TWOC with the two study groups was found significant (p=0.010). Conclusion: TWOC in men catheterized for AUR due to BPH was significantly more successful if treated in a combination of ketoconazole and tamsulosin as compared to tamsulosin only.

Objectives: To determine the long-term outcome and complications of non-transecting anastomotic bulbar urethroplasty for the treatment of small bulbar urethral strictures presenting at Liaquat National Hospital, Karachi. Methods: This interventional study was conducted from January 2012 to December 2019 with the study duration of eight year at Liaquat National Hospital, Karachi. All patients presenting in the outpatient department with urethral strictures were included in the study. Patients were evaluated postoperatively for complications and outcomes were determined. The data was analyzed using SPSS v.25. Results: A total of 358 patients were treated with non-transecting anastomotic bulbar urethroplasty during this 8-years period. The most common site of stricture formation was bulbar urethra 186 (50%), followed by bulbo-membranous urethra; 103 (31%), and bulbo-penile urethra; 69 (19%). The mean stricture was 1.2 cm (0.5-2.5 cm) in length. The main postoperative complications were scrotal swelling in 7 (1.9%), wound infection in 6 (1.6%), wound dehiscence in 3 (0.8%), and transient sexual dysfunction in 31 (8.6%) patients with an overall initial success rate of 97.8%. No permanent deficit in sexual function was reported. Conclusions: Non-transecting anastomotic bulbar urethroplasty has a good outcome with insignificant postoperative complications in patients with small bulbar urethral stricture disease. doi: https://doi.org/10.12669/pjms.37.5.3879 How to cite this:Abdullah A, Ahmed SF, Memon II. Long-term outcome of Non-Transecting Anastomotic Bulbar Urethroplasty for Urethral Strictures: An 8-year experience from Liaquat National Hospital Karachi. Pak J Med Sci. 2021;37(5):---------.  doi: https://doi.org/10.12669/pjms.37.5.3879 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 (p<0.01), while the scores were comparative by the 5th attempt. All the enrolled members resected >80% 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<0.01) at 1st attempt while on 5th attempt, the outcomes were comparative in both groups. The objective assessment of operative skills of the trainee’s displayed improvement in all 5 parameters including tissue injury, movement and time, instrument application, surgical process and surgical details. Conclusion: Simulation-based TURP teaching significantly improves simulative operative skills in resection, bleeding control and safety parameters. GRS is an effective tool in assessing simulative operative skills and may evaluate endo-urological procedural training in urology trainees periodically.