Bangladesh Journal of Urology <p>Official journal of the Bangladesh Association of Urological Surgeons. Full-text articles are available.</p> Bangladesh Association of Urological Surgeons (BAUS) en-US Bangladesh Journal of Urology 2304-8514 Treatment Modalities of Muscle Invasive Transitional Cell Carcinoma of Bladder <p>The treatment of muscle invasive bladder cancer (MIBC) is complex. This review describes the available therapies for invasive urothelial carcinoma. Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) and lymph node dissection has been considered the slandered treatment for MIBC. Many patients those are unfit for surgery or cisplatin ineligible, bladder sparing strategies are considered in highly selected patients. Even though there are no level I data, the treatment outcomes for highly select patients given bladder sparing therapy appear promising, with many patients retaining a functional bladder. So it can be concluded that treatment of MIBC is a multidisciplinary collaborative program of surgery, radiation and medical oncology.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.205-209</p> ATM Mowladad Chowdhury Bakhtiar Ahmed Md Muntasir Chowdhury Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 205 209 10.3329/bju.v23i2.50316 Prospect of Cadaveric Transplantation in Bangladesh <p>Abstract Not Available</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.112</p> Md Habibur Rahman Dulal Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 112 112 10.3329/bju.v23i2.50299 A Case Report on Bilateral Adrenal Histoplasmosis <p>Disseminated histoplasmosis affecting the adrenal glands is a very rare infection and an uncommon cause of adrenal insufficiency. We present a case of bilateral adrenal histoplasmosis in a 77 years old immunosuppressed patient who presented with bilateral adrenal masses. The fine needle aspiration cytology of the adrenal mass was positive for Histoplasma capsulatum.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.210-212</p> Md Sazzad Hossain Mohammad Zahid Hasan Mir Ehteshamul Haque Mostakim Maoya Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 210 212 10.3329/bju.v23i2.50317 One Shot Dilatation (OSD) in Percutaneous Nephrolithotomy (PCNL) - A Safe and Feasible Technique <p><strong>Objective: </strong>To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in standard percutaneous nephrolithotomy (PCNL).</p> <p><strong>Methods: </strong>This is a prospective, single -center study conducted between January 2017 to June 2019. Patients who underwent PCNL using one shot dilatation (21 – 24 Fr) for access in PCNL were included in the study. Access time, fluoroscopy time, successful dilation time, stone free rate, decrease hemoglobin level and transfusion rate, complication rate, length of post operative hospital stay, cost were recorded. Data was analyzed and reported using summary statistics.</p> <p><strong>Results: </strong>A total of 30 patients were enrolled in this survey. 30 patients in one shot dilation (OSD) group.The mean age was 39.5 years. Control group of 30 patients were included in standard PCNL procedure where method of tract dilation was done by regid Amplatz dilators. Access time and fluoroscopy time in OSD group was approximately shorter. Statistically it was significant. Successful dilation and stone free rate were subsequently 98% and was significant. Data collected included patient access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions.</p> <p><strong>Conclusion: </strong>The use of one shot and standard prone position under general anaesthesia combines the advantages of these both methods including less radiation exposure and shorter access and operative time. One shot dilation technique is safe, economical and feasible technique with added advantage,lesser radiation exposure and lesser chance of blood transfusion.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.114-117</p> Abdul Matin Anamur Rashid Choudhury Tohid Mohammad Saiful Hossain Tasmina Parveen Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 114 117 10.3329/bju.v23i2.50300 Outcome of Obturator Nerve Block by Inguinal and Transvesical Approach in Transurethral Resection of Bladder Tumor <p><strong>Introduction and aim of the study : </strong>Spinal anaesthesia for transurethral resection of bladder tumor (TURBT) does not prevent unintended stimulation of the obturator nerve when electro resection is performed on the lateral and Postero-lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to compare the outcome of obturator nerve block by inguinal and transvesical approach.