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Introduction: Transrectal rectal ultrasound (TRUS)-guided systematic biopsy is the gold standard for diagnosis of prostate cancer. However, systematic biopsy has high false-negative rate and often misses anteriorly located tumors. Magnetic resonance imaging (MRI)-TRUS fusion biopsy can potentially improve cancer detection by better visualization and targeting of cancer focus. We evaluated the role of fusion biopsy in detection of prostate cancer and the association of prostate imaging reporting and data system (PI-RADS) score for predicting cancer risk and its aggression. Methods: Ninety-six consecutive men with suspected prostate cancer underwent MRI-TRUS fusion-targeted biopsy of suspicious lesions and standard 12 core biopsy from May 2014 to July 2015 in our institution. All patients underwent 3.0 T multiparametric MRI before biopsy. mp-MRI included T2W, DWI, DCE and MRS sequences to identify lesions suspicious for prostate cancer. Suspected lesions were scored according to PI-RADS scoring system. Comparison of cancer detection between standard 12 core biopsy and MRI-TRUS fusion biopsy was done. Detection of prostate cancer was primary end point of this study. Results: Mean age was 64.4 years and median prostate-specific antigen was 8.6 ng/ml. Prostate cancer was detected in 57 patients (59.3%). Of these 57 patients, 8 patients (14%) were detected by standard 12 core biopsy only, 7 patients (12.3%) with MRI-TRUS fusion biopsy only, and 42 patients (73.7%) by both techniques. Of the 7 patients, detected with MRI-TRUS fusion biopsy alone, 6 patients (85.7%) had Gleason ≥7 disease. Prostate cancer was detected on either standard 12 core biopsy or MRI-TRUS fusion biopsy in 0%, 42.8%, 74%, and 89.3% patients of suspicious lesions of highest PI-RADS score 2, 3, 4, and 5, respectively. Conclusions: MRI-TRUS fusion prostate biopsy improves cancer detection rate when combined with standard 12 cores biopsy and detects more intermediate or high-grade prostate cancer (Gleason ≥7). With increasing PI-RADS score, there is an increase chance of detection of cancer as well as its aggressiveness. [ABSTRACT FROM AUTHOR]

Introduction: With the improvement in anastomotic technique, it is rare to find anastomotic site leak after robot‑assisted radical prostatectomy (RARP). It may not always be necessary to do regular check cystogram before catheter removal. We evaluated our 230 consecutive RARP patients and their cystograms to determine the indications for selective use of cystogram before catheter removal. Materials and Methods: We reviewed our prospectively collected RARP database of 230 consecutive patients. Cystography was performed at low pressure by gravity instillation of diluted contrast through the catheter. Patients were observed under fluoroscopy in lateral oblique position for any contrast leak at the site of anastomosis. All patients were followed for a minimum of 6 months, and the longest follow-up was 5 years. Results: A total of 207 patients (90%) underwent catheter removal on postoperative day 7. Nine patients (3.9%) had extravasation on initial cystogram. Two patients with leak had a history of transurethral resection of prostate (TURP) and seven other had bladder neck reconstruction for wide bladder neck. Three patients with minimal leak did not require catheter replacement. In rest of the 6 patient with leak, continued catheter drainage was done. No significant difference in the intraoperative variables, blood loss, duration of drain, length of hospital stay, and continence outcomes was noted between the patients with leak compared to rest of the patients. None of the patient needed any procedure/intervention related to the surgery and none developed bladder neck stenosis. Conclusion: In usual circumstances, catheter removal can be done safely on a postoperative day 7 without routine cystography. Selective use of check cystogram can be done in the case where bladder neck reconstruction is performed or those had a prior TURP and a wide bladder neck. [ABSTRACT FROM AUTHOR]

