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OBJECTIVE: To determine the frequency of stone-free rate after extracorporeal shockwave lithotripsy (ESWL) and its relationship with Hounsfield Units (HUs) of renal calculi. METHODOLOGY: This observational study was carried out at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan, from June 2015 to December 2015. All patients were evaluated for serum creatinine, coagulation profile, urinalysis and culture and imaging studies including non-contrast computed tomography (NCCT). All were evaluated with X-ray and ultrasound KUB at six weeks of ESWL session. Patients with residual fragments more than 4 mm in size were offered another session of ESWL. In case of persistent stone fragments more than 4 mm in size, stones were labeled as ESWL-refractory and alternative treatment options offered. RESULTS: A total of 139 patients were included in this study. The mean age was 40.0 ± 8.9 years and 91 (65.47%) were males. The mean stone size and mean HUs of all patients were 12.7 ± 3.6 mm and 616.9 ± 304.3, respectively. On last follow-up, out of 139, 95 (68.3%) patients were in stone-free group and 44 (31.6%) in residual stone group, with a mean HUs value of 565 ± 62.1 and 905 ± 61.7, respectively (p=0.001). The mean HUs of stone-free group was significantly lower than that of residual stone group. CONCLUSION: Our findings suggest that the HU measurement of renal calculi on pretreatment NCCT might be helpful in predicting stone-free rate after ESWL. [ABSTRACT FROM AUTHOR]

Background: Partial nephrectomy (PN) is a viable treatment option for patients with T1a-b solid renal masses. We herein aim to describe our experience on the use of open partial nephrectomy (OPN) and its outcome. Material and Methods: All patients who underwent open partial nephrectomy at Sindh Institute of Urology and Transplantation (SIUT), between January 2009 and December 2015 were included in this study. Data items were collected and analyzed. Results: A total of 55 OPN procedures were undertaken on 55 patients between 2009 and 2015. The mean age of patients was 48.9±11.7 years with majority of males (65.5%). The mean maximum tumor dimension was 4.3±0.8 cm. The mean operation time was 139±29.7 min. Warm ischemia time was 13.19±5.3 min. The median R.E.N.A.L ((R)adius (size at the maximal diameter), (E)xophytic/endophytic properties, (N)earness of tumour to the collecting system or sinus, (A)nterior/posterior descriptor, and (L)ocation relative to polar lines) and P.A.D.U.A. (pre-operative aspects and dimensions used for an anatomical) scores were 8 (IQR: 7 - 8) and 5 (IQR: 4.5 - 7), respectively. The mean pre- and post-operative creatinine levels were 7.3 mmol/L and 7.4 mmol/L. Estimated blood loss was 217±143 ml. No intraoperative and post-operative complications were documented. The mean length of stay was 4 days. The majority of patients showed clear cell carcinoma (80%), followed by papillary tumors (12.8 %) and one oncocytoma. There were no positive oncological surgical margins. Patients were followed up for a median of 40 months. There were no recurrences. Conclusion: In conclusion, open partial nephrectomy is a safe and effective method of treatment for localized solid renal tumors of less than 7cm with contralateral normal kidney. [ABSTRACT FROM AUTHOR]

Peripheral primitive neuroectodermal tumor/Ewing's sarcoma (PNET/EWS) is primarily a tumor of soft tissues and bones. Primary localization of PNET/EWS in genitourinary organs is rare. No data on this localization of PNET/EWS are available in literature from Pakistan. We searched our adult uro-oncology records from 1994 till date and identified all cases of adult genitourinary and adrenal PNET/EWS diagnosed on histology and immunohistochemistry. Their case records were reviewed to obtain data on demographics, presentation, pathologic features, management and outcome. Six cases were found; all were young and had aggressive disease at presentation. Four had renal PNET/EWS. One case each of prostate and adrenal PNET/EWS was seen. Surgery and chemotherapy formed the mainstay of management. Three patients (50%) died during treatment, two were lost to follow-up and one case with renal PNET/EWS showed good initial response to chemotherapy but was later on lost to follow-up. In conclusion, PNET/EWS should be considered in the differential diagnosis of genitourinary malignant tumors in young patients. These tumors are aggressive with poor outcome. [ABSTRACT FROM AUTHOR]