</p> <p><strong>Materials and Methods: </strong>A prospective experimental study was done in the department of Urology Dhaka Medical College Hospital during the period of November 2016 to April 2018. Total 60 Patients were included for the study as per inclusion and exclusion Criteria. Patients were than allocated purposively into two groups by simple random sampling. Group A consisted of 30 patients where obturator nerve block (ONB) was done by transvesical approach and Group B also consisted of 30 patients where ONB was done by inguinal approach.</p> <p><strong>Results: </strong>In the present study, the baseline characteristics of the patients in Group-A and Group-B were almost similar having no statistically significant difference. Obturator jerk more frequently occurred in group-B, in 13 (56.37%) patients following TURBT compared to Group-A, where 05(16.67%) patients developed obturator jerk. The intergroup difference was statistically significant (p&lt;0.05). In case of 26 (86.67%) patients tumour was completely resectable in group-A, while in 21 (70.00%) patients of Group- B tumour was completely resectable. This was not a statistically significant difference (P&gt;0.05). There was no incidence of bladder wall perforation in group-A, wherears this complication occurred in 02 (06.67%) cases of Group-B (p&gt;0.05). Mean operative time in Group-A and group-B is 50.46 (±11.64) and 59.10 (±15.83) respectively (p&lt;0.05).</p> <p><strong>Conclusion: </strong>We conclude that transvesical approach is better in case of Jerk elimination and Less Procedure related time than inguinal approach during TURBT</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.118-123</p> Md Mahmud Ur Rahman Md Shafiqul Alam Chowdhury Md Amanur Rasul Sudip Das Gupta Mohammed Mizanur Rahman Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 118 123 10.3329/bju.v23i2.50301 Outcome of Single Shot versus Serial Dilatation Technique for Percutaneous Nephrolithotomy <p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is a common procedure for the removal of renal stones larger than 2 cm size with the advantages of lower morbidity rates, decrease in post-operative pain with faster post-operative recovery &amp; thereby less duration of postoperative hospital stay. One of the fundamental steps of PCNL is the creation of the nephrostomy access. It can be done either by single shot dilatation or by multi-increment serial dilatation technique.</p> <p><strong>Objectives: </strong>To compare the outcome of PCNL done by single versus serial dilatation technique with specific reference to renal access time, total operative time, stone clearance rate, postoperative haematuria and duration of postoperative hospital stay.</p> <p><strong>Methods: </strong>It was a prospective interventional study with a sample size of sixty where odd number patients were included in group A (PCNL by single shot dilatation technique) &amp; even number patients were in group B (PCNL by serial dilatation technique). After meticulous checking and rechecking, collected data were compiled and statistical analysis was done using computer based software SPSS (statistical package for social science, Version- 16) and Students t-test and Chi-square test were applied for hypothesis testing. ‘P’ value &lt;0.05 was considered as significant.</p> <p><strong>Results: </strong>Comparison between the two groups regarding stone size, stone clearance rate, postoperative haematuria and postoperative hospital stay were not statistically significant (p&gt; 0.05). But mean renal access time in minutes (group A was 3.43 ± 1.14 and group B was 4.20 ± 1.37) and the mean operative time in minutes (group A was 91.13 ± 19.08 and group B was 101.67 ± 15.81) between the groups were statistically significant (p &lt; 0.05).</p> <p><strong>Conclusion: </strong>Percutaneous nephrostomy access can be successfully performed by single shot dilatation technique during PCNL with the advantages of shorter renal access time and total operative time.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.124-128</p> AHM Mostofa Kamal Md Shawkat Alam Md Naushad Alam Md Safiul Alam Babul Anup Roy Chowdhury Shahriar Md Kabir Hasan Md Moynul Hoque Chowdhury Md Habibur Rahman Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 124 128 10.3329/bju.v23i2.50302 Outcome of Stone Fragmentation with Pneumatic and Ultrasonic Lithotripter During Percutaneous Nephrolithotomy <p><strong>Background of the study: </strong>Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for kidney stones larger than 2 cm. PCNL has replaced open surgical removal of large or complex calculi at the most institutions. The success of PCNL is related to the ability to achieve an optimum access tract and proper fragmentation. A wide range of lithotripsy techniques are currently available. One of these is ultrasonic lithotripsy, in which the stones are fragmented and sucked out simultaneously. This technique induces minimal tissue injury and could be considered as a standard modality for PCNL. The pneumatic lithotripter uses pneumatic ballast, which crushes the stones without producing any thermal effects. Because this mechanical energy passes along the metal wire to the stone, the probe works like a chisel on the stone surface. This modality destroys all stones, regardless of their composition. There were very few studies had been done in this context in our country, so I had decided to do this study to compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy.