Introduction. Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods. This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results. Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion. Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.

Introduction: Patients with enlarged prostate generally rate their storage symptoms (frequency, urgency and nocturia) as the most bothersome as these symptoms interfere more with daily activities and have huge impact on quality of life. Effect of transurethral resection of prostate (TURP) on storage symptoms is unknown. Objective of the study is to assess the change in storage symptoms in patients undergoing TURP.Methods: A prospective observational study was conducted at the author’s institute from August 2011 to July 2012. Patients undergoing TURP for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate were included. Patients were evaluated by International prostate symptom score (IPSS) questionnaires. The question number 2, 4 and 7 of the IPSS questionnaire gave the storage symptom subscore (0-15). After initial evaluations, the patients underwent TURP. After 3 months, the IPSS was reevaluated and the change in storage symptom was analyzed.Results: A total of 57 patients who had undergone TURP were eligible for final data analysis. Majority of the patients had severe bothersome LUTS with mean IPSS score of 24.6±6. The baseline storage symptom subscore was 11.1±3. After 3 months of follow-up, there was significant decrease in total IPSS score and both of its subscores. On comparing the mean change in storage and voiding subscore, there was less decrement in storage subscore which was statistically significant (p=0.001). Conclusions: This study showed that after TURP change in voiding subscore occurs more than storage subscore and storage symptoms may not revert to normal.

Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass.

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice.They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life, and can be applied in routine clinical practice. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied.Methods: This RCT was carried out in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin(T) group and Control(C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4mg Tamsulosin daily and Paraceramol on demand and control group received only Paracetamol. Stent related symptoms and quality of life was assessed by IPSS at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by VAS and analgesic requirement was documented. Data were analysed using SPSS 20, chi-square test and Student’s t- test was used. A p-value of <0.05 was considered significant.Results: Mean age in Tamsulosin group was 37.96±12.98 and Control group 36.43± 10.99(p=0.67).There was no significant difference in IPSS(p=0.141), QoL index (p=0.089) and VAS (p=0.59) in the two groups at the time of discharge.At the time of DJ stent removal, IPSS (p<0.001), QoL index (p<0.001), VAS (p=0.004) and analgesic needed (p<0.001) was significantly lower in T group than in C group.Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patients with indwelling DJ stent though the effect is not immediate.

Gestational choriocarcinoma with kidney and lung metastases with delayed presentation after term pregnancy is rare event and not described frequently in literature. We describe a rare case of 24-year-old female with hematuria after 3 years of term delivery. Management includes chemotherapy and even renal embolization in case of life threatening hematuria.