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Byline: Swadeep. Srivastava, Debansu. Sarkar, Dilip. Pal Introduction: Reconstruction of fossa navicularis stricture (FNS) poses a challenge in providing acceptable functional and cosmetic outcomes. We describe our novel surgical technique [...]

Introduction: Recent studies have shown a high prevalence of depression and anxiety in patients with end-stage renal disease (ERSD) and renal transplant recipients. Aim: The aim of this observational study is to asses prevalence of depression and anxiety symptoms in CKD patients and post renal transplant patients. Methods: In this study 100 patients divided in 50–50 each group. Group 1 with CKD patients on dialysis and group 2 with post renal transplant patients. Each group evaluated for depression and anxiety symptoms using BDI (Beck's Depression Inventory) and STAI (State-Trait Anxiety Inventory) score which is divided into STAI-X1 and STAI-X2, respectively. Results: Our study revealed in group 1 48% patient versus group 2 34% patients present with depressive symptoms whereas in case of anxiety symptoms STAI-X1 and STAI-X2. Group 1 24% and 18% whereas group 2 34% and 28% patients, respectively. Conclusion: It is observed that depressive symptoms are more common in CKD patients on dialysis whereas anxiety symptoms observed more in patients after renal transplant. The obtained results indicate that screening tests and monitoring of the emotional state of patients with CKD are necessary, regardless of the disease stage and treatment; this includes patients after kidney transplantation. [ABSTRACT FROM AUTHOR]

Objective: This is a prospective randomized study with the aim of comparing (thulium laser enucleation of the prostate (ThuLEP) and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) treatment. Methods: Patients are assessed preoperatively and up to 6 months postoperatively. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rates (Qmax), international index of erectile function-5 (IIEF-5) and post-void residual volume (PVR) are collected on each follow-up. Results: In comparison to TURP, the ThuLEP group has significantly less need for catheter traction and less need for postoperative irrigation. The operative time is significantly higher in ThuLEP compared to TURP. ThuLEP is significantly superior to TURP in terms of early catheter removal, less drop in haemoglobin, less fall in serum sodium level, and early hospital discharge. ThuLEP and TURP resulted in a significant improvement from baseline in terms of IPSS, PVR, Qmax, and QoL, but there was no significant difference between the 2 groups. The IIEF-5 is the same as the baseline in both groups. Early and late complications are also comparable. Conclusion: The ThuLEP outperforms TURP in terms of blood loss, significantly less need for postoperative catheter traction, bladder irrigations, early catheter removal, and less hospital stay. Transurethral resection of the prostate takes longer operative time in the early stages of experience. The results of both surgeries are comparable in terms of PVR, Qmax, and subjective scoring systems (IPSS, QoL). Transurethral resection of the prostate is a safe and efficient BPH treatment method comparable to the monopolar TURP. [ABSTRACT FROM AUTHOR]

Background: PCNL outcomes among urologists are different because of the vast heterogeneity in the methods for clinical, academic characterisation and evaluation of surgical outcomes of nephrolithiasis. So assessing the preoperative factors that affect SFR (Stone Free Rate) and complications is critical. Heterogeneity in reporting of PCNL outcomes among different centres has led to the invention of nephrolithotomy scoring systems based on preoperative parameters to better counsel patients contemplating PCNL. The Guy's stone score, CROES nomogram and the S.T.O.N.E score are seen as predictors of stone-free status (SFS) and complications after PCNL. No universally accepted stone scoring system for predicting SFR and complications after PCNL exists. This is a prospective observational study to compare and analyse the existing stone scoring systems (SSS) and to assess the best parameters to predict PCNL outcomes concerning SFR and complications. Methods: This study is done in a tertiary level institute in eastern India which included 200 patients who underwent PCNL from November 2019 to November 2021. The relevant operative parameters were documented and compared to the preoperative factors with the help of nephrolithotomy scoring systems. Results: The Guy score, CROES nomogram and S.T.O.N.E. score were accurate in predicting the SFR in patients undergoing PCNL. A new IPGMER preoperative stone scoring system based on the most relevant parameters could be used as an alternative to predict SFR and complications in PCNL. Conclusion: The Nephrolithometry scoring systems are simple, straightforward and easily reproducible systems to classify the severity of nephrolithiasis and to stratify the complexity of PCNL. [ABSTRACT FROM AUTHOR]

