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As the current management of BPH/lower urinary tract symptoms by traditionally involved pharmacological agents such as 5alpha-reductase inhibitors and α1-adrenoceptor antagonists is suboptimal, there is definite need of new therapeutic strategies. There is ample evidence in literature that suggests the role of estrogens in BPH development and management through the different tissue and cell-specific receptors. This article reviews the beneficial actions of selective estrogen receptor modulator (SERM) and ERβ-selective ligands, which have been demonstrated through in vitro studies using human prostate cell lines and in vivo animal studies. SERMs have anti-proliferative, anti-inflammatory and pro-apoptotic mechanisms in BPH, and also act by inhibiting various growth factors, and thus represent a unique and novel approach in BPH management directed at estrogen receptors or estrogen metabolism. [ABSTRACT FROM AUTHOR]

Purpose: Complication rates with ventral onlay technique of oral mucosa graft urethroplasty have been attributed to the poor ventral support for the graft. We herein describe a new technique which overcomes these problems and also discuss the short-term follow-up. Materials and Methods: In a prospective study conducted between January 2006 and June 2008, 13 patients with proximal stricture of the bulbar urethra underwent ventral bulbar augmentation. In this technique, the graft was sutured only to the bulbar urethra and the rest of spongiosal tissue was closed superficially. Longitudinal incisions were given in the partial depth of the bulb, adjacent to the suture line and were sutured together over the first suture line. Results: The mean follow-up period was 16.4 months (range, 6 to 30 months). Two of the patients developed restricture; one at the proximal anastomosis of the graft with native urethra and one at the distal anastomosis. Remaining 11patients have satisfactory postoperative uroflow rates and are doing well. The success rate at the last follow-up was 84.6%. Conclusion: This technique exploits the local bulbar anatomy by successfullymoving the lateral bulbar tissue medially, below the ventrally placed mucosal graft. This results in a thicker ventral bulbar platform which provides enhanced support to the graft. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and compare the results of regimen A (3 instillations at 8-hourly intervals in 1 day) with the control regimen B (9 instillations at 8-hourly intervals in 3 days) of using 1% silver nitrate solution for renal pelvic instillation sclerotherapy in ‘clinically significant’ filarial chyluria. Materials and Methods: Forty-seven patients with clinically significant chyluria attending on 2 different days our urology clinic were prospectively randomized between two groups; the study group received regimen A (n = 21) while the control group received regimen B (n = 26). The variables evaluated included visualization of pyelolymphatic fistulae on retrograde pyelography, hospital stay, outcome and morbidity of the two regimens. Results: Patients in both groups were comparable for age and sex. The morbidity (fever, symptomatic UTI, hematuria) following regimen A was less than that of regimen B although not statistically significant. The average hospital stay was 3 days for regimen A and 5.5 days for regimen B (p = 0.001). The initial success rate was 80.95% in group A and 92.30% in group B (p = 0.47). The mean duration of follow-up was 15 months (range 9–18). There was no significant difference in recurrence between the two groups during follow-up (group A: 21.05% and group B: 22.72%; p = 0.98). Conclusions: Regimen A was as effective as regimen B. Regimen A had the advantages of having less morbidity and shorter duration of hospital stay. We recommend only a 3-instillation regimen in patients with clinically significant chyluria, particularly those who demonstrate pyelolymphatic fistulae on retrograde pyelography. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Develops a technique to enhance the precision of apical enucleation, thereby minimizing sphincteric injury in India. Use of a cystoscopy to assess the prostatic anatomy; Advantages of retropubic prostatectomy; Complications of open prostatectomy.

For buccal mucosal graft urethroplasty, nasal or oral endotracheal intubation anesthesia is used for harvesting the graft from the oral cavity. A technique of graft harvesting under local anesthesia using 2% lidocaine solution with adrenaline (1:200 000) is described. This method requires a cooperative patient but saves the morbidity of general anesthesia. [Copyright &y& Elsevier]

Abstract: The objective of this study was to evaluate the expression pattern of PDZ-binding kinase/T-LAK cell-originated protein kinase (PBK/TOPK) and its clinical significance in human bladder cancer (BC). We detected PBK/TOPK mRNA overexpression in BC and human normal testis tissues using RT-PCR. Using qRT-PCR revealed a higher expression of PBK/TOPK in BC tissues than their adjacent noncancerous tissues (ANCTs) (p <0.0001). Cytoplasmic expression of PBK/TOPK protein was found to be positive in 64.6% (42 of 65) BC patients. Expression of PBK/TOPK protein was found to be significantly higher in muscle-invasive bladder cancer (MIBC) than in non-muscle-invasive bladder cancer (NMIBC) (86.1% vs. 37.9%, p <0.001). The immunohistochemical (IHC) expression of PBK/TOPK was found to be significantly (p <0.001) associated with the stage of disease. Study findings suggest that the PBK/TOPK mRNA/protein expression is specific to human BC and might be used as a novel target for development of cancer immunotherapy and diagnostic biomarker. [Copyright &y& Elsevier]

