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Byline: Nidhi. Mahajan, Arti. Khatri, Niyaz. Khan, Natasha. Gupta Sir, Massive ovarian edema is a very rare, benign entity. There are A 7-year-old girl presented to the pediatric surgery outpatient [...]

Female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy (RC) techniques have been shown to be oncologically safe and to improve sexual function outcomes among select patients with organ-confined disease. We sought to characterize practice patterns regarding female ROS and nerve-sparing RC among US urologists.

Anorectal malformations (ARM) in females are identified by abnormal location of the anal opening. Management is guided by clinical examination to find the number of perineal openings. Two openings in the perineum of a female may be seen in cases of imperforate anus without fistula, vaginal agenesis with vestibular fistula or imperforate anus with recto-vaginal fistula (RVF). We present a case series of ARM with RVF and discuss their diagnosis and management.

Background: India announced nationwide lockdown on March 24, 2020, to control the COVID crisis. Due to lockdown, the health care system, that is, delivery and utilization of the health facilities were adversely affected.Clinical Setting: Presentation and management of nasal foreign body cases over 3 months post COVID lockdown has been discussed. Factors for delayed diagnosis and management are assessed and compared with pre-COVID era.Result/Outcome: Due to lockdown and COVID phobia, more complicated cases of nasal foreign body are presented in post lockdown period.Conclusion: We need to formulate and standardize the management strategies to avoid such unfortunate circumstances so that even non-COVID cases are managed more appropriately and in a timely manner.

This systematic review evaluates the variation in molar bite force (MBF) with the type and severity of dental malocclusion in young adults with permanent dentition.

Background: Plant-based diets are increasingly popular and have many well-established benefits for health and environmental sustainability. Our objective was to perform a systematic review of plant-based diets and prostate cancer. Methods: We performed a systematic database and citation search in February 2022. Studies were included if they reported primary data on plant-based dietary patterns (i.e., vegan, vegetarian, plant-based) and incidence among at-risk men for prostate cancer, or oncologic, general health/nutrition, or quality of life outcomes among patients with prostate cancer or caregivers. Results: A total of 32 publications were eligible for the qualitative synthesis, representing 5 interventional and 11 observational studies. Interventional studies primarily focused on lifestyle modification including plant-based diets for men on active surveillance for localized prostate cancer or with biochemical recurrence after treatment, showing improvements in short-term oncologic outcomes alongside improvements in general health and nutrition. Observational studies primarily focused on prostate cancer risk, showing either protective or null associations for plant-based dietary patterns. Studies of the vegan diet consistently showed favorable associations with risk and/or outcomes. Gaps in the current literature include impact for long-term disease-specific outcomes. Conclusions: Interventional studies showed generally favorable results of lifestyle modifications incorporating a plant-based diet with prostate cancer outcomes as well as improvements in nutrition and general health. Observational studies demonstrated either a lower risk of prostate cancer or no significant difference. These results are encouraging in light of the many benefits of plant-based diets for overall health, as well as environmental sustainability and animal welfare.

Background: The prevalence of sleep disturbances among prostate cancer (PCa) survivors, and extent of urologist involvement in sleep care are not well-studied. Methods: PCa survivors (n= 167) and urologists (n= 145) were surveyed about sleep disturbances and survivorship care practices. Results: Most PCa survivors had sleep disturbances, including 50.9% with poor sleep quality, 18.0% with clinical/severe insomnia, and 36.5% at high-risk for sleep apnea. Few urologists routinely screened for sleep disturbances, as recommended in national cancer survivorship guidelines. Conclusions: Optimal PCa survivorship care should incorporate screening for sleep disturbances, addressing comorbid factors affecting sleep and referring to sleep medicine when appropriate.

