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Crossed fused ectopic kidney is a rare congenital anomaly wherein the kidneys are present on the same side due to fusion. It is a rare disease that may remain undiagnosed throughout life. Its rarity and anatomical abnormality make any intervention challenging. A 32-year-old male patient presented with symptoms of pain in the abdomen and burning micturition for a year. Serum creatinine, along with other blood tests, was normal. X-ray KUB showed renal calculi in the region of the right kidney. However, a Computed Tomography (CT) scan showed that the left kidney was malrotated and fused with the lower pole of the right kidney, suggestive of crossed fused renal ectopia. A cystoscopy and retrograde pyelography were performed, followed by open pyelolithotomy, wherein calculi were removed, and a stent was placed. Through this case report, it is suggested that adequate presurgery evaluation is necessary for patients with such malformations. [ABSTRACT FROM AUTHOR]

This letter to the editor responds to a recent article on the medical management of stent-related symptoms. The authors propose a modification to the traditional DJ stent by cutting its lower coil and stitching its lower end with a suture. This method, performed under fluoroscopy supervision, can greatly reduce symptoms associated with the stent and save patients time and money. The authors support their position with evidence from a trial that showed improved tolerance and lower stent-related symptoms with a custom-made distal coil. The authors declare no conflicts of interest and have not received any funding. [Extracted from the article]

Tuberculosis (TB) is an opportunistic infection caused by Mycobacterium TB, and it has plagued mankind since ages, posing a major health concern in developing countries. Pulmonary TB is the most common form, but extrapulmonary TB is also not uncommon, with an incidence of 8-14%. Cutaneous manifestations of TB, known as lupus vulgaris, are extremely rare, constituting less than 1% of cases worldwide. Diagnosing a cutaneous lesion of TB poses a challenge for clinicians, as it requires both absolute and relative criteria. In the present case report, the author presents the case of a 15-year-old male from a low socio-economic background who presented with painless oedema over the penis for one and a half months. The patient had a history of dry cough and tested positive for Coronavirus Disease-2019 (COVID-19). Systemic examination was normal, and vital signs were stable. Local examination revealed oedema, redness, and phimosis over the penile shaft, along with non tender ulcerative lesions and deep cracks in the groin crease. A skin biopsy revealed lymphocytic infiltration with Langhans-type giant cells and epithelioid cell granulomas, suggesting TB of the skin overlying the penis. Laboratory investigations revealed a positive Mantoux test and an elevated Erythrocyte Sedimentation Rate (ESR) of 42. The patient was initiated on antitubercular therapy, comprising isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). After one month of treatment, the oedema subsided, and the penile ulcers and groin skin cracks healed. Penile skin involvement in TB is rare, and the clinical appearance of such involvement may vary. [ABSTRACT FROM AUTHOR]

Context: Management of urolithiasis in patients with chronic kidney disease. Aims: To ascertain the best method surgical or noninvasive. Settings and Design: This was a single-institute study. Subjects and Methods: A total of 50 patients of CKD with urolithiasis were enrolled in this comparative study. Clinical evaluation, biochemical evaluation, and radiological imaging were done. The management strategies were individualized to patient need. Following procedure, imaging and biochemical assessment were done to assess the stone clearance and improvement in the renal parameters. Intraoperative and postoperative complications are also noted. The patients were followed up to 6 months. Statistical Analysis Used: Statistical Package for the Social Sciences version 21.0 software was used for statistical analysis. Results: The mean age of the patients was 55.22 ± 10.76 years (range 28–76). Majority were male (76%) and had unilateral involvement. The mean preoperative hemoglobin (Hb), urea, creatinine, and total leukocyte count (TLC) were 9.49 ± 0.84 g%, 71.13 ± 24.09 mg/dl, 4.71 ± 2.45 mg/dl, and 8.67 ± 1.81 thousands/cumm, respectively. Percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) were the most common procedures performed in 23 (46%) and 12 (24%) patients, respectively. In 5 (10%) patients, PCNL with URSL was used. The clearance rate for different techniques ranged from 40% (PCNL with URSL) to 91.7% (URSL alone). The overall clearance rate was 78.3%. Fever (40%) and deranged renal function test requiring hemodialysis (16%) were the most common postoperative complications. Postoperatively, a significant decline in the mean Hb, serum (S.) urea, and S. creatinine was observed. The mean TLC levels showed a significant increase. During follow-up, S. creatinine levels showed consistent decline. Auxiliary procedures were needed in six (12%) cases. There were two (4%) mortalities. Conclusions: The management of urolithiasis among CKD patients requires individualized approaches. The selection of appropriate strategy results in good outcome and minimum complications. [ABSTRACT FROM AUTHOR]