Introduction: Many healthy elderly Indian men seek surgical treatment for localized prostate cancer. Quite often, radical surgery is not offered to the patients over 70 years of age due to the perception of increased side‑effects and complications. We have previously reported our results of robotic radical prostatectomy in a study comprising 150 Indian patients, where almost a quarter of patients were elderly. This subgroup analysis was therefore focused on evaluating perioperative and continence outcomes in elderly men (≥70 years) with localized prostate cancer. Materials and Methods: Between April 2010 and August 2013, 153 men had robot‑assisted radical prostatectomy performed by two surgeons. Of the 150 men analyzed, 39 (26%) were aged ≥70 years. All patients underwent robotic prostatectomy using a 4 arm da Vinci surgical system. Pre‑operative, intraoperative and post‑operative parameters were studied. Check cystogram was performed in all patients prior to catheter removal. Complications were categorized using the Clavien‑Dindo classification system. Continence was defined as use of “no pad” or security liner only. All data were recorded prospectively and analyzed using SPSS version 20. Results: There were no significant intraoperative or perioperative complications in this group. Median blood loss during surgery was 150 mL. None of the patient required blood transfusion. There were two minor complications (5.1%) within the first 30 days of surgery: Minimal anastomotic site leak (one patient) requiring replacement and prolongation of Foley's drainage by 1 week and ileus (one patient). No patient had any cardiopulmonary or vascular complications in the post‑operative period. The median duration of hospital stay was 3 days. The median duration of catheterization was 7 days. No patient had problem of bladder neck stenosis in the follow‑up period. At 1 month, 3 months, 6 months and 1 year of follow‑up, 66.7% (n = 26), 74.3% (n = 29), 87.9% (n = 34) and 94.8% (n = 37), respectively, were continent. Conclusions: Robotic surgery is safe and feasible in a select group of elderly patients. It has acceptable and minimal perioperative complications along with good continence outcome. [ABSTRACT FROM AUTHOR]

Introduction: Urinary continence is an important outcome parameter after robot assisted radical prostatectomy (RARP). We evaluated the continence outcomes following RARP using a double-layered urethrovesical reconstruction. Materials and Methods: One hundred fifty consecutive patients undergoing RARP and double-layered urethrovesical reconstruction were prospectively studied for preoperative, intraoperative and post operative parameters. Key points followed during surgery were: Minimal dissection of sphincteric complex, preservation of puboprostatic ligament, selective ligation of deep venous complex and both posterior and anterior reconstruction using the Von Velthoven stitch. Intraoperative bladder fill test was done at the end of anastomosis to rule out urine leak. Check cystogram was done prior to catheter removal in the outpatient department. Patients were subsequently followed at regular intervals regarding the status of urinary continence. All patients irrespective of adjuvant therapy were included in the analysis. Results: The mean age was 64 years (standard deviation ± 6.88), and mean serum PSA was 20.2 ng/ml. The mean BMI was 25.6 (SD: ±3.84). The mean prostate weight was 44.09 gm (range 18-103 gm, SD: ±15.59). Median days to catheter removal after surgery was 7 (range 4-14 days) days. Cystographically determined urinary leaks were seen in two patients. Urine leak was managed by delaying catheter removal for 1 week. Minimum 6 month follow up was available in 126 patients. 'No pad' status at 1 week, 1 month, 3 months, 6 months and 1 year was 15.1%, 54.9%, 78%, 90.5% and 94.1%, respectively. Conclusion: Excellent continence outcomes are observed in patients undergoing double-layered urethrovesical reconstruction. [ABSTRACT FROM AUTHOR]

Transurethral resection of prostate (TURP) has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE), but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP), the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP), photo-selective vaporization of prostate (PVP), etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (>60 g). For extremely large glands (>150 g), HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient's comorbidities and surgeon's expertise. [ABSTRACT FROM AUTHOR]

Objectives: To assess the accuracy of Gleason grading/scoring on preoperative needle core biopsy (NCB) compared to the radical prostatectomy (RP) specimen. Materials and Methods: Data of NCB and RP specimens was analyzed in 193 cases. Gleason grade/scoring was done on both NCB and RP specimens. Sixteen cases were excluded for various reasons. The Gleason scores of the two sets of matched specimens were compared and also correlated with the PSA, age, and number of needle biopsy cores. The overall change was also correlated with the initial score on NCB. Results: The mean age and PSA were 63.3 ± 2(5.27) years and 18.48 ± 2(28.42) ng/ml, respectively. The average Gleason score increased from 5.51 ± 2(1.52) to 6.2 ± 2(1.42) ( P < 0.02). The primary grade increased in 57 (32.2%) cases. Overall, 97 (54.8%) cases had an increase in Gleason score. Five other cases had a change from 3 + 4 = 7 to 4 + 3 = 7. Change in Gleason score was significantly more if the score on NCB was ≤ 6 or number of needle cores was ≤ 6. Besides, 28 cases had perineural invasion, 16 had capsular invasion (pT3a), and 4 had vascular invasion on RP specimen. Conclusions: There is a significant upgrading of Gleason score on RP specimens when compared with NCB. This trend may be correlated positively with lower initial Gleason score on preoperative biopsy and the lower number of cores taken. [ABSTRACT FROM AUTHOR]

