Extra Burden on Urology Outdoor Due to Non Urology Flank Pain

Background: Flank pain is one of common urological emergency. It can be result of various causes. Most commonly results from one of three causes: urinary tract infection (UTI), kidney stones, and musculoskeletal problems like a muscle strain or pinched nerve. Objective: Determine frequency of none urological flank pain burden in urology outdoors. Methods: This was prospective descriptive case study conducted at department of urology and transplantation at Jinnah Postgraduate Medical Center Karachi from September 2020 to December 2020. All patients with flank pain, who visited in urology outdoor, were included in study. All patients had detailed history and physical examination. Urinalysis and ultrasound abdomen were done in all patients. CT KUB was also done in patients who had abnormal ultrasound finding of kidney ureter and bladder. Results: Total 100 patients were included in this study, 41 (41%) male while 59 (59%) patients were females. 45 patients had right sided pain, 34 had left sided while remaining 21 patients had bilateral flank pain and six patients had also lower urinary tract symptoms along with pain. 13 patients had positive renal punch on examination, 23 patients had positive straight leg rising sign and rest of the 64 patients’ examination was unremarkable. 55 patients had urology related pathology on ultrasound, in 9 patients had non urological pathology and rest 36 patients it was unremarkable. CT KUB was done in all 55 patients who had positive findings on ultrasound showing pathology in kidney and ureter in which 47 patients CT scan had confirmed the diagnosis while in 8 patients it was in remarkable. Conclusion: flank pain is not always secondary to renal origin. It has wide spectrum of alternative significant causes also. Keywords: Flank pain, none urological, CT KUB

Efficacy of Tamsulosin as Compared to Placebo, in Reducing Post Operative Flank Pain during Voiding, in Patients with Ureteric Stent

Objective: To evaluate the efficacy of tamsulosin in reducing post operative flank pain during voiding, in patients with ureteric stent. Study Design: This is a Randomized control trial (RCT) study. Place and Duration: Study carried out at Department of Urology, Jinnah Post Graduate Medical Centre, Hospital, Karachi, Pakistan, from June 2016 to November 2016. Methodology: 60 patients aged between 15 – 45years, undergone placement of ureteric stent to treat ureteric and renal calculi and have pain score >4, were included in the study. Divided into two groups ‘group A’ and ‘group B’. In group ‘A’ and group ‘B’ Tamsulosin and Placebo was given respectively in patients with ureteric stent and reduction in post-operative flank pain was measured and compared. Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours. Patients having uretral trauma, patients having BPH, patient underwent TURP or TURBT, patent having urinary tract infection and patients with pregnancy or lactating females were excluded. All patients were received intravenous antibiotic (Ceftrixone 1gr). Also all patients were receive oral analgesic (diclofenic sodium 50mg BID) and antispasmodics (Drotaverine 80mg BID). Patients were discharged after 24 hours. Postoperatively stent related flank pain during voiding was assessed via Pain Scale. Results: 60 Patients who got operated for ureteric stent. In group ‘A’ there were 21 males (70%) and 9 females (30%), the mean age of group A was 35.67±5.99 as In group ‘B’ there were of 21 males (70%) and 9 females (30%) and mean age of group B was 35.04±6.42 (Table 1). Mean Pain score in ‘Group A’ (Tamsulosin) in week 1, 2, 3, 4, 5, 6 was 4.1, 3.5, 2.9, 2.3, 1.9, 1.3 respectively as shown in Table 2. Mean Pain score in ‘group B’ (Placebo) in week1, 2, 3, 4, 5, 6 was 6.9, 6.3, 5.9, 5.6, 5, 4.2 respectively as shown in Table 2. Average pain score in ‘group A’ and ‘group B’ came out to be 2.67 and 5.64 respectively (P value 0.005). Conclusion: Alpha blockers reduces the post-operative flank pain and voiding complaints in patients with ureteric stent. Our study shows that the efficacy of Tamsulosin in reducing post-operatice flank pain in patients with uretercic stent is better than placebo.

Predictors of renal infarction in patients presenting to the emergency department with flank pain: A retrospective observational study

Objectives Flank pain is a common symptom in the emergency department and can be caused by a variety of diseases. Renal infarction (RI) is a very rare disease, and many RI patients complain of flank pain. However, there is no definitive predictor of RI when patients complain of flank pain. This study aimed to identify the clinical factors for predicting RI in patients with flank pain. Methods This retrospective single-center study was conducted on patients complaining of flank pain from January 2016 to March 2020 at a South Korean tertiary care hospital. Exclusion criteria included patients who did not undergo contrast-enhanced computed tomography, age < 18 years, and trauma. Demographic and laboratory data were obtained from medical records. Logistic regression analysis was conducted to identify predictors of RI occurrence. Results In all, 2,131 patients were enrolled, and 39 (1.8%) had RI. From a multivariable logistic regression analysis, an age ≥ 65 years (odds ratio [OR], 3.249; 95% confidence interval [CI], 1.366–7.725; p = 0.008), male sex (OR, 2.846; 95% CI, 1.190–6.808; p = 0.019), atrial fibrillation (OR, 10.386; 95% CI, 3.724–28.961; p < 0.001), current smoker (OR, 10.022; 95% CI, 4.565–22.001; p < 0.001), and no hematuria (OR, 0.267; 95% CI, 0.114–0.628; p = 0.002) were significantly associated with the occurrence of RI. Conclusions Five clinical factors, i.e., age ≥ 65 years, male sex, atrial fibrillation, current smoker, and no hematuria, were significantly associated with the occurrence of RI in patients with flank pain.

Clinical- pathological features and surgical outcome of renal cell carcinoma: Experience from a zonal referral hospital-northern of Tanzania

Background: Renal cell carcinoma (RCC) is the most common primary malignant tumour of kidney in adults. Recent studies from developed countries have shown that most renal tumour are currently diagnosed incidentally during screening for other disease which leads to better prognosis while few studies done in Africa still shows significant proportion of patients present with classic triad ( >10%) which is a sign of advanced disease. Objectives: This study aimed at determining clinical pathological feature and outcome of RCC in Northern zone of Tanzania. Patients and Methods: This was a hospital based descriptive retrospective cohort study conducted at Kilimanjaro Christian Medical (KCMC) from January 2002 to December 2017. Data were analysed using statistical package for social science (SPSS) version 16. 0 and summarized in tables and figures. Results: Forty three patients (43) underwent radical nephrectomy for RCC during the study period. Male to female ratio was1. 7: 1 with mean age of 53+/- 12 years. Flank pain (84%), abdominal mass (76%) and hematuria (44%) were the most common clinical presentation while classical triad was found in 40%. The most common clinical tumor stage was T3(72. 1%) whilst clear cell carcinoma was the commonest histological pattern. Five years survival length for T1, T2, T3 and T4 were 100%, 62. 5%, 32. 3% and 0% respectively. Conclusion: The most common presenting symptom of RCC in our centre is flank pain, and abdominal mass. Majority of the patients presented with advanced disease with less than five year survival rate. Clear cell type was the predominant histological type.

Cancer of unknown primary origin presented with rapid deterioration without significant symptoms, a case report

A 34-year-old woman with flank pain was referred for suspicious lymphadenopathy. PET/CT scan revealed disseminated lesions without apparent primary origin. Although she did not complain of any symptoms, after rapid deterioration, she died of respiratory distress and cardiac arrest. Her strong beliefs contribute to symptoms tolerance and late diagnosis.