Subcutaneous leiomyosarcomas (LMS) are rare soft tissue sarcomas arising from small-to-medium-sized blood vessels. Involvement of the anterior abdominal wall is extremely rare. We present a case of a 72-year-old gentleman who presented with 3 months history of a progressively increasing mass in the supra-pubic region reaching the root of penis without any regional lymphadenopathy. Magnetic resonance imaging (MRI) pelvis showed a large heterogeneous mass in lower abdomen indenting the penile corpora. Complete pathological clearance was achieved by wide excision of the mass with total penectomy and cutaneous urethrostomy. The patient received adjuvant radiation therapy and is free of local recurrence or distant metastasis two years after the surgery.

Urolithiasis is a highly recurrent disease. The incidence of urolithiasis is on the rise. Although stone prevention is highly desirable, there is significant controversy and lack of quality evidence to suggest a standard approach to prevention. In the current chapter, we have looked at the contemporary evidence, lack of long-term compliance, and various dietary and pharmacological treatment options for prevention of recurrent stone disease.

Purpose: Percutaneous ultrasound (US)-guided aspiration is the first line of management for breast abscess. Our study aimed to look at the success of US-guided percutaneous drainage in managing breast abscesses at a tertiary care center and additionally to look for any correlation between US features and failure rate.Methods: A retrospective review of the radiology database at a tertiary care hospital in Pakistan was done to identify 54 patients through non-probability convenience sampling who underwent a US-guided percutaneous aspiration with laboratory confirmation of abscess. A treatment course was observed for the development of complications or failure of treatment. A chi-square test was performed to correlate US features and patient characteristics with outcomes of treatment (p<0.05). Fisher's exact test was applied to evaluate the success of aspiration in small versus large abscesses, and in lactating versus non-lactating patients.Results: 75% of all women were successfully able to avoid surgery. Specifically, 80.6% of all lactating women and 66.7 % of non-lactating women with breast abscesses were successfully managed with US-guided percutaneous aspiration. Across a variety of parameters measured, including pathological and etiological factors, as well as features on imaging, no significant association was established between the variables and the failure of the intervention.Conclusion: Low morbidity and high patient satisfaction rates make percutaneous aspiration preferable to surgical intervention as a first-line treatment of breast abscess. Early use of antibiotics is recommended as an adjunct to drainage.

Background This study aimed to translate the Bladder Cancer Index (BCI) questionnaire to Urdu and validate it to assess the quality of life of patients with bladder cancer. Material and methods After forward and backward translation of the BCI questionnaire into Urdu, content validity was calculated using the content validity index (CVI) based on input from five health experts regarding the clarity and relevance of the questionnaire. Construct validity was measured by comparing the inter-scale domains and subdomains of BCI and by comparing BCI with Short Form 36 (SF-36) using correlations. For assessment of reliability, Cronbach's alpha was calculated to measure internal consistency and for test-retest reliability, the questionnaire was re-administered four weeks later and the correlation of responses at baseline and at a four-week time point was evaluated. Results The questionnaire has good content validity for clarity ( 0.91) and relevance (0.87). The construct validity of BCI was also adequately displayed by moderate to high correlation between different subdomains of BCI (Pearson's r: urinary - 0.62, bowel - 0.78, sexual function - 0.43) and low to moderate correlation between responses of BCI compared with SF-36 (Pearson's r mostly >0.45). Test-retest reliability was excellent (Pearson's r 0.90-0.98), and there was good internal consistency (Cronbach's alpha 0.79-0.92) in the different domains of the questionnaire. Conclusion The Urdu-translated BCI is a valid and reliable tool to measure the impact of bladder cancer on the quality of life of patients.

Introduction Urolithiasis is a common disorder worldwide with an increasing prevalence and high recurrence rate. This makes preventive measures like dietary modification an essential part of patient care. This study focuses on gauging the perception of dietary habits favoring kidney stone formation. Materials and methods A cross-sectional questionnaire-based study was conducted at Aga Khan University, Karachi, Pakistan. For nine food items and 14 beverages, respondents chose one of four options with regards to their relationship with stone formation, i.e. "increasing", "decreasing", "no effect", and "do not know". Responses were matched against evidence from the literature to generate correct and incorrect responses, thereby gauging perception for individual items. Results Seven hundred and three participants including 69 (9.6%) with a prior history of kidney stones, were recruited for the study. Participants with a personal history of kidney stone disease were older (odds ratio (OR}: 1.042 CI 1.020-1.064) with a significantly higher family history of stones (OR: 2.151 CI: 1.472-3.144). The majority were managed medically (87%) but never received dietary counseling (57%). Water, soft drinks, and tomatoes were the only three items out of 23 that were correctly identified by >50% of the participants with regards to their effect on stone formation. Responses did not differ significantly between those with stone disease and those without. Conclusion There is a lack of awareness among the general population, including individuals with a prior history of kidney stones regarding dietary prevention of kidney stone disease. This demonstrates a lack of existing dietary counseling thus necessitating the need for incorporating it at a mass level.

Background In this study, we aimed to translate and validate the 19-item version of the Bristol Female Lower Urinary Tract Symptoms (Bristol FLUTS) Questionnaire in Urdu among women experiencing urinary incontinence at a tertiary care hospital in Karachi, Pakistan. Methodology A cross-sectional validation study was conducted in the urology clinic at Aga Khan University Hospital, Karachi, Pakistan, between April and September 2021. After forward and backward translation of the Bristol FLUTS questionnaire, content validation was done by six experts, followed by the administration of the questionnaire to 10 respondents in the pilot phase of the study. In total, 207 participants were approached to fill the final version of the translated questionnaire. Overall, 188 respondents filled out the questionnaire, including 94 women with urinary incontinence and 94 women from the community to test construct validity. Finally, 30 women with urinary incontinence were asked to fill the form again two weeks later to determine test-retest reliability. Cronbach's alpha was employed to assess the internal consistency of the questionnaire. Results The questionnaire displayed good content validity for reliability (content validity index: 0.84) and clarity (0.89). The scores reported by cases were significantly higher than the controls in all but the sexual function domain, suggesting good construct validity. Cronbach's alpha of 0.81 signified good internal consistency, and a Pearson's coefficient of 0.993 (p < 0.001) comparing responses at baseline and after two weeks indicated good test-retest reliability. Conclusions The Urdu translation of the Bristol FLUTS is a valid and reliable questionnaire that can be used in the clinical setting.

OBJECTIVE To determine the association of essential hypertension with pregnancy-induced hypertension in women. METHODS The case-control study was conducted at Aga Khan University Hospital, Karachi, from January 2012 to March 2013, and comprised on hypertensive female patients who visited the outpatient medicine clinics. The patients were aged 18-65 years and had been pregnant atleast once. Cases were women diagnosed as hypertensive or pre-hypertensive and the controls were normotensive women. The primary outcome was essential hypertension and the main exposure was pregnancy-induced hypertension. RESULTS Of the 258 subjects, 175(49.7%) were cases and 177(50.3%) were controls. The overall mean age was 44.6±13.3 years. Odds Ratio (95% Confidence interval) for pregnancy-induced hypertension for the outcome of essential hypertension was 1.6 (0.88, 3.0). The odds ratio increased further to 2.5(1.2, 5.2) after adjustment for age, family history of hypertension and physical activity. The association remained after further adjusting for body mass index in the final model; 2.20 (1.06, 4.57). CONCLUSIONS Women who develop hypertension in pregnancy are at higher risk of developing essential hypertension later in life.