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INTRODUCTION: Retrograde urethrography (RGU) is the standard imaging study for the evaluation of anterior male urethra. Sonourethrography(SUG) offers comparable information with added advantages. MATERIAL AND METHODS: 196 males with anterior urethral stricture studied. RGU/MCU, sonourethrogram and urethroscopy done in all and information regarding urethral stricture was compared keeping urethroscopy as gold standard. Strictures > 4 cm were excluded. Chiou et al classication used to classify urethral stricture on SUG. Bulbar urethra was the most common si RESULTS & DISCUSSION: te for urethral stricture. Sensitivity of sonourethrography for location of stricture was >98%. Strength of agreement between SUG and urethroscopy for location of stricture was very good. Number of the strictures were diagnosed with higher accuracy on urethroscopy than SUG and RGU respectively. Kappa value for number of strictures was suggestive of very good agreement between SUG & urethroscopy. Length of stricture in urethroscopy was better correlating with SUG. Both RGU and SUG were equally sensitive in location and number of stricture while RGU correlated poorly in the bulbar urethra, older studies also showing RGU underestimating the length of stricture in bulbar urethra. Sonourethrography also providing additional information regarding periurethral pathologies. The complications encountered during RGU were contrast intravasation, pain during the procedure, urethral bleeding and UTI after the procedure. During sonourethrography no signicant complication noted. CONCLUSIONS: Sonourethrography is a multiplanar, easily available and cost-effective technique for evaluating anterior urethra without radiation exposure. When compared with RGU, sonourethrography is equally efcacious with added important technical advantages which help surgeons to plan surgical procedure.

Background Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience. Methods We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up. Results There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period. Conclusion The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

Introduction: Studies on the effects of chemotherapy in Indian Castration-Resistant Prostate Cancer (CRPC) patients are very limited and world data is inconsistent. The purpose of the present study is to assess the effects of Docetaxel therapy in CRPC in Indian patients in terms of survival benet, both progression-free survival, and overall survival. This study also analyzes the effects of various factors on the survival of CRPC patients. Methodology: This is a single institutional prospective observational study. CRPC patients were treated with Docetaxel and followed till death as the primary endpoint or till the end of the study. Survivals were calculated with the Kaplan Meier method. Factors affecting survival were analyzed with univariate and multivariate analysis by log-rank t-test and Cox proportion hazard regression analysis. Result: Out of enrolled 101 patients, 78 were treated with Docetaxel. A decline in PSA (>50% reduction) was observed in 61.54%. Radiological response of regression noted in 40 % Nuclear Bone Scan and 19.23% CT/MRI by RECIST criteria. Progression-free survival and overall survival with Docetaxel (n=78) were 11.8 and 21 months respectively. Hemoglobin less than 11 gm%, Alkaline phosphatase more than 115 IU/dl, PSAmore than 14 ng/ml, Gleason score more than 7 and duration from diagnosis of carcinoma prostate to CRPC less than 24 months, the number of chemotherapy cycles less than 6 were all found to be signicantly associated with poor overall survival in univariate analysis while only Hemoglobin (P=0.0159) showed an independent association with overall survival in multivariate analysis. Conclusion: Overall and progression-free survival of CRPC patients with Docetaxel is 21 & 11.8 months respectively. Hemoglobin, Alkaline phosphatase, PSA, Gleason score, Docetaxel cycle, and duration from diagnosis of carcinoma prostate to CRPC were found to be signicantly associated with poor overall survival.

Introduction Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer. The clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we evaluated the efficacy, safety profile, and outcomes of side-firing KTP laser enucleation with bipolar transurethral resection of bladder tumor (TURBT) in carefully selected patients with small bladder tumors in an office setting. Material and methods A total of 83 patients with small bladder tumors were treated with either side-firing KTP laser enucleation (Group A; n = 40) or bipolar TURBT (Group B; n = 43). Intraoperative and postoperative parameters of interest were recorded and analyzed as per the study so as to evaluate the efficacy, safety profile, and outcome of KTP laser enucleation. Results The mean enucleation time was 23 ±5.24 min in Group A and the mean operative time was 21.98 ±4.77 min in Group B (p = 0.207). Group A had a lower risk of obturator reflex (0 vs 8; p = 0.005) and lesser amount of irrigation used intraoperatively as compared to Group B (6.2 ±0.61 L vs 7.65 ±0.75 L; p

Despite the high incidence of secondaries to lymph nodes, bones, and lungs in carcinoma (CA) prostate, metastatic involvement of scrotal organs is rare and usually associated with a poor prognosis. Here, we report a case series of three cases of CA prostate with metastatic involvement of scrotal organs. All three patients had metastatic involvement of the spermatic cord, with involvement of epididymis in the first patient and testes in the third patient, revealed incidentally on orchiectomy. Two patients were also found to have coexisting lymphatic filariasis. To date as per the best of our knowledge, only one such case of CA prostate with metastasis to scrotal organs and associated filariasis has been reported. This highlights the need for histopathological evaluation of all orchiectomy specimens. Chronic infection and inflammation leading to lymphatic obstruction due to filariasis probably led to the unusual retrograde spread of the tumor.

Abnormal Uterine Bleeding is most common complaint during reproductive age group. The woman with AUB were classified according to PALM-COEIN classification. The most of the woman (38%) belongs to AUB(L). The most common histopathological finding was secretary phase of endometrium 44.28%. The most common histopathological finding in AUB(M) was simple hyperplasia without atypia was 77.77%. Therefore the PALM- COEIN classification system is applicable globally and should be followed every health facility. Keywords: Acute kidney injury, Pregnancy, Preeclampsia.

