Objective: To determine diagnostic accuracy of NMP 22 and urine cytology in the detection of transitional cell carcinoma (TCC) urinary bladder taking cystoscopy as a gold standard in patients having provisional diagnosis of bladder cancer (BC). Methods: This cross sectional validational study enrolled 380 patients fulfilling selection criteria and was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan form July 2018 to July 2019. The urine sample collected underwent NMP22 and cytological analysis followed by rigid cystoscopy. Reports of all three tests divided patients into positive or negative for malignancy as per defined criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NMP 22, urine cytology and their combination was determined. Receiver operating characteristic (ROC) curve analysis performed and area under the curve (AUC) compared among these tests. Results: The average age of patients was 53.08 ± 12.41 years having male to female ratio 3.75:1(300 males and 80 females). NMP 22 had better sensitivity and comparable specificity to cytology (81.9 & 81.2% vs 54 & 93.9%). Combination of NMP 22 / cytology outperformed both in terms of sensitivity (91.63 vs 81.83 vs 53.96), NPV (87.59 vs 77.46 vs 61.02) and diagnostic accuracy (85.26 vs 81.58 vs 71.32) but at the cost of specificity (76.97 vs 81.21 vs 93.94) and PPV (83.83 vs 85.02 vs 92.06). ROC curve revealed statistically significant higher AUC (0.843 vs .815 vs .73) for combination as compared to NMP 22 and Cytology (p<0.001). Conclusion: NMP22 is a quick, point of care test having higher sensitivity, NPV and accuracy but similar specificity and PPV to urine cytology for detection of TCC urinary bladder. Combination outperformed both in terms of sensitivity while having modest specificity. doi: https://doi.org/10.12669/pjms.36.4.1638 How to cite this:Sajid MT, Zafar MR, Ahmad H, Saif Ullah, Mirza ZI, Shahzad K. Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1638 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.
Objective: To determine the frequency of various metabolic abnormalities in children with urinary lithiasis. Methods: This cross-sectional study was conducted at the Armed Forces Institute of Urology, Rawalpindi, from 30 January 2017 to 1 February 2020. A total of 1355 children who were aged 4 to 14 years and who had renal stones were included, while those with urinary tract infections, posterior urethral valve, pelvi-ureteric junction obstruction, reflux disease, and chronic renal failure were excluded. Twenty-four-hour urine samples were analyzed for urinary uric acid, calcium, oxalate, citrate, and magnesium. Demographics and metabolic abnormalities—hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, and hypomagnesuria—were noted and analyzed. Results: The study analysis included 1355 patients. Low urine volume was observed in 465 (34.3%) of the patients. Three hundred nine patients (22.8%) had metabolic abnormalities, the most common being hypocitraturia (184, 59.5%) followed by hypercalciuria (136, 44%) and hypomagnesuria (126, 40.8%). Mean age of presentation, disease duration, recurrent bilateral stones were found significantly different in those having metabolic abnormalities (7.81±2.25 versus 8.76±2.50 P < 0.001, 7.73±1.50 versus 8.43±1.54 P < 0.001, 19.4 versus 2.4% P < 0.001 respectively). No significant difference was found in frequency of abnormal urinary metabolic parameters between boys and girls (P > 0.05) or, upon data stratification, on the basis of disease duration, stone laterality, and recurrence. Conclusion: Metabolic abnormalities were found in 22.8% % of children presenting with urinary lithiasis. The most frequent abnormality observed was hypocitraturia followed by hypercalciuria and hypomagnesuria. Early identification helps manage such patients appropriately, mitigating long-term sequelae.
Objective: To compare our experience of genitourinary injuries during the war against terrorism with the record of those in previous wars of the World. Study Design: Cross sectional study. Place and Duration of Study: Urology department, Combined Military Hospital Peshawar, from Jun 2011 to Aug 2014. Methodology: We treated 89 (5.6%) cases of genitourinary injuries received in our tertiary care hospital in Khyber Pakhtunkhwa. The hospital was located at a distance of 2-3 hours of evacuation time by helicopter from the forward operational area. Results: The frequency of genitourinary injuries among 1589 war casualties was (5.6%). Out of these 49 (55%) were due to sniper shots and 40 (45%) due to improvised explosive device. Kidney was the most common organ injured 30 (33.7%), followed by bladder 20 (22.5%) and urethra 14 (15.7%). Majority of renal and bladder injuries were afflicted in those soldiers who were not wearing the protective jackets. Associated injuries to other organs were identified in 81% cases. Salvage of all genitourinary organs was the aim; however, nephrectomy and orchiectomy had to be performed in 30% and 50% respectively. Conclusion: Salvage of genitourinary war injuries poses a challenge to the trauma surgeon as lifesaving measures take precedence over organ preservation. Renal trauma in war was found to be the leading critical genitourinary injury.
Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019. Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented. Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%). Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors.
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