INTRODUCTION: The purpose of this study was to determine the frequency of androgen decline in the aging male (ADAM) in a group of Indian men working in the health sector. MATERIALS AND METHODS: A free medical health checkup camp was organized for the male workers aged between 40 and 60 years employed in surgical departments of our hospital. Of 180 listed male workers, 170 attended this camp and 157 eligible men participated in the study. After clinical history and systemic inquiry, the participants were requested to complete the Saint Louis University's ADAM questionnaire, and their serum levels of free and total testosterone were measured. RESULTS: Symptomatic andropause was found in 106 men (67.5%) on the basis of their responses to the questionnaire, of whom 41 (38.7%) had low serum free testosterone levels and 32 (30.2%) had low serum levels of total testosterone. Fifty-one men were asymptomatic according to the questionnaire and in this group, 11 (21.6%) had low serum free testosterone levels and 6 (11.8%) of these had low total testosterone levels. The frequency of andropause was 33.1% on the basis of low serum free testosterone levels and it was 26.1% when both symptoms and low serum free testosterone levels were taken into account. CONCLUSION: In our study, the high frequency of symptoms related to ADAM was unusual. This might be due to the nature of the questionnaire itself. Serum free testosterone measurement may be a better single test for diagnosis of hypogonadism than serum total testosterone measurement. [ABSTRACT FROM AUTHOR]

Introduction: Concurrent chemo-radiotherapy (CTRT) as a component of trimodality therapy (TMT) is a reasonable treatment option in muscle invasive bladder cancer (MIBC). The role of advanced radiation techniques in this setting is still not well established. Intensity modulated radiotherapy (IMRT) allows improved tumor coverage and better normal tissue sparing, thus potentially minimizing gastrointestinal (G.I), genitourinary (G.U) and bone marrow toxicities. Volumetric modulated Arc therapy (VMAT) is a form of IMRT that employs dose delivery using continuous arcs, reducing treatment delivery time. Aims and Objectives: To assess the feasibility and acute toxicity in patients of MIBC treated with VMAT technique. Materials and method: This study was a prospective, interventional, single arm study. 20 patients having histologically proven MIBC (T2 -T4a, N0-2, M0), after transurethral resection of bladder tumor were recruited from dec-2015 to march-2017. Contrast enhanced computed tomography simulation was done with empty bladder. Total dose of 60-66Gy at 1.8-2Gy/ fraction as 5 fractions/ week to the primary tumor and 45-54Gy at 1.6-2Gy/fraction to nodal disease was delivered using VMAT technique along with concurrent Cisplatin (35-40 mg/m2) weekly. Acute toxicities were assessed as per RTOG criteria and hematological toxicities were assessed using CTCAE (version 3.0) Results: Ninteen patients were male and one female with median age of presentation being 62 years. 12 (60%) patients had stage II disease, 4 (20%) patients each had stage III and stage IV disease with a median Karnofsky performance status of 90. Median RT duration was 46±2 days with treatment interruption in only 1 patient due to grade 3 haematological toxicity. 1 patient had grade 3 while 4 (20%) patients had grade 2 anemia. 8 (40%) patients experienced grade 2 leukopenia. Acute grade 2 GI and GU toxicities were noted in 7 (35%) and 2(10%) respectively. 2 (10%) patients suffered from grade 1 skin reactions. No patient had grade 3 or 4 acute GI or GU toxicity. Conclusions: VMAT has acceptable early acute toxicity profile in patient of MIBC treated with CTRT. Follow up of patients in our study would further define its role. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 35 year old female admitted with acute urinary retention following tingling-sensation in the urethra and bladder. Stool examination confirmed the infection due to Ascaris lumbricoides. The patient was treated with albendazole 400 mg once after three weeks. The case shows that the infections due to Ascaris lumbricoides is primarily limited to the gastrointestinal tract.

Formation of bone in cases of renal cell carcinoma is a rare finding and only a couple of case reports from Japan and one from India are mentioned in the literature. Calcification inside renal mass has been reported earlier but the prognostic implications have not been clearly elucidated. We report a case which showed heterotopic bone formation (ossification) inside the renal mass and was managed by radical nephrectomy. The histopathology showed clear cell renal carcinoma with multiple centers of ossification in the region of calcification suggesting bone formation. In this case report we discuss bone morphogenetic proteins which have been implicated as a prognostic and causative factor, highlight the difficulties in distinguishing between calcification and bone formation on the basis of radiological investigations and mention the geographic implications of this rare phenomenon which has not been described earlier. [ABSTRACT FROM AUTHOR]

