Background: Prostatic Specific Antigen (PSA) is a protease secreted by epithelial cells of prostate. Serum PSA level is increased when the normal structure of gland is destroyed by benign or malignant tumor or inflammation. Though there is established relation between PSA plasma level and age among the two most common prostate diseases (Benign prostatic hyperplasia and Carcinoma Prostate) in the literature, relation has not been explored in our part of the world, therefore, this study was done to see the relation between age and PSA amount with Prostate diseases. Material and Methods: This was a Cross-sectional study conducted in a tertiary hospital, Nobel Medical College Teaching Hospital from January 2017 to December 2018. Ethical clearance was obtained from Institutional Review Committee (IRC). All the cases of prostate diseases presenting to urology department undergoing transurethral resection of the prostate (TURP) were included. Histopathology report of TURP specimen were collected from department of pathology and the relationship between diagnosis, PSA level and age were established. Results: BPH was the most common diagnosis (72.41%). Age of BPH patients ranged from 48-78 years and mean age with SD was 60.56±7.32. Median age with interquartile range was 61.00. Similarly, in the BPH group, PSA value ranged between 0.80-15.40 ng/ml with mean PSA value along with SD being 5.64±4.16 ng/ml. Similarly, Median PSA value with interquartile range was 4.20ng/ml. Carcinoma Prostate (27.59%) was the second most common diagnosis. Histological type of all cases diagnosed as cancer was adenocarcinoma. Their age ranged between 54-83. Their mean age with SD was 67.67±7.68. Similarly, Median age with interquartile range was 68.00. PSA value in this group ranged between 8.50-147.30 ng/ml. Again, the mean PSA value with SD is 55.72±33.40 ng/ml. Similarly, Median PSA value with interquartile range is 54.30 ng/ml. Conclusion: PSA level in the blood of men over 40years is highly correlated with a Age, irrespective of diagnosis. In above 40 age group, with advancing age, Carcinoma Prostate becomes more and more common diagnosis than BPH. Similarly, average PSA level is higher in Carcinoma Prostate than BPH.

Background: Laparoscopic Cholecystectomy is considered as a gold standard treatment for symptomatic cholelithiasis. The timing of surgery for acute Cholecystitis is still controversial, weather to go early surgery or wait for six to eight weeks after conservative management. Therefore, the aim of this study is to compare the clinical outcomes of early versus delayed laparoscopic cholecystectomy for acute Cholecystitis. Materials and Methods: A prospective study was conducted in Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Total of 80 patients with the diagnosis of acute Cholecystitis were enrolled in the study. The patients were equally divided in two groups: 40 underwent early laparoscopic cholecystectomy within 72 hours of admission (Group A) and next 40 underwent delayed laparoscopic cholecystectomy after 6-8 weeks of conservative management (Group B). Results: Out of 80 patients of acute Cholecystitis, mean age of the patients in Group A was 43.40±13.45 years and that in Group B was 44.80±14.36 years. The mean operative time in Group A was 90.22±2.81 minutes whereas in Group B it was 80.97±4.47 minutes. Mean duration of Hospital stay in Group A was 2.02±0.15 days whereas in Group B it was 2.15±0.36 days. Two patients in Group A and one patient in Group B converted to open cholecystectomy. Three patients of Group A and one patient of Group B landed in outpatient department with superficial surgical site infection.  Group B patients underwent second hospital admission compared to Group A patients. Conclusion: Early Laparoscopic cholecystectomy for acute cholecystitis is almost comparable with delayedLaparoscopic cholecystectomy. However, early laparoscopic cholecystectomy reduces the morbidity of patients as well as it is cost-effectiveness.