Among patients awaiting kidney transplantation (KT), sexual dysfunction is common owing to end-stage kidney disease but may improve post-KT. Leveraging a 2-center prospective study, 2422 adult KT candidates and 490 adult KT recipients (May 2014 to December 2023) were identified. Using the Kidney Disease Quality of Life Scale Short Form, participants reported on the negative impact of sexual dysfunction due to end-stage kidney disease (ie, sexual bother) at KT evaluation, admission, and post-KT follow-ups. Using mixed-effect logistic regression models, we estimated odds and trajectories for odds of sexual bother. At evaluation, 46.1% of male and 29.6% of female candidates reported sexual bother; 39.0% and 34.5%, respectively, had been sexually active in the past 4 weeks. At admission, 53.8% male and 27.0% female recipients reported sexual bother; 41.6% and 41.8%, respectively, had been sexually active in the past 4 weeks. The estimated prevalence of sexual bother decreased during the first 3 years post-KT (odds ratio per year: 0.39; 95% CI: 0.25-0.60). Sexual activity increased and peaked 1-year post-KT. At 3 years post-KT, 48.9% of male and 50.0% of female recipients were sexually active. Sexual bother is common pre-KT and improves post-KT, and sexual activity increases post-KT. Sexual health is important and should be considered during KT management.

We developed a new instrument to measure sexual health in female partners of patients with prostate cancer (Sexual Concerns In Partners of Patients with Prostate cancer [SCIPPP-F]), and found it to be valid in a diverse sample of female partners across the USA.

Aim:A maximum surgical blood order schedule (MSBOS) was implemented at our institution to optimize preoperative blood ordering and reduce unnecessary blood preparation for patients undergoing radical prostatectomy (RP), a common urologic procedure. Materials & methods:We conducted a retrospective review of patients who underwent RP from 2010 to 2016 and categorized patients by date of RP (pre- or post-MSBOS) and compared preoperative blood-ordering practices. Results:After MSBOS implementation, preoperative blood orders changed from predominantly type and cross-match 2 units (53%) to no sample (56%) for robot-assisted laparoscopic RP, and from mostly type and cross-match 2 units (62%) to type and screen (75%) for open RP with resultant cost savings. Conclusion:MSBOS implementation and compliance decreases unnecessary preoperative blood orders.

Background:Our purpose was to determine the beneficial effect of ultrasound (US) assisted lumbar puncture (UALP) to increase lumbar puncture (LP) success compared with the clinical conventional palpation (CCP) method.Methods:This parallel randomized controlled single-center trial was conducted in a Neonatal Intensive Care Unit in a tertiary care Hospital. Neonates >28 weeks requiring LP were enrolled and stratified into two groups ≥34 and <34 weeks gestational age. Prior to study initiation, training under the supervision of a qualified radiologist was undertaken. The primary outcome was successful LP (defined as no dry tap and cerebrospinal fluid RBC <1,000/mm3). Secondary outcomes were time taken for the procedure, US estimation of the point of formation of conus.Results:A total of 55 cases were randomized after exclusion out of which 29 cases were assigned to UALP and 26 cases to CCP. There was no difference in the primary outcome of LP success between the UALP group and the CCP group [89.7% vs. 84.6%; difference: 5.1% (95% confidence interval: −12.7% to 22.7%)], p= .57. There was a statistically significant difference in time taken for procedure 81.46 ± 65.21 seconds (mean ± SD) in CCP versus 327.93 ± 128.07 seconds in UALP (p< .001). Results were similar in both groups (<34 and ≥34 weeks gestational age) if analyzed separately.Conclusion:UALP did not improve the successful LP when compared with the CCP method. Time taken for procedure is higher in the UALP group.

ABSTRACTBackground Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents.Objective We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years.Methods We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12728 ob-gyn residents who graduated between academic years 2002–2003 and 2012–2013.Results The average number of cesarean sections per resident increased from 191.8 in 2002–2003 to 233.4 in 2012–2013 (17; P < .001; 95 CI −47.769 to −35.431), the number of vaginal deliveries declined from 320.8 to 261 (18.6; P < .001; 95 CI 38.842–56.35), the number of forceps deliveries declined from 23.8 to 8.4 (64.7; P < .001; 95 CI 14.061–16.739), and the number of vacuum deliveries declined from 23.8 to 17.6 (26; P < .001; 95 CI 5.043–7.357). Between 2002–2003 and 2007–2008, amniocentesis decreased from 18.5 to 11 (P < .001, 95 CI 6.298–8.702), and multifetal vaginal deliveries increased from 10.8 to 14 (P < .001, 95 CI −3.895 to −2.505). Both were not included in ACGME reporting after 2008.Conclusions Ob-gyn residents' training experience changed substantially over the past decade. ACGME obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills.