</p> <p><strong>Objective: </strong>To compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy.</p> <p><strong>Materials &amp; Methods: </strong>This Prospective Interventional Study (Quasi Experimental Trial) was performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-E- Bangla Nagar, Dhaka during the period from December 2014 to May 2016. A total of 60 subjects will be selected with renal calculi (as per inclusion &amp; exclusion criteria), among these, half of the patients will be group A (using pneumatic lithotripsy) &amp; rest of the patients will be group B (using ultrasonic lithotripsy). The study subjects were underwent PCNL under general anesthesia, half of which used pneumatic lithotripter and rest used ultrasonic lithotripter for stone fragmentation. Above mentioned outcome variables were assessed both per-operative and post-operatively. Data were collected, processed &amp; analyzed. Statistical analysis of relevant variables was done by unpaired Student’s T test and Chi Square test. P value Â0.05 was considered significant.</p> <p><strong>Results: </strong>Total 60 patients were selected for study according to the selection criteria. Of the 60 subjects, 30 patients, those who were done PCNL by pneumatic lithotripsy were labeled as Group A and 30 patients, those who were done PCNL by ultrasonic lithotripsy, were labeled with Group B. Distribution of respondents in terms of different parameters is shown in tabulated form and statistical analysis was done in both groups to see statistical significance, p value less than 0.05 was considered significant. The mean stone fragmentation time was 27.23±4.78 (18-38) min in PCNL by pneumatic lithotripsy and those were 23.80±5.30 (13-34) min in by ultrasonic lithotripsy which is statistically significant. Other variables of interest which includes stone clearance rate, post operative haematuria and post operative hospital stay, were not statistically significant.</p> <p><strong>Conclusion: </strong>Comparing the findings of the present study, results indicate that stone fragmentation time is lesser in ultrasonic lithotripsy than pneumatic lithotripsy in PCNL which decreases the overall operative time.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.129-135</p> Shariful Islam Khan Md Nurul Hooda Md Safiul Alam Babul Mohammad Habibur Rahman Anup Roy Chowdhury Md Moynul Hoque Chowdhury Mohammad Zia Uddin Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 129 135 10.3329/bju.v23i2.50303 Voiding Disorders in Patients with Cerebrovascular Accident <p><strong>Background: </strong>Cerebrovascular accident often happens in elderly group, frequently causing voiding dysfunction. The aim of the study was to determine the magnitudes of various types of voiding disorders among patients of cerebrovascular accidents attending in Dhaka Medical College Hospital.</p> <p><strong>Methods: </strong>It was a cross-sectional study conducted at the department of Urology ofDhaka Medical College Hospital from July 2009 to June 2011. Hundred and eight patients were enrolled in the study.</p> <p><strong>Results: </strong>More than 61% subjects were male (n=66).Leading number of patients (45.4%) had three to six months disease duration. In this group 67.3% had overactive bladder, 64.7% had underactive bladder and 24.5% had normal activity of bladder. In patients with irritative symptoms majority had overactive bladder (71.4%) while in patients with obstructive symptoms half of the subjects had overactive bladder (50.0%). Majority of the subjects with DM (71.4%) and HTN (82.6%) had overactive bladder. Seventy percent (n=) subjects with overactive bladder had arterial stroke while around 82% (n=) of the underactive bladder subjects had venous stroke. More than 85% subjects with underactive bladder and around 78% subjects with overactive bladder had infection.</p> <p><strong>Conclusion: </strong>Voiding dysfunction is a common sequel of acute stroke and most of the patients with irritative symptoms and about half of the subjects with obstructive symptoms had overactive bladder. Diabetes mellitus, hypertension and arterial stroke were found to be associated with overactive bladder.