Background: Benign prostatic hyperplasia is regarded as non-malignant growth of prostatic tissueIt is the most common benign tumor in men, and the incidence is age related. In men aged more than 50 years, it is the fourth most prevalent disease. This study aim to determine the association of benign prostatic hyperplasia with diabetes mellitus and/or hypertension and this may help to bring out new dimensions in management of benign prostatic hyperplasia, hypertension and diabetes mellitus. Materials and Methods: Five hundred forty patients, diagnosed as benign enlargement of prostate with control group 270 at Urology out patient door between May 2018 to February 2019 with approval of Institutional review committee, were included. Patient with history of prostate cancer, neurogenic bladder, those who had undergone surgical intervention for prostate, not willing to take part in study were excluded. Results: Age range in cases and control were from 41–94 years. Diabetes was present in 14.63% of cases and 11.85% of controls. The positive association was established between prostatic hyperplasia and Diabetes (P-0.27). Hypertension was present in 37.96% of cases and 29.63% of controls (P-0.019). Diabetes and Hypertension were present in 56.48% in cases and 43.33% in control (P-0.000). Conclusion: Study suggests that benign prostatic hyperplasia is associated with diabetes mellitus and hypertension and may help to bring out new dimensions in management of benign prostatic hyperplasia.

Background: To determine the relationship between expulsion rate of distal ureteric calculus less than orequal to 10mm in size and C reactive protein (CRP) level, white cell count and neutrophil percentage. Materials and Methods: A total of 186 patients with distal ureteric calculus of ≤10mm were evaluated for stone expulsion rate and its correlation with serum CRP, white cell count and neutrophil percentage. All patients received tablet Tamsulosin 0.4mg for 4 weeks or till the expulsion of stone. Patients were called weekly till 4 weeks, or early if there was history of stone expulsion. Patients were divided in two groups according to normal and elevated CRP levels, white cell count and neutrophil percent age at baseline for statistical analysis. Results: The patients had an average age of 35.6 } 13.9 years. 52.2% were male. Ratio of right to left was1.58:1. Majority of the patients with distal ureteric calculus ≤ 10mm passed their stone (74.7 %) with medical expulsion therapy. Expulsion of stone less than 5mm was statistically significant (p0.017). Patients with normal neutrophil percentage and normal CRP level had higher stone expulsion rate than elevated neutrophil or CRP (85.2% vs. 40.9, 91.8% vs. 30.8% respectively).In patients with normal white cell count, 86.4% passed their stone while in elevated white cellcount group 39.1% passed their stone. Conclusion: This study showed patients with distal ureteric calculus of ≤10mmwith normal CRP level and normal neutrophil count had higher expulsion rate while WBC count showed no statistically significant association.

Introduction: Urolithiasis refers to a condition characterized by the formation or occurrence of calculi in the urinary tract. In Asia, about 1%-19.1% of the population suffers from urolithiasis. Pneumatic and laser intra corporeal lithotripsy are mostly preferred and frequently used during endoscopic management for ureteral stone. Aims: This study was done to compare the efficacy of the laser versus pneumatic lithotripsy. Methods: This was a prospective comparative study conducted from May 2019 to April 2020 in Nobel Medical College and Teaching Hospital, Biratnagar. Patients with mid- or distal ureteric calculi of size 5mm and more or failed medical management were included in the study. The patients were equally divided into two groups: laser & pneumatic. The efficacy of the procedure was measured in terms of stone clearance. Stone size less than 5mm, nephrolithiasis on same side of ureteric stone, pregnancy, bleeding disorder and patient not giving consent were excluded from the study. Results: Total 130 patients were enrolled in this study. The stone clearance was observed in 86.15% in pneumatic group and 96.92% in laser group at the end of 6 weeks. In pneumatic group 13.85% did not achieve stone clearance where as in laser group it was 3.08%. In patients with mid ureteric stone the clearance rate was significantly higher in laser group (93.33%) than in pneumatic group.(p=0.041) When the clearance rate of two techniques were compared  for  distal ureteric stone the results were similar. The mean operation time was 28.89 ± 8.26 min in pneumatic group and 22.93 ± 6.05 min in laser group(p<0.05). Conclusion: Holmium: YAG laser lithotripsy is superior to pneumatic lithotripter in terms of stone clearance rate for the mid ureteric calculus and also less time consuming.