Urology Outpatient Department Research Articles

Evaluation of serum inhibin B and inhibin B/FSH ratio in the diagnosis of non-obstructive azoospermia and oligozoospermia.

Infertility affects approximately 15 % of couples globally, with 50 % cases of male factor infertility. Precise assessment of spermatogenesis is essential for evaluating male infertility. Recent studies suggest serum inhibin B as a promising biomarker for testicular function. This study aims to evaluate the diagnostic utility of serum inhibin B in predicting male infertility, particularly focusing on its relationship with sperm count. A cross-sectional study was conducted on 80 adult men (mean age 31.4±6.89 years) presenting with infertility at gynecology and urology outpatient departments. Semen analysis was performed following WHO (2010) guidelines, and serum inhibin B levels were quantified. The correlation between serum inhibin B levels and sperm parameters was assessed using Pearson's correlation test. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of serum inhibin B and the inhibin B/FSH ratio for non-obstructive azoospermia (NOA) and oligozoospermia. A significant positive correlation was observed between serum inhibin B and sperm count (r=0.94, p<0.001). ROC analysis demonstrated that the inhibin B/FSH ratio had the highest diagnostic accuracy for NOA and oligozoospermia (AUC=0.986), with sensitivity of 100 % and specificity of 91.67 %. Serum inhibin B alone also showed high diagnostic value (AUC=0.965 for NOA and 0.969 for oligozoospermia). Serum inhibin B is a reliable biomarker for assessing male infertility, particularly in evaluating spermatogenic function. The inhibin B/FSH ratio provides superior diagnostic accuracy for NOA and oligozoospermia, offering valuable clinical utility in male infertility diagnosis.

Prevalence of Asymptomatic Rise in Troponin I in Hemodialysis Patients at a tertiary care hospital

Objective: To determine frequency of asymptomatic rise in troponin-I among hemodialysis patients. To compare the mean of asymptomatic rise in troponin I between twice and thrice weekly hemodialysis patients. Methods: It is a Cross Sectional Study held in Sindh Institute of Urology and Transplantation outpatient dialysis department from June 25, 2020 to December 26, 2020 All patients of either gender age greater than 18-80 years undergoing hemodialysis via permanent angio-access without any history of shortness of breath and chest pain in preceding two weeks were consecutively enrolled. Information related to age, gender, causes of ESRD, duration of hemodialysis, date of last dialysis and date of sample collection was noted. Those whose troponin I was in cardiac range was admitted. Results: Of 127 patients, mean age was 38.17 ±14.75 years. There were 64 (50.4%) females and 63 (49.6%) males. Twice weekly hemodialysis was observed in 64 (50.4%) and thrice weekly in 63 (49.6%) patients. Mean troponin I level was 33.99 ±63.38 ng/ml. Raised troponin I level was found in 26 (20.50%) patients. The mean troponin I level among with twice weekly hemodialysis was 38.46 ±78.42 while among thrice weekly hemodialysis session was 29.45 ±43.27 (p-value 0.425). Conclusion: The frequency of asymptomatic rise in troponin-I was found to be 20.5% among hemodialysis patients. However, the mean difference of troponin I level with number of sessions showed insignificant difference.

Bilateral Complete Ureteral Duplication with Obstructing Stones in Both Left Ureters: A Case Report and a Review of Literature