Background Bacillus Calmette-Guerin (BCG) is widely used as an immunotherapeutic agent and recommended in management of non–muscle-invasive bladder cancer (NMIBC). There is no consensus on the optimal dose of the BCG. However, dose reduction has been assessed to decrease the side effects following instillation of BCG. This study compared the efficacy and safety of 80 and 120 mg doses of Sii Onco BCG (Moscow I, Russian strain) in patients with NMIBC. Methods Patients with histologically confirmed, completely resected solitary or multiple Ta or T1 (with or without carcinoma in situ), grade 1 to 3 urothelial carcinoma of the bladder were included. After transurethral resection of the tumor, repeated intravesical instillations with Sii Onco BCG (80 or 120 mg) were administered, following the induction and 3 weekly maintenance schedule (at 3, 6, 9, 15, 21, 27, and 33 months). Recurrence and progression of the tumor were monitored at scheduled time intervals using cystoscopy. Results A total of 104 eligible patients were enrolled to receive 80 mg (n = 51) dose or 120 mg dose (n = 53) of Sii Onco BCG. On completion of 3 years follow-up, recurrence-free survival rate of 84.31% and 86.79% and progression-free survival rate of 84.31% and 94.34% were observed for 80 and 120 mg groups, respectively; difference being statistically nonsignificant. Conclusion Both, 80 and 120 mg doses of Sii Onco BCG are effective and safe for prophylaxis and management of NMIBC.

Objective: To evaluate the relationship between erectile dysfunction (ED), based on the five-item International Index of Erectile Function questionnaire (IIEF-5), and presence of metabolic syndrome (MetS) or its components based on Adult Treatment Panel III guidelines. We also explored the impact of increasing insulin resistance (IR), as calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) equation, on severity of ED. Pathophysiological links between ED and testosterone were re-evaluated. Patients and methods: In all, 357 patients with ED were evaluated; 53 patients with primary, psychogenic, surgical, post-traumatic or drug-induced ED were excluded. The remaining 304 patients were evaluated after obtaining written informed consent. The Institutional Review Board approved the study. We assessed comorbidities, IIEF-5 scores, lower urinary tract symptoms (LUTS) based on International Prostate Symptom Score (IPSS), blood sugars, lipid and hormonal profiles, and vitamin D3 levels. Further evaluation was done when indicated. Results: In all, 171 patients had MetS and 134 had pre-existing comorbidities (diabetes mellitus, 58; hypertension, 73; coronary artery disease, 13). The mean (SD) age was 44.6 (9.21) years and IIEF-5 score was 13.81 (3.17). ED severity was significantly correlated with presence of MetS. On multivariate analysis, there were significant correlations between ED and waist circumference, serum triglycerides, and fasting blood sugar. There was a statistically significant positive correlation between serum testosterone and IIEF-5 score (r = +0.292). The mean (SD) IR value (using the HOMA-IR formula) was 2.64 (2.87), which was statistically and negatively correlated with IIEF-5 scores (r = – 0.398). Receiver operating characteristic analysis showed that an IIEF-5 score of 2.1778 predicted MetS. Conclusion: MetS or its components were present in 56.25% of the patients. Therefore presence of ED merits further evaluation for presence of MetS. This may help to prevent catastrophic and life-threatening consequences of MetS. Abbreviations: BMI: body mass index; CRP: C-reactive protein; CVD: cardiovascular disease; DBP: diastolic blood pressure; DM: diabetes mellitus; ED: erectile dysfunction; FBS: fasting blood sugar; HDL: high-density lipoprotein; HOMA-IR- Homeostatic Model Assessment for Insulin Resistance; HTN: hypertension; IIEF-5: five-item version of the International Index of Erectile Function; IR: insulin resistance; LDL: low-density lipoprotein; LUTS: lower Urinary Tract Symptoms; MetS: metabolic syndrome; NO: nitric oxide; OR: odds ratio; PPBS: post-prandial blood sugar; ROC: receiver operating characteristic; SBP: systolic blood pressure; TG: triglyceride; WC: waist circumference

INTRODUCTION AND OBJECTIVE:Female urethral stricture (FUS) isn’t as rare a cause of LUTS in women as previously thought. It remains largely undertreated, being managed mostly by repeated dilatation...

Gestational trophoblastic disease is a heterogenous group of interrelated lesions that arise from abnormal proliferation of placental 1 trophoblasts . Choriocarcinoma differs from any type of villous trophoblast and is the most aggressive GTN and is highly chemosensitive. When a patient reports with irregular bleeding during her postpartum or postabortion, pregnancy related causes should be ruled out. We describe a patient who presented to us after a term pregnancy and was diagnosed to have stage III choriocarcinoma.

Introduction Prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET-CT) is widely used as a staging tool for patients with prostate cancer (PCa). The objective of the study is to assess the diagnostic accuracy of 68Ga-PSMA-PET/CT for PCa, which may help us avoid unnecessary biopsies in patients with intermediate prostate-specific antigen (PSA) levels. Material and methods In this prospective study, 81 patients suspected of PCa, with either raised PSA between 4–20 ng/ml or abnormal digital rectal examination (DRE) findings were included. 68Ga-PSMA-PET/CT was performed for all patients followed by transrectal ultrasound (TRUS) guided prostate biopsy. SUVmax (maximum standardized uptake value) was measured and correlated with biopsy results. Results Out of 81 patients, 31 (38.3%) patients were found to have malignancy on biopsy. Median SUVmax of biopsy positive patients was 10.4 (IQR 6.5–16.1) and biopsy negative patients (n=50) was 3.5 (IQR 1–4.9), (p