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.136-141</p> Md Siddiqur Rahman Md Monowarul Islam Mohammad Asaduzzaman Shahana Afroze Is mot Ara Zannat Mohammad Mahbubul Haque Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 136 141 10.3329/bju.v23i2.50304 Quality of Life and Renal Functional Status In Patients With Cutaneous Ureterostomy and Ileal Conduit Urinary Diversion after Radical Cystectomy <p><strong>Introduction</strong>: Radical cystoprostetectomy in male patients and anterior pelvic exenteration in female patients coupled with en-block pelvic lymphadenectomy and urinary reconstruction or diversion remains the gold standard surgical approach to muscle invasive bladder cancer in the absence of metastatic disease. In Bangladesh, commonly performed urinary diversions are Cutaneous ureterostomy and Ileal conduit. Types of urinary diversion have a great impact on different aspects of quality of life (QoL) as well as post -operative renal function.</p> <p><strong>Aims and Objectives</strong>: This study was designed to compare the Quality of Life and Renal Function in between Cutaneous ureterostomy and Ileal conduit urinary diversion after radical cystectomy.</p> <p><strong>Methodology: </strong>This was a hospital based Quasi Experimental study in which patients were selected by purposive sampling and, conducted from July, 2017 to September, 2018 in the department of Urology Bangabandhu Sheikh Mujib Medical University. This study was performed among the patients with muscle invasive bladder cancer treated by radical cystectomy with cutaneous ureterostomy or Ileal conduit fulfilling the exclusion and inclusion criteria. Total 34 patients were taken for the study, among them 17 for cutaneous ureterostomy and, 17 for Ileal Conduit Group. Quality of Life was assessed through EORTC-QLQ-C30 questionnaire both pre and post operatively (3 months after operation). Renal function was assessed before and 1st POD, 7thPOD, one month and three months after operation by measuring eGFR.</p> <p><strong>Result: </strong>Mean age of the patients was 59.00 ± 8.60 years and 53.35 ± 8.43years in group- A (Cutaneous ureterostomy) and group-B (Ileal conduit) respectively. Three months after operation, overall QoL in all scales were improved in both group but, more improvements were noted in group-B than group-A which were statistically significant (p&lt;0.05). The mean pre-operative eGFR was significantly lower in group-A than group-B (p&lt;0.001). Three months after operation, statistically significant differences in eGFR, were observed within, and in between two groups (p&lt;0.05). Percentage of eGFR changed (renal function deterioration) were significantly more in group-A than group-B (p=0.001).</p> <p><strong>Conclusion: </strong>Quality of life, after radical cystectomy with ileal conduit is better than cutaneous ureterostomy and, post- operative renal function deterioration significantly less in ileal conduit group than cutaneous ureterostomy group. So, ileal conduit is an appropriate option of urinary diversion for the patient those who permit prolong operative procedure.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.142-150</p> Subrata Deb Md Golam Mowla Chowdhury Mohammad Shafiqur Rahman Mohammad Salahuddin Faruque Ashraful Islam Madhusudan Mondal Nirupom Mondal Md Moktadir Hossain Mridha Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 142 150 10.3329/bju.v23i2.50305 Flexible Cystoscopy a Valuable Diagnostic Lool for Lower Urinary Tract Pathology <p><strong>Objective</strong>: To assess the role of flexible cystoscopy in the diagnosis of lower urinary tract pathology and its suitability as a routine diagnostic protocol in outdoor patients.</p> <p><strong>Methods: </strong>The cross sectional study was conducted at the advanced centre of kidney diseases and urology, Dhaka central international medical college, Dhaka from Jan 2016 to jan2019. All adult patients presenting with lower urinary symptoms to outdoor department were included. Flexible Cystoscopy was performed as a outdoor based procedure without sedation.</p> <p><strong>Results</strong>: Of the 249 patients in the study,198(79%) were male and 51(21%) were female. Lower urinary tract pathologies were found in 192(72%) patients. The most common pathology among males was enlarged prostate 56(31%) patients. Urethral stricture, bladder neck high were found 23(11%),21(10%) respectively. Among females, urethral stenosis was the most common pathology in 23(32%)patients. Transitional cell carcinoma was seen in 11(4.4%) patients having hematuria with inconclusive ultrasound and intravenous urography. .All patients tolerated the procedure well with no procedure related complaints.