Purpose of Review: A cooperative patient is essential in maintaining stone targeting for optimal fragmentation during extracorporeal shock wave lithotripsy (ESWL). Therefore, it is important to choose an appropriate analgesic with minimal adverse effects. The guidelines for pain management during ESWL have not been established. Current Status: Various analgesic agents including opioids (morphine, pethidine, and fentanyl), nonsteroidal anti-inflammatory drugs (NSAIDS - diclofenac, propofol, ketorolac, and piroxicam), local anesthetic agents and a number of combinations have been used during ESWL by various techniques (general anesthesia, regional anesthesia, subcutaneous and intravenous injections, patient-controlled analgesia, and monitored anesthesia care). Cutaneous creams like eutectic mixture of local anesthesia (EMLA) whether used alone or in combination with oral NSAIDS have also been used and are able to reduce analgesic requirements. Topical application of a combination of dimethyl sulfoxide and lidocaine has also been found to be effective. Conclusion: The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine) offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects. [ABSTRACT FROM AUTHOR]

Objective: To understand role of mitochondrial (mt) mutations in genes regulating oxidative phosphorylation (OXPHOS) in pathogenesis of male infertility. Infertility affects approximately 15% of couples trying to conceive. Infertility is frequently attributed to defects of sperm motility and number. Mitochondrion and mitochondrial DNA (mtDNA) play an important role in variety of physiological process. They control the oxidative energy supply and thus are central to growth, development and differentiation. Mitochondrial function is controlled by a fine-tuned crosstalk between mtDNA and nuclear DNA (nDNA). As mitochondria supply energy by OXPHOS, any mutation in mtDNA disrupts adenosine triphosphate (ATP) production and thus result in an impaired spermatogenesis and impaired flagellar movement. As sperm midpiece has few mtDNA copies, thus enhanced number of mutant mtDNA results in early phenotypic defect which manifest as spermatogenic arrest or asthenozoospermia. Oxidative stress and mtDNA mutations are positively correlated and mutations in mitochondrial genome (mt genome) are implicated in the lowered fertilising capacity of the sperm and affects the reproductive potential of an individual. Materials and Methods: A thorough review of articles in the last 15 years was cited with reference to the below-mentioned keywords. The articles considered discuss the role of mt genome in the normal functioning of sperm and the factors associated with mt mutations and impact of these mutations on the reproductive potential. Results: Sperm motility is a very important factor for the fertilisation of ova. The energy requirements of sperm are therefore very critical for sperm. Mutations in the mitochondrial genes as COX II, ATPase 6 and 8 play an important role and disrupts ATP production affecting the spermatogenesis and sperm motility. Therefore, the aberrations in mt genome are an important etiopatholgy of male infertility. Conclusion: In the context of male infertility, mt mutations, generation of reactive oxygen species and lowered antioxidant capacity are interlinked and constitute a unified pathogenic molecular mechanism. In the era of assisted reproduction technique (ART), it is very important to distinguish between mutations in nuclear and mitochondrial genomes in sperm, as mtDNA mutations are better diagnostic and prognostic markers in infertile men opting for ART. [ABSTRACT FROM AUTHOR]

