Non-invasive predictors of response to tamsulosin for benign prostatic obstruction

Objectives: To identify non-invasive predictors of response to tamsulosin 0.4 mg in patients with benign prostatic obstruction (BPO).Methods: Males ≥ 50 years of age with lower urinary tract symptoms (LUTS) suggestive of BPO for over three months were included in the study. We assessed change in the mean International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) after six weeks of medical therapy. Clinical and uroflowmetry parameters were compared between two groups of patients with \u3e25% vs. \u3c25% change in the IPSS after treatment. Pre- and post-treatment post-void residue (PVR), Qmax, and IPSS were compared by independent t-test, univariate/multivariate regression analysis.Results: A total of 121 patients were included. At presentation, the mean prostate size was 35.7±12.2 grams and the mean IPSS was 16.3 ± 4.8. Improvement in the mean IPSS was 7.83, with more marked improvement in storage compared to voiding LUTS (5.26 vs. 2.57). Majority (58%) had a quality of life (QoL) score of 4-5 at presentation whereas after 6-weeks of medication (83.5%) had a QoL score of 0-2. Treatment failure was noted in 11 (9.1%) patients. IPSS was higher and Qmax was lower at the time of presentation in patients who had \u3c25% improvement. However, the two groups were identical on the basis of demographic and other factors (BMI, age, prostate size, PVR).Conclusion: Moderate LUTS secondary to BPO responds favourably to alpha-blocker (tamsulosin 0.4 mg) treatment. Uroflowmetry (UFM) parameters, that is, Qmax and IPSS are important factors in predicting short-term response to medical therapy

Urdu translation and validation of premature ejaculation diagnostic tool (PEDT)

Objective: To validate an Urdu translation of premature ejaculation diagnostic tool (PEDT) by analyzing the association of this diagnostic tool with the clinical diagnosis of premature ejaculation (PE) and intravaginal ejaculatory latency time (IELT).Methods: This cross-sectional study was conducted at the urology section of the Aga Khan University Hospital, Karachi, for six months duration, from July 2018 to December 2018. In our study 108 subjects, aged 20 to 50 years, who were in a stable sexual relationship (heterosexual) for a minimum duration of six months, were asked to fill the Urdu version of PEDT, 61 with PE and 47 without PE.Results: The two groups matched for mean age, duration of relationship and education level. The duration of 1.2 (±0.5) minutes was the mean self-estimated IELT in the PE group and 3.7±0.9 minutes in patients without PE. There was a significant negative correlation of 0.6 (p-value \u3c0.001) between the PEDT score and self-estimated IELT. The test-retest reliability for each item was found to be significant for each individual item (≥ 0.84, p-value \u3c0.001) and 0.94 was the correlation coefficients of the total score, showing an excellent test-retest reliability. 0.93 was the Cronbach\u27s alpha score (95% Confidence interval = 0.905 - 0.948) indicating a significant internal consistency in the Urdu version of PEDT.Conclusions: The Urdu version of PEDT is a valid tool to define and quantify PE objectively, with adequate internal consistency. This version of PEDT has a good negative correlation with self-estimated IELT and excellent correlation with clinical PE

The correlation between stone nephrolithometry score and hemoglobin drop in patients undergoing percutaneous nephrolithotomy

Objective: In this study, we aimed to determine the correlation between the STONE score [(S)ize of the stone, (T)opography or location, degree of (O)bstruction of the urinary system, (N)umber of stones, and (E)valuation of Hounsfield units] and postoperative hemoglobin drop in patients undergoing percutaneous nephrolithotomy (PCNL).Methods: This was a prospective observational study and all adult patients aged 18-65 years undergoing unilateral, single-tract PCNL using 26 Ch. Amplatz sheath for renal calculi were included. The five variables of the STONE nephrolithometry score were calculated prior to the procedure. The stone-free rates were assessed on imaging at four weeks and complications were graded using the modified Clavien system.Results: Of the 142 patients included, 75% were below 55 years of age. More than half of our patients were diabetic with more than 60% having a body mass index (BMI) above 25 kg/m2. The mean STONE score was 7 with 33% having a high (\u3e9) STONE score. The mean hemoglobin drop was 1.15 +0.92 g/dL with eight patients (5.63%) requiring transfusion and one (0.7%) requiring angioembolization; one patient required readmission for observation. Complete STONE clearance was achieved with PCNL alone in 78.2% of the patients. There was a significant correlation of hemoglobin drop with the STONE score, stone size, and preoperative creatinine clearance. Patients with a hemoglobin drop of \u3e1 g/dL had a higher STONE score and mean stone size. The overall complication rate was significantly higher (10.5%) in patients with a hemoglobin drop of \u3e1 g/dL as compared to those with a hemoglobin drop of \u3c1 g\u3e/dL (2.8%).Conclusion: Stone complexity as measured by the STONE score correlates with post-PCNL hemoglobin drop, stone clearance, and complication rates. The STONE score may be used for preoperative counseling and to evaluate the potential need for transfusion

Factors Associated with Premalignant Epithelial Changes in Chronic Calculous Cholecystitis: A Case-Control Study

Introduction: Gallstones are known to be associated with premalignant changes in the gallbladder epithelium that range from atypical hyperplasia, metaplasia, dysplasia to carcinoma. Recognition of factors associated with these changes in patients with gallstones can potentially be helpful in identifying patients to whom prophylactic cholecystectomy can be offered to reduce the chances of developing carcinoma.Objective: To identify factors associated with premalignant epithelial changes including atypical hyperplasia, metaplasia, and dysplasia in gallbladder mucosa in patients with chronic calculus cholecystitis.MATERIALS AND Methods: This was retrospective case-control study conducted over a period of 10years from 2004 to 2014. Cases were patients with reported histopathological premalignant epithelial changes along with chronic calculus cholecystitis, and controls were patients without premalignant epithelial changes but chronic calculus cholecystitis. Controls were twice the number of the cases.Results: Over study period, 92 patients were reported to have premalignant epithelial changes on gall bladder histopathology for whom 184 controls were selected. Of cases, 61 (66%) patients had atypical hyperplasia, while metaplasia and dysplasia were present in 26 (28%) and 5 (5%) cases, respectively. Mean age was 47.5±14.5years, and 74% of the study population were female. Wall thickness of more than 3mm (OR=4.14, p value\u3c0.001) turned out to be statistically significant independent variables associated with premalignant lesions in gallbladder mucosa.CONCLUSION: Odds of premalignant epithelial change in gall bladder mucosa in patients with gall bladder wall thickness of more than 3mm is four times the odds of patients with wall thickness less than 3mm, and the effect is statistically significant. Prophylactic cholecystectomy should be considered for this group of patients