</p> <p><strong>Conclusion: </strong>Flexible cystoscopy is an effective, well tolerated and easy way of detecting lower urinary tract pathologies. It can alter the management as well as support the diagnosis and management. It is also helpful in routine surveillance of bladder tumours of low grade and low stage. Flexible cystoscopy should therefore be used as routine diagnostic protocol in outdoor practice.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.151-153</p> Md Rokonuzzaman Khan Fazal Naser Moazzam Hossain Mostafizur Rahman Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 151 153 10.3329/bju.v23i2.50306 Clearance of Renal Stone in PCNL Under Spinal Anaesthesia <p><strong>Objective: </strong>To evaluate the Outcome of PCNL under spinal Anaesthesia.</p> <p><strong>Material and Method: </strong>A total of 74 patients with renal stone disease were treated by PCNL under spinal anasthesia. Total study period was from January 2013 to October 2019. Pre operative and post operative variables and complications were recorded.</p> <p><strong>Result: </strong>Age range from 25 years to 65 years, mean 41.37 ± 33 yrs. Male female ratio was 6.4:1 stone size ranges from 15mm to 40mm, majority was 21.33mm. Mean operative time was 69±4.2 min. Total stone clearance was 15.60%. Only 10.82% patients were suffering from grade I complications and mean hospital stay was 3.1±0.6 days.</p> <p><strong>Conclusion: </strong>Percutaneous nephrolithotomy is effective and safe under spinal anesthesia with shorter hospital stay and minimal complication.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.154-157</p> Muhammad Hossain Sayedul Islam Mohammad Shafiqur Rahman Faruk Hossain Md Saiful Islam Shahil Ismam Hossain Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 154 157 10.3329/bju.v23i2.50307 Female Urethroplasty: A new hope for better quality of life <p><strong>Introduction: </strong>Female urethral stricture is a difficult issue in Urology. Many of the times it may follow any sort of urethral instrumentation but in other cases no definite precipitating causes are unidentified.</p> <p><strong>Methods: </strong>This was a prospective study. The sample size was n – 50. All cases were recurrent with the history of urethral dilatations, urethrotomies in multiple sessions. The diagnostic investigations in VCUG (voiding cystourethrogram), Ultrasound scan of kidney Ureter, bladder with post void residues, Uroflometry etc. Due to limitations, Urodynamic study was done in limited cases. Urethral augmentation was done using dorsal substitution of OMG (oral mucosal graft). Urethral catheter was left for 03 – 04 weeks.</p> <p><strong>Results: </strong>After removal of catheter, urinary flow was observed; excellent in all the cases. It remain satisfactory in 06 months of follow-up. Overall result is excellent.</p> <p><strong>Conclusions: </strong>Female urethral stricture is a difficult issue in Urology, Urethral dilatation, urethrotomies, clean intermittent catheterization are good options but need frequent procedures. Urethral augmentation with dorsal substitution of oral mucosal graft is a curative approach in long-run.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.158-163</p> Md Zahid H Bhuiyan Syed Alfesani Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 158 163 10.3329/bju.v23i2.50308 Correlation Between PSA Density and Gleason Score In Prostate Cancer Patients <p><strong>Background: </strong>Prostate cancer is the most common form of malignancy and the second leading cause of cancer death among men. The histological grade is an independent determinant of disease prognosis and survival. The Gleason System (GS) grading is the most widely accepted classification. Several recent studies have searched for factors that could predict GS upgrading. High prostate specific antigen density (PSAD) has been shown to be predictors of risk progression in many studies, reflecting the possibility of undetected aggressive cancer.</p> <p><strong>Objective: </strong>To detect the association between PSA density and Gleason score in prostate cancer patients.</p> <p><strong>Methodology: </strong>This cross sectional study was carried out at the department of urology, Sir Salimullah Medical College Mitford hospital, Dhaka. Patients diagnosed as prostate cancer meeting the inclusion criteria admitted in the above mentioned place was the study population. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Student t-test was used for continuous variables. Pearson’s correlation coefficient was used to test the relationship between the groups. P values &lt;0.05 was considered as statistically significant.