Introduction: Urogenital infections are usually seen during pregnancy and considered as an important cause of preterm labour. Preterm labour is the one of the foremost reason of neonatal morbidity and mortality. Bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and trichomoniasis are responsible for near about 90% of cases of infectious conditions which can lead to eventually gynecological and obstetrical complications such as preterm labour, pelvic inflammatory disease, post-abortion endometritis and chorioamnionitis. Most common infection among women in preterm labour is BV. This study was conducted to find the association between urogenital infections and preterm labour and also to find out prevalence of urogenital infections in preterm and full term labour. Method: It was an observational study done in the Department of obstetrics and gynecology IGMC Shimla H.P. from 1st August 2017 to 31st July 2018. A total of 200 women were observed for urogenital infections and their association with preterm labour. Case Group I included 100 women with preterm labour after 24 weeks and before 37 completed weeks of gestation with or without rupture of membranes. Control Group II included 100 women at completed or more than 37 weeks of gestation with no history of preterm labour, matched to the case group with respect to age and parity. Midstream urine was sent for microscopic examination and culture sensitivity. Samples were taken for microbiological study from posterior fornix of vagina. These were studied for microscopic examinations along with Culture sensitivity by standard methods and saline wet mount for BV, VC, Tricomoniasis. Results: In present study, overall 18% urogenital infection was observed. Statistical analysis reveals that there was association in high vaginal swab, urine culture and both culture positivities. Conclusion: We concluded that in our study, urogenital infection was more common in women with preterm labour compared to those in full term labour patients group which indicates a significant association of urogenital infections in preterm labour. Keywords: Urogenital Infections, Bacterial Vaginosis, Vulvovaginal Candidiasis, Premature Labour

Introduction: Preterm prelabor rupture of the membranes (PPROM) refers to spontaneous rupture of membranes in the absence of labor pains, before 37 completed weeks of gestation. Chorioamnionitis (CAM) affects many pregnancies complicated by PPROM. Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes. It has been claimed that estimation of C-reactive proteins (CRP) is helpful in the diagnosis of chorioamnionitis, and this study aims to appraise such claimsObjective: To determine the diagnostic accuracy of C-reactive protein in the detection of chorioamnionitis in women with PPROM and to test sensitivity/specificity/positive predictive valve/negative predictive value of CRP in diagnosing chorioamnionitis against histopathological examination of placenta.Method: A study conducted on total 440 antenatal women, 220 cases of PROM and 220 cases with same gestation but without PPROM used as a control. A detailed obstetrical and menstrual history was taken and systemic and local examination was done. Subjects were managed expectantly with use of tocolytics, antibiotics and steroids. Frequent vital signs monitoring and hematological investigation were done. CRP levels were determined. After delivery placenta was sent for histopathological examination for the presence of chorioamnionitis.Results: CRP appears to be the most sensitive acute phase protein; rising of less than 24 hours makes it suitable to serve as a marker for diagnosing an infection. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (45.45%) in identifying chorioamnionitis. The positive predictive value was 31.4% and negative predictive value was 100%.Conclusion: CRP is early and reliable indicator of histopathological and clinical chorioamnionitis in comparison of TLC and clinical parameter. Thus CRP can prove useful markers in identify early and subclinical infection which could lead to premature rupture of membrane.Key-words- Preterm birth, C-reactive protein, PPROM, Chorioamnionitis.

Prostatic utricle is a Mullerian duct remnant with an incidence of 1 %. Excision of utricle is challenging because of the close proximity of seminal vesicle, ejaculatory ducts, bladder, rectum, ureter, and nerve plexus. Here, we report the case of a 23-year-old male presented with complaints of painful terminal hematuria associated with clots along with retrograde ejaculation. The abdominal and local examination was within normal limits. MRI pelvis showed a large non-communicating cystic structure present in the pelvic cavity, compressing posterior wall of the urinary bladder, seminal vesicle, anterior wall of the rectum and also causing left hydroureteronephrosis. After evaluation, the patient was diagnosed with giant prostatic utricle cyst. Laparoscopic excision of prostatic utricle cyst was done successfully. Postoperative period was uneventful and the patient was discharged in satisfactory condition. Laparoscopic excision of prostatic utricle cyst is technically challenging but with acceptable complications and good surgical results.

Penile Mondor’s disease (PMD) is a rare condition characterized by thrombosis of superficial dorsal vein of the penis. PMD is usuallycaused due to vigorous sex or repeated trauma to the penis leading to painful swelling of the penis. Most of the patients improvegradually on conservative treatment. Very rarely cord like lesion persists and causes painful erection and intercourse, meriting surgicalmanagement. Here, we report the case of a traumatic Thrombophlebitis of Superficial Dorsal Vein of Penis managed surgically alongwith a brief explanation of the surgical technique. Color Doppler was helpful in delineating the whole extent of thrombus in thevein. Excision of the whole length of the thrombosed vein was done. Abstinence from sex was advised for six weeks and the patientimproved symptomatically.

Background: Cancer is the second leading cause of death globally and is estimated to account for 9.6 million deaths in 2018. Due to the lack of cancer awareness, variable pathology, and dearth of proper screening facilities in developing countries such as India, most women report at advanced stages, adversely affecting the prognosis and clinical outcomes. The aim of the study was to study the sociodemographic profile, clinical profile, pattern of gynaecology malignancies and their histopathological findings of all gynaecological malignancy patients attending gynaecological OPD.Methods: A prospective observational study was conducted in the Department of OBG, KNH Shimla from June 2019 to May 2020 where 241 gynaecological malignancy patients were recruited. Detailed history, general physical examination, systemic, gynaecological examination and required investigation was done and the data was analysed.Results: The most commonly occurring gynaecological malignancy was cervical cancer. 82.2% of the patients belonged to the age group 40-69 years. Majority of the patients were multiparous, belonged to rural background, belonged to Hindu community. 69.3% were menopausal. Among the 132 women who gave history of age at first coitus as less than 18 years, 60.6% of them had cervical cancer. Most common presenting complaints was post-menopausal bleeding. In cervical cancer 43.6% of patients diagnosed at stage III and were managed by radiation therapy.Conclusions: According to this study, cervical cancer is the most common gynaecological malignancy followed by ovarian cancer. Most of these patients seeked medical attention in advanced stage.

