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Objectives: To compare the efficacy of intraprostatic infiltration of lidocain injection and periprostatic nerve block for pain free TRUS guided prostate biopsies. Methods: A hospital based prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from July 2007 to June 2009 to compare the different anesthesia technique for TRUS guided prostate biopsy for the detection of carcinoma prostate. All male patients aged over 55 years having lower urinary tract symptoms (LUTS) attending to urology OPD as well as in patient department were evaluated by history, physical examination including D/R/E and necessary investigations to identify the potential candidates for prostate biopsy and potential participants were counselled for prostate biopsy. Before taking biopsy patients were again judged by selection and exclusion criteria. Overall general examination as well as examination of urinary system and anorectal region was done. DRE was done to see the size, consistency and nodularity of prostate prior to biopsy. Who fulfilled the selection criteria included in this study in out patient basis or admitted in the urology ward and numbered chronologically, odd numbers for group-I includes periprostatic nerve block and even numbers for group-II includes intraprostatic infiltration of lidocain injection. They underwent 10 core prostate biopsy (standard 6 plus lateral 4 core) and hypoechoic lesion directed biopsy to see the unique cancer detection rate in each lobe. Data were analyzed using SPSS (Statistical package for social science) software program. The test of significance were chi-square, student t test, Fisher exact test, Mann Whitney test. Probability value (P Value<0.05) was considered significant. Results: Intensity of pain using visual analogue scale (VAS) demonstrates that the mean pain intensity during probe insertion was significantly less in Group-I than that in Group-II (5.8 ± 1.3 vs. 6.7 ± 1.3, p = 0.007). The mean pain intensity during anesthesia was also significantly less in the former group compared to the latter group (4.5 ± 1.2 vs. 5.1 ± 1.1, p = 0.036). Then the pain intensity of both the groups decreased, but the decrease was significantly faster and steeper in Group-II than in Group-I (p = 0.001). The pain intensity of Group-II 30 minutes after biopsy further decreased to 1.9 cm on visual analogue scale, while the pain intensity of Group-I increased from 4.1 cm during biopsy to 4.4 cm 30 minutes after biopsy (p < 0.001) . Results of the study revealed that -intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with conventional periprostatic nerve block. Conclusions: Intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with periprostatic nerve block. It is a simple, safe and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.87-93

Objective: To determine the outcome of antibiotic treatment regime in patient with indwelling DJ stenting having a per-interventional antibiotic prophylaxis compared with those of a continuous low-dose antibiotic treatment. Methods: A hospital based prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from July 2012 to June 2014, to evaluate the antibiotic treatment regime in patient with indwelling DJ stenting, the benefits and disadvantages of a peri-interventional antibiotic prophylaxis compared with those of a continuous low-dose antibiotic treatment by enrolling a total number of 60 subjects in the department of Urology, Dhaka Medical College, Dhaka. Among 60 subjects 30 subjects were Group A comprised of subjects treated with continuous low dose antibiotic and Group B with 30 subjects treated with peri-interventional antibiotic. The patients would undergo temporary D J stent placement due to upper tract urolilhiasis who meet the inclusion criteria and exclusion criteria. Informed written consent would be taken from all patients. Urine samples would be analysed conventional antibiotic susceptibility and resistance was determined. All analyses was conducted at department of Microbiology, Dhaka medical college hospital. All patients who received peri-interventional antibiotic prophylaxis with 1g ceftriaxon was given l.v. at anaesthesia induction to obtain a peak concentration at the time of highest risk during the procedure.According to the pathogens profile and susceptibility, the antimicrobial agent of choice for continuous low-dose treatment was Cefixim 200mg twice daily. All stents placements were performed under sterile conditions applying a retrograde technique or antregrade in PCNL and open procedure under spinal or general anaesthesia. Patients were prescribed ketorolac (10mg) or Tramadol (50mg), while none of the patient received alpha blocker agents or anti-cholinergic drugs. Evaluations for UTI were performed before stent insertion and consecutively after 1, 2 and 4 weeks and/or at stent withdrawal. Statistical analysis of the result was obtained by using window based computer software devised with statistical packages for social science (SPSS-20 IBM) (SPSS inc, Chicago, IL, USA). The result was presented in tables, figures, and diagrams. Statistical