Bangladesh Journal of Urology

Paradigm Shift in the Management of Upper Tract Urothelial Cancer

Md Jahangir Kabir — 2023-10-10

Abstract not available

Bangladesh J. Urol. 2022; 25(2): 67-69

Mini Percutaneous Nephrolithotomy in Ectopic Lumber Kidney: A Case Report

Tohid Md Saiful Hossain — 2023-10-10

The chance of the development of hydronephrosis and the formation of stones is more in the ectopic kidney. Treatment of stones in ectopic kidneys is challenging for urologists due to abnormal location and rotation of the kidney and unfavourable local anatomy. We herein report a case of stone in a lumber kidney successfully managed by mini percutaneous nephrolithotomy (PCNL) in a prone position. A 55-year-old male presented with right lower abdominal pain. His CT scan of the KUB reveals the right kidney is in an ectopic location and has a hyperdense structure measuring about 15 mm in length, seen in the right renal pelvis with mild dilatation of the pelvicalyceal system. The patient underwent right-sided prone mini PCNL under the subarachnoid block (SAB), and complete stone clearance was achieved. There was no adverse event during or after surgery or post-operative blood transfusion.

Bangladesh J. Urol. 2022; 25(2): 122-125

Superperc: Minimally-Invasive Percutaneous Nephrolithotomy Initial Experience

N I Bhuiyan — 2023-10-10

Introduction: For the management of renal stones, Percutaneous nephrolithotomy (PCNL) has undergone significant changes in the last few years in the quest for improving efficacy and reducing morbidity. Minimally-invasive modalities of PCNL, such as mini- PCNL, ultra-mini PCNL, and micro-PCNL, have evolved with advancements in optics and technology. However, with these newer advancements, the migration of small fragments produced with laser lithotripsy remains a concern, which may result in incomplete stone clearance. A new technique of PCNL is termed “Superperc” that utilizes suction to remove all the fragments and maintain a one-way flow.

Methods: This study involved 35 consecutive patients who underwent PCNL with the Superperc technique from March 2020 to December 2020. Surgery was performed using a pediatric ureteroscope used as a nephroscope and a specially designed sheath with a suction attachment. The Superperc uses a 10/12 F tract size, a specially designed Superperc sheath (Shah Sheath) with a suction mechanism, and a pediatric ureteroscope 4.5/6.

Results: The age range is 20-65 years, with 23 males and 12 females. Stone size was 1- 3 cm, and operative time was 30-90 min. Upper calyceal punctures 7cases , 19 had middle, 6 lower calyceal and 3 had two punctures. DJ stent was placed in 7 patients, whereas 28 patients had a ureteric catheter for 24 hours. Only three patients required a nephrostomy tube. No blood transfusion. Postoperatively one patient had a mild fever, and one had transient hematuria. Complete stone clearance as per nephroscopy &fluoroscopy. The hospital stay was 24-72 h.

Conclusion: Superperc is a new technique of minimally-invasive PCNL and can be successfully done with minimal modification in the armamentarium, with the potential advantage of good stone clearance.

Bangladesh J. Urol. 2022; 25(2): 71-75

Low Molecular Weight Heparin (Enoxaparin) Induced Hematuria in covid-19 Patients, Experience at a Covid Dedicated Hospital

Md Mominul Islam — 2023-10-10

Introduction: The nightmare of Covid -19 is still not over, due to its antigenic diversity. Covid produces a hypercoagulable state and results in thrombosis which is one of the leading causes of death of Covid 19 patients. Low molecular weight heparin (LMWH)- enoxaparin has proven the benefit of reducing morbidity and mortality by reducing the thrombotic effect. But unfortunately, this anticoagulant can result haematuria and unnecessary hemorrhagic manifestation that may require immediate intervention. The exact scenario of enoxaparin-induced hematuria in the covid patient is still not explored by standard high-volume study.

Objective: Determine the incidence of hematuria by enoxaparin (LMWH) in covid-19 patients.

Material and method: The study was conducted over 210 cases for 6 months duration. Indoor patients receiving subcutaneous enoxaparin who tested positive for Covid19-RTPCR or who had signs of Covid in chest CT (Computerized Tomography) were enrolled. Both microscopic and gross haematuria cases were included in the current study.

Result: Out of 210 patients, only 5 patients (2.38%) developed haematuria. 2 had only microscopic and 3 had gross haematuria. Out of them, 3(60%) were male and 2(40%) were female. Hematuria was more common in those who received a higher dosage of enoxaparin.