Synovial sarcomas constitute 5-10% of all soft-tissue sarcomas and tend to occur in the extremities, particularly the lower extremity. Renal sarcoma is a rare entity, constituting approximately 1-5% of all malignant renal tumours. Metastatic large renal synovial sarcoma with Inferior Vena Cava (IVC) thrombus is a rare surgical challenge that demands thorough preoperative evaluation and planning for its management. A 31-year-old young male presented with symptoms of left flank pain for 10 days, with a past history of similar complaints two years prior. On examination, a massively large renal mass was palpable. A Computed Tomography (CT) scan showed an IVC thrombus and metastatic deposits. The patient underwent a radical nephrectomy with ileal segment resection, followed by chemotherapy, which showed near-complete resolution of the metastatic deposits. Renal synovial sarcoma should be considered as a differential diagnosis in young patients presenting with a metastatic, exceptionally large renal mass complicated by an IVC thrombus, necessitating thorough preoperative evaluation for effective management. [ABSTRACT FROM AUTHOR]

One in seven neonates on antenatal scan detected hydronephrosis has Pelviureteric Junction Obstruction (PUJO), making PUJO one of the most common cause of congenital urinary tract obstruction, with an incidence of one in 1000 to one in 2000 live births. Hereby, the authors present a case report of 19-year-old female who presented with pain in abdomen since, two weeks. There was no history of dysuria, haematuria. No history of lower urinary tract symptoms. No history of fever. There was no history of comorbidity. No similar episodes of pain in past. All blood investigations were within normal limits with serum creatinine of 0.78 mg/ dL. Computed Tomography (CT) Intravenous Urography (IVU) showed right ectopic kidney with Pelviureteric junction obstruction with left small atrophic kidney. Diethylenetriaminepentaacetic Acid (DTPA) reported crossed fused kidneys. Two investigations gave two different diagnoses. It made diagnosis and treatment challenging. Cystoscopy showed two ureteric orifices are normal position. Retrograde pyelogram showed left blind ureter. Right pelvic kidney was seen. Delayed drainage of contrast made diagnosis of pelvi ureteric junction obstruction. So it ruled out diagnosis of crossed fused kidneys with help of cystoscopy and retrograde pyelogram. Such anomalous kidneys are rare to find in day to day life. As anomalous kidneys usually have abnormal blood supply it makes surgery challenging. Abnormal position of kidney, malrotation makes surgery difficult. So decision was made to do open surgery for present patient. Open pyeloplasty was performed for right pelvi ureteric obstruction. Also, DTPA interpretation as anatomical investigation should be used with pinch of salt. [ABSTRACT FROM AUTHOR]

