Background: Percutaneous nephrolithotomy (PCNL) is a common procedure for the removal of renal stones larger than 2 cm size with the advantages of lower morbidity rates, decrease in post-operative pain with faster post-operative recovery & thereby less duration of postoperative hospital stay. One of the fundamental steps of PCNL is the creation of the nephrostomy access. It can be done either by single shot dilatation or by multi-increment serial dilatation technique. Objectives: To compare the outcome of PCNL done by single versus serial dilatation technique with specific reference to renal access time, total operative time, stone clearance rate, postoperative haematuria and duration of postoperative hospital stay. Methods: It was a prospective interventional study with a sample size of sixty where odd number patients were included in group A (PCNL by single shot dilatation technique) & even number patients were in group B (PCNL by serial dilatation technique). After meticulous checking and rechecking, collected data were compiled and statistical analysis was done using computer based software SPSS (statistical package for social science, Version- 16) and Students t-test and Chi-square test were applied for hypothesis testing. ‘P’ value <0.05 was considered as significant. Results: Comparison between the two groups regarding stone size, stone clearance rate, postoperative haematuria and postoperative hospital stay were not statistically significant (p> 0.05). But mean renal access time in minutes (group A was 3.43 ± 1.14 and group B was 4.20 ± 1.37) and the mean operative time in minutes (group A was 91.13 ± 19.08 and group B was 101.67 ± 15.81) between the groups were statistically significant (p < 0.05). Conclusion: Percutaneous nephrostomy access can be successfully performed by single shot dilatation technique during PCNL with the advantages of shorter renal access time and total operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.124-128

Background of the study: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for kidney stones larger than 2 cm. PCNL has replaced open surgical removal of large or complex calculi at the most institutions. The success of PCNL is related to the ability to achieve an optimum access tract and proper fragmentation. A wide range of lithotripsy techniques are currently available. One of these is ultrasonic lithotripsy, in which the stones are fragmented and sucked out simultaneously. This technique induces minimal tissue injury and could be considered as a standard modality for PCNL. The pneumatic lithotripter uses pneumatic ballast, which crushes the stones without producing any thermal effects. Because this mechanical energy passes along the metal wire to the stone, the probe works like a chisel on the stone surface. This modality destroys all stones, regardless of their composition. There were very few studies had been done in this context in our country, so I had decided to do this study to compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy. Objective: To compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy. Materials & Methods: This Prospective Interventional Study (Quasi Experimental Trial) was performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-E- Bangla Nagar, Dhaka during the period from December 2014 to May 2016. A total of 60 subjects will be selected with renal calculi (as per inclusion & exclusion criteria), among these, half of the patients will be group A (using pneumatic lithotripsy) & rest of the patients will be group B (using ultrasonic lithotripsy). The study subjects were underwent PCNL under general anesthesia, half of which used pneumatic lithotripter and rest used ultrasonic lithotripter for stone fragmentation. Above mentioned outcome variables were assessed both per-operative and post-operatively. Data were collected, processed & analyzed. Statistical analysis of relevant variables was done by unpaired Student’s T test and Chi Square test. P value Â0.05 was considered significant. Results: Total 60 patients were selected for study according to the selection criteria. Of the 60 subjects, 30 patients, those who were done PCNL by pneumatic lithotripsy were labeled as Group A and 30 patients, those who were done PCNL by ultrasonic lithotripsy, were labeled with Group B. Distribution of respondents in terms of different parameters is shown in tabulated form and statistical analysis was done in both groups to see statistical significance, p value less than 0.05 was considered significant. The mean stone fragmentation time was 27.23±4.78 (18-38) min in PCNL by pneumatic lithotripsy and those were 23.80±5.30 (13-34) min in by ultrasonic lithotripsy which is statistically significant. Other variables of interest which includes stone clearance rate, post operative haematuria and post operative hospital stay, were not statistically significant. Conclusion: Comparing the findings of the present study, results indicate that stone fragmentation time is lesser in ultrasonic lithotripsy than pneumatic lithotripsy in PCNL which decreases the overall operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.129-135

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods & Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A & even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value >.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value <.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value <.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value <.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

Objective: In this study, we aimed at making a comparison between the laparoscopic nephrectomy and open nephrectomy in terms of post-operative pain and pethidine consumption. Methods: The study has been designed with patients who underwent prospective and randomized laparoscopic and open nephrectomy operation. We assessed the post-operative pain through visual analogue scale (VAS) at the 0st, 2nd, 4th, 8th, 12th, 18th, and 24th post-operative hours. We carefully recorded the intraoperative and post-operative results along with the post-operative pain-relieving analgesic doses. Results: A total number of 30 patients were included in this study. The VAS scores of the two groups did not demonstrate a significant difference, but the analgesic (Pethidine) requirement was significantly lower in the laparoscopic group (p=0.031). The groups demonstrated no difference in terms of adverse effects. Conclusion: Along with similar perioperative results, laparoscopic nephrectomy offers an advantage in case of post-operative pain with regard to analgesic requirement and hospital stay duration. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.31-35

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