Conclusion: This study found that enoxaparin-induced haematuria in the covid patient is not uncommon, and hematuria is significantly higher in patients receiving higher doses. Further high-volume study is recommended on this issue.

Bangladesh J. Urol. 2022; 25(2): 76-79

Povidone Iodine Intrarectal Cleaning versus Formalin Needle Disinfection for Minimizing Transrectal Prostate Biopsy-related Infections

Md Asaduzzaman Rajib — 2023-10-10

Background: A most feared complication of transrectal prostate biopsy is post-biopsy infection and/or sepsis. Safe intraprocedural measures that complement the antibiotic prophylaxis are intrarectal povidone iodine instillation or formalin needle disinfection after every core of the biopsy. Both are more effective at preventing post-biopsy infection than performing antibiotic prophylaxis alone.

Objective: To assess the effectiveness of povidone-iodine intrarectal cleaning and formalin needle disinfection to prevent infection after prostate biopsy.

Methodology: This study was conducted from July 2021 to June 2022 with 90 patients who underwent prostate biopsy at NIKDU. Patients were randomized into 2 equal groups, 45 in each group, by lottery. Two groups were Group-F: Standard biopsy, where the needle is disinfected with 10% formalin after each core, and Group-P: intrarectal luminal instillation of 10 ml 10% povidone-iodine for 10 min before the biopsy. Endpoint of the study was the development of signs and symptoms of infection within 7 days of prostate biopsy.

Result: In terms of age, S. PSA & prostate volume, there was no significant difference between the two group. Infective complications within 7 days of the prostate biopsy were observed in 14 patients (15.6%), 3.67 times more in Group-F patients (p=0.03), and a higher incidence of UTI (72.73%) was observed in Group-F (p=0.03) than Group- P patients. The incidence of septicemia, epididymal-orchitis, and acute prostatitis was not statistically significant between the two groups. E. coli was the predominant organism found on urine culture, followed by Klebsiella pneumoniae, Enterococcus faecalis, and proteus species.

Conclusion: Along with prophylactic antibiotics, povidone iodine intrarectal cleaning is superior to formalin needle disinfection in preventing infective complications of prostate biopsy.

Bangladesh J. Urol. 2022; 25(2): 80-83

Retroperitoneoscopic Ureterolithotomy for the Management of Proximal Ureteric Stones: Initial Clinical Experience

Md Mostafiger Rahman — 2023-10-10

Objective: Laparoscopic ureterolithotomy provides results equivalent to open ureterolithotomy for proximal ureteric stones, can be performed transperitoneally and retroperitoneally. The study aims to assess the efficacy of retroperitoneoscopic ureterolithotomy for managing proximal ureteral stones.

Patients and Methods: It was a retrospective study carried out in the period from March 2018 to November 2021. 14 patients with proximal ureteric stones 16–26 mm (20.07± 02.8), all located above the upper border of the sacroiliac joint. Eleven (78.57%) patients underwent retroperitoneoscopy as a primary procedure, one (07.14%) had a history of failed ESWL, and two patients (14.28%) failed retrograde ureteroscopy. Retroperitoneoscopic ureterolithotomy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital and homemade balloon dissection and secured 10 mm Hasson trocar at the primary port site, and 0° telescope advanced. Two 5-mm trocars were placed under visualization forming a triangle. The stone was removed from the primary port site while visualizing retrieval through the 5 mm. port using a fine 30° Cystoscope. Ureterotomy closure was performed by intracorporeal interrupted sutures of 4-0 polyglactin over 5 fr double-J stent, and a drain was left in the retroperitoneum.

Results: Retroperitoneoscopic ureterolithotomy was accomplished in 11 out of 14 cases (78.58%). Three (21.42%) were converted to open surgery (2) and transperitoneal ureterolithotomy (1). The reason for open conversion was the failure to locate the ureter due to severe adhesion in 1 case, technical problems during dissection in 1 case, and another access problem, injury to the peritoneum, which was converted to the transperitoneal route. In 11 successful cases, the mean operative time was 126.5 ± 23.81 (90-170) min. There was no requirement for transfusions. There were no major perioperative and post-operative complications were observed. According to the modified Clavien classification, 07(63.63%) patients were reported to be grade I, whereas 04(36.36%) patients were reported to be grade II. One patient was managed with a course of antibiotics due to post-operative fever. Two patients who developed subcutaneous emphysema and superficial wound infection were treated conservatively. One urinary leakage was subsided by urethral re-catheterization. The drain was removed at 03.81 ±01.25(03-07) days. The mean hospital stay was 04.09 ± 01.13 (03-07) days.