Objectives: Evaluation of safety, efficacy, and feasibility of emergency extracorporeal shockwave lithotripsy (eESWL) in combating obstructing stones with colic on emergency basis. Materials and methods: From November 2019 to November 2021, 102 subjects underwent emergency ESWL for obstructing ureteric and renal stones with colic within 24 h of presentation. Results: Patients in this study belonged to age group of 18–67 years with mean being 39 years consisting of 85 males and 22 females (M:F = 85:22). Mean stone dimensions were 8.26 mm in length and 7.65 mm in width. A total of 42 patients had their stone in kidney or upper ureter while 24 patients had stone in mid ureter and remaining patients (n = 36) had stone in lower ureter. About 65 patients had their stone completely cleared after single ESWL session while 20 patients required multiple sessions to achieve complete clearance. Of these 17 patients (16.67%) were not rendered stone free even after three sessions and had to undergo ureteroscopic lithotripsy (URSL). Overall Stone Free Rate (SFR) was 83.33%. For stone attenuation of ⩽900 HU, SFR was 97.18% while for >900 HU it was only 51.61%. Conclusion: eESWL is safe, feasible, and efficacious noninvasive alternative for definitive management of obstructing ureteral and renal stones with colic as far as stone clearance and rapid and definitive pain relief are concerned and that too with very minimal morbidity without the need for admission and hence can reduce the prolonged waiting period for endoscopic stone surgery in any high-volume tertiary care hospital. Length, width, and attenuation of stone were found to be the main factors dictating the success of eESWL. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer development and progression to androgen-independent disease is correlated with increased expression of growth factors and receptors capable of establishing autocrine and/or paracrine growth-stimulatory loops. Overexpression of the Her2/neu receptor tyrosine kinase has been associated with the progression to androgen independence in prostate cancer cells. Objective: Our primary aim was to investigate the frequency of HER2/neu amplification in prostate biopsy specimens in newly diagnosed metastatic carcinoma prostate and its correlation to progression of androgen independent carcinoma. Materials and Methods: In our study, expression of HER2/neu was carried out by immunohistochemical analysis in TRUS biopsy specimen of newly diagnosed metastatic carcinoma prostate. Results: Out of 36 patients, seven (19.4%) showed her2neu overexpression on immunohistochemical staining. Five out of seven (71%) were associated with higher histological grade >7 at diagnosis (p < 0.05). Her2neu overexpression was not significantly associated with age and serum PSA at diagnosis. However progression to castration resistant stage was not dependant on Her2/neu status (p > 0.05). Conclusion: Overexpression of her2/neu was associated with high grade carcinoma prostate at diagnosis, however progression to castration resistant stage was not related with her2neu expression. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of extracorporeal shockwave lithotripsy (ESWL) in supine trans-abdominal approach for distal ureteric calculi and to determine the variables that could affect the outcome results. Materials and methods: Between November 2019 and January 2021, 172 patients with a solitary distal ureteric calculus were treated with ESWL in supine position with a pronated shock wave head against the anterior abdominal wall. The outcome of treatment evaluated and the clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone-free rate (SFR). Results: Overall SFR was 84.84% (140/165). Those with stone clearance, 83.57% (117/140) cleared after one session and 16.42% (23/140) needed more than one session. Only three factors had a significant impact on SFR, that is stone length, stone width, stone attenuation. For stone length ⩽ 9 mm SFR was 93.44% (114/122) compared to 60.46% (26/43) for stone length of 10–12 mm (p < 0.00001). There were statistically significant increased SFR for stones with attenuation of <0.0001 and for the mean stone width of 8.02 mm (p < 0.00001). Stone localisation was easy with good patient comfort. Conclusion: Supine trans-abdominal ESWL is a new, effective and safe form of treatment for distal ureteric calculi. The stone length, stone width along with stone attenuation were the only significant predictors of stone free status in supine position. [ABSTRACT FROM AUTHOR]