We present the outcomes of a large series of patients treated with radical cystectomy and pelvic lymphadenectomy for transitional cell carcinoma of bladder. Materials and Methods: A total of 502 patients underwent radical cystectomy (RC) for bladder cancer from 1992 till December 2006. Of these, 432 patients with primary transitional cell carcinoma of bladder underwent RC with bilateral pelvic lymphadenectomy with a curative intent. The clinical course, pathologic characteristics and long-term clinical outcomes were evaluated in this group of patients. Results: The median follow-up was 62 months. There were 30 (6.9%) perioperative deaths and 111(25.7%) early complications. The recurrence-free survival (RFS) and overall survival (OAS) were 66% and 62% at five years and 62% and 40% respectively at 10 years. The RFS and OAS were significantly related to the pathological stage and lymph node status with increasing pathological stage and lymph node positivity associated with higher rate of recurrence and worse OAS (P < 0.001). A total of 145 patients (33.5%) developed bladder cancer recurrence. Of these, 40 (27.6%) developed local pelvic recurrence and 105 patients (72.4%) developed distant recurrence. The median time to local and distant recurrence was 12 and 16 months respectively. Conclusion: The clinical results reported from this large group of patients demonstrate that radical cystectomy provides good survival results for invasive bladder cancer patients with low incidence of pelvic recurrence. [ABSTRACT FROM AUTHOR]

Bisphosphonates are a relatively newer class of drugs which have been used for the prevention of skeletal related complications of age related osteoporosis or metastatic disease from carcinoma breast or multiple myeloma. Their role in the management of prostate cancer is still under evolution. We hereby review the ongoing and some published randomized trials to define the role of bisphosphonates in various stages of prostate cancer. [ABSTRACT FROM AUTHOR]

Objectives: Men with nonobstructive azoospermia may father a child through intracytoplasmic injection of testicular sperms. This can result in transmission of genetic defects such as Y chromosome microdeletions which primarily caused the infertility and occur in up to 55% such men. It may not be feasible to screen all patients for Y chromosome microdeletions due to the cost and technical difficulty. A correlation with existing markers such as follicle stimulating hormone (FSH) and testicular histology may help identify a subgroup for screening. We therefore studied the association between regions of azoospermia factor (AZF) deletion, testicular histology and serum FSH level in men with nonobstructive azoospermia. Materials and Methods: One hundred and nine men presenting with primary infertility and diagnosed as nonobstructive azoospermia based on standard guidelines were included in the study. Fasting blood sugar, serum FSH, testosterone and prolactin estimation was done and testicular fine needle aspiration biopsy was performed where clinically indicated. Patients with normal karyotype on standard Q banding (n=82) were evaluated for microdeletions in the Y chromosome. Eight AZF loci which mapped to interval 5 and 6 of the Y chromosome were evaluated. Results: Microdeletions were found in seven of 82 men with normal karyotype (8.5%). Three patients had deletions in both AZFa and AZFb regions with Sertoli cell only (SCO) histology. Two had AZFc deletion with hypospermatogenesis and maturation arrest in one each. Two patients had cryptorchidism. FSH levels were higher (mean 38.77 mIU/ml) in patients with deletions in the AZFa and AZFb regions than in those with AZFc deletions (mean 5.86 mIU/ml). In patients without a deletion, FSH was higher in the group with SCO (mean 18.28 mIU/ml) compared to those with hypospermatogenesis or maturation arrest (mean 6.83 mIU/ml). Conclusions: Serum FSH is raised in patients with severely depleted germ cell function, irrespective of the presence or absence of a microdeletion. The levels may correlate with the region of deletion in that the patients with AZFa and AZFb deletion had a sertoli cell only picture on histology and raised FSH. [ABSTRACT FROM AUTHOR]

Varicoceles are variably considered the commonest 'correctable' cause of male infertility or the commonest 'over-reported' cause of infertility, depending on the individual viewpoint. This dichotomy has resulted from a lack of clear understanding of the effect of varicoceles on spermatogenesis and an absence of well-designed trials to evaluate the outcomes. This is coupled with surgery in unclear indications and sometimes by surgeons with limited surgical skills who assume that the surgery can cause no harm. A recent debate on 'Are we overdoing varicocelectomies' that was initiated by the Urological Society of India at its annual meeting in 2006 prompted us to review the recent developments in the fields of pathogenesis and surgical technique and the issue of 'overdoing' varicocelectomies. A review of recent literature on the subject was performed. There is an increasing body of evidence pointing towards the role of reactive oxygen species (ROS) and oxidative stress in the pathogenesis of varicocele related subfertility. This has been found in studies evaluating both direct and indirect markers of oxidative stress. Apoptosis and DNA fragmentation may be the end effectors of ROS induced damage. Other proposed etiologic factors are tissue hypoxia and hormonal imbalances. Among the various therapeutic options for varicoceles, microsurgical ligation has the best results with minimal complications. Loupe magnification may be an acceptable alternative in case of non availability of expertise with microsurgery or the microscope itself. The anatomical reasons for this and the studies on which this conclusion is based are reviewed. Finally, we discuss the problem of too many varicocele surgeries and its possible demerits. We also review the current guidelines and the need for proper case selection before surgery. [ABSTRACT FROM AUTHOR]

Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. In this article, we have reviewed the current literature to elucidate the indications, contraindications, surgical techniques, results and complications of laparoscopic nephrectomy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increasing numbers of patients with renal cell carcinoma (RCC) are incidentally detected and can be potentially cured by surgery alone. In treating metastatic RCC, worthwhile survival rates are achieved in cases of low burden recurrences. This necessitates a rational follow up protocol, which picks up early recurrences and avoids costly surveillance for those with a favorable prognosis. AIMS: We studied the patterns of metastases occurring in patients operated for localized or locally advanced renal cell carcinoma in the Indian setting and tried to evolve a suitable follow up protocol. SETTING AND DESIGN: Institution-based, retrospective data. METHOD AND MATERIALS: Records of patients from January 1988 to December 2003, operated for initially localized RCC were reviewed. Follow up was performed using an established protocol. Occurrence of metastases and their patterns were studied. STATISTICAL ANALYSIS USED: Comparison of the different survival times was performed using the one-way analysis method. Multiple comparisons ( post hoc test) were performed using the Bonferroni method. RESULT: Follow up was available on 209 patients. Mean survival was 43.75 months (SD ± 28.72). Thirty-nine patients developed 59 metastases. Lungs were the commonest site of metastases (37%), followed by bone (22%), liver (19%), and brain (8%). Relapse and survival showed significant correlation with pathological stage ( p < 0.001), with higher stage being associated with greater relapses and lesser survival. There was no correlation between site of recurrence and stage of disease. CONCLUSIONS: Occurrence of metastases correlate with the pathological stage of the disease at primary presentation. Tailored, stage-based follow up protocols allow adequate surveillance for disease activity and progression without escalating the overall costs. [ABSTRACT FROM AUTHOR]

Anterior urethral valve (AUV) is a long known but rare anomaly, which is occasionally encountered in boys with obstructive uropathy. We present a case of AUV with a diverticulum which was misdiagnosed at other center as neurogenic bladder resulting in chronic renal failure. The case was further complicated by breakage of tip of the catheter used for clean intermittent catheterization (CIC) in the diverticulum presenting as a foreign body in the urethra. This article highlights the frequently missed diagnosis of AUV by most practitioners wrongly labeling it as neurogenic bladder, leading to improper management and renal failure in young boys. [ABSTRACT FROM AUTHOR]

Epitheloid hemangioendothelioma is an uncommon vascular neoplasm and has an unpredictable clinical behavior. It is characterized by round or spindle-shaped endothelial cells with cytoplasmic vacuolation. Most often, epitheloid hemangioendothelioma arise from the soft tissues of the upper and lower extremities and it has borderline malignant potential. We describe the first reported case of epitheloid hemangioendothelioma in the urinary bladder, which was treated by transurethral resection. The diagnosis was confirmed by immunohistochemistry. [ABSTRACT FROM AUTHOR]

