Background: Primary bladder stones are common among children from developing countries but may be difficult to cure. Transurethral cystolithotripsy, open cystolithotomy, and shock wave lithotripsy are the treatment modalities for vesical calculi in children. Transurethral lithotripsy is less efficient in children because of the small caliber of the urethra. PCCL is a less intrusive and efficient procedure for removing bladder stones in pediatric patients. Objectives: The objective of the study was to determine the safety and efficacy of PCCL in children with bladder stones in third-world nations. Materials and Methods: There was a search for( PCCL) in pediatric individuals diagnosed with vesical calculus. 90% male and 10% female total of 120 patients enrolled in the single-center trial at the Department of Pediatric Urology at the Institute of Kidney Diseases between January 2021 to January 2022. The surgery was performed under a general anesthetic. After a thorough inspection, a suprapubic puncture of the lower urinary tract (by cystoscopy) was done. The tract was only dilated up to 14 Fr. The stone was fragmented using pneumatic lithotripsy after passing the nephroscope. After 36 hours per urethral catheter was removed. Results: In this study, the mean age of the patients was 4.2.14 years. The majority of patients were kids. The average gem was 9.3 millimeters in diameter. Successful stone fragmentation and retrieval took place in an average of 40 min. The only major problems seen during or after surgery were hematuria, infection, and moderate mucosal injury; all three were managed conservatively. In 108 out of 120 cases (90%), ammonium acid urate was found to be the primary constituent of the stones and the core. Conclusion: The success rate of percutaneous cystolithotripsy in the treatment of bladder stones in children is higher, and it is ready for immediate use. The operation is quick and causes minimal discomfort. Keywords: Effectiveness, Percutaneous , Cystolithotripsy, Vesical Calculus, Children

Aim: This study aims to characterize the clinical manifestations, location of the obstruction, and surgical intervention results of individuals with obstructive urethral stones. Study design: A single-center study Place and Duration: IKD Peshawar, Departboyst of Urology, from January 1, 2020, to January 1, 2021. Methods: 124 obstructive urethral stones were treated at IKD Peshawar. 4 to 14-year-old patients Obstructive urethral stones were treated surgically by removing the stone from the external urethral meatus (stone retrieval) with or without Meatotomy, retrograde manipulation (push back), and then cystolithoclasty or cystolitholapaxy, depending on the stone's position and size. Results: The mean age was 04±12.14 was between 10 and 12 years old. A total of 118 boys (98%), together with 06 girls (02%), were aged 13 and above. Sixty boys had stones in the proximal urethra (prostatic and membranous) or bulbar urethra, while 24 boys had stones in the external urethral meatus. Stones were found in the external urethral meatus of 60 boys individuals. Conclusion: For the most part, obstructive urethral stones may be managed with endoscopic therapy, but in certain situations, a minor operation like a meatotomy is necessary. Keywords: urethral obstruction, managment t, outcome, surgery, intervention

Objective: To compare the efficacy of solifenacin and oxybutynin in the treatment of overactive bladder in female patients. Study Design: Quasi Experimental study. Setting: Department of Urology, Institute of Kidney Diseases, Peshawar. Period: July 2018 to May 2019. Material & Methods: After selection of 312 female patients with overactive bladder by simple random sampling, written informed consent was taken and pre-treatment overactive bladder symptoms (OABS) score was calculated. Patients were randomly distributed in two equal groups of 156 subjects, where Group A received Oxybutynin (3 mg, BD) and Group B received Solifenacin (5mg, OD) for a period 12 weeks. Patients were called for follow up visit to determine and compare the efficacy of study drugs. Those who showed improvement in at least 03 points in OABS score taken pre-treatment were considered as positive responders. Results: The mean age of patients was 38.8 ± 7.62 years with age range from 20 to 50 years. 110 (70.5%) subjects in oxybutynin treated group while 126 (80.8%) subjects in solifenacin treated group reported significant improvement in OAB symptoms. Conclusion: Solifenacin is relatively more effective than oxybutynin for treating female patients with overactive bladder.

