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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]

Background: Functional paragangliomas are one of the rare and curable causes of secondary hypertension. Its usual location is in the region of the head and neck but is rarely seen in the retrocaval region. Case Presentation: We present a rare case of an 18-year-old young boy who presented with functional retrocaval paraganglioma. The Imaging workup revealed a 6cm mass abutting the inferior vena cava (IVC). The mass was successfully excised. Histopathology showed it was a paraganglioma. Conclusion: Retroperitoneal retrocaval paragangliomas are rarely seen tumors with very few cases reported so far. The location of paragangliomas in this region is usually uncommon and its surgical resection is itself a challenge for the surgeon. Complete surgical resection with prior adequate hypertension control is the only curative treatment of paragangliomas. Lifelong follow-up is necessary to detect early recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Bladder cancer is the most common malignancy of the urinary tract, and recurrence following transurethral resection poses the biggest challenge. Intravesical Bacillus Calmette–Guerin (BCG) maintenance with the Southwest Oncology Group (SWOG) protocol remains the gold standard but with poor patient compliance.Materials and Methods: The present study aims to compare the SWOG maintenance protocol with a monthly maintenance protocol comprising 12 monthly doses of intravesical BCG. Patients are included in the study only if induction BCG is completed and cystoscopy at 3 months is negative. All patients receive 80 mg BCG in each dose with strict cystoscopic surveillance every 3 months.Results: Patient demographics and tumor characteristics were similar in the two groups. There were no statistically significant differences in outcome in terms of recurrence, progression, and adverse reactions in both the groups. Although a larger number of patients in the SWOG maintenance group were lost to follow-up, the difference was not statistically significant proportions.Conclusion: From this study, we can conclude that monthly maintenance BCG for 1 year is comparable in terms of outcome with SWOG protocol maintenance BCG. A greater percentage of patients in the monthly maintenance protocol completed the treatment as planned. [ABSTRACT FROM AUTHOR]

Objective: Purpose of our study was to aggregate and analyse rare cases of Ectopic Ureter (EU), their association with other anomalies, clinical features, diagnosis and management. Material and methods: A total of nine patients with rare presentation of EU were evaluated. Combination of endoscopic and imaging modalities was used as required to define the anatomy and devise the best surgical approach in these cases. Results: Among six females and three males with EU, four cases had bilateral EU, four unilateral EU and one case had EU of a solitary kidney. Urinary incontinence was encountered in five cases including one male patient whilst other cases presented with varied clinical features and associated anomalies. Two patients had anorectal malformations, and two had uterine anomalies in the form of bicornuate uterus. Other patients had multiple rare associations such as triplication of ureter, bilateral absence of seminal vesicles with infertility, multicystic dysplastic kidney, ureter draining in uterus, renal failure, absence of bladder trigone, and hypospadias etc. Ureteric reimplantation was performed in four cases, two required ureteroureterostomy, another two had undergone upper pole nephrectomy and in one case renal transplant had been carried out owing to chronic renal failure. Conclusion: EU is among group of those congenital entities which remain shrouded until adulthood, when symptoms become distressing. Fortunately, prognosis is favourable after surgical correction, in spite of its rarity. Complexity arises when other associated anomalies are identified. [ABSTRACT FROM AUTHOR]

Byline: Debansu. Sarkar, Anupam. Lal, Mayank. Agarwal, Ravimohan. Mavuduru, Santosh. Kumar, Shrawan. Singh Background and Objectives: Patients with chronic kidney disease (CKD) are more prone for bleeding following percutaneous renal [...]