Aim: To determine if Yq microdeletion frequency and loci of deletion are similar in two tissues (blood and sperm) of different embryological origin. Methods: The present study included 52 infertile oligozoospermic cases. In each case, DNA was isolated from blood and sperms and polymerase chain reaction (PCR) microdeletion analysis was done from genomic DNA isolated from both the tissues. The PCR products were analyzed on a 1.8% agarose gel. PCR amplifications found to be negative were repeated at least three times to confirm the deletion of a given marker. Results: Only 1 case harbored microdeletion in blood DNA, whereas 4 cases harbored microdeletion in sperm DNA. Conclusion: The frequency of Yq microdeletions is higher in germ cells as compared to blood. As the majority of infertile couples opt for assisted reproduction procreation techniques (ART), Yq microdeletion screening from germ cells is important to understand the genetic basis of infertility, to provide comprehensive counseling and most adapted therapeutics to the infertile couple. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The use of the standard monopolar electrocautery is associated with significant risks of implant malfunction in patients on a cardiac pacemaker. It is also associated with a risk of adverse cardiac events due to blood loss and fluid absorption. The properties of the holmium laser prevent the occurrence of these adverse events. We report the successful use of this technology in resecting the gland in patients on a permanent cardiac pacemaker implant. MATERIALS AND METHODS: Six patients with permanent cardiac pacemaker implant were treated with holmium laser resection of prostate over a period of two years. Treated patients had bothersome prostatic symptoms and failed to respond to medical therapy. All patients were operated under spinal anesthesia using a high power VersaPulse® PowerSuite™ Holmium laser source. Normal saline was used as irrigant. Intravesical tissue morcellator was also used to remove the larger fragments in two of the patients. RESULTS: Median patient age was 60 years (range 56-73) and median prostate volume was 40cc (range 20-48cc). None of the patient required blood transfusion or had significant hyponatremia or Transurethral resection syndrome. No patients had any pacemaker malfunction or hemodynamic instability during the procedure or in immediate postoperative period. Improvement in maximum urine flow rate was observed from an average of 7 ml/sec in preoperative period to 22 ml/sec postoperatively at 3 month followup. CONCLUSIONS: Holmium laser prostatectomy offers the ideal modality of surgery in patients on a cardiac pacemaker. It helps to avoid additional preparation and minimizes the risk of device malfunction and adverse post operative events. [ABSTRACT FROM AUTHOR]

Solitary fibrous tumor of the ureter is extremely rare. We describe a case where the polyp was prolapsing into the bladder mimicking a bladder tumor. [ABSTRACT FROM AUTHOR]

Lasers have been given much hype as regards their use in surgical management of benign prostatic hyperplasia (BPH). Transurethral resection of prostate (TURP), especially with its modifications still remains the gold standard treatment for BPH, owing to its efficacy and proven advantages over laser prostatectomy. Cost, unproven long-term durability, steep learning curve, and no advantages of laser prostatectomy over TURP and its modifications, make lasers superfluous in the surgical management of BPH in developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of hormone refractory prostate cancer (HRPC) is mainly based on cytotoxic chemotherapy. We evaluated the efficacy of Docetaxel/prednisolone and Zoledronic acid in these patients and analyzed the prognostic factors predicting overall survival. Methods: 44 cases of HRPC were given thrice weekly regimen of docetaxel (75 mg/m²), prednisolone (5 mg b.d.) and Zoledronic Acid (4mg) and were followed up with repeated PSA evaluation. Overall and progression free survival curves were made. Using log rank test, we analyzed the variables like age, gleason score, baseline PSA, PSA response and no. of chemotherapy cycles in predicting overall survival. Results: Chemotherapy was given in 44 cases, with a median age of 66 years. Mean PSA in these patients was 171.25 ng/mL and average 6.2 no. of cycles were given to them. 17/44 (38.6%) of patients expired with a median overall survival of 38.5 weeks. Using univariate analysis, it was found that patients with gleason score <7, patients who received more than 4 cycles and had > 75% fall in their PSA had significantly better survival, compared to those with gleason score >7, no. of cycles less than 4 and PSA fall <75% or PSA progression. Whereas other variables like age, baseline PSA does not significantly affect survival. Conclusions: In HRPC patients docetaxel based chemotherapy provides improved survival, particularly in patients with gleason score < 7, PSA fall > 75%, and who received more than 4 cycles. [ABSTRACT FROM AUTHOR]