Purpose: To review our success in PCNL for managing large horse shoe kidney stones as primary treatment . Method: Between 2012 and 2016, a total of 23patients (24 renal units) underwent percutaneous renal surgery for stone dieses in horseshoe kidneys. Indications were HSK with stone more than 1 cm in size and failed ESWL. Results: Mean age was 35.60 ± 10.10 years out of which 18 were males and 5 females .One patient had stone in both kidneys. Mean stone size was 22.03 ± 10.33 mm . Access site was upper calyceal and subcostal in all patients. In 2 patients an extra middle calyceal puncture were used for total clearance (8.69%). Mean operation time was 67.22 ± 7.63 minutes. One patient with staghorn stone was converted to open surgery because of inaccessibility of the stone and complexity of the renal calyceal system. Post operatively, 2 renal units with residual stone more than 8mm were cleared with ESWL. Complete clearance was achieved in 21 renal units with PCNL (87.50%). There was no significant intra operative complication. Post operatively 2 patients developed fever which was treated conservatively(clavien grade I). Conclusion: PCNL can be recommended as first line of management in the treatment of horseshoe kidneys with large stone burden considering its higher clearance rate and minimal complications. [ABSTRACT FROM AUTHOR]

Aims: The aim is to study the clinical significance of urodynamics study (UDS) in patients of benign prostatic hyperplasia (BPH), with and without diabetes mellitus (DM) and to predict the outcome of surgical depending on UDS findings. Materials and Methods: A total of 120 BPH patients were studied and divided into two groups, BPH with DM and without DM. Initial evaluation, diagnostic tests, and urodynamic examination were done in all patients, and results were statistically analyzed. Results: There was no significant difference of age and prostate volume in both groups (P > 0.05), but there was a significant increase in symptom score in patients of BPH associated with DM (P < 0.05). Bladder outlet obstruction (BOO) was found in majority of patients in our groups (96.66%) with good detrusor function. Out of 120 patients, 6 patients (2 patient in BPH group and 4 patients in BPH with DM group) had detrusor underactivity (DU). There was a significant difference in the International Prostate Symptom Score, quality of life, peak flow rate, and postvoid residual urine, pre- to post-operatively in each group (P < 0.05). Out of the 6 patients who had DU, 4 patients (1 patient in BPH group and 3 patients in BPH with DM group) showed improvement in their flow rate and symptom score. Conclusion: DM in cases of BPH patients is not the prominent factor in deciding surgical treatment. It is the severity of BOO which determines the treatment and its outcome. UDS is an invasive and costly test and does not appear to be mandatory in clinically significant BPH even if associated with DM. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to evaluate the effect of parenteral testosterone on penile length, preputial hood, vascularity of dartos pedicle in patients with hypospadias. Materials and Methods: A total of 42 patients with hypospadias were included in this study. Injection aquaviron (oily solution each ml containing testosterone propionate 25 mg) was given deep intramuscularly in three doses with an interval of 3 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Preoperatively penile length, transverse preputial width and diameter at the base of the penis were measured. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial width and diameter at the base of penis was 1.01 ± 0.25 cm (P < 0.001), 1.250 ± 0.52 cm and 0.61 ± 0.35 cm, respectively, (P < 0.001). Serum testosterone level after injection was well within normal range for that age. Conclusion: Parenteral testosterone increased phallus size, diameter and prepuce hypertrophy without any adverse effects. However, due to lack of a control group we cannot make any inferences. Controlled studies are required to establish the benefits of parenteral testosterone. [ABSTRACT FROM AUTHOR]