Objective: To conduct a prospective randomised study comparing the safety, effectiveness and treatment outcomes in patients undergoing bipolar transurethral resection of the prostate (bTURP) and photoselective vaporisation of the prostate (PVP) under sedoanalgesia, as sedoanalgesia is a safe and effective technique suitable for minimally invasive endourological procedures and although studies have confirmed that both TURP and PVP are feasible under sedoanalgesia there are none comparing the two. Patients and methods: Between November 2014 and April 2016, all patients satisfying the eligibility criteria underwent either bTURP or PVP under sedoanalgesia after randomisation. The groups were compared for functional outcomes, visual analogue scale (VAS) pain scores (range 0â10), perioperative variables and complications, with a follow-up of 3Â months. Results: In all, 42 and 36 patients underwent bTURP and PVP under sedoanalgesia, respectively. The mean VAS pain score was

Objective: To evaluate the efficacy of androgen-deprivation therapy (ADT) in relieving urinary retention in patients with advanced prostate cancer presenting with urinary retention or a high post-void residual urine volume (PVR). Patients and methods: Patients with advanced prostate cancer with an indwelling catheter for acute/chronic urinary retention, or with a high PVR (>200 mL) who had not received any previous treatment were included in the study. Patients with localised prostate cancer eligible for receiving any therapy aimed at cure were excluded. All enrolled patients were managed by ADT (LHRH antagonist/agonist or orchidectomy) combined with α-adrenoceptor antagonist/combined therapy for at least 1 month to a maximum of 3 months; they were given their first trial of voiding without catheter after 1 month, and monthly thereafter. Results: A total of 101 patients received ADT of which 97 were able to void successfully at the end of 3 months. In all, 27 patients could void in the first month, followed by 50 in the second month, and an additional 20 in the third month. There was a significant decrease in prostate volume, PVR, and International Prostate Symptom Score, and maximum urinary flow rates improved with normalisation of renal functions and resolution of upper tract changes noted on ultrasonography. Conclusion: ADT can relieve retention and decrease PVR over a period of time obviating the need for channel transurethral resection of the prostate. Keywords: ADT, ADT in retention, Prostate cancer

This study assesses the practice patterns of diagnosing ophthalmologists, as reported by glaucoma patients attending specialty glaucoma clinics in urban and rural areas of North India, for a second opinion. Prospective cross-sectional study using a structured interview-based survey was conducted from 1 November 2011 to 31 October 2012 on patients attending two specialty glaucoma care facilities in North India. Both clinics were in North India; however, one was rural (Kaithal) and one was urban (Delhi). Patients were asked through descriptions of machines and processes, regarding practice patterns of their glaucoma diagnosing ophthalmologists. The interview was conducted by ophthalmic assistants in tune with the vernacular of the region, in a language understood by the interviewee. A total of 1506 patients consented to participate in the survey. The majority of patients reported undergoing tests for intraocular pressure measurement; however, 56–60% of these tests were carried out by the non-contact tonometer. More than 90% of patients reported no knowledge regarding the type and severity of the glaucoma they suffered from, and even less reported undergoing gonioscopy (3.6% Karnal and 16% Delhi). 84–86% patients who underwent perimetry reported undergoing at least some digital imaging of the optic disc. Better counselling of, and communication with, the patient would help increase their awareness regarding their condition and the care required. This has the potential to enable better compliance with and adherence to treatment. Standardized training of ophthalmologists to improve clinical diagnosis of glaucoma would also go a long way.

Coronavirus Disease (COVID-19) pandemic is a challenge to the healthcare system including urology which is big and formidable. The present scenario has changed the health preferences to emergency and essential services only. Reallocation of healthcare providers, wards and equipments resulted in suspension of all outpatient and elective activities to select only non-deferrable and critical procedures. Consequently, all health care workers including urologists must abide by the recommendations when dealing with the COVID-19 patients. This pandemic has also disrupted the training and education programs of urology residents also. Subsequently, in this review article, authors have discussed the influence of COVID-19 on urological practice. Authors have also reviewed the recommendations on triaging of urology procedures (emergent and non-emergent), office based urological procedures, oncologic surgeries, paediatric urology, urology-pathology interaction and economic burden on healthcare system during COVID-19 pandemic.

Background CSE is a novel combination of ceftriaxone, sulbactam, and disodium ethylenediaminetetraacetic acid (EDTA) with activity against multidrug-resistant Gram-negative pathogens. Methods Adult patients aged ≥18 years with a diagnosis of complicated urinary tract infections (cUTIs), including acute pyelonephritis (AP), were randomized 1:1 to receive either intravenous CSE (1000 mg ceftriaxone/500 mg sulbactam/37 mg disodium EDTA) every 12 hours or intravenous meropenem (1000 mg) every 8 hours for up to 14 days. The primary objective was to show the noninferiority of CSE to meropenem at the test-of-cure visit (8–12 days after the end of therapy), with a noninferiority margin of 10%. Results Of 230 randomized patients, 74 of 143 and 69 of 143 were treated with CSE and meropenem, respectively. Of these, 98% were ceftriaxone nonsusceptible and 83% were ESBL-positive at baseline. Noninferiority of CSE to meropenem was demonstrated for both the US Food and Drug Administration-defined coprimary endpoints of (1) symptomatic resolution at test-of-cure (71 of 74 [95.9%] patients vs 62 of 69 [89.9%]; treatment difference, 6%; 95% confidence interval [CI] −2.6% to 16%) and (2) symptomatic resolution as well as microbiological eradication at test-of-cure (70 of 74 [94.6%] vs 60 of 69 [87.0%]; treatment difference, 7.6%; 95% CI, −2.0% to 18.4%). Microbiological eradication at test-of-cure (European Medical Agency’s primary endpoint) was observed in 70 of 74 (94.6%) vs 61 of 69 (88.4%) (treatment difference, 6.2%; 95% CI, −3.2% to 16.6%) patients treated with CSE and meropenem, respectively. Safety profile of CSE was consistent with that of ceftriaxone alone. Conclusions The results support the use of CSE as a carbapenem-sparing treatment for patients suffering from cUTI/AP caused by resistant Gram-negative pathogens.