Congenital anomalies like duplex renal collecting systems are rare developmental conditions. Among these anomalies, ureteral duplication is rarely observed, with partial ureteral duplication comprising a majority of cases. Bilateral ureteral complete duplication, where fully duplicated ureters drain separately into the bladder via separate orifices, is extremely rare, making it a seldom-documented anomaly in the medical literature. A case of bilateral complete ureteral duplication complicated by calculi in both the upper and lower moieties of the left kidney presented to the urology outpatient department with complaints of left flank pain for one month. His computed tomography-urogram revealed complete duplication of bilateral collecting systems with bilateral double ureters with an 8.2×5.9 mm2 sized stone in the pelvi-ureteric junction of the left upper moiety and 11.9×5.6 mm2 sized stone in the proximal ureter of left lower moiety causing hydronephrosis of both upper and lower moiety pelvicalyceal system. Calculi in both the upper and lower moieties were cleared in a single setting using a Ureteroscopic Lithotripsy. Duplex renal systems, while often asymptomatic, are linked to a higher occurrence of treatable conditions like stones and renal reflux diseases. The duplicated structure may lead to stagnant urine, causing obstructions and consequently infections. Stones that obstruct the ureter for a prolonged period can cause renal impairment and require active intervention. Currently, flexible or semirigid ureteroscopy with laser lithotripsy is the standard procedure. Even in this case, both stones were effectively managed in a single session using a standard procedure.

An outbreak of Pseudomonas aeruginosa urinary tract infections following cystoscopy traceable to a malfunctioning drying cabinet

Pseudomonas aeruginosa is an important bacterial pathogen, particularly as a cause of nosocomial infections in hospitalized patients. Only few reports exist in which cystoscopes were implicated as an outbreak source. We describe an investigation into the cause of a sudden increase in the number of urinary tract infections (UTI) with P. aeruginosa in patients after cystoscopy. In addition, we share the lessons learned and measures taken to reduce the risk of similar infections in the future. Over a period of two weeks the urology outpatient department noticed a UTI in four patients following cystoscopy. An investigation was started for a common source of the outbreak in the urological treatment room. Additional screening of patients revealed a total of eleven males with P.aeruginosa UTI following cystoscopy. The infections were found to be due to a defective drying cabinet, which lacked an alarm signaling in case of loss of airflow. Amplified fragment length polymorphism (AFLP) analysis revealed that P.aeruginosa isolates from three patients and six isolates from environmental cultures (including cystoscopes from the drying cabinet) genotypically belonged to one strain. The AFLP results suggest that contaminated cystoscopes caused P.aeruginosa UTI in 11 patients, with the drying cabinet as site of transfer of the infective strain. To our knowledge, this is the first report describing a malfunctioning drying cabinet as source of an outbreak following cystoscopy. In case of concomitant P.aeruginosa infections, cystoscopes and drying cabinets should be suspected as a potential source. Molecular techniques are helpful in investigating the epidemiology of an outbreak.

Transitional Urology in Korea: Initial Insights Through a Cross-Sectional Study.

In Korea, the field of transitional urology (TU) is in its nascent stages, with its introduction only beginning. This study aims to evaluate the existing state of TU prior to implementing a transition protocol, and to identify key areas of focus for the development of an effective transition protocol. From June 1, 2021 to May 31, 2023, clinical data were retrospectively collected for patients who visited the adult urology or pediatric urology outpatient departments of this hospital and were aged 10 or older, with medical conditions falling under the category of TU. We analyzed the patient distribution across different disease groups. The transitional stages were categorized from T1, indicating initial care by pediatric urologists, to T4, denoting complete transition to adult care. 'T4x' was used for patients with unknown medical histories, and 'T4only' for those who had never been under pediatric urology care. During a 2-year period, a total of 1,484 patients received outpatient care for diseases in TU field. The most prevalent diseases were hypospadias (40.4%), spinal bifida (37.3%), and congenital ureteral anomalies (17.7%), with other conditions accounting for 4.6%. Among 553 spinal bifida patients, only 5.3% completed transitional care (T4), while 80.1% were in the initial phase (T1). For patients introduced to adult urology (T2-T4), 37.7% reached T4, highlighting a marked increase in transition completion within this subset (P<0.001). TU in Korea is in its nascent stage, with a significant gap in the initiation and completion of transitional care for patients with congenital urologic conditions. Early initiation and active engagement in transitional care are crucial for successful transition. This study highlights the need for structured transition protocols to address the complex needs of this patient population.