test was done by Chi square test and Z test for qualitative data and t test for quantitative data. A p-value <0.05 is considered as level of significance. Results: To evaluate the antibiotic treatment regime in patient with indwelling DJ stenting, the benefits and disadvantages of a peri-interventional antibiotic prophylaxis compared with those of a continuous low-dose antibiotic treatment, a total number of 60 subjects were enrolled in this present study in the department of Urology, Dhaka Medical College, Dhaka. Among 60 subjects 30 subjects were Group A comprised of subjects treated with continuous low dose antibiotic and Group B with 30 subjects treated with periinterventional antibiotic only. Outcome of these two treatment techniques were studied. For urinary tract infection rate the concept of a peri-interventional antibiotic prophylaxis during DJ stent implantation is known to be better antibiotic coverage and is therefore recommended by the European Association of Urology. However, there is a lack of evidence concerning the exact antibiotic strategy for the entire stent-indwelling time. In clinical routine, it is an applied practice among urologists to continue antibiotic treatment in a low-dose fashion, even after previous uncomplicated implantations. Conclusion: In case of indwelling DJ stenting, subjects with continuous low dose antibiotic regimen had significantly less proportion of UTI, dysuria and frequency of micturition than those with peri-interventional antibiotic. So, if haematuria, skin rash and GIT disturbance is carefully managed then continuous low dose antibiotic regimen is better treatment option than peri-interventional regimen for with indwelling DJ stenting in different cases. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.127-136

Objective: T0 compare the outcome of Transurethral Resecton of Prostate between Patients with Preoperative Low or Normal and High Voiding Pressure. Methods: This hospital based prospective observational study was conducted in the Department of Urology of Dhaka Medical college Hospital from July 2008 to June 2010 on male patients aging >59 years having Lower urinary tract symptoms (LUTS) attending to urology OPD& IPD were evaluated by history, physical examination including DRE and necessary investigations like USG of KUB and prostate with MCC & PVR, Q max, IPSS score to identify the potential candidates for TURP. Potential participants were counseled for urodynamic study. Who fulfilled the selection criteria included in this study in outpatient basis or admitted in the urology ward and numbered chronologically and performed urodynamic study and then patients underwent TURP, after 12 weeks of completion of TURP again a follow-up urodynamic study performed in all patients to compare the outcome between two groups. Sample size was 65, high pressure voiding group were 36 in number and Normal or low pressure voiding group were 29 in number. Data were collected on variables of interest using a structural data collection format. Data were processed and analyzed using SPSS (Statistical package for social science) software program. The test of significant employed to analyze the data was descriptive statistics and Student’s t-test, Paired and unpaired t- test, Fisher exact test. Probability value (P value < 0.05) was considered significant. Results: In this study the age ranges were 59 and 88 years and mean age was 70.7 ± 6.7 years. the maximum urinary flow rate, residual urine volume and maximum intravesical pressure 3 months after transurethral prostatic resection were significantly better in patients with high detrusor pressure compared to those with normal/low normal/low detrusor pressure (15.9±0.7 vs. 21.3±2.2ml/sec, p<0.001, 18.1±11.8 vs. 2.9±0.7 ml, p<0.001 and 48.3±6.2 vs. 71.9±15.2 cmH2O, p<0.001 respectively).The maximum urinary flow rate ( Q max ), residual urine volume, maximum intravesical pressure and detrusor pressure at peak urinary flow rate and also IPSS score were significantly improved 3 months after operation in both groups, more improvement was observed in preoperative high voiding pressure group. Post-voiding residual urine is a clear indication of poor outcome, and also the maximum urinary flow rate, maximum intravesical pressure and detrusor pressure at peak urinary flow rate all factors may precipitate decompensation of bladder and in low voiding pressure group decompensation of bladder occurs more than the high voiding pressure group as the preoperative and postoperative residual urine develops more in low voiding pressure group. Conclusion: The high voiding pressures (detrusor pressure) may influence in good postoperative outcome and helps in resolution of a significant outflow obstruction, there are good urodynamic reasons for avoiding unwanted TURP rather it could be justified by using urodynamic study which may predict outcome of TURP. So, we may assess properly the patient for prostatectomy by urodynamic study. As if we do this type of evaluation before TURP it may reduce the unwanted operation. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 111-119