Pelvic fracture with urethral injury in girls is an uncommon entity that is usually associated with concomitant vaginal lacerations. Management options vary from immediate exploration and urethral anastomosis to delayed urethroplasty. We report our experience of managing a 10-year old girl presenting 6 months after a pelvic fracture with urethrovaginal injury and a completely obliterated urethral meatus managed successfully with a single-stage bladder tube repair.

Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p

Background: Preterm labour and preterm deliveries are very challenging obstetric complications. Early identification of risk factors may help identify women at risk for preterm deliveries.Methods: A one-year observational study was conducted in the department of obstetrics and gynecology, IGMC Shimla, Himachal Pradesh from 1st August 2017 to 31st July 2018. All mothers who delivered between 24 to 37 weeks were subjected to a detailed history with respect to age, parity, previous pregnancy outcomes and to identify the presence of any risk factors. A thorough obstetric and systemic examination was done. Parametric and non-parametric test of significance were used to find the association between different quantitative and qualitative variable.Results: Incidence of preterm deliveries was 11.4%. Maximum cases were of age group 25-30 years. 71.7% belonged to lower socio-economic status. 54% cases were seen in multigravida. History of previous abortion was seen in 18.4% and 9.7% had history of preterm deliveries. 12% cases had history of 1st trimester bleeding. Spontaneous onset of preterm labour was seen in 55.1%. The significant risk factors associated were PIH and genitourinary infections.Conclusions: The risk factors of preterm birth to a large extent can be identified in antenatal period. Adolescent health education including good nutrition, good hygiene, counselling for contraception to reduce unintended pregnancies and birth spacing can lower the preterm birth rate. Better prenatal care, early identification of risk factors and complicated cases, regular follow up and proper management can help us in reducing preterm births.

Introduction: Urologists tend to prefer retroperitoneal approach for open nephrectomy and transperitoneal route for laparoscopic nephrectomy. Urologists consider retroperitoneal laparoscopic approach difficult to learn and perform. There is a need to objectively define predictors of difficulty during laparoscopic retroperitoneal simple nephrectomy (LRSN) for the proper preoperative selection. To the best of our knowledge, this is the first study to prospectively assess the factors associated with difficulty during LRSN. Materials and Methods: All adult patients of nonfunctioning kidneys (due to benign causes) planned for simple nephrectomies from November 2014 to January 2017 were included in the study. Various clinical and radiological parameters were noted along with intraoperative difficulty parameters (difficulty score, total operative time, and estimated blood loss). Renal and perirenal parameters were assessed and noted on computed tomography scan. Difficulty scale was calculated based on the three difficulty parameters and was used to objectively categorize the patients in easy and difficult group. Results: A total of 44 patients were included in the study. There were 23 patients in Group I (Easy) and 21 patients in Group II (Difficult). Various preoperative clinical and radiological parameters were analyzed and compared between these two groups. History of pyonephrosis and presence of nephrostomy tube were the only two statistically significant factors associated with difficult cases (Group II). None of the factors were statistically significant in multivariate analysis. Conclusion: Based on the findings of our study, history of pyonephrosis and presence of nephrostomy are the most significant factors predicting difficulty during LRSN.

Background: The objective of the stusy was to ascertain any differences in fetomaternal outcomes in induced and spontaneous labour among primiparous women delivering at term without an identified indication for induction. Methods: This was a prospective study of 500 women with spontaneous labour and 204 women with induced labour who were delivered at 37 weeks to 40+6 weeks gestation, all without identified medical and obstetrical indications for induction. Results: Initial Bishop score in the induced group was low (≤5) in 78% compared to 46% in spontaneous group (p

The aim of the study was to assess level of glaucoma awareness amongst glaucoma patients by studying characteristics amongst urban and rural glaucoma populations in North India. A questionnaire was designed and administered after appropriate validation amongst patients to identify determinants of glaucoma awareness. Trained personnel delivered the 11 questions to 1506 patients, aged 18 and above through random sampling. The questionnaire evaluated source of awareness, education, gender, location and age on the level of awareness of glaucoma. The outcomes were assessed based on patient’s responses. Age and education essay a significant role in glaucoma awareness. Awareness levels increased with the level of education significantly in both rural and urban settings (P value

OBJECTIVES: To assess the various causes and incidence of maternal near miss (MNM) and maternal deaths (MD) and to define the limitations and to search the level of delay. METHODS: A prospective and observational study, including women who were admitted in emergency from April 2012 to March 2013 with severe maternal complications and who fulfilled any of the WHO criteria of MNM. Results: A total of 6008 live births (LB) and 156 severe maternal outcomes (25.9/1000 LB) were observed, consisting of 140 MNM (23.3/1000 LB) and 16 MD(266/100, 000 LB). The maternal near miss/mortality ratio was 8.75. Hypertensive disorders accounted for the most common event of MNM (50.6%), followed by haemorrhagic disorders (38.6%). Majority of maternal deaths were due to hypertensive disorders (31.2%) and sepsis (25%). CONCLUSION: Reduction of present MNM and MD may be achieved by strictly following management protocols for hypertension and haemorrhage.