Therapeutic effectiveness and adverse drug reactions of mirabegron versus solifenacin in the treatment of overactive bladder syndrome.

Overactive bladder (OAB) syndrome is a chronic disease characterized by urinary urgency with or without urge incontinence, frequency, and nocturia and antimuscarinic drugs such as solifenacin have been the mainstay of treatment. Mirabegron a beta 3 adrenoreceptor agonist has recently gained importance in the management of OAB. The rationale of the study is that mirabegron improves the storage function without affecting voiding which increases the therapeutic effectiveness. The objective was to determine the therapeutic effectiveness of mirabegron versus solifenacin. A prospective observational study was conducted on 298 patients with OAB syndrome attending the urology outpatient department of government medical college after obtaining institutional review board clearance. Patients of both genders, belonging to the 18-65 years of age group, attending the urology outpatient department were selected for the study. Patients were evaluated using the OAB-validated 8-question awareness tool (OAB-V8 score) before and after receiving drugs by direct questionnaire method after receiving informed consent. Patients were prescribed either solifenacin 5 mg or mirabegron 25 mg once daily by the urologist. Follow-up was done after 4 and 12 weeks. Adverse drug reactions of the drugs were assessed using the Central Drug Standard Control Organization suspected adverse reaction (ADR) form, and ADRs were notified to the nearest ADR monitoring center. The mirabegron group showed maximum improvement in the mean OAB-V8 score values from baseline at 4 weeks (12.82 ± 5.86, P < 0.001) and 12 weeks (5.74 ± 3.31, P < 0.001) when compared to solifenacin. OAB-V8 scores of the solifenacin group also showed significant improvement from the baseline at 4 weeks (15.30 ± 5.54, P < 0.001) and 12 weeks (8.05 ± 4.59, P < 0.001). Heart rate, systolic, and diastolic blood pressures did not show significant changes during the follow-up in both the study groups. Thirteen patients developed ADRs such as dry mouth (four patients) and constipation (nine patients) in the solifenacin group. No ADRs were noted in the mirabegron group. Mirabegron showed maximum improvement in the OAB-V8 scores in patients with OAB syndrome, although the solifenacin group also showed improvement. Adverse effects were less in the mirabegron group when compared to the solifenacin group.

Selective angioembolization in symptomatic renal angiomyolipoma: A series of four cases along with review of literature

Abstract The management of renal angiomyolipoma (R-AML) should be characterized on the basis of symptoms and/or the presence of associated risk factors of hemorrhage. In total, four cases of large symptomatic R-AML were visited in our urology out-patient department within the 9-month period. They underwent selective angioembolization (SAE) and were followed up for at least 3 months. Case 1—A 40-year-old female with bilateral R-AML, largest 4 cm × 8 cm × 9 cm lesion on right kidney. Postangioembolization, she underwent a right partial nephrectomy and is in further follow-up with contrast-enhanced computed tomography of the kidney ureter bladder (KUB) region (CECT KUB). Case 2—A 36-year-old female had bilateral large R-AML associated with active bleeding and perinephric hematoma on her right side and underwent urgent SAE. Follow-up CECT KUB revealed bilateral large AML with no evidence of perinephric hematoma. Now, we are planning for a bilateral partial nephrectomy. Case 3—A 52-year-old female with symptomatic 54 × 53 mm left mid-pole R-AML. She developed postembolization syndrome and managed it conservatively. Follow-up CECT KUB revealed a marked reduction of the left R-AML lesion (1 cm × 1 cm). Case 4—A 41-year-old female with 44 mm × 40 mm exophytic upper pole right R-AML with active bleed underwent urgent SAE. Follow-up CECT KUB revealed right kidney AML lesion size reduction (27 mm × 28 mm) with no perinephric hematoma. SAE is better suited for AML with acute hemorrhage or patients with multiple comorbidities or multiple AML lesions. For large AMLs, SAE can also be used before surgery to decrease the size of tumors and the possibilities of procedural difficulty for nephron-sparing surgery.