Introduction: To determine the effect of Tamsulosin, as adjunctive medical therapy on the outcome of extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteric calculi. Methods: From Jan 2007 onwards, a prospective, randomized controlled study was conducted in patients with solitary renal or ureteral calculus measuring less than 20 mm undergoing ESWL. The Study group (n=62) received 0.4 mg of Tamsulosin daily till stone clearance or a maximum period of 12 weeks and control group (n=58) received ESWL only. Parameters assessed were stone size, composition, location, stone clearance, mean time to clearance, analgesic requirement, steinstrasse, need for hospitalization and/or auxiliary procedures. Results: There was no difference between the 2 groups with regards to age, stone size, location or composition. The complete clearance rate for renal stones was 62.7% and 36.5% (P=0.004) and for ureteric stone was 89.4% and 58.8% (P=0.03) in study and control groups, respectively. The control group had a higher rate of clinically insignificant residual fragments (CISF i.e. <3mm), 12.9% vs. 35.4% (P=0.002).There was no significant difference in the mean time to stone clearance (P=0.07) or in the incidence of steinstrasse formation (P=0.12). The mean analgesic requirement (P=0.01), need for auxiliary procedures and hospitalization (P=0.03) was significantly was higher in the control group. Conclusions: Tamsulosin increase the complete clearance rate and decrease the incidence of CISF. It also reduces analgesic requirement, need of additional procedures and hospitalization rate and might be useful as a routine adjunctive therapy following ESWL. [ABSTRACT FROM AUTHOR]

The author reflects on the significance of the contributions of Dr. Patrick Walsh on the anatomic dissection for preservation of the neurovascular bundles (NVBs), making radical prostatectomy (RP) the treatment of choice for patients with clinically localized prostate cancer and life expectancy of more than 10 years. Topics discussed include the unpopularity of laparoscopic radical prostatectomy (LRP) when launched in 1994, the different scene in India, and the other issues concerning RP.

The article presents an obituary for Doctor Sarinder Man Singh.

Introduction: Ether a go-go (EAG) and EAG related (ERG) voltage-gated potassium ion channels are involved in tumor generation and progression. Their over and/or mis-expression has been demonstrated in various tumors and inhibition of these channels has suppressed proliferation of various cancer cells. We investigate the pattern of expression of EAG and human ERG (HERG) channels in 'normal' renal tissue and renal cell carcinoma. Methods: Tissue samples, obtained at the time of radical nephrectomy from the tumor bearing areas and uninvolved renal tissue, were preserved in 4% paraformaldehyde and cryosectioned at 20µm. Immuno-histochemical and western blot analysis was performed on the tumor and uninvolved kidney parenchyma by incubating with polyclonal anti-HERG 1b [Alomone Lab, Israel], anti-EAG1 and anti-EAG2. Pattern of expression of EAG/ HERG channels in the normal renal tissue and carcinoma were noted and compared. Results: The study was performed on 16 radical and 4 partial nephrectomy specimens (n= 20). All tumors in the cohort were clear cell renal carcinoma. Normal renal tissue was found to exhibit heterogeneous cytoplasmic positivity for EAG1 and focal HERG immunoreactivity in the proximal (PCT) and distal convoluted tubules (DCT). EAG2 immunoreactivity was absent in the normal renal tissue. Clear cell RCC demonstrated a loss of HERG expression while a diffuse over-expression of EAG1 and EAG2 was noted. Western blot analysis corroborated the immunohistochemical observations. Conclusions: In our study both EAG1 and EAG2 potassium channels are over-expressed in clear cell renal cancer. In contrast to other adenocarcinomas, there is loss of HERG expression in clear cell RCC, which may possibly explain its chemo-resistance. Further work is required to evaluate the role of these ion channels in RCC, which may provide a potential for future targeted therapy. [ABSTRACT FROM AUTHOR]