Introduction: Office cystourethroscopy is one of the common and most frequent urological procedures. Pain and anxiety during the procedure might lead to noncompliance and incomplete cystoscopic examination. Negotiating cystoscope through external sphincter is the most painful and uncomfortable distressing part of cystoscopy. To overcome this, manual compression of irrigation bag during cystoscopy has been used and found to be helpful. Numerous other methods were also studied. Despite these, cystoscopy is still painful and causes anxiety in patients. External sphincter gets relaxed naturally during the act of micturition. Based on this principle, pain and anxiety were studied with voiding instruction during cystourethroscopy. Objective: To study the effect of voiding instruction on anxiety and pain during cystourethroscopy using the Hamilton Anxiety Rating Scale (HAM-A) and visual analogue scale (VAS), in a well-matched Eastern Indian male patient population in a prospective, randomized pattern. Methods: A total of 100 male patients were recruited from those who underwent cystourethroscopy examination in SSKM Hospital and were prospectively randomized into two groups: cystoscopy with or without voiding instruction. Pre-and postprocedure HAM-A score and postprocedure VAS score were recorded. Results: The mean postprocedural pain (VAS) score between voiding instructed and noninstructed groups reached statistical significance: 3.06 ± 1.98 (Range, 2-5) and 5.16 ± 2.86 (Range, 4-8), respectively (P < 0.001). Preprocedure HAM-A score was similar between both groups. Postprocedure median HAM-A score was statistically significantly lower (mean 17.86 ± 2.8 vs. 19.76 ± 3.12; P < 0.001) in voiding instructed group. Conclusion: Pain and anxiety level during cystourethroscopy examination in males can be significantly reduced when the patient is instructed to void during cystourethroscopy examination. [ABSTRACT FROM AUTHOR]

Teratomas are tumors consisting of two or three germ layers, seen commonly during childhood. Mature teratomas are benign and demonstrate well differentiated tissues such as sebaceous glands, hair, and teeth. Bladder is a very rare extragonadal site for teratoma, moreover so in adults. Presentation may vary from with irritative lower urinary tract symptoms or urinary retention to pilimiction (passage of hair in the urine). We hereby present a case of mature teratoma of the urinary bladder, with a classical symptom of pilimiction, in a 22-year-old male patient, which to our knowledge is the first male case reported in the literature. [ABSTRACT FROM AUTHOR]

Background: DJ stents are routinely used in urological procedures. Rarely these may dislodge or migrate. Case Series: Here we report proximal migration of DJ stent in three children with pelvi-ureteric junction (PUJ) obstruction treated with dismembered pyeloplasty. Ureteroscopy and retrieval of migrated DJ stents were performed in each of these patients. Conclusion: Proximal migration of DJ stent, though rare, can cause significant morbidity and complicates it's removal. Proper size and positioning of stent is required for pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction: To present our experience of primary amyloidosis of the genito-urinary tract. Methods: Clinical, radiological and histopathological data of five cases of primary amyloidosis of genitourinary tract treated at our Institute during last 10 years were analysed. Results: All the patients were above 50 years. Four were males and one female. Two patients with bladder amyloidosis and one patient with bladder and prostatic amyloidosis presented with hematuria and were found to have bladder mass on imaging. They were managed with TURBT. One patient who recurred, was managed with Re-TURBT. All the three patients are doing well at three to six years follow-up. The patient with ureteral amyloidoisis presented with right flank pain and hematuria. Imaging revealed right sided hydroureteronephrosis with upper ureteric intraluminal filling defect. Endoscopic biopsy elsewhere showed TCC, however slide review showed amyloidosis. He Underwent excision of the diseased segment and uretero-ureterostomy. The patient is well at 6 -months follow-up. The case of urethral amyloidosis presented with failed urethroplasty and OIU following a straddle injury. Staged urethroplasty with excision of the indurated mass at the anastomotic site was successful. Histopathology of the resected specimens in all the cases was amyloidosis. Immunohistochemical stain for AL chain confirmed primary amyloidosis. Investigation for secondary amyloidosis was negative. Conclusions: Primary amyloidosis of genitourinary tract is rare. It usually presents with local symptoms and commonly confused with malignancy. Local excision is successful in most of the cases with low recurrence. [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.)