External urology consultation quality at a third-level public hospital in Mexico

IntroductionPatient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. ObjectiveTo identify the quality of care in the Urology outpatient department of a third-level hospital. Materials and methodsThe NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. ResultsAccording to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11−20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. ConclusionsThe use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Comparison of Miniperc and Standard Percutaneous Nephrolithotomy in the Treatment of Renal Stone: An Open Level Parallel Arm Randomized Control Trial

Background: Treatment of renal stone is very crucial for the outcomes of the patients. Objective: The purpose of the present study was to compare the Miniperc and standard percutaneous nephrolithotomy in the Treatment of Renal Stone. Methodology: This randomized control trial was conducted in the Department of Urology at National Institute of Kidney Diseases and Urology, Dhaka and some private hospitals in Dhaka city of Bangladesh from July 2016 to November 2017 for a period of one and half year. Patients from 18 to 65 years of age with renal calculi ( 2cm) were selected on the basis of plain X-ray and ultra-sonogram of KUB region, from Urology outpatient Department (OPD) in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and some private hospitals in Dhaka city. Patients were selected in every alternate sequence (odd numbers for Miniperc in Intervention group and even numbers for Standard PCNL, control group). All patients underwent PCNL of both the procedures under general anesthesia and received intravenous broad spectrum antibiotics. Results: A total number of 60 patients were selected for study of which 30 patients were underwent miniperc and 30 patients were undergoing standard PCNL. The mean age of miniperc group and PCNL group were 34.43±11.09 and 36.70 ± 12.27 years respectively. An overall stone clearance rates was 93.33 (28) in intervention group and 6.67 % (2) was not cleared. Among the control group an overall stone clearance rates were 96.67% (29) and 3.33% (1) was not cleared. Stone clearance rates were not significant. The mean operative time (min) of intervention group was 97.47±15.03 and the mean operative time (min) of control was 86.37±17.73 Operative time was significant between the groups (p&lt;0.05). Conclusion: In conclusion the rate of clearance of intervention group is not statistically significant. Journal of Current and Advance Medical Research, January 2023;10(1):19-24

Calidad de la consulta externa urológica en un hospital público de tercer nivel en México

IntroductionPatient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. ObjectiveTo identify the quality of care in the Urology outpatient department of a third-level hospital. Materials and methodsThe NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25minutes was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. ResultsAccording to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2hours in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11 to 20minutes in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. ConclusionsThe use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Prevalence of LUTS in young female population attending tertiary care centre.

To obtain the prevalence of lower urinary tract symptoms (LUTS) in young female population in tertiary care centre. We conducted a descriptive and analytic study with ques tionnaire based data collection. All subjects were interviewed using conventional method and International Consultation on Incontinence Questionnaire (ICIQ) Female LUTS form in the urology outpatient department, SMS medical college and hospital, Jaipur (India). Total 1278 patients enrolled in study. Using the well-structured questionnaire using ICIQ-FLUTS form, the prevalence of LUTS was 78.01% while conventional method having only 35.8%. This result revealed that LUTS is a common condition among young Indian female population with vaginal delivery as the common risk factor. Screening for LUTS using a structured questionnaire identified a significantly higher prevalence of LUTS than the conventional method. The ICIQ-FLUTS form is a robust questionnaire that can be recommended for use in epidemiological research as well as routine clinical practice.