Aims To assess the efficacy and safety of mirabegron 50 mg once daily compared with placebo and the active control, tolterodine extended-release (ER) 4 mg once daily, in patients with symptoms of overactive bladder (OAB) in Taiwan, Korea, China, and India. Methods A 12-week multinational, randomized, double-blind, parallel-group placebo- and active-controlled trial. The primary efficacy endpoint was change from baseline to final visit in mean number of micturitions/24 hr. Secondary endpoints were: mean number of urgency episodes, incontinence episodes and urge incontinence episodes/24 hr, mean number of nocturia episodes per night, mean volume voided per micturition, and quality-of-life (QoL) scores as assessed by the King's Health Questionnaire (KHQ). Results Of 1,126 patients who were randomized to receive double-blind study drug, 921 patients (300, 311, and 310 in the placebo, mirabegron 50 mg, and tolterodine ER 4 mg groups, respectively) completed the treatment period. Demographic characteristics were similar across treatment groups. A statistically significant improvement versus placebo in mean number of micturitions/24 hr was seen with mirabegron 50 mg at all timepoints (P

Background CSE, a novel combination of Ceftriaxone, Sulbactam and Disodium EDTA (Class 1 Antibiotic Resistance Breaker), is being developed for the treatment of patients with serious Gram-negative infections and has completed a Phase-3 clinical trial (NCT03477422) for treatment of complicated urinary tract infections (cUTI), including acute pyelonephritis (AP). It restores and enhances the in vitro activity of Ceftriaxone against various β-lactamases (BLs), including enzyme families that belong to Ambler class A (TEM, SHV, CTX-M), class B (NDM, VIM, IMP), class C (some variants of AmpC), and class D {OXA extended spectrum BLs (ESBLs)}. This analysis was performed to assess the clinical and microbiological outcomes in patients infected with Ceftriaxone non-susceptible (C-NS), MDR and ESBL-producing Gram-negative pathogens at baseline. Methods Patients were randomized 1:1 to receive either CSE (1g Ceftriaxone/500 mg Sulbactam/37 mg EDTA) every 12 hours or Meropenem (MR) 1 g every 8 hours as 30 minutes IV infusion for 5–14 days. Oral step-down therapy was not allowed. Biological specimens were analyzed, and resistant pathogens identified. MDR was defined as resistance to at least three categories of antimicrobials. Identification of pathogens and antibiotic susceptibility testing were performed and interpreted according to Clinical and Laboratory Standards Institute methodologies. Combined Disc Diffusion Test was used to detect ESBL-production in pathogens. Results Of 230 randomized patients, 143 (62.2%) were included in m-MITT [72/74 (97.3) in CSE and 68/69 (98.6%) in MR groups had C-NS pathogens; 63/74 (85.1%) in CSE and 56/69 (81.2%) in MR groups had ESBL-producing pathogens; 55/74 (74.3%) in CSE and 45/69 (65.2%) in MR group had MDR pathogens]. Mean duration of IV therapy was 7 days. The clinical cure and microbiological eradication rates for CSE and MR at the test of cure (TOC) visit in C-NS, ESBL and MDR pathogens is shown in Figures 1, 2, and 3, respectively. Conclusion At TOC, clinical cure and microbiological eradication rates were higher for CSE as compared with MR across all three analyses sets. Overall, CSE was effective in the treatment of patients with cUTI and AP caused by resistant Gram-negative pathogens. Disclosures M. A. Mir, Venus Medicine Research Centre: Employee, Salary. S. Chaudhary, Venus Medicine Research Centre: Employee and Shareholder, Salary. M. Chaudhary, Venus Medicine Research Centre: Board Member and Shareholder, Salary. G. Shiekh, Venus Medicine Research Centre: Employee, Salary.

Background: Hypertensive disorder of pregnancy complicates 5 to 8% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Hypertensive disorders of pregnancy account for nearly 18% of all maternal deaths worldwide, with an estimated 62000-77000 deaths per year.Methods: This one-year prospective case control study total 200 pregnant women attending antenatal care and admitted in Eclampsia ward fulfilling the inclusion criteria were studied. Fetal and maternal outcomes data recorded and documented. Statistical analysis of data was done by student’s t-test and p-value.Results: In PIH 68% women had normal vaginal delivery (p=0.004) 10% women had instrumental delivery. In PIH group 22% women had emergency caesarian section and in normotensive group 10% women had emergency caesarian section. In PIH group 58% delivered at term and 42% had preterm delivery. In normotensive 95% delivered at term and 5% had preterm delivery (p 2.5 kg (p=0.0009). While In normotensive group only 9% women had newborn with birth weight

Background: Hypertensive disorders during pregnancy are one of the most common medical complication seen during pregnancy, affecting around 5-10% of all pregnancies. Spectrum of this disease ranges from mildly elevated blood pressure with minimal clinical significance to severe hypertension with multi organ dysfunction. Pre-eclampsia complicates about 2-8% of all pregnancies. Pre-eclampsia incidence in India is about 8-10%. Various studies have depicted that, there is a strict relationship between PIH and elevated serum β-hCG level.Methods: This one-year prospective case control study toteled 200 pregnant women attending antenatal care and admitted in eclampsia ward fulfiling the inclusion criteria were studied. Serum βhCG levels were estimated by chemiluminescent microparticle immunoassay. Statistical analysis of data was done by student’s t-test and p-value.Results: The mean β hCG level in PIH patients was found to 36851.59 mIU/ml with standard deviation of 22916.58 while the mean β hCG in normotensive patient was 15433.26 mIU/ml with standard deviation of 6861.56. (p