Bladder cancer (BC) is one among the most common and lethal urothelial malignancies worldwide. The expression of cancer-testis (CT) antigens in some tumours and restricted expression among normal tissues make CT antigens as attractive vaccine targets. In this context, we evaluated Centrosomal protein 55 kDa (CEP55), which is specifically expressed in normal human testis and various malignancies. Until the expression pattern of CEP55 in transitional cell carcinoma (TCC) of human urinary bladder and its clinical significance are not known. The aim of the present study is to evaluate mRNA/protein expression of CEP55 in TCCs of urinary bladder and correlate its expression with the clinicopathological characteristics of BC patients. In this study, the methods of quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC) were used to investigate mRNA/protein expression of CEP55 in TCC. Independent Student's t test, ANOVA and Chi-square (χ²) were used to analyze the data statistically. We observed CEP55 mRNA overexpression in testis and 48.7% of BC patients. Relative mean fold expression of CEP55 mRNA was found to be significantly (p < 0.01) higher in muscle-invasive bladder cancer (MIBC) as compared to non-muscle-invasive bladder cancer (NMIBC) patients (7.88 ± 3.88 vs. 4.75 ± 2.30, p = 0.01). CEP55 protein expression was evaluated using IHC and cytoplasmic staining pattern was recorded in formalin fixed, paraffin-embedded (FFPE) bladder tumour tissues. No significant difference was observed in protein expression of CEP55 between the two groups (NMIBC and MIBC patients) (72.2% vs. 69.0%, p = 0.774). No significant protein expression of CEP55 was observed among adjacent noncancerous tissues (ANCTs) and benign prostatic hyperplasia (BPH) used as control. Our study results suggest that CEP55 mRNA/protein expression was observed is specific to TCC of human urinary bladder and might be used as a diagnostic biomarker and vaccine target in development of BC specific immunotherapy. [ABSTRACT FROM AUTHOR]

Objective: To report a novel surgical approach for single-stage repair of exstrophy-epispadias, with the specific aim of innervation, preserving sphincteroplasty corporal detachment for penile lengthening and ischio-pubic ramotomy for Linia-alba approximation. Material and Methods: Twenty-five classic exstrophy with compliant bladder plate and 10 incontinent epispadias patients were selected. Preoperative magnetic resonance angiogram of urogenital diaphragm showed triangular space between ischio-cavernosus, bulbo-spongiosus, and transverse-perinei muscles containing sphincteric branch of perineal artery indicating the course of sphincteric nerve. Bladder plate was mobilized. Through a midline scrotal septal and transverse incision along the base of urogenital triangle, the urogenital diaphragm was exposed. Corpora were separated from the urethral plate while preserving the glanular continuity and innervation to striated urethral sphincter, using muscle stimulator and nerve integrity monitor. In the subperiosteal plane along the ischio-pubic rami, the corpora were detached. Repair included ureteric reimplantation; anatomic reconstruction of bladder, bladder neck, urethra, and striated sphincter; corporo-glanuloplasty; ischio-pubic ramotomy; and abdominal closure. Assessment included surgical problems, cosmetic satisfaction, erectile function, continence, and upper tract status at 2-year follow-up. Result: There was no corporal loss. Postoperative complications included 4 perineal suture line infections, 11 peno-pubic fistula, and 1 adhesive intestinal obstruction. Erectile function was good in 33 patients. Penile length was gratifying in 25. Of 28 patients, 20 (71.4%) had dry interval of two hours. Dimercaptosuccinic acid study demonstrated upper tract scarring in 2 patients. Conclusion: This approach facilitates innervation preserving sphincteroplasty and precise restoration of anatomy to near normal without operative accidents because of wide exposure gained, improving the functional and cosmetic results. [Copyright &y& Elsevier]

The article comments on the study "Causes of Hospital Readmissions after Urologic Cancer Surgery" by M. Schmid and others.

Formation of bone in cases of renal cell carcinoma is a rare finding and only a couple of case reports from Japan and one from India are mentioned in the literature. Calcification inside renal mass has been reported earlier but the prognostic implications have not been clearly elucidated. We report a case which showed heterotopic bone formation (ossification) inside the renal mass and was managed by radical nephrectomy. The histopathology showed clear cell renal carcinoma with multiple centers of ossification in the region of calcification suggesting bone formation. In this case report we discuss bone morphogenetic proteins which have been implicated as a prognostic and causative factor, highlight the difficulties in distinguishing between calcification and bone formation on the basis of radiological investigations and mention the geographic implications of this rare phenomenon which has not been described earlier. [ABSTRACT FROM AUTHOR]

A case study of a 9-year-old boy with a posttraumatic bulbomembranous urethral stricture is presented. The patient had a suprapubic catheter placed 3 months earlier, just after the trauma. A single-stage anastomotic urethroplasty was undertaken, during which the old catheter was replaced through the same tract without opening the bladder. With this, urethral calibration showed a patent anastomosis.