Knowledge of prostate cancer and its screening among males attending Urology OPD in a tertiary care hospital in Kathmandu

Prostate cancer is a global burden on public health and it has been ranked as the second most common cancer in males worldwide. The incidence of prostate cancer generally increases with age and men with family history of prostate cancer have an increased risk of getting prostate cancer. The incidence varies across the world, where developed countries have a higher incidence as compared to developing countries. It is well known that early detection of certain grades of prostate cancer leads to a higher remission rate. Starting the screening for prostate cancer at the age of 40 for specific population provides the only way to reduce mortality from prostate cancer. A cross sectional hospital study was conducted using Consecutive sampling of eligible patients in the Urology Outpatient Department (OPD) of a tertiary care hospital in Kathmandu. A total of 378 patients attending Urology OPD were included in the study. A structured questionnaire which was sectioned into sociodemographic characteristics, knowledge of prostate cancer and its screening practices was administered to all the participants. Male more than 60 years of age attending Urology OPD were more (33.3%) followed by age group less than 40 years of age (28.6%). The majority of the patients visiting Urology UPD were from Province 3 (73.0%) and Province 1 (11.1%). Most of these patients were literate (34.9%) but the education level of college or higher were less (17.7%). When knowledge of prostate cancer among the participants were assessed, 55.6% participants replied that they have heard about the prostate cancer and among them, the majority of the participants (28.6%) had heard it from media like TV, radio and internet. The most common symptoms chosen by patients were hematuria (80.2%) and weight loss (72.0%). When asked about the prevention and cure of prostate cancer, 61.1% and 78.6% of them did not know about the prevention and its cure respectively. When knowledge on screening of prostate cancer was assessed, more than half of the participants were found to be aware of screening test and among them 94.4% chose blood test, Serum Prostate Specific Antigen (PSA) as the screening test. Majority of the patients (61.4%) had chosen the age for screening as &lt;40 years and many more (91.3%) wanted to go for screening. Overall, 55.6% had heard about prostate cancer and 30.7% did not know any symptoms of prostate cancer. This study identifies some deficits in knowledge of prostate cancer and screening among participants which can be addressed to increase the knowledge related to prostate cancer. It is thus important that these participants and other men be educated more on these important domains of prostate cancer.

Efficacy of Tamsulosin Alone versus Tamsulosin Plus Tadalafil in Treatment of LUTS due to BPH: A Comparative Study

1. Background: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are common disorders whose prevalence increases with advancing age. Recent large-scale epidemiological studies reported a statistically significant association between these two conditions, independent of age and cardiovascular co-morbidities. Furthermore, a significant association between the increased severity of LUTS and the increased severity of ED has been confirmed. Objectives: The purpose of the study is to offer a clinical evaluation to verify the safety and efficacy of the combination of tamsulosin 0.4 mg/day plus tadalafil 5 mg/day vs. tamsulosin 0.4 mg/day alone to treat patients with LUTS due to BPH. Materials &amp; Methods: This comparative study was conducted in the Department of Urology, Dhaka Medical College Hospital. The duration of this study was 1 year from April 2018 to March 2019. A total of 170 patients, with a history of symptomatic BPH who attended the Urology Outpatient Department, Dhaka Medical College Hospital, were selected as per inclusion and exclusion criteria. Of them, 85 patients were treated with tamsulosin 0.4mg/day in group A whereas 85 patients were treated with tamsulosin 0.4mg/day plus tadalafil 5mg/day in group B. The general medical condition of the patients was evaluated through history, physical examination. The size of the prostate and PVR were evaluated through ultra-sonogram, and Qmax was assessed with uroflowmetry. The outcome of the patient was assessed by IPSS, IPSS total, IPSS voiding subscore, IPSS storage subscore, IPSS nocturia questionnaire, QOL, International Index of Erectile Function (IIEF-5) questionnaire, Qmax, USG of KUBP with MCC with PVR. Follow-up will be recorded in 4 visits in screening, week 0 randomization, 6 and 12. Results: One hundred and forty patients completed the study. Improvements in IPSS score and IPSS-QOL were significant with both treatments but greater with.....