Introduction: Transurethral resection of the prostate (TURP) for large volume prostates has been associated with significant morbidity in form of longer operative times, greater blood loss and higher irrigant fluid requirements. This morbidity associated with TURP has necessitated constant attempts at modifications to standard equipment and technique. We assessed safety and effectiveness of transurethral vapor resection of the prostate (TUVRP) for the management of prostate glands with a volume of > 100 grams. Methods: Twentyfive patients with a diagnosis of BPH and prostate volume of > 100 grams as determined by ultrasonography underwent TUVRP between July 2002 and March 2008. International prostate symptom score (IPSS), prostate volume, postroid residue (PVR), and maximum flow rate (Qmax) formed part of preoperative evaluation. We also assessed intraoperative and postoperative parameters including operative time, irrigant fluid requirement, blood loss, duration of postoperative catheterization, hospital stay and postoperative complications. Results: The mean prostate volume was 120.87 grams (range 101-232 grams). The mean age was 66.75 years (range 55-94 years). 4 patients used a catheter preoperatively. Mean IPSS score was 24.87. Mean Qmax and PVR were 07 and 134 ml respectively. Mean operative time was 78 minutes and mean irrigant used was 24.68 litres. Mean resected weight of prostate was 48.4 grams. Average postoperative catheter duration was 2.38 days with average postoperative hospital stay being 3.75 days. Complications included transient dysuria in 3 patients, urethral stricture in 2 and hyponatremia in 1 patient. No patient required blood transfusion postoperatively,and none of the patients had postoperative incontinence. Effectiveness assessed at 6 months was IPSS 5.7, Qmax 20.5 ml/sec, and insignificant PVR. Conclusions: TUVRP is an ideal treatment modality in present times, for prostates > 100 gm. Excellent intraoperative vision, shorter operative time and reduced hospital stay should make TUVRP 'the gold standard' treatment for > 100 gm prostates. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the role of an electrothermal bipolar coagulator (Biclamp) on the performance and outcome of open radical cystectomy in comparison with conventional methods of dissection. Methods: Over 1 year period, a prospective study was carried out in patients undergoing open radical cystectomy and urinary diversion for muscle invasive carcinoma bladder employing either conventional ligation/clip in the control group (n=22) or Biclamp device in the study group (n=20). Biclamp was used to divide the posterior and lateral pedicles of bladder. Outcome measures evaluated were estimated blood loss (EBL), transfusion requirement, operating time (total/cystectomy) and postoperative variables such as analgesia requirement, time to drain removal, duration of hospital stay and incidence of complications in both the groups. Results: Both groups were similar with regards to age, sex, BMI, associated co morbidity and clinical stage of the disease. Mean EBL and transfusion requirement in study and control groups were 605 and 1116 ml (P= 0.03) and 1.4 and 2.9 units (P=0.008), respectively. Mean cystectomy and total operating time were 74 and 104 minutes (P=0.02) and 295 and 304 minutes (P=0.76) in study and control groups, respectively. There was no significant difference in respect to analgesic requirement, drain removal, duration of hospital stay and incidence of complication between the groups. Conclusions: Use of Biclamp in radical cystectomy reduces blood loss,saves operating time and is particularly useful in dividing vessels deep in the pelvis where it acts as an viable alternative to hemostatic clips and sutures. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy of NMP22 in the diagnosis or recurrent, superficial bladder cancer and its use as an adjunct to cystoscopy in the follow-up of these patients. Materials and Methods: Patients of known superficial TCC urinary bladder were prospectively enrolled. These patients underwent urine cytology, NMP22 and cystoscopy at first follow-up and cystoscopy and cytology at 3 monthly intervals for the next 1 year. Ability of NMP22 to predict recurrence was determined using cystoscopy findings as gold standard and results were analyzed using Pearson Chi-square-test. Results: 145 patients were included in the study. 56 of them had a recurrence of which 48 were NMP22 positive while 23 had positive urine cystology. Sensitivity, specificity, positive predictive value and negative predictive value were 85.7%, 77.5%, 70.6% and 89.6% respectively of NMP22 alone and 92.9%, 77.5%, 70.3% and 94.4% when cytology and NMP22 were combined. During subsequent follow-up over 1 year, 47 patients developed tumor recurrence. Of these 47 recurrences, 38 occurred in those who were initially NMP22 positive while only 9 occurred in patients who were NMP22 negative. This difference was highly significant ( P value<0.001). Further, at each follow-up, significantly more recurrences occurred in patients who were initially NMP22 positive. Conclusions: The addition of a non-invasive test NMP22 to cytology in the follow-up of patients with superficial bladder cancer increases the sensitivity and specificity for recurrence detection. Patients with a positive NMP22 were found to develop significantly more recurrences. This may impact the frequency of follow-up required for these patients. [ABSTRACT FROM AUTHOR]

This section introduces several chapters which discussed genitourinary tuberculosis.