Introduction: Lower Urinary Tract Symptoms (LUTS) in association with Benign Prostatic Hyperplasia (BPH) are common in elderly males. Almost half of this age group over fifth-decade of age complain of moderate to severe degree of LUTS which impedes their Quality of Life (QoL). Aim: To assess the QoL in patients with LUTS due to BPH and compare the outcomes on modified BPH-QoL scale and International Prostate Symptom Score (IPSS) scale. Materials and Methods: An observational study was conducted from November 2019 to November 2020. A total of 400 men were selected for the study. The responses on both the scales (IPSS and BPH specific QoL scale) were noted and the total score was calculated. The BPH-specific QoL was compared with the IPSS scale by using the Pearson coefficient relation test. Results: Most men were in age group 50-60 years with median age of 58 years. The correlation of BPH-specific QoL scale questions with QoL question of IPSS was found to be statistically significant. The correlation coefficients of BPH-specific QoL questionnaire were found to be r =0.560 (p<0.0001) with the total IPSS and r=0.376 (p<0.0001) with the QoL score of IPSS. The reliability i.e., Cronbach’s alpha for BPH specific QoL was 0.879. Adverse symptoms of BPH in the form of fear of cancer and fear for surgery were noted while conducting the study. Conclusion: The correlation of BPH specific QoL scale and IPSS was found to be statistically significant. BPH specific QoL scale is very useful and more comprehensive in addressing the QoL in patients with LUTS due to BPH than the IPSS scale. The BPH specific QoL scale was brief and easy to administer. It is the first study in India to use the BPH specific QoL scale to assess QoL and compare it with IPSS. [ABSTRACT FROM AUTHOR]

Introduction and objective: Nephrectomy leads to derangement of renal function and various adaptive changes by the remaining kidney over a period of time. This study is performed to evaluate the amount of derangement of renal function in donor and radical nephrectomy, how much the remaining kidney adapts over a period of time and the time taken for stabilisation of renal function. Method: A total of 60 patients who underwent nephrectomy (Radical/Donor) were followed up for 12 months with serial estimation of renal function and was compared with preoperative renal function. Data was analysed with statistical analysis. Result: Patients who underwent radical nephrectomy had 37% initial decline in renal function which was later stabilised at 19% lower than baseline value. Patient who underwent donor nephrectomy had initially 39% decline in renal function which was later stabilised at 24% lower than normal. Conclusion: Removal of functional renal tissue led to reduction of renal function. This decline is more evident in the initial post-operative period and then begin to stabilise over months. The greater is the amount of normal tissue removed, the greater is the reduction of renal function and more time it will take to stabilise, increasing overall morbidity of the patient. This study suggests that even patients with normal GFRs should be followed up postoperatively to determine their ultimate renal functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Adrenocortical carcinoma is a rare malignancy and even rarer in infancy. Most of these tumors in the pediatric age group are hormonally active and predominantly present with virilization. We report a case of a 1-year-3-month-old female child presenting with virilization. She presented with hypertension, hypertrichosis, clitoromegaly (virilization), and elevation of plasma testosterone and dehydroepiandrosterone. A discussion of this case and a review of the literature on this entity are presented., (Copyright © 2024 Copyright: © 2024 Indian Journal of Pathology and Microbiology.)