Evaluation of automated microscopy sediment analysis in urinary tract infection screening: a practical insight in adjusting fixed cut-off values for urine culture

PurposeThe aim of our study was to evaluate a procedure in which urine culture was only being performed based on fixed cut-off values of urine sediment analysis with intention to prevent unnecessary negative urine cultures.MethodsFrom January 2018 to August 2018, all urine samples from patients visiting the urology outpatient department were analyzed. Urine culture was only performed if urine sediment contained more than 130 bacteria per microliter and/or more than 50 leukocytes per microliter.ResultsIn total, 2821 urine cultures with accompanying urine sediments were analyzed. 2098 cultures (74.4%) were defined negative and 723 (25.6%) positive. By adjusting cut-off values of sediment analysis > 20 per microliter or bacteria more than 330 per microliter, 1051 cultures would have been saved with an estimated cost reduction of € 31.470. Eleven clinically relevant urine cultures would have been missed (1%).ConclusionUsing cut-offs values leads to a notable decrease of the total number of urine cultures. According to our analysis, adjusting cut-off values could result in 37% less urine cultures and almost 50% less negative cultures. Hereby, unnecessary cost can be prevented [in our department estimated €31.470 in eight months (€ 47.205/year)].

COMPARISON OF EFFICACY OF TAMSULOSIN, ALFUZOSIN, AND SILODOSIN IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

Objectives: This study was done to determine the efficacy of alpha-1 adrenoceptor blockers such as tamsulosin, alfuzosin, and silodosin in patients with the lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) over 6 months by assessing change in international prostate symptom score (IPSS), quality of life scale for urinary symptoms (Bother score), and improvement in peak urine flow rate (Qmax) from baseline. We also tried to identify any adverse drug reactions (ADRs) caused by these drugs. Methods: A prospective observational study was conducted in 291 patients with LUTS secondary to BPH attending urology outpatient department of a tertiary care center for 1 year. Ninety-seven patients in each group received tamsulosin, alfuzosin, or silodosin once daily. IPSS, Qmax, and the quality of life scale for urinary symptoms by Bother score were assessed at 1st, 3rd, and 6th month of treatment period. ADR was noted and recorded in ADR reporting form. Results: IPSS, mean bother score, and mean Qmax showed significant improvement from the baseline in each follow-up visit at 1, 3, and 6 months for all the three groups, but maximum was for alfuzosin and was found to be statistically significant (p&lt;0.001). Two patients developed adverse drug reaction during the study; asthenia in tamsulosin group and hypotension in Silodosin group. Conclusion: Patients on alfuzosin showed maximum improvement in the values of IPSS, Bother score, and Qmax in BPH patients as compared to tamsulosin and silodosin. Alfuzosin would be a better choice in the treatment of LUTS due to BPH.

Renal Stone Density: Determinant of ESWL Success

Background: The worldwide prevalence of developing renal stones is as high as 15% with an estimated 1 in every 5 persons being affected with the condition in Pakistan. Among the many treatment options available for renal calculi, extracorporeal shockwave lithotripsy (ESWL) is among the commonest owing to its non-invasive nature, however, it has its drawbacks; one being limitation against dense stones. &#x0D; Objective: To assess association between stone density (detected on CT KUB) and ESWL outcome among patients with renal calculi.&#x0D; Methodology: This clinical trial was conducted upon a sample of 150 patients (of either gender, aged 16 to 70 years) presenting to the Urology out-patient, emergency and lithotripsy department of Ziauddin University Hospital with renal calculi from 30th August 2017 to 30th September 2019. After taking written informed consent, data was recorded onto a prestructured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, and disease history, inferences obtained from C.T KUB, operative notes and the eventual treatment outcome. The data obtained was analyzed using SPSS v. 21.0. &#x0D; Results: The mean age of the sample stood at 36.7 (SD ± 3.1). 104 (69.3%) patients had multiple calculi and 46(30.7%) have single calculi with mean density of 812 (SD ± 219) HU. A (having stone density &lt;500-HU) group B (having stone density 501 to 1000-HU) and group C (having stone density &gt;1000-HU). The success of group A was 95.34% group B was 88.5% and group C was 80.3%. Major proportion of the sample (39.3%) required up to 3 ESWL sessions. The stone density was observed to be inversely proportional to the success of ESWL. &#x0D; Conclusion: After careful consideration, it can be concluded that higher stone density is associated with a poor ESWL outcome and thus other treatment modalities may be considered among patients with a stone density of more than 900 HU.