Objective To prospectively evaluate the feasibility and initial results of an everted saphenous vein graft (eSVG) as a dorsolateral onlay, in patients with long anterior urethral strictures and/or chronic tobacco users. Patients and methods In all, 20 patients with long anterior urethral strictures (>7 cm) and/or chronic tobacco exposed oral mucosa were included in the study. The harvested SVG was hydro-distended, detubularised, and everted. Substitution urethroplasty using an eSVG was performed using a dorsolateral onlay technique. Symptoms were assessed using the International Prostate Symptom Score (IPSS) and uroflowmetry at 1, 3 and 6 months; and voiding and retrograde urethrograms, and urethroscopy were done at 3 months. Failure was defined as failure to void, need for interventions in form of direct-vision internal urethrotomy or endodilatation. Results Three patients were excluded because they underwent a staged urethroplasty. In all, 17 patients underwent eSVG substitution urethroplasty. The mean (SD, range) follow-up of our patients was 17.64 (5.23, 10–26) months. The mean (SD, range) length of the strictured segment was 14 (2.5, 10–18) cm and the length of the harvested SVG was 16.3 (2.7, 12–20) cm. The mean (SD) IPSS at 1, 3 and 6 months after catheter removal was 10 (2.8), 10 (3.4) and 10 (1.4) and the quality-of-life score was 1.76 (0.5), 2.05 (1.0) and 2.05 (1.0), respectively. Postoperatively, endodilatation was required in two patients. Complete failure occurred in one patient. Conclusions An eSVG, as a dorsolateral onlay graft, is a promising and prudent option for long anterior urethral strictures, especially in patients with poor oral hygiene and chronic tobacco use.

Functional evaluation of the renal unit has often been quoted as a standard practice for management of stone disease of the upper urinary tract. However, there is very little available evidence from the existing literature to directly support or refute this practice. Here we try to critically review the existing literature on related questions, put into perspective its clinical utility and attempt to rationalize the concept of functional evaluation in patients of renal stone disease in the contemporary era of minimally invasive surgery.

Introduction: Both dorsal and ventral approaches are acceptable options for the surgical reconstruction of female urethral strictures (FUS), but damage to the sphincter and the clitoral nerves resulting in sexual dysfunction is the chief argument against the dorsal approach. Most of the reported case series are retrospective and none has evaluated sexual functions. This study prospectively evaluates the early sexual and functional results after dorsal onlay vaginal graft urethroplasty (DVGU) for FUS. Materials and Methods: All women with a history of obstructive voiding symptoms and previous urethral dilatation were evaluated with urodynamic study, voiding cystourethrography, and cystoscopy for the presence of FUS, which was defined as visual demonstration of anatomical narrowing on urethro-cystoscopy. DVGU was offered as a definitive management for all those identified with FUS. Surgical outcomes were assessed at 3 and 6 months with the International Prostate Symptom Score (IPSS), uroflowmetry, and postvoid residual (PVR) estimation. For sexually active females, sexual function was assessed using the Female Sexual Function Inventory (FSFI) score both preoperatively and at 3 months following surgery. Results: Seventy-one women were evaluated. FUS was identified in 29 women (flimsy in 12 and dense in 17). Thirteen women with dense strictures underwent DVGU. The mean improvement in the IPSS score, Qmax, and PVR was 12.6, 16.64 ml/s, and 103.08 ml at 3 months, respectively. The FSFI score improved with a mean of 6.42 points after urethroplasty. None of the patients developed incontinence. There were three failures after a mean follow-up of 8.5 months. Conclusion: The early functional results after DVGU are good without any negative impact on the continence or the sexual functions.

Background Ceftriaxone–sulbactam–disodium EDTA (CSE) is being developed for Gram-negative infections caused by multidrug-resistant (MDR) bacteria. PLEA was a Phase 3, double-blind, multicenter, randomized study of CSE vs. meropenem (MR) for treatment of adults with complicated urinary tract infections (cUTI) or acute pyelonephritis (AP). Non-inferiority of CSE over MR at the EMA/FDA primary endpoints has been reported. The effect of baseline MIC on clinical and microbiological outcome at the test of cure (TOC) visit was investigated. Methods Adult patients were randomized 1:1 to receive either CSE (1 g ceftriaxone/500 mg Sulbactam/37 mg EDTA) every 12 h or MR 1g every 8 hours as 30 minutes IV infusion for 5–14 days. Oral step-down therapy was not allowed. Prior to dosing, urine specimens were collected, and MICs were conducted using CLSI methods for both study drugs. Patients that were nonsusceptible to MR were not included in the mMITT population. Results Of 230 subjects randomized, 143 (62.2%) were included in the mMITT population. Baseline Enterobacteriaceae was found in 131 (91.6%) patients, 67/74 (90.5%) in CSE and 64/69 (92.8%) in MR arm. Mean duration of IV therapy was 7 days. Favorable clinical and microbiological outcomes were observed in ≥90% patients for all MICs across the two study groups, with the exception of MIC 1 μg/mL in MR (associated with >20% failures). Overall, both clinical cure and microbiological eradication rates were higher in CSE as compared with MR (95.9% Vs. 89.9% and 94.6% vs. 88.4% respectively) (Table 1). CSE MR MIC(μg/mL) Clinical Cure n/N (%) Microbiological Eradication n/N (%) MIC(μg/mL) Clinical Cure n/N (%) Microbiological Eradicationn/N (%) 97% for MICs up to 4 μg/mL and is a potential new treatment option in patients with cUTI or AP. Disclosures P. Mandale, Venus Medicine Research Centre: Employee, Salary. M. A. Mir, Venus Medicine Research Centre: Employee, Salary. S. Chaudhary, Venus Medicine Research Centre: Employee and Shareholder, Salary. M. Chaudhary, Venus Medicine Research Centre: Board Member and Shareholder, Salary. A. Pyasi, Venus Medicine Research Centre: Employee, Salary.