Conclusion: Retroperitoneoscopic ureterolithotomy has acceptable overall complication rates. It is an effective, low-morbidity alternative for the treatment of proximal ureter stones.

Bangladesh J. Urol. 2022; 25(2): 84-92

Efficacy and Safety of Treatment Options for Large Upper Ureteral Stone

Imtiaz Enayetullah — 2023-10-10

Background: There are three minimally invasive methods for the treatment of large (>1 cm) upper ureteral stones: ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LUL). With multiple surgical options, the controversy of choosing the best option for a given patient lies.

Objective: To compare efficacy and safety between URSL, PCNL and LUL to determine the best choice.

Methodology: This study was conducted from March 2020 to February 2022 with 120 patients who had upper ureteral stones admitted at NIKDU. They were randomized into 3 equal URSL, PCNL & LUL groups, 40 patients in each group. The primary outcome was a stone-free rate after 1 month of surgery, and the secondary outcomes were the duration of surgery, length of hospital stay, and complication rate postoperatively.

Result: Eight patients needed auxiliary PCNL after URSL and 1 patient after LUL, but none after PCNL. The stone-free rate was 78.1% (25/32) in the URSL group, 95% (38/ 40) in the PCNL group and 100% (39/39) in the LUL group. Operation time was the shortest with URSL and the longest with LUL (all p <0.05). Hospital stay was shorter in the URSL group compared with PCNL & LUL group (p=0.0001). Operation-related complications were almost similar among the three groups.

Conclusion: Laparoscopic ureterolithotomy followed by PCNL is the most efficacious modality for treating large upper ureteral stones with a superior stone-free rate and lesser need for auxiliary treatments compared to URSL.

Bangladesh J. Urol. 2022; 25(2): 93-97

Current trends in the incidence of Urological malignancy at a tertiary level hospital in the northern part of Bangladesh

Md Mashiur Arefin — 2023-10-10

The second most common cause of death is malignancy. In clinical practice, genitourinary tumours are commonly encountered. Urological malignancies are raising due to increasing tobacco consumption, air and water pollution (arsenic, nitrate, chlorinated hydrocarbon) by unbalanced development, unhealthy diet, chronic infection, uncontrolled pesticides & fungicides used, food adulteration, using Chinese herbal products containing aristolochic acid, obesity and longer life expectancy. Over the past few years, advancement of diagnostic imaging, surgical technique, radiotherapy, chemotherapeutics and targeted agents have helped improve treatment outcomes. The incidence of urological malignancies is increasing like other malignancies in Bangladesh, which is poorly addressed. There is generally poor documentation of urological malignancies in Bangladesh. This study was carried out to document the pattern and distribution of urological malignancies in Rajshahi Medical College, Rajshahi, Bangladesh.

Bangladesh J. Urol. 2022; 25(2): 98-105

The Changing Landscape of Urologic Practice, An Issue of Urologic IR: 2022

Md Abdus Salam — 2023-10-10

Interventional Uroradiology or Urological IR covers various minimally invasive procedures to treat problems that affect the kidney, bladder and ureter (the tube connecting the kidney to the bladder), and testes.

Almost all patients in the UK with obstructed and/or infected kidneys are referred to interventional radiology for percutaneous nephrostomy and/or placement of an anterograde JJ stent. Although this ‘tradition’ is going strong in the UK, urologists worldwide have evolved their practice to encompass such interventional procedures in their remit.1

Advances in imaging technology, especially in the last two decades, have led to a paradigm shift in the field of image-guided interventions in urology. While the traditional biopsy and drainage techniques are firmly established, image-based stone management and endovascular management of hematuria have evolved further. Ablative techniques for renal and prostate cancer and prostate artery embolization for benign prostatic hypertrophy have evolved into viable alternative treatments. Many urologic diseases that were earlier treated surgically are now effectively managed using minimally invasive image-guided techniques, often on a daycare basis using only local anaesthesia or conscious sedation. This article presents an overview of the technique and status of various image-guided urological procedures, including recent emerging techniques.

Bangladesh J. Urol. 2022; 25(2): 106-121