Background : Urolithiasis is one of the oldest disease known to human beings and has been documented in ancient Greek. Urolithiasis continues to pose a significant health hazard, causing progressive renal impairment, if left untreated. The etiology of renal insufficiency in patients with nephrolithiasis is multifactorial and includes renal obstruction, urinary infection, frequent surgical interventions, and coexisting medical diseases. The purpose of this study is to assess the change in renal function following removal of kidney stones by Percutaneous Nephrolithotomy (PCNL) in patients with associated impaired renal function. Materials and methods : 50 Patients with renal stone disease with associated impaired renal function who were admitted and underwent PCNL in Urology department were selected as per inclusion and exclusion criteria by purposive sampling. Complete clinical evaluation including history, physical examination, relevant examinations & laboratory investigations were performed. All the patients were treated by PCNL monotherapy with Double J stenting. Mean age was 46.63±11.95 years (Age range: 24-72 years). There were 36 males (72%) & 14 females (28%) & male to female ratio was 2.57:1. Results : In this study, a significant fall in mean serum creatinine (0.5 mg%) was demonstrated following the stone removal. The creatinine value remained unchanged in 12% and improved in 84% patients. In contrast to the improvement of renal function as evident by a decline in the mean serum creatinine values, the mean Glomerular Filtration Rate (GFR) registered a small fall of 1.78 ml/min (Statistically not significant). we have observed that total 12 (24%) patients out of 50 cases experienced different sorts of complications. Conclusion: This study showed that PCNL approach to urolithiasis in patients with impaired renal function significantly improves renal functional status manifested according to the preoperative and postoperative difference of serum creatinine and 99mTc DTPA performance. JCMCTA 2019 ; 30 (2) : 70-74
Back ground: The incidence of renal calculi is rising and more patients are presenting with small renal calculi. The treatment options for renal calculi (d”2 cm) are ESWL, percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The development of minimal invasive surgery for the treatment of renal calculus has led to an increase in success rates and, at the same time, has decreased the morbidity associated with these treatments. Objective: The study aimed to evaluate outcome of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy in the treatment of upper calyceal stone of d”2 cm in diameter. Methods: 60 Patients with radiopaque upper calyceal stone (d”2 cm) were admitted and underwent RIRS (Group A) & PCNL (Group B) in Urology department as per inclusion and exclusion criteria by purposive sampling (30 patients in each group). Complete clinical evaluation including history, physical examination, relevant examinations & laboratory investigations were performed. Result: Mean age was 37.23±11.59 years (range 18-62years) in group A and 40.10±11.49 (range 18-65 years) in group B. Mean operative time was significantly lower in group A (90.13 +/- 18.79 min) than group B (107.36 +/- 16.4 min) (p <0.05). Mean volume of irrigation fluid used during surgery, mean drop in the postoperative hemoglobin concentration, hospital stay, mean VAS score at 8 hours & 24 hours after operation were significantly lower in RIRS group than PCNL group (p< 0.05). We achieved a stone clearance of 90.00% in the RIRS group and 96.67% in the PCNL group. The difference in stone clearance in two groups was not statistically significant (p=0.30). Conclusion: The study concluded Retrograde intrarenal surgery (RIRS) in the treatment of upper calyceal stone of d”2cm in diameter is a feasible, effective and safe treatment option. Given the added morbidity in PCNL, RIRS should be considered standard therapy in these patients. Bangladesh J. Urol. 2021; 24(1): 99-104
Background: Advancements in the endoscopic armamentarium, retrograde intrarenal surgery has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. Objective: To describe our experience and outcome of RIRS for the treatment of renal stones and to assess its effectiveness and safety. Design, setting, and participants: A retrospective analysis of 60 patients who underwent RIRS for renal stones at our institute between January 2018 to December 2018 was performed. Surgical procedure: Flexible ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes (Flex-Xc) using Holmium-YAG laser. Outcome measurements and statistical analysis: Clinical data were collected and intraoperative and postoperative outcomes were assessed (Ureteral access sheath placement, operation time, hospital stay, stone free rate, post-operative blood transfusion & fever, need for second session of RIRS. A descriptive statistical analysis was performed. Results and limitations: The mean overall stone size was 13±3 mm. Pre stenting done in all cases. Ureteral access sheath placement was possible in 54(90%) patients. At 1 month follow-up, the overall primary SFR was 86.67%(52 cases), the secondary SFR was 96.67%(58 cases).The mean operative time was 91.96±18.7 min. Mean hospital stay was 1.86±1.02 days. Complications were reported in 8 (13.33%) patients overall, with fever in 6 patients (10%), steinstrasse in 2(3.33%) patients need for second session RIRS in 6 patients (10%).No patient needed blood transfusion. The main limitation of the study is the retrospective nature. Conclusions: RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. It is safe and effective procedure and an alternative to extracorporeal shock wave lithotripsy (ESWL) and Percutaneous nephrolithotomy (PCNL) in the treatment of selected renal stones. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.3-10
Objective: To evaluate the improvement of renal function after pyeloplasty measured by 99mTc-DTPA renography. Materials and Methods: This hospital based quasi experimental study was done in the department of urology, National Institute of Kidney Diseases and Urology (NIKDU) and Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from July 2014 to December 2020. Sixty patients were included in this study who underwent Anderson-Hynes (A-H) dismembered pyeloplasty for pelviureteric junction (PUJ) obstruction. All patients were evaluated with diuretic 99mTc- DTPA renogoam before and at 3 and 6 months after operation. Improvement of renal function was evaluated by comparing preoperative and postoperative differential renal function (DRF) and glomerular filtration rate (GFR). Results: Sixty patients with unilateral hydronephrosis due to PUJ obstruction were included in this study. Of these patients 34 male and 26 female with mean age of 15.6 years (ranged from 3 – 38 years). Out of 60 patients, 56.7% had left sided hydronephrosis and 43.3% had right sided hydronephrosis. Diuretic renography was done using 99mTc- DTPA in all patients preoperatively and at 3 and 6 months postoperatively. Preoperative mean DRF and GFR were compared with post-operative findings. The mean preoperative DRF in the study was 16.72 ± 8.35% at baseline which increased to 26.03 ± 7.08% at the end of 3rd month and 28.15 ± 5.84% at the end of 6th month. The mean preoperative GFR was 14.29 ± 6.73 ml/min/1.73 m2 at baseline which increased to 24.13 ± 5.31ml/min/ 1.73 m2 at the end of 3rd month and 27.38 ± 4.78 ml/min/1.73 m2 at the end of 6th month. Conclusion: The result demonstrates that, after pyeloplasty renal function improves. Highest recovery of renal function occurs in children and patients with poor pre-operative DRF and GFR. Bangladesh J. Urol. 2021; 24(2): 155-160
Background: Bladder cancer is the second most common cancer of the genitourinary tract. Mitomycin C has been commonly used in a perioperative fashion delivered intravesically immediately after TURBT Objective: To compare the results of post TURBT immediate single dose and multidose regimen of Mitomycin C therapy in the management of superficial transitional cell carcinoma of the urinary bladder. Method: The present prospective and comparative interventional study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology, Sher-E-Bangla Nagar, Dhaka from January 2015 to December 2016. Patients of superficial bladder cancer (tumor size ≤3 cm, number ≤3, grade I, II) were randomly included in the 2 groups. The sample size was seventy four (74). Thirty (30) patients were in each group and fourteen (14) were excluded from the study. In MMC single dose group (Group A), single dose of MMC 40mg/ 40ml was started immediately within 24 hours of TURBT. In MMC multi-dose group (Group B) 1st instillation of chemotherapy was started immediately within 24 hours of TURBT and additional instillation (5 instillations) were given as OPD basis and was continued weekly for 5 weeks. Follow-up was done on 3rd, 6th, 12th month of initial TURBT. Results: In this study mean age was 61.8±13.7 years in group A and 62.7±13.6 years in group B. Male was found 25 (83.3%) in group A and 26 (86.7%) in group B. Female was found 5 (16.7%) in group A and 4 (13.3%) in group B. Mean size of the tumor was found 2.13±0.78 cm in group A and 2.05±0.84 cm in group B. Mean number of tumor was found 1.8±0.8 in group A and 1.9±0.7 in group B. Tumor grade I was found 23 (76.7%) in group A and 25 (83.3%) in group B. Tumor status Ta of superficial bladder was found 25 (83.3%) in group A and 26 (86.7%) group B. Tumor status T1 of superficial bladder was found 5(16.7%) in group A and 4 (13.3%) group B. Five (16.7%) patients was found recurred in group A and 4 (13.3%) in group B at 6th month follow up. At 12th month follow up, 6 (20.0%) patients was found recurred in group A and 5 (16.7%) in group B. Side effect was found in 2 (6.7%) patients in group B and not found in group A. Conclusion: MMC single dose was similar to MMC multi-dose regimen with insignificant difference among the two. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.62-66
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