Prevalence of Urinary Tract Infection among Patients Presenting with Complex Renal Stones at SIUT

Introduction: The link between stone formation and urinary tract infections (UTIs) is complicated; research has primarily focused on bacteria's potential to stimulate the formation of kidney stones. Infective urolithiasis has long been thought to be the result of a urinary tract infection (UTI) caused by bacteria, most commonly belonging to the Proteus genus. Staghorn stone, which is characterised by a massive calculus entirely occupying the renal pelvicalyceal system, is one of the most common kinds of infective lithiasis. This study can serve in identifying the risk of UTI in a patient with complex renal stones, as well as preventing and intervening early. Objective: The goal of this study was to investigate the prevalence of urinary tract infections (UTIs) among patients with complex renal stones who were sent to the Sindh Institute of Urology and Transplantation. Subject and Methods: This cross-sectional study was conducted at Sindh Institute of Urology and Transplantation's out-patient urology department. This study included a total of 113 patients with complex renal stones. Culture and sensitivity (C/S) tests were performed on a urine sample supplied to the SIUT microbiology lab. The C/S results were gathered and categorized as positive or negative according to the operational criteria. Results: The patients' average age was 30.83±8.29 years. There were 45 females (39.82 %) and 68 males (60.18 %). A urinary tract infection was observed in 22.12 % (25/113) of patients with complex renal stones. Conclusion: We discovered a high prevalence of urinary tract infection in individuals with complex renal stones, and we propose that patients with acute nephrolithiasis have urine cultures taken and be monitored closely. Empiric therapy should be considered for patients with pyuria, women, or those with clinical characteristics suggestive of infection if sensitivity to diagnose urinary tract infection is to be prioritized because of the potentially serious consequences of under-treatment Keywords: Nephrolithiasis, Urinary tract infections, Complex renal stones, Staghorn Stones.

A Quasi Experiment on Outcome of Mirabegron and Solifenacin in the Treatment of Primary Over Active Bladder in A Tertiary Hospital in Dhaka, Bangladesh

Background: Overactive bladder (OAB) syndrome is a common symptom complex that affects millions of people worldwide, with an increasing prevalence with increased age in primary overactive bladder.&#x0D; Objective: The study was done to find out the efficacy and outcome of Mirabegron and solifenacin on primary overactive bladder.&#x0D; Methodology : This study was a quasi-experimental study conducted on 100 study population (Group A-50 Group B-50) in Urology Outpatient Department, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2017 to December 2018. Study population were total 100 men and women aged at least 18 &amp; up to 60 years (Group A -50 and Group B-50) with persistent primary overactive bladder (OAB) symptoms for 3 months or more were enrolled in this study. Patients were eligible for the study who were able to give a written informed consent before starting the intervention &amp; was also able to complete a voiding diary. Patients were recruited at the urology outpatient department, SSMCMH, Dhaka and were selected by the following inclusion and exclusion criteria. A data sheet was completed for each patient which included particulars of the patient, history, examination findings and baseline investigations. Half of the patients were enrolled in each group. Mirabegron group was experimental group and Solifenacin group was control group. Cases of Mirabegron group was given once daily dose of Mirabegron 25 mg and Solifenacin group was also given single dose of Solifenacin succinate 5 mg, at for 12 weeks.&#x0D; Result: The result of age distribution of the study patients belonged to age 31-40 years in group A (Mirabegron 25 mg) 21(42.0%) and 16(32.0%) in group B (Solifenacin 5 mg). The mean voided volume of each micturation at 12 week of treatment was more increased in group A (Mirabegron 25 mg) than group B (Solifenacin 5 mg). The mean change in micturition frequency per 24 hours, episodes of urgency per 24 hours, urge incontinence episodes per 24 hours and nocturia episodes per 24 hours were statistically significant (p&lt;0.05) between group A (Mirabegron 25 mg) and group B (Solifenacin 5 mg).&#x0D; Conclusion The study shows that Mirabegron is more effective than Solifenacin in the treatment of primary over active bladder and can be used in without organic and pathological diseases of urinary bladder&#x0D; Sir Salimullah Med Coll J 2022; 30: 55-60