Patient-level risk factors for delayed graft function (DGF) have been well described. However, the Organ Procurement and Transplantation Network definition of DGF is based on dialysis in the first week, which is subject to center-level practice patterns. It remains unclear if there are center-level differences in DGF and if measurable center characteristics can explain these differences.

Background: Mixed cortico-medullary adrenal carcinoma (MCMAC) is an extremely rare entity with scarce literature on its cytomorphology. Case presentation: A 2-year-old girl presented with abdominal pain for 3 days and a past history of fever with significant weight loss. On examination, a non-tender left hypochondrial firm mass and an enlarged left supraclavicular node were found. Twenty-four-hour urinary levels of VMA were marginally high. Contrast-enhanced computed tomography of the abdomen showed a suprarenal heterogeneous mass encasing major vessels. Aspiration cytology of both mass and node showed similar features comprising a predominant population of singly scattered large cells with moderate cytoplasm, eccentric nucleus and prominent nucleolus in a necrotic background. Tumour cells expressed Synaptophysin and Melan-A. In view of increasing respiratory distress, debulking surgery was performed, and histopathology of the specimen revealed the presence of both malignant medullary and cortical components supported by immunohistochemistry making a final diagnosis of MCMAC. The patient succumbed to death in the postoperative period. The cytology slides were reviewed and were seen to show a dual cell population. Conclusion: Coexistent malignant cortical and medullary tumour of the adrenal gland is the first case reported in the paediatric age group in the literature with only three previous case reports in adults.

Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage.

Ovarian vein thrombosis (OVT) is an extremely rare but life-threatening complication of the postpartum period. It has never been reported as a complication of laparoscopic surgery. We report a case of right ovarian vein thrombosis that occurred in the postoperative period after patient underwent laparoscopic salpingectomy for a right side ectopic pregnancy. She presented with 1-week history of abdominal pain and fever. A complete workup for fever was performed and was found negative. Computed tomography of the abdomen and pelvis revealed right ovarian vein thrombosis. The patient was treated with anticoagulant therapy and responded well.

Placenta percreta in early pregnancy is an extremely rare but life-threatening complication, for which very few cases have been reported in the literature worldwide, none from the United States. We report a patient with two previous cesarean deliveries, who presented with incomplete abortion at 17 weeks and underwent dilatation and curettage. She was found to have retained, adherent placenta that led to extensive hemorrhage, requiring emergency supracervical hysterectomy. Postoperative course was also complicated by severe consumption coagulopathy, necessitating reexploration after hysterectomy. Pathology revealed a placenta percreta. Patient lost more than 8000 cc blood through the 2 surgeries, received massive transfusions due to severe disseminated intravascular coagulopathy (DIC), and underwent a complicated surgery because of great difficulty in separating lower uterine segment and cervix from the bladder. Abnormal placentation in early pregnancy has increased in prevalence due to marked rise in cesarean deliveries and curettages in recent decades. We reviewed all reported cases of first and second trimester placenta percreta in the literature, to emphasize the early recognition of abnormal placentations in patients with risk factors, consider prenatal evaluation in such patients, anticipate complicated placental implantations during termination procedures, and prevent associated maternal morbidity and mortality.

Ovarian pregnancy is a rare variant of ectopic pregnancy, and an accurate preoperative diagnosis is very challenging. Dr. Saint Monnissey described the first reported case of ovarian pregnancy in 17th century. Transvaginal ultrasonography is a valuable tool in identifying an ovarian pregnancy from other types of ectopic pregnancies. Management with laparoscopy or laparotomy is required in all cases, and in almost all cases, ovary can be preserved since implantation is usually superficial (Koo et al.; 2011). A single case of an ovarian pregnancy, consistent with Spiegelberg’s criteria is presented here. This case history demonstrates the use of ultrasonography (USG) and surgery in the diagnosis and treatment, respectively, of the ovarian pregnancy. As we step into an era where in vitro fertilization rate is on its hike, one should be aware that incidence of ovarian pregnancy is also increasing, necessitating a high index of suspicion.