Introduction: Hypospadias is a complex congenital deformity which requires meticulous surgical technique. Several techniques have been advocated during the past 150 years to address chordee and construction of neourethra. This study highlights the surgical techniques and experience with primary hypospadias cases. Materials and Methods: A total of 65 patients aged ranges from 1 to 18 years underwent primary hypospadias repair at our center from August 2007 to December 2012. Exclusion criteria - previous surgical attempt or with incomplete follow-up. Patients with inadequate phallic size and age <12 years were administered injection testosterone (Testoviron) prior to the surgery. Patients with significant chordee underwent chordee correction followed by urethral reconstruction by either tubularized incised plate (TIP) or on-lay flap repair/dartos flap repair. In all the patients, infant feeding tube was kept per urethrally for 3 weeks and was removed between the post-operative day 18th and 21st day. Results: Out of 65 patients, 24 patients underwent TIP. A total of 41 patients underwent on-lay flap repair; of this six patients of midscrotal/perineal hypospadias underwent a combination of paraurethral skin and on-lay flap repair. Chordee correction was done in all the five cases of chordee without hypospadias (congenital short urethra) and dysplastic, transparent urethra repaired with on-lay flap repair. In our study, complications like flap necrosis and fistula were seen in 10 cases and other minor complications like superficial epidermal sloughing were seen in 13 cases which healed with epithelialization. Meatal stenosis was more commonly observed with TIP (four cases) and in two cases of on-lay repair. Conclusion: Historically, hypospadias surgery was regarded as non-rewarding surgical reconstruction due to higher complication and failure rates. For hypospadias, if planned properly, primary single stage repair; acceptable surgical success is an achievable target. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment for Benign Prostatic Hyperplasia (BPH) has advanced significantly in recent years. Transurethral Resection of the Prostate (TURP) is a minimally invasive procedure associated with a low risk of complications and clinical limitations, including life-threatening Transurethral Resection (TUR) syndrome, as, well as higher costs due to longer hospital stays and challenges in managing large glands. Aim: To compare the safety and effectiveness of prostate enucleation using Holmium Laser Enucleation of the Prostate (HoLEP) with bipolar resection of the prostate in cases of BPH. Materials and Methods: A hospital-based prospective interventional study was conducted in the Department of Urology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from January 2020 to July 2022. The study included 60 patients, divided into two groups of 30 each. Males aged =45 years with recurrent Lower Urinary Tract Symptoms (LUTS) secondary to BPH, with or without Acute Urinary Retention (AUR) (drug-refractory) or with failed medical therapy (alpha-blockers, 5-alpha reductase inhibitors), were included in the study. In the first group, HoLEP was performed (Group I), while in the second group (Group II), patients underwent bipolar resection. Data were analysed and statistically evaluated using Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the HoLEP group was 60.25 years, while in the Bipolar TURP (B-TURP) group, it was 59.67 years. Both groups had similar proportions of patients with moderate urinary symptoms {International Prostate Symptom Score (IPSS)} and large prostates (>80 grams). The mean amount of irrigation fluid used (40.83±9 litres vs. 21.2±5.9 litres) and the duration of surgery (106.33±14.24 min vs. 67.4±9.73 minutes) were significantly higher in the HoLEP group compared to the B-TURP group (p-value<0.001). Postoperative catheterisation time (1.003±0.23 days vs. 2.38±0.52 days) (p<0.001) and length of hospital stay (3.2±0.65 days vs. 4.67±1.32 days) (p<0.001) were significantly longer in the B-TURP group compared to the HoLEP group. Both the HoLEP and bipolar resection of the prostate groups did not experience significant intraoperative or immediate postoperative complications; however, one patient in the HoLEP group developed urethral stricture as a late complication. Conclusion: The B-TURP procedure is an equally effective and feasible method for treating BPH patients, with a smaller learning curve and lesser financial burden. [ABSTRACT FROM AUTHOR]

The anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children; they are much rarer than posterior urethral valves. A 13-year-old male presented with obstructive and irritative lower urinary tract symptoms (LUTS). On urethrocystoscopy, an AUV with a diverticulum was noted in the ventral surface of the urethra. It was ablated endoscopically using the holmium laser. Postoperatively, the patient voided successfully without any immediate complications. AUV with diverticulum may occur in adolescents. Endoscopic holmium laser ablation of the valve and the diverticulum is associated with good outcome. [ABSTRACT FROM AUTHOR]