Background: The presence of distant metastasis is known to drastically reduce survival of adrenal pheochromocytoma (PH) and extra-adrenal paraganglioma (PGL). Therefore, predicting malignant potential has an immense impact on prognosis. Pheochtomocytoma of adrenal gland scaled score (PASS) and the grading of adrenal pheochromocytoma and paraganglioma (GAPP) score are two histological algorithms used to predict metastatic potential, but neither has been regarded as 'gold-standard'. Both these scoring systems are yet to be validated. Here, we tried to validate the association of GAPP/PASS scores with disease outcome and strength of association between individual GAPP/PASS parameters with prognosis., Materials and Methods: This was a prospective study comprising 22 pheochromocytomas and eight paragangliomas. GAPP score was calculated in paraganglioma cases, and both GAPP/PASS scores were calculated for pheochromocytomas. Disease outcome was then tallied with risk stratification of the GAPP/PASS scoring system. Succinate dehydrogenase B (SDHB) immunohistochemistry was done in 15 cases to see its impact on prognosis., Results: The common PASS parameters associated with malignancy were 'high cellularity', 'tumor cell spindling' and 'extension into adipose tissue'. PASS score showed high sensitivity and negative predictive value but low specificity and positive predictive value. Similarly, GAPP score also showed high sensitivity and negative predictive value but low specificity and positive predictive value., Conclusion: In our study, GAPP/PASS scores successfully segregated tumor with low malignant potential from tumor with higher risk of metastasis, although specificity of GAPP was more than PASS. We also found that addition of objective parameters like SDHB immunohistochemistry may further increase the specificity of the existing scoring system., (Copyright © 2024 Copyright: © 2024 Indian Journal of Pathology and Microbiology.)

Introduction Androgens play a key role in modulating periurethral and preputial vascularity, cavernosal smooth muscle integrity, and penile growth. As a result, low testosterone may adversely affect the severity and outcome of urethral stricture patients. So, to find out the hormonal influence on the clinical outcome of urethral stricture we conducted a prospective longitudinal study at our institute. Methods The study was conducted at the Department of Urology, Institute of Post Graduate Medical Education & Research (IPGMER), Kolkata, India, from February 2023 to September 2023. This study was approved by the Institutional Ethics Committee at IPGMER, Kolkata with the approval number IPGMER/IEC/2023/436. Hormonal levels in patients with diagnosed non-traumatic urethral stricture were compared with patients without stricture. Patients with any overt hormonal abnormality or androgen-secreting tumor were excluded. A morning 10 cc blood sample was collected for testosterone, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone. The association of hormonal levels was measured in both groups and compared statistically. Any association of hypogonadism (testosterone <300 ng/dL) with respect to length, severity, and recurrence of urethral stricture was also studied. Results Forty patients with urethral stricture and same number of patients without stricture were included in the study. The mean testosterone level was found to be significantly low in patients with stricture (386 ng/dL vs 660 ng/dL). The age-wise distribution also showed low mean testosterone compared to patients without stricture. The incidence of hypogonadism is also found to be higher in stricture patients (47.5% vs 27.5%). It was also observed low testosterone is more prevalent in pan-anterior stricture (10/40) and long-segment stricture(>2 cm). Patients with stricture were also followed up for 6 months for recurrence of symptoms. Thirteen patients had recurrence. Patients with recurrence had significantly low serum testosterone (272 ng/dL vs 440 ng/dL). Conclusion Our study documented stricture patients with low serum testosterone have poor outcomes. Low testosterone level is strongly associated with longer stricture and increased risk of stricture recurrence., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mondal et al.)

Objective: This is a prospective randomized study with the aim of comparing (thulium laser enucleation of the prostate (ThuLEP) and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) treatment., Methods: Patients are assessed preoperatively and up to 6 months postoperatively. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rates (Qmax), international index of erectile function-5 (IIEF-5) and post-void residual volume (PVR) are collected on each follow-up., Results: In comparison to TURP, the ThuLEP group has significantly less need for catheter traction and less need for postoperative irrigation. The operative time is significantly higher in ThuLEP compared to TURP. ThuLEP is significantly superior to TURP in terms of early catheter removal, less drop in haemoglobin, less fall in serum sodium level, and early hospital discharge. ThuLEP and TURP resulted in a significant improvement from baseline in terms of IPSS, PVR, Qmax, and QoL, but there was no significant difference between the 2 groups. The IIEF-5 is the same as the baseline in both groups. Early and late complications are also comparable., Conclusion: The ThuLEP outperforms TURP in terms of blood loss, significantly less need for postoperative catheter traction, bladder irrigations, early catheter removal, and less hospital stay. Transurethral resection of the prostate takes longer operative time in the early stages of experience. The results of both surgeries are comparable in terms of PVR, Qmax, and subjective scoring systems (IPSS, QoL). Transurethral resection of the prostate is a safe and efficient BPH treatment method comparable to the monopolar TURP.