Objective: To compare the efficacy of voided urine cytology with findings of cystoscopy and histopathology of biopsy specimens in the diagnosis of bladder cancer. Study Design: Comparative cross-sectional study Place and Duration of Study: Armed forces Institute of Urology (AFIU), Rawalpindi Pakistan from Jan 2019 to Jan 2020. Methodology: All patients presenting to the urology clinic with complaints of haematuria, visible and non-visible, and any radiologic evidence of bladder growth were included in the study after informed consent. Urine cytology was performed for all patients, followed by cystoscopy under anaesthesia, transurethral resection was conducted, and biopsy was taken where needed. Results: 170 patients were included in the study134 (78.8%) were males, while 36 (21.2%) were females. The mean age was 54 ± 9.47 years (range 36 to 73 years). The overall sensitivity of voided urine cytology was 46.7%, while specificity was 79.2%. The positive predictive value was 85.1%, and the negative predictive value was 36.9%. Conclusion: Bladder cancer is a disease which demands an early diagnosis, prompt treatment, and long-term follow-up. Cystoscopy remains the gold standard for this purpose; urine cytology can be used as a supplement as it is non-invasive, more specific and cost-effective.

Objective: To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy with fluoroscopy aided renal access in the lateral position, in patients who were high-risk cases for anesthesia in prone position. Study Design: Prospective observational study. Place and Duration of Study: Armed forces institute of Urology, Rawalpindi, from Jan 2018 to Dec 2019. Methodology: Fifty-three patients with renal stones >1.8cm underwent minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral position. All the patients were obese, some had severe ischemic heart disease, few had diabetes mellitus. All the patients were unfit for the prone position. Results: Successful renal access was achieved in all the patients (100%). The mean size of stone was 28 + 13.2 mm, with an average operative time being 55 ± 13.56 minutes and the mean hospital stay was 1.8 ± 2.3 days (range 2-4 days). No visceral or pleural injuries were documented. In addition, only two patients required postoperative transfusion. After procedure, the rate of complete stone clearance initially was 90.6%, which improved to 96% after single session of extracorporeal shockwave lithotripsy (ESWL). Only 2 (3.77%) patients had persistent residual stone fragment. Conclusion: Minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral decubitus flank position, is safe and convenient in high-risk patients where prone position is contraindicated.