</p> <p><strong>Results: </strong>Total eighty three patients were included in this study. The mean age was found 69.2±7.7 years ranging from 50 to 85 years. The mean volume of prostate was 42.3±17.6 ml ranging from 13.0 to 68.0 ml. The mean Gleason score was 7.8±1.4 ranging from 6.0 to 10.0. More than one third (33.7%) patients had PSA density 0.15- 0.5 ng/ml/ml. Three patients had found Gleason score 9 (5+4) within PSA density 0.51-1.0 ng/ml/ml, 5 patients within PSA density 1.1-1.5 ng/ml/ml, 3 patients within PSA density 1.51-2.0 ng/ml/ml, 6 patients within PSA density 2.1-2.5 ng/ml/ml, 5 patients within PSA density 2.51-3.0 ng/ml/ml and 2 patients within PSA density &gt;3.0 ng/ml/ml. The difference was statistically significant (p&lt;0.05) among seven groups. Positive correlation (r=0.717; p=0.001) between PSA density with Gleason score.</p> <p><strong>Conclusion: </strong>In this study, we find there is a strong correlation between PSA density and Gleason score.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.164-168</p> Md Naved Yusuf Sudip Das Gupta Mohammed Mianur Rahman Md Mahmud Ur Rahman Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 164 168 10.3329/bju.v23i2.50309 Outcome of Lower Ureteric Stone Fragmentation by Laser in Comparison with Pneumatic Lithotripsy <p><strong>Background: </strong>Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes.</p> <p><strong>Aims: </strong>To see the outcome of lower ureteric stone fragmentation by laser in comparison with pneumatic lithotripsy.</p> <p><strong>Methods: </strong>The prospective clinical study was conducted during the period from July 2012 to June 2014 in Dhaka Medical College Hospital. From the patient admitted in Dhaka medical college hospital a total of 60 patient were selected using purposive sampling methods. Selected patients were numbered chronologically and odd number group as group A (laser lithotripsy) and even number group B (pneumatic lithtripsy). Cystoscopy followed by ureterescopy with the help of guide wire was done and stone fragmentation done by either laser lithotripsy (done in general operation theatre in Dhaka Medical College Hospital) or pneumatic lithotripsy (done in Urology operation theatre in Dhaka Medical College Hospital). Collected data were processed and analyzed using computer software SPSS (statistical package for social science), version-18. Un-pair t-test, chisquare test and Fishers Exact probability test were used to analyze the data. The findings of the study showed age and sex are almost identically distributed in both groups.</p> <p><strong>Results: </strong>The mean age of group A and group- B were 35.63±11.66 and 38.90±11.21 years respectively. A male predominance was observed in both groups with 70% male in group- A and 53.3% in group-B. Stone size was also observed identically in both groups. 43% of stone are larger than 10mm in group- A and 47% stone are larger than 10mm. None of other baseline variable found very between groups. Immediate stone clearance was much higher in group-A (96.7%) then that in group- B (80%). Although both the groups demonstrated 100% clearance after 1 month. Immediate complications were higher in group B then those of group- A. Ureteral perforation in group B was found 6.7% as opposed to none in group-A. Fever in group A (6.7%) was observed to be more than 3 times higher than in group- B (23.3%). Comparison of complications after 1 and 3 months shows some differences (higher in group-B) but that is not significant. Ureteral stricture developed in 3 patients in group- B compared to nil in group- A. More than 90% of patients of group-A were released from the hospital within 3 days after operation, in contrast about 40% in group-B left the hospital within 3 days.</p> <p><strong>Conclusion: </strong>So, laser lithotripsy is better option for the management of lower ureteric stone by using semi rigid ureteroscope, in term of stone migration, rate of stone fragmentation and clearance, operation time, hospital stay and complication.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.169-175</p> SA Anowar Ul Quadir Khan Nazrul Islam Md Mostafizur Rahman Md Shafiqul Alam Chowdhury SM Mahbub Alam Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 169 175 10.3329/bju.v23i2.50310 Low intensity Extra Corporeal Shock Wave Therapy in Patients with Erectile Dysfunction: Our experience in ACKU <p><strong>Introduction: </strong>Oral 5-phosphodiesterase inhibitors (PDE5-I) is the main therapeutical options in erectile dysfunction (ED). It shows good results, but non-responders lack other effective options and its effect is also not long lasting. Since last few years, low-intensity extracorporeal shockwave therapy (Li-ESWT) in the corpora cavernosa showing promising results. This article presents our early experiences in Advanced Center of Kidney disease and Urology (ACKU) with the aim to evaluate clinical efficacy of Li-ESWT.