Background: Leading urology guidelines recommend intravesical chemotherapy and immunotherapy for non-muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. This study aims to evaluate the self-reported practices regarding intravesical therapy use for patients with non-muscle-invasive bladder cancer among urologists in Karachi. Methodology: In this cross-sectional study, a proforma-based survey was conducted between January and March 2018, in which printed questionnaires regarding adjuvant treatment options for NMIBC were administered and collected by primary investigators among urologists in leading institutions of Karachi. Results: Overall, 80% of respondents reported routine administration of single instillation of intravesical chemotherapy (SICA) after transurethral resection of bladder tumor (TURBT), and almost one-third of them (37.3%) give SICA within 6 hours inward. A quarter of respondents practice induction therapy routinely in low-risk BC using Mitomycin, whereas 76.5% in high-risk cases use Bacillus Calmette Geurin (BCG) as immunotherapy. Regarding the time duration of intravesical therapy installation, most of the urologists reported for 45 mins (49%) followed by 30 mins (29.4%), 2 hrs (17.6%), and 3 hrs (3.9%). Only 39% reported routinely using maintenance therapy with BCG for high-risk BC. As for BCG failure, 76.5% of participants reported radical cystectomy. Conclusion: Our survey results provide evidence of variation in practices among urologists and poor guideline adherence with the risk of under-treatment of patients with NMIBC. This requires joint efforts of all those involved in the treatment of non-muscle invasive bladder cancer to improve the quality of care.

Background: Unusual genitourinary activity is categorized by the genital deposit of foreign objects. It has been known for centuries and common etiological factors include sexual stimulation. Psychiatric disorders and intoxication may also be associated. Foreign body retrieval and the evaluation of psychosocial factors are involved in management. This study intends to present a 'hair pin' case as a foreign body in the bladder. Methodology: A 25-year-old female presented to the urology outpatient clinic in early pregnancy with a history of manually inserting hairpin into the urinary bladder through her urethra four years back. She lost to follow up during pregnancy and then presented again after C-section. A plain abdominal film of the kidneys, ureters, and bladder (KUB) confirmed the location of the hairpin and large stone around it in the urinary bladder. Results: The patient underwent endoscopic removal of foreign body and stone. At cystoscopy urethra was normal, but in the urinary bladder, there was a hairpin with stone formation at its proximal end, and distal portion of the hairpin was embedded in the bladder neck. The hairpin was pushed back in the bladder to separate from the bladder neck, followed by stone fragmentation using a stone punch. After complete removal of stones, the hairpin was aligned in the line of the urethra and removed with the help of forceps. Conclusion: Depending on the nature of the foreign body and available expertise, methods for removing intravesical foreign bodies are opted. Mostly endoscopic techniques are used for retrieval of intravesical foreign bodies without resorting to open surgery.