2019) Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial, Arab Journal of Urology, 17:4, 279-284, ABSTRACT Objective: To assess the effect of diuretics (furosemide) administered before extracorporeal shockwave lithotripsy (ESWL) followed by continuous infusion of 0.9% NaCl during the ESWL in patients with renal stones. Patients and methods: A tertiary care teaching hospital-based prospective randomised controlled trial was conducted from July 2015 to June 2017, including 714 patients who underwent ESWL. The patients were randomised in two groups: in Group-A, patients received 40 mg furosemide 30 min before each ESWL session and 1000 mL 0.9% NaCl intravenous hydration during the procedure. In Group-B, the patients only received 0.9% NaCl. All patients were followed-up every 2 weeks for 3 months with X-ray and ultrasonography of the kidney, ureter and bladder. Patients without a radio-opaque stone at follow-up were classified as successes. Results: After 2 months, the stone-free rate (SFR) was much higher in Group-A, at 77.0% vs 65.3% (P < 0.001). Further, for patients aged ≤40 years, the SFR was significantly higher in Group-A than Group-B, at 89.2% vs 71.4% (P < 0.001). The mean (SD) age of the patients was 34.4 (8.23) years. Amongst them, 441 (61.8%) were male and 273 (38.2%) were female. The mean (SD) stone size was 1.42 (0.21) cm in Group-A and 1.40 (0.20) cm in Group-B. Conclusion: We conclude that the efficacy of diuretics (furosemide) along with hydration is superior to hydration alone during ESWL for renal stone clearance.Abbreviations: BMI: body mass index; KUB: kidney, ureter and bladder; OPD: Outpatient Department; ESWL: extracorporeal shockwave lithotripsy; SFR, stone-free rate. ARTICLE HISTORY

Objectives: To correlate the clinically diagnosed prostatic lesion with histopathological evaluation, Gleason scoring andserum prostate specific antigen (PSA) levels in a tertiary care centre. Study Design: Observational Study. Setting: The current study was conducted in multiple centers of Sindh like Department of Surgery Unit-III, Peoples University of Medical and Health Sciences, Nawabshah CMCH Larkana, Jinnah Sindh Medical University and Al-Tibri Medical College and Hospital Karachi. Period: January 2018 to December 2019. Material & Methods: on 112 consecutive cases of clinically diagnosed prostatic disease, all the relevant demographic and clinical details including digital rectal examination (DRE) findings and serum PSA levels were recorded on a proforma designed for the study. PSA values of all these cases were recorded before the surgical procedure. The tissue sample of prostate was collected after surgery and histologically analysed for the confirmation of diagnosis and the Gleason scoring was made. All the results obtained were statistically analysed and tabulated. Results: The age of patients ranged 34-81 years, with mean age of 58+3.4 years. The adenocarcinoma was detected in 05 cases, hyperplasia in 92 cases and hyperplasia with prostatitis in 07 cases. The carcinoma was clinically diagnosed in 17 cases but after histological evaluation, the carcinoma was confirmed in 03 cases and 02 cases of cancer were confirmed among clinically diagnosed cases of hyperplasia. Majority of cases of hyperplasia were having the PSA level < 4ng/ml No any case of adenocarcinoma have PSA level below 4ng/ml, and majority of the cases of denocarcinoma were having PSA level above 20ng/ml. majority of malignant lesions were having PSA level above 20ng/ml and the Gleason score above 6. No any case of malignancy was detected in those patients having PSA level below 4ng/ml. Conclusion: The histopathological evaluation with serum PSA levels is necessary in all cases of prostatic disease to rule out the possibility of malignant pathology.

Objectives: To determine the outcome of extracorporporeal shock waves lithotripsy for high density renal stone on non-contrast computed tomography. Study Design: Descriptive study. Setting: Urology Department of Sindh Institute of Urology and Transplantation, Karachi. Period: 1st November 2017 to 31st October 2018. Material & Method: Patients in the age range of 25-75 years were selected, irrespective of their gender. After 12 weeks final outcome of ESWL was measured by performing plain X-ray KUB films before and after procedure. Satisfactory outcome was defined as stone clearance in <3 sessions of the procedure. Results: According to our inclusion and exclusion criteria 122 patients were selected for ESWL. Among them there were 41.8 (n=51) females and 58.1% (n=71) males. The mean age of the patients was found to be 34.08+ 9.53 years. Approximately more than half of the patients 57.4% (n=70) patients were present in the age group of in ≤35 years. The mean size of the stone was 1.51+ 0.5 cm whereas mean stone density as scan was 772 + 22.2HU. Patients were having renal or ureteric stones for mean duration of 2.07 + 0.31 months. Around 69.7% of patients had renal stones and 30.3% of patients had ureteric stones. Stone clearance was found in 58.2% (n=71) of the patients. Conclusion: Non-contrast enhanced CT scan is the most frequently used investigation to diagnose kidney stones and decide its treatment modality. Outcome of ESWL also depends on various factors as mentioned in the study.

Aim: To detect usefulness of triple D score in ESWL (extracorporeal shock wave lithotripsy) for management of renal stone. Methodology: Retrospective Study was conducted at Urology department, CMCTH) at SMBBMedical University Larkana. 50 patients underwent ESWL from 2018 to 2020. All the related data were taken as well as demographic details, history and risk factor from the patients. Routine investigation carried out including Blood CP ESR, Urine DR, Blood sugar, Renal profile, urine culture sensitivity and CT KUB. The stone density, skin-to-stone distance, and stone size were calculated by a radiologist. Results: ESWL was performed on 50 patients with average age of 30± 8 years and a sex ratio (male female) of 1:0.3. The stone-free percentage after the first treatment session was 40 percent and 90 percent on 2nd sitting, based on the triple D score, which included stone size, skin to stone distance, and stone density (HU). The mean stone size was 15.8 mm, the Skin to Stone Distance was 6.4 cm, and the stone density was 594 HU were established respectively. Conclusion: The Triple D Score is easy to compute and reported by radiologist. The use of the Triple D Score in ESWL patients has been shown to improve overall ESWL success rates. Keywords: Extracorporeal, Shock, Wave, Lithotripsy, Renal stone and Triple D score