Purpose: We investigated Patients presenting with chronic orchialgia at Andrology in institute of kidney and diseases Peshawar, from 2003 August up to when were included. Materials and Methods: A thorough history and physical examination was undertaken including description of pain by the patient in terms of site, severity, radiation and associated pain. Extensive workup, directed by history and phsical examination, was done to rule out reversible causes of orchalgia. All patients had urinalysis, culture and ultrasound scrotum with color Doppler. Further investigations like semen analysis, culture and hormonal workup were done if indicated. The intensity of the pain was noted according to visual analogue scale. Patients were subdivided into three groups as mild pain (group A, pain score=1 - 3), moderate pain (group B, pain score=4 - 6) and severe pain, (group C, pain score=7 - 10). Site of pain and radiation/association to any other region was recorded. Finding: Results of the study indicated that 92 patients reported at institute of kidney diseases Peshawar with chronic orchialgia had their mean age at 37+/-4years. Five patients lost to followo 92 were included in final analysis (table 01). Pain was partially relieved in 14 patients and not relieved in another 9 patients which is almost 76% of total patients. These non-responders were compared with the remaining in which pain was completely relieved. There was no difference in etiology among responders and non-responders, however pain severity was more in non-responders at initial presentation (table 2). Conclusions: Patients with pelvic floor muscle spasm are more likely to experience treatment failure following microscopic subinguinal spermatic cord denervation for chronic scrotal content pain, even with a favorable response to spermatic cord block. A history relating to pelvic floor muscle spasm should be taken for all patients presenting with chronic orchialgia or chronic scrotal content pain, and digital rectal exam should be performed if the history is suggestive. If underlying pelvic floor dysfunction exists, pelvic floor physical therapy can be offered to patients prior to spermatic cord denervation. History of prior vasectomy, epididymectomy, prior inguinal or scrotal surgery or other patient demographic factors were not associated with treatment failure.

Purpose: Varicocele is a common type of male genital disease and can occur in men of any age, especially young people. Clinically venous enlargement or varicocele are found in about 15% of the general male population, up to 35% of men with primary fertility, and 75% of men with secondary fertility dysfunction. Varicoceles are known to be the most common cause of male infertility and can be corrected surgically, but the exact mechanism of sperm formation caused by varicocele-induced impairment remains controversial. Most men with varicocele are asymptomatic and infertile, with only 15% – 20% suffering from physical discomfort or other fertility-related problems. With therefore systematically evaluated the RCTs published together and summarized evidence evaluating the benefits of testicular delivery and ligation of gubernacular vein in microsurgical varicocelectomy. Methodology: Comprehensive electronic search using the keywords "microsurgical varicocelectomy", "gubernacular vein", "testicular delivery", "infertility" and "varicocele" was done in databases of Cochrane, PubMed, Embase, CINAHL and Web of Science databases. English language used to search databases. Some studies were taken from studies references. Result: Two studies reported grade II and III of varicoceles in patients that participated in the study. Overall sperm count in microsurgical resection with testicular delivery compared to microsurgical resection without testicular delivery, increased significantly (SMD = 0.23, 95% CI = 0.07-0.39, p =<.05), but sperm motility, sperm concentration and gradual increase have no difference in between the two microsurgical methods (p> 0.05). Conclusion: In conclusion, as a result of this systematic review and meta-analysis, compared with microsurgical varicocelectomy without testicular delivery, delivery of the testicles during microsurgical varicocelectomy to further to further ligate the gonadal veins leads to epidydemo orchitis and oedema, and longer surgery. In addition, testicular delivery may not improve parameters of sperm, serum testosterone, and incidence of varicose veins, wound inflammation and spontaneous pregnancy compared to non-delivered testicles. However, a higher level of research is needed to determine if testicular delivery is an important surgery in microsurgical venous ligation.