Context: Use of conventional double j stent with string and single loop stent with string after ureterorenoscopy. Aim: The aim of this study was to compare the use of both types of stents using the Ureteral Symptom Score Questionnaire (USSQ) and assess proximal migration. Settings and Design: This was a single institute study. Subjects and Methods: A total of 96 female patients with unilateral ureteric stones were enrolled. Patients underwent ureterorenoscopic lithotripsy, conventional double J (DJ) stent with string and single loop stent with string was placed. Before stent removal at 7–10 days, they were evaluated with X-ray kidney ureter bladder for proximal migration and USSQ for stent-related complaints. Statistical Analysis Used: Data were analyzed using Chi-square and Student's t-test. Results: In our study, Group A (DJ loop with string) had 51 patients and Group B (single J loop with string) had 47 patients. The mean stone size in group A was 10.06 mm and Group B was 9.7 mm. Both groups had one case each of early stent expulsion and none had proximal migration of the stent. Group A had two cases of urinary tract infection and Group B had one case which resolved on antibiotics. Evaluating the USSQ questionnaire in both groups, urinary symptoms such as urgency (P = 0.03), dysuria (P = 0.02), interference with life (P = 0.01), and quality impact overall (P = 0.016) were statistically significant. Evaluating pain, sleep disturbance (P = 0.04), pain at voiding (P = 0.03), and flank pain during voiding (P = 0.018) was statistically significant. In general health, difficulty with heavyweight physical activity (P = 0.02), feeling calm (P = 0.16), social life enjoyment (P = 0.26), and need for extra help (P = 0.008) was significant. In sexual matters, 13 (28%) patients in Group B had no active sex (conscious) and 6 (12%) patients had stopped intercourse due to stent-related symptoms, whereas in Group A, it was 10 (20%) and 2 (4%) patients, respectively. Conclusions: The use of a single J stent with string is an effective method, has lesser complication, and is easier to remove. [ABSTRACT FROM AUTHOR]

Aim: 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 <15 mm. Materials and Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Management of ureteric stricture especially long length upper one-third poses a challenging job for most urologists. With the successful use of buccal mucosa graft (BMG) for stricture urethra leads the foundation for its use in ureteric stricture also. A 35-year-old male diagnosedcase of left upper ureteric stricture, postureteroscopy with left percutaneous nephrostomy (PCN) in situ. Cysto-retrograde pyelography and nephrostogram done simultaneously suggestive of left upper ureteric stricture of 3 cm at L3 level. On exploration, diseased ureteral segment exposed, BMG harvested and sutured as onlay patch graft with supportive omental wrap. The treatment choice for upper ureteric long length stricture is inferior nephropexy, autotransplantation, or bowel interposition. With PCN in situ, inferior nephropexy becomes technically difficult, other two are morbid procedures. Use of BMG in this situation is technically better choice with all the advantages of buccal mucosa. Onlay BMG for ureteral stricture is technically easy, less morbid procedure and can be important choice in future. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn and large renal stones. The success of PCNL is highly related to optimal renal access. Upper calyceal puncture being more difficult and more demanding have relatively few studies presented. Aims and Objectives: This prospective study was carried out to evaluate the effectiveness and safety of upper calyceal versus lower calyceal puncture for the removal of complex renal stones through PCNL. Materials and Methods: A total of 94 patients underwent PCNL for complex renal stone in our institute. Fifty-one of them underwent lower calyceal, while 43 underwent upper calyceal puncture. The two approaches are compared as per total duration of surgery, intraoperative blood loss, infundibular/pelvic tear, rate of complete clearance and rate of postoperative complications (pulmonary, bleeding, fever and sepsis, etc.). Observation and Results: In our study, the success rate was 76.47% for those in the lower, 90.70% for those in the upper calyceal access group. Thoracic complications (hydrothorax) occurred to 1 patient in upper calyceal supracostal access group. Bleeding requiring blood transfusion happened to 5 patients in lower calyceal access and 1 in upper calyceal group. Conclusion: In our study for the management of complex renal calculi, we conclude that in a previously unoperated kidney, upper calyceal puncture through subcostal or supra 12th rib is a feasible option minimizing lung/pleural rupture and gives a better clearance rate. We suggest that with due precautions, there should not be any hesitation for upper calyceal puncture in indicated patients. [ABSTRACT FROM AUTHOR]