</p> <p><strong>Materials and methods: </strong>Thirty four patients with ED were prospectively included in the study during the period of January 2018 to Jun 2019.Treatment was performed using the PiezoWave2 (Richard Wolf, Germany) device with a linear probe. Treatment protocol included a weekly session for four weeks. Each session delivered 2000 shocks on the perineum plus 4000 shocks on dorsum penis with an energy flux density (EFD) of 0.160 mJ/mm2. Every patient has been re-evaluated 1.5 and 3 months after the last session. Pre- and post-procedure International Index Erectile Function – Erectile function domain (IIEF-EF) score, Erection Hardness Score (EHS) and Global Assessment Questionnaire-Question 1 (GAQ-Q1) answers were obtained.</p> <p><strong>Results: </strong>Mean age of the study population was 39.4 (±12.9) years, 35.29% diabetic, 20.59% with hypertension and 55.85% smokers. Mean baseline IIEF-EF was 14.6, at 6 week post LiSWT was 16.4 (p &gt;0.05) and at 3 months post LiSWT was 19.2 (p &lt; 0.05). EHS was significantly improved at 3 month in comparison to baseline (p&lt;0.05). 20.59% patients answered positively to GAQ-Q1 at 6 week and 61.76% at 3 months. IIEF-EF score change of &gt;5 and increase of EHS &gt;2 were observed in 62.88% and 70.59% study subjects respectively.</p> <p><strong>Conclusions: </strong>Li-ESWT is a safe, harmless and repeatable treatment tool for ED with good outcomes reported.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.176-180</p> Md Fazal Naser Mahmood Hasan Md Waliul Islam Tajkera Sultana Chowdhury Md Shohrab Hossain Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 176 180 10.3329/bju.v23i2.50311 Outcome of Laser Urethrotomy in Comparison with Optical Internal Urethrotomy in Recurrent Stricture Urethra Following Perineal Anastomotic Urethroplasty for PUDD <p><strong>Objective: </strong>To compare the outcome of laser urethrotomy and optical internal urethrotomy(OIU) for the treatment of recurrent stricture urethra following perineal anastomotic urethroplasty for posterior urethral distraction defect.</p> <p><strong>Materials and methods: </strong>The study was conducted in Dhaka Medical College Hospital from January 2013 to December 2014.Male patients presented with obstructed voiding symptoms following perineal anastomotic urethroplasty were evaluated by their history, physical findings and investigations (urinalysis, uroflowmetry, retrograde urethrogram and micturiting cystourethrogram ) &amp; primarily 64 patients are selected by purposive sampling. Patients are divieded again by random allocation into group A and group B and underwent for OIU and laser urethrotomy respectively.</p> <p><strong>Results: </strong>Comparison was made to find out the better method between optical urethrotomy and laser urethrotomy. Overall per-operative complications (bleeding, extravasations of irrigating fluid, false passage and broken knife) in the former group were 31.3% compared to none in the latter group. Post-operative complications like bleeding, haematoma, penile oedema and erectile dysfunction were found only in Group-A (p=0.002). The mean duration of postoperative catheterization and average hospital stay were observed to be much higher in Group-A than that in Group-B (p=0.000008; p=0.0006). Comparison of final outcome (development of stricture) between groups at 1 year of evaluation in Group-A and Group-B was not significant (p= 0.320).</p> <p><strong>Conclusion: </strong>Laser urethrotomy is better than optical urethrotmy in regards of peroperative and post-operative complications.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.181-187</p> Ripan Debnath Md Nabid Alam Md Towhid Belal Prodyut Kumar Saha Uttam Karmaker Md Shafiqul Alam Chowdhury Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 181 187 10.3329/bju.v23i2.50312 Comparative Study Between Holmium Laser versus Pneumatic Ureteroscopic Lithotripsy for Proximal Ureteric Stones Close to Pelvi-ureteric Junction (PUJ) -A Prospective Trial <p><strong>Objective: </strong>To compare the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter versus Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper ureteric stones.</p> <p><strong>Materials and methods: </strong>Patients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper ureteric stones were reviewed. Patients with urinary tract infection, ,loss of follow-up, concurrent middle or lower third ureteral stones or acute renall failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups.</p> <p><strong>Results: </strong>There were 70 patients with upper ureteric stones (35 in pneumatic group and 35 in laser group) meeting the study criteria. Patients’ age, gender, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less upward migration and secondary intervention rate, sepsis as compared with pneumatic lithotripsy (94.2% vs. 60%; 85% vs. 100%; 5.7% vs 40%; 5.7% vs 34.2%; 2.8 vs 2.8 respectively, all p &lt; 0.05). In patients with stones sizes 8-10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate.</p> <p><strong>Conclusions: </strong>Ho:YAG laser lithotripsy is better and much effective than pneumatic lithotripsy in the management of upper ureteric stones in terms of, stone free rate and secondary intervention rate for stones of sizes about 8 to 10 mm.Although the access of upper ureter is difficult but our small calibre (4.5 fr) ureteoscope and gentle manuevre have made the procedures safe and successful.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.188-192</p> Harun Or Rashid Md Shahidul Islam SM Shameem Waheed Md Abdur Rakib Md Ashif Chowdhury Md Shafiul Alam ATM Nurul Amin Muhammed Alam Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 188 192 10.3329/bju.v23i2.50313 Surgical Repair of Posterior Urethral Distraction Defects and its Outcome : Initial Experience in a Tertiary Level Hospital <p><strong>Purpose: </strong>Management of posterior urethral distraction defects are challenging for urologists and need very careful and meticulous dissection for getting a good outcome. Dhaka medical college hospital is a tertiary referral hospital where we receive a lot of cases from different districts. The study was done to observe the outcome of anastomotic urethroplasty for posterior urethral distraction defects. Methods : This was a prospective experimental study. This study was done in a single unit of DMCH urology department by a single surgeon . Those who were suffering from posterior urethral distraction defects with suprapubic catheter in situ were included and underwent anastomotic urethroplasty from the period of January, 2018 to october, 2019. After proper evaluation and counseling all patients underwent perineal anastomotic urethroplasty under spinal anesthesia with 6-8 interrupted suture, using 4/0 vicryl. A 14 Fr Foley catheter was placed in urethral lumen and 16 Fr catheter in SPC site. A latex strip drain was placed for perineal wound. Drain was removed after 48 hours of operation . Patients were usually discharged in between 5th to 7th POD with definite follow up protocol and medications with supra pubic catheters (SPC) and per urethral catheters in situ. On 21 POD urethral catheter was removed. SPC was removed after 7 days if patient can void normally. 1st and 2nd follow up were done at the completion of 3rd and 6th month respectively. The prevalence of post-operative sexual disorders was investigated using the International Index of Erectile Function-5 (IIEF-5) questionnaire during follow-up. If the patient can able to void per urethra in a well manner and Qmax&gt;15 mL/s then repair was defined successful.</p> <p><strong>Result : </strong>Success rate of perineal anastomotic urethroplasty for posterior urethral distraction defect was 83.33.%. 18 patients were included in the study. The mean age was 28.27 years. 17 patients were able to void successfully after surgical procedure but among those 2 patients had urinary flow rate &lt; 15 ml/sec and one patient didn’t able to void. 3 patients had developed wound infection, 3 patients developed erectile dysfunction.</p> <p><strong>Conclusion : </strong>Perineal anastomotic urethroplasty is gold standard for treatment of posterior urethral distraction defects. Long term follow up is needed to give a opinion regarding the ultimate outcome of the surgical procedure and that have give a good idea for future management.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.193-198</p> Md Selim Morshed Hafiz Al Asad Md Fazal Naser Uttam Karmaker Md Towhid Belal Md Saruar Alam Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 193 198 10.3329/bju.v23i2.50314 Comparative Study Between Mini PCNL and RIRS in the Treatment of Renal Stones <20mm : Our Experience in CMH Dhaka <p><strong>Aim: </strong>The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter &lt;15 mm.</p> <p><strong>Materials and Methods: </strong>This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software.</p> <p><strong>Results: </strong>Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group.</p> <p><strong>Conclusions: </strong>Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi.</p> <p>Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.199-204</p> Md Abdur Rakib Md Shahidul Islam SM Shameem Waheed Md Ashif Chwdhury Mohammad Shafiul Alam Mohammad Harun Or Rashid Copyright (c) 2020 Bangladesh Journal of Urology 2020-11-15 2020-11-15 23 2 199 204 10.3329/bju.v23i2.50315