Background: One of the most common complaint in the ER is colic due to Ureteric calculi. They usually pass out but stones > 5mmmay require intervention. ESWL and TPL are one of the treatment options.Objectives: To compare the effectiveness of transurethral pneumatic lithotripsy (TPL) and extracorporeal shock wavelithotripsy(ESWL) in treatment of lower ureteric stones.Material and Methods: Over period of six months a group of 70 patients presenting with ureteric calculi were randomly allocated intwo groups. Group Aunderwent TPL while Group B ESWL. Follow up was done to determine the effectiveness with regards to stoneclearance.Results: The mean age of the whole study sample was 35.6 + 8.5 years. The difference between mean age of both groups wasstatistically not significant (p 0.665). there were 70% males compared to 30% females in the overall sample and the difference ofgender across both groups was comparable (p 0.192). The mean size of stone of the whole study sample at presentation was 6.4 +2.5mm and the duration of illness was 4.8 + 1.8months. On follow up, the effectiveness of the procedure in terms of stone clearancewas recorded in 88.6% of TPL group and 77.1% of ESWL group (p 0.205).Conclusion: TPL is comparable to the ESWL in terms of its effectiveness for ureteric calculi of size less than or equal to 10mm.More research trials need to be done for conclusive outcome.Key Words: Urolithiasis, ureteric calculi, transurethral pneumatic lithotripsy, extracorporeal shock wave lithotripsy, stoneclearance

Background Percutaneous Nephrolithotomy (PCNL) is a surgical procedure used for the removal of renal stones. The technique is minimally invasive and is often used for the removal of renal stones that are located near the pelvis. The topical administration of local anesthetics in the surgical area has been proven effective in minimizing post-operative pain after various surgical procedures. Purpose This study was conducted to compare the mean post-operative pain score in patients with pre-operative Bupivacaine infiltration of nephrostomy tract with placebo in control group of patients undergoing percutaneous Nephrolithotomy. Methods A randomized controlled trial was carried out in Department of General Surgery, Kuwait Teaching Hospital, Peshawar with diagnosis of renal stones. A total of 66 patients (33 males and 33 females) age: 16-50 years were admitted with diagnosis of renal stones. Statistical analysis was performed by using SPSS version 17. Results Patients with renal stones who underwent PCNL were randomly divided into Group A (Bupivacaine) and Group B (Placebo). The overall Average pain score for Group A was 4.15 ± 1.48 range (2 to 7) on visual analogue scale (VAS), while that for Group B was 6.06 ± 1.02 range (4 to 8) p-value < 0.05, which indicates that preoperative infiltration of bupivacaine significantly decreases the postoperative pain in patients undergoing Percutaneous Nephrolithotomy. Conclusion The study concludes that local bupivacaine infiltration along the nephrostomy tract is an effective method of management of postoperative pain after PCNL, regardless of age and gender as shown by results of the study.

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Introduction: Hydrocephalus is the accumulation of excess cerebrospinal fluid (CSF) in the ventricular system of the brain. Objectives: The main objective of this study is to find the surgical outcomes of third ventriculostomy in patients of obstructive hydrocephalus. Material and methods: The data was collected through non-probability consecutive sampling technique. There were 60 patients which were included in the study. A flexible endoscopic telecamera and a Bugbee electrocautery wire and monitor were used for the procedure. The main causes of hydrocephalus have been identified. history of meningitis, ventriculitis, or illness prior to the development of hydrocephalus; x-rays indicating separation or septa within the ventricles; or postoperative residue of hemosiderin or the presence of yellowish deposits were all taken into consideration of post infectious hydrocephalus. Results: There were 49 male and 11 female patients. The mean age of the patients was 39.38 ± 11.2 years. 27 (45%) patients had hydrocephalus due to tumors, 21 (35%) patients had aqueductal stenosis while 12 (20%) patients had benign cysts. Intraoperative bleeding occurred in 24 patients. ETV was successful in 54/60 – 90percent of the patients. A CSF leak was recognised in 09 patients. 07 patient developed a transient gaze palsy which had resolved when he came for his follow up visit on 10th post operative day. Practical implication: Use effective method for treatment of hydrocephalus in hospitals Conclusion: It is concluded that endoscopic third ventriculostomy, in general, is a very effective method of treatment for hydrocephalus. Keywords: Obstructive Hydrocephalus, ETV, Outcome, CSF, Brain, Ventricular

First trimester vaginal bleeding has been considered as one of the commonest obstetrical and gynecological emergencies estimated in 20-25 % of all obstetrical emergencies all over the world. The aim of this study was the use of ultrasonic (US) imaging to identify the commonestcauses of first trimester vaginal bleeding , finding their incidence in primigravida and multigravida pregnant women , detecting the most frequent mean age of occurrence according to gestational age in weeks , looking for the incidence of viable and nonviable pregnancy among them , detecting their relations with a bad obstetrical history and finally estimating the disparity between clinical and ultrasonic diagnosis . Patients and Methods: This study is a cross sectional study that has been done on one hundred thirteen pregnant women presented with vaginal bleeding in their first trimester of pregnancy, attending Azadi Teaching Hospital and Duhok Maternity Hospital from 1stJune to 22th of November (2019 ). All patients were clinically referred byspecialized clinicians and subjected to ultrasound examination and examined under supervision of specialized radiologists. Results: The mean age of the examined patients was29.4±5.9 years, multigravida were more than primigravida constituting (81.4%) of the cases compared with the primigravidawhich constituted (18.6%) of the cases , regarding the gestational age of these referred cases most of them were between 6-8 weeks of gestational Age (GA) with the mean 8.2±1.6 weeks. The prevalence ofnon-viable pregnancy constituting (67.3%) and the most common cause of vaginal bleeding was miscarriage (84.1%). The next frequent reason was ectopic pregnancy (6.2%) subsequently hydatiformmole (3.5%). The most common subtype of miscarriage was threatened miscarriage (32.7%). Among all the patients, thewhole difference between ultrasound diagnosis and medical diagnosis were found in 72 patients. Consequently, (63%) wasthe whole accurateness of clinical diagnosis while ultrasound accuracy was (100%). Conclusion: Ultrasound examination for the cases who are complaining from the first trimester vaginal bleeding ishelpful in confirming and detecting the different causes behind this bleeding,in addition to allow an early detection and more confident early obstetrical management with less subsequent complications