Objective: To determine diagnostic accuracy of NMP 22 and urine cytology in the detection of transitional cell carcinoma (TCC) urinary bladder taking cystoscopy as a gold standard in patients having provisional diagnosis of bladder cancer (BC). Methods: This cross sectional validational study enrolled 380 patients fulfilling selection criteria and was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan form July 2018 to July 2019. The urine sample collected underwent NMP22 and cytological analysis followed by rigid cystoscopy. Reports of all three tests divided patients into positive or negative for malignancy as per defined criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NMP 22, urine cytology and their combination was determined. Receiver operating characteristic (ROC) curve analysis performed and area under the curve (AUC) compared among these tests. Results: The average age of patients was 53.08 ± 12.41 years having male to female ratio 3.75:1(300 males and 80 females). NMP 22 had better sensitivity and comparable specificity to cytology (81.9 & 81.2% vs 54 & 93.9%). Combination of NMP 22 / cytology outperformed both in terms of sensitivity (91.63 vs 81.83 vs 53.96), NPV (87.59 vs 77.46 vs 61.02) and diagnostic accuracy (85.26 vs 81.58 vs 71.32) but at the cost of specificity (76.97 vs 81.21 vs 93.94) and PPV (83.83 vs 85.02 vs 92.06). ROC curve revealed statistically significant higher AUC (0.843 vs .815 vs .73) for combination as compared to NMP 22 and Cytology (p<0.001). Conclusion: NMP22 is a quick, point of care test having higher sensitivity, NPV and accuracy but similar specificity and PPV to urine cytology for detection of TCC urinary bladder. Combination outperformed both in terms of sensitivity while having modest specificity. doi: https://doi.org/10.12669/pjms.36.4.1638 How to cite this:Sajid MT, Zafar MR, Ahmad H, Saif Ullah, Mirza ZI, Shahzad K. Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard. Pak J Med Sci. 2020;36(4):---------.  doi: https://doi.org/10.12669/pjms.36.4.1638 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019. Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented. Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%). Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors.

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.

O b j e c t i v e : To assess the need for routine ureteral stenting after ureteroscopic lithotripsy. D e s i g n : Prospective interventionalstudy. D u r a t i o n a n d p l a c e of s t u d y : Study was carried out between November 2006 to march 2009 at C.M.H Peshawar and C.M.H Lahore.Patients a n d m e t h o d s : A total of 100 patients were equally randomized into stented and non-stented group. All these patients under wentureteroscopy and lithotripsy. The inclusion criteria was stone 6 to 10 mm.Those patients with large stones, previous surgery or ESWL wereexcluded.8.9 Fr rigid ureteroscope was used with pneumatic lithotripter and 4.7 to 6 Fr double pigtail catheter was placed in stented group for02 weeks. No ureteral dilator was used and stones were fragmented and no extraction device was used. A complete urine analysis, x-ray KUBand USG were performed before and after operation in each patient. Pain score and lower urinary tract symptoms were recorded at the timeof admission and three days after the operation. R e s u l t s : Regarding post-operative pain no statistically significant difference was noted betweenthe two groups (p < 0.5). The stone free rate was 100% with hydronephrosis resolved equally in both groups. 20 patients(40%) in stented groupcomplained of at least two irritative bladder symptoms and only 05 patients (10%) in the non-stented group experienced bladder discomfort.There was no significant difference in patients reported Haematuria in either group. Two patients in each group developed urinary tract infectionC o n c l u s i o n : All those patients who were with out a stent after uncomplicated ureteroscopic lithotripsy have similar renal function recovery andsatisfactory pain reduction and with less irritative symptoms as compared to those with stent. We suggest that it is not necessary to place aureteral stent in every case after ureteroscopic lithotripsy for stones smaller than 01 cm.

Objective: To compare the surgical outcome of extravesical and transvesical repair of Vesicovaginal fistula. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi Pakistan, from Jul 2019 and Jul 2020. Methodology: Forty-two patients with vesicovaginal fistula were included in the study. The causes of the development of vesicovaginal fistula were evaluated. Half of the patients underwent extravesical and remaining transvesical repair. The results were compared regarding operative time, mean blood loss, complications and recurrence. Results: The vesicovaginal fistula was secondary to prolonged obstructed labour 27(66%), with an iatrogenic cause 15(34%).Mean operative time for extravesical repair was 83.00±20.00 minutes and for transvesical repair was 60.00±20.00 minutes.71% patients undergoing extravesical repair experienced bladder spasms compared to 47% in the transvesical Group. Three cases suffered prolonged illeus in case of extravesical repair. The mean hospital stay for extravesical repair was 6.00±1.08 days,relatively more than transvesical, which was statistically significant (p-value <0.001) Conclusion: Transabdominal approach for managing vesicovaginal fistula is the most preferred successful technique.