Incidence of meatal stenosis after circumcision by heat cautery device during early infancy in Erbil/ Iraq

Background:Meatal stenosis is one of the late and potential complications of male circumcision in children who underwent circumcision in early infancy by a heat cautery.Objective: To estimate the incidence of Meatal Stenosis (MS) in children who undergone circumcision in early infancy by a heat cautery which had been done by a medical sub staff in our locality (Erbil)Patients and Methods: From September 2020 to May 2021, 113 children were examined in urology outpatient departments at Rizgary Teaching Hospital/ Erbil after a referral from primary health centers by general practitioners for evaluation of genitourinary symptoms. All children included in the study were circumcised during the early infancy period by heat cautery devices by medical sub-staffs. The examination included a focused genital system examination focusing on meatus opening and detail history has been taken from their parents. Results: Within Eight Months, we evaluate 113 children (13 children Excluded) in the urology outpatient department in Rizgary Teaching Hospital/ Erbil City, 55% having stenosis of urethral meatus after circumcision by heat cautery, and it was most common in group B (6-12 years of age) 34% and 21% in group A (3-6 years of age) and can explain this either that most of the children represented Group B or might be due to neglecting by their families. Conclusion: Circumcision in early infancy using a heat cautery device may lead to meatal stenosis in children. In our study, the incidence of meatal stenosis was surprisingly high (55%) compared to other research, and this can be explained by the fact that non-qualified personnel is engaging in this surgical procedure or medical sub staffs with inexperienced medical knowledge and no training course are indulging in this surgery to gain quick money. Keywords: Penis, Circumcision, Meatal Stenosis, Erbil

Frequency and Antibiotic Susceptibility of Pathogens from Cases of Urinary Tract Infection: A Prospective Observational Study.

Objectives Urinary tract infection (UTI) is one of the most common diagnoses in patients visiting urology clinics. Rampant use of empiric and inadequate doses of antibiotics leads to an increase in resistance and poses a huge financial burden. We evaluated UTI in relation to antibiotics used, frequency, susceptibility, and resistance pattern of different pathogens at a tertiary care center and made some important observations. Methods Prospectively 729 patients diagnosed with UTI attending a urology outpatient department from July 2018 to January 2020 were managed accordingly. Antibiotics were started on the basis of urine culture and sensitivity (c/s) or empirically and changed according to subsequent urine c/s. Repeat urine c/s was performed after 5 to 7 days of starting therapy and 10 days after completion of therapy. Results Out of 729 subjects, 417 (57.2%) were males and 312 (42.8%) were females. The most common symptom at diagnosis was dysuria 512 (70.2%), whereas 221 (30.3%) patients presented with fever. Escherichia coli was the most common organism isolated, 453 (62.1%). Among 729 patients, 239 took antibiotics without c/s report, whereas in 490 patients antibiotics were prescribed after the report. A total of 431 (59.1%) patients required one antibiotic session for clearance of pathogen, whereas 135 (18.5%) required two sessions, and three sessions were required in 66 (9%) cases. Among 239 patients whose culture came out to be positive, 145 (60.6%) were found to be resistant to the previously given antibiotic and the common pathogens isolated were E. coli (61 [42%]), Pseudomonas (28 [19.3%]), Enterococcus (22 [15.1%]), Klebsiella (14 [9.6%]), and others. Conclusion Unchecked, rampant, and inadequate use of antibiotics leads to complicated UTI with the increasing share of Pseudomonas, Klebsiella , or other dangerous microbes, which are difficult to treat as well as pose threat in the future.