Purpose: To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting. Material and Methods: This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables. Results: This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8±4.34 minutes for TUCL, 36.18±7.4 minutes for open cystolithotomy, and 38.6±5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC. Conclusion: Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine the pattern and outcome of renal tumors in young adults in a large surgical series in Pakistan. MATERIALS AND METHODS: We retrospectively analyzed 133 young adults (age: >= 16 to <= 40 years) with 136 renal tumors, who underwent surgical treatment for suspected renal cancer from 1994 till 2010. The clinical and pathological parameters were determined and their impact on final outcome was analyzed. RESULTS: The mean age of the patients was 33.3 ± 6.2 years. Of 136, 121 (88.9%) renal tumors were malignant and 15 (11%) were benign. Among malignancies, 76 (62.7%) patients had stage I or II tumors, 22 (18.1%) stage III, and 23 (19%) stage IV at surgery. The overall cancer-specific survival for malignant tumors at 1, 5, and 10 years was 97%, 83%, and 83%, whereas the cancer-free survival (CFS) was 80%, 63%, and 37%, respectively. Patients with age <= 35 years had 1 and 5-year CFS of 83% and 71%, respectively, as compared with 76% and 49% for patients > 35 years (P = .02; odds ratio = 2.3; P = .03). Regarding tumor size, 1 and 5-year CFS for tumors <= 10 cm was 93% and 75%, while tumors > 10 cm showed CFS of 56% and 41%, respectively (P = .0001; odds ratio = 4.2; P = .0001). For stage I tumors, CFS at 1 and 5 years was 98% and 84%; for stage II, 82% and 63%; and for stage III, 62% and 50%,respectively. One-year survival for stage IV was 48% only (P = .0001). CONCLUSION: A wide heterogeneity of renal tumors is seen in young adults with delayed presentation. [ABSTRACT FROM AUTHOR]

Objective: To document the prevalence of Helicobacter pylori (H. pylori), Hepatitis A virus (HAV), Hepatitis C virus (HCV), Hepatitis E virus (HEV) antibodies and Hepatitis B virus surface antigen (HBsAg), in the pediatric age group of low socioeconomic urban communities of Karachi and to identify risk factors associated with these infections., Design: Cross-sectional survey., Place and Duration of Study: Three selected squatter settlements of Karachi during April 2002 to December 2004., Patients and Methods: Three hundred and eighty children, ages 5 months to 15 years were investigated. Venous blood samples were collected and questionnaire filled on sociodemographic characteristics (family income, number of dependents in the family, area of living, number of people per room per house, and number of children sharing bed with parents and siblings). Gastrointestinal symptoms were recorded. Anti-HAV IgG (Hepatitis A virus IgG antibody), anti-HCV (Hepatitis C virus antibody), anti-HEV (Hepatitis E antibodies) and HBsAg, were analyzed by enzyme immunoassays (EIAs). Samples were also screened for anti-HIV1/2 (human immunodeficiency virus 1 and 2 antibodies by EIA. IgG antibodies against H. pylori were detected by immunochromatography., Results: A correlation between increasing age and seroconversion was seen for hepatotropic viruses. At 14 years and above,100% of the children were found to be positive for anti-HAV, 26% for anti-HEV, and 1.4%, for anti-HCV while HBsAg was positive in 1.9%. H. pylori infection did not show a significant increase with age. Both anti-HAV and anti-H. pylori were present simultaneously in 30% of the population investigated., Conclusion: With age, increasing number of children acquired antibodies against hepatotropic viruses and H. pylori. Occurrence of HBsAg and anti-HEV at a later age suggests horizontal, rather than vertical transmission.