Background: Worldwide rise in cesarean section (CS) rate during the last three decades has been the cause of alarm and needs an in-depth study. The purpose of this study was to determine the outcome of pregnancy in women with previous one cesarean section and maternal and perinatal complications. It also aimed at identifying the factors, which can influence the outcome of trial of labour (TOL).Methods: The prospective study was conducted in the department of Obstetrics and Gynaecology, Kamla Nehru hospital for mother and child, Indira Gandhi Medical College, Shimla, from June 2013 to May 2014 which included all women undergoing trial for vaginal birth after a previous cesarean who were more than 34 weeks, singleton viable fetus of appropriate size with cephalic presentation with inter delivery interval more than 18 months. Collected data was analysed by Student T-test and Chi-square test was used where required, for statistical analysis using Epi info 7 software. P value

INTRODUCTION AND OBJECTIVES: Based on classic teaching, functional studies (Intravenous pyelography or contrast enhanced CT scan) are often considered a prerequisite before proceeding for surgery for urolithiasis. The routine use of imaging is time consuming and associated with real risks. There is no adequate clinical evidence as to whether detailed functional imaging as a routine has any role in management of calculi and at present no randomized controlled trial exists to evaluate the role and need of such investigations. A randomized study was performed to evaluate the role of functional studies in management of ureteric stones. METHODS: 195 patients presenting to the outpatient department with a diagnosis of a demonstrable solitary unilateral ureteric calculus sized 0.5 to 1.5 cm with normal renal function tests and only mild to moderate hydronephrosis were included in the study. Patients with either increased creatinine, gross hydronephrosis with thinned out renal parenchyma, pyonephrosis or pregnancy were excluded. All included patients were randomized using a computer generated table into two groups. In the first group functional imaging was routinely done but in the other group no such study was performed. However, retrograde pyelogram was performed wherever required to delineate the anatomy. All patients were managed initially with medical expulsive therapy for a period of at least two weeks before they were subjected to ureterorenoscopy (URS). All patients were followed up with imaging after 3 months of successful management. The rates of spontaneous expulsion, difficulty or surprises during surgery and incidence of complications were noted. Results and complications in each of these groups were analysed using appropriate statistics. RESULTS: 97 patients were randomized to the functional studies arm and 98 patients managed without any functional studies. The mean age, sex ratio, body mass index, size of calculus and location of calculus were comparable. Rate of spontaneous expulsion with medical expulsive therapy was 88.71%. Only 11 cases in each group required URS and 1 patient in each group had perforation. A weakly positive but clinically insignificant correlation was seen between size of calculus and need for URS. No significant difference was found in the spontaneous stone expulsion rates, difficulty and incidence of complications during URS and stone free rates between the two groups. CONCLUSIONS: Functional studies may be obviated in management of solitary ureteric calculi amenable to endoscopic treatment in the presence of normal kidney function and absence of gross hydronephrosis.

We performed antegrade endopyelotomy in 34 cases in the last 2½ years. In all cases standardized antegrade percutaneous method was used. A single guide wire and a cold knife were used to perform the endopyelotomy. Nephrostomy tube was retained for 48 hours and the repair stented for 6 weeks. Patients were followed up at 3 months, 6 months and 1 year post-operatively for subjective improvement and objectively by DTPA scans/IVU and ultrasound. The population included 2 bilateral cases, one horseshoe kidney and 3 children. The patient's age ranged from 9-59 years, average 32 years. There were 21 males and 13 females. 28 renal units were primary and 8 were secondary pelviureteric junction (PUJ) obstruction. Follow up period was 3-28 months. Most cases had significant symptomatic and functional recovery postoperatively. Five cases presented with urinary tract infection, which regressed after treatment. At 3(rd) month postoperatively the DTPA/IVU scan was equivocal in 7 cases. In these, a RGP was done which in every case showed a patent PUJ. In 5 cases that were still symptomatic, 6-8 weeks of further stenting produced symptom regression. Two cases failed and needed revision, one by open pyeloplasty and the other by endopyelotomy. Our success rate overall in these cases followed upto 1 year post operatively is 91.6%. We conclude that endopyelotomy is successful across a wide spectrum of cases.

Background: Urinary bladder carcinoma ranks ninth in worldwide cancer incidence. About 74,000 new cases were diagnosed in 2015 alone and 16,000 persons died of the disease. Since histopathology is considered gold standard for diagnosis, it is prudent to look for potential tumor proliferation and predictive markers in such a prevalent malignancy so as to alert surgical and medical oncologists for timely intervention and provide better patient-tailored therapy. Aims: This study is to analyze the role of potential biomarkers-proliferating cell nuclear antigen (PCNA) and angiogenesis using CD31 in urothelial neoplasms in relation to tumor grade and stage. Methods: Histopathology slides were prepared from transurethral resection of bladder tumor chips and assessed by three independent observers as per the WHO/International Society of Urologic Pathology criteria 2016. Representative sections were subjected to immunohistochemistry. PCNA labeling index (PCNA LI) and mean vessel density (MVD) were calculated. Statistical Analysis: Tests of analysis were applied as appropriate. A statistical P < 0.05 was considered significant. Results: Forty-nine patients were analyzed. PCNA LI increased with grade and stage. PCNA was significantly higher in noninvasive papillary urothelial carcinoma high grade (NIPUCHG) than in noninvasive papillary urothelial carcinoma low grade (NIPUCLG) and in infiltrating urothelial carcinoma as compared to NIPUCLG. MVD also increased with tumor grade and stage; however, a significant difference was observed only between infiltrating urothelial carcinoma and papillary urothelial neoplasm of low malignant potential. A cutoff value of 73% for PCNA and 49 vessels/high-power field for CD 31 showed 100% accuracy to differentiate between noninvasive papillary urothelial carcinoma high grade and NIPUCLG. No association was observed between tumor recurrence and PCNA or CD31 expression. Conclusion: PCNA and CD31 when used together are valuable markers to help classify urothelial neoplasms in limited tumor material. However, larger prospective studies are required for better prognostication.

Men’s Health lags behind even to this day despite of increased awareness and much ado. The gravity of the situation is yet to be realized as data from various parts of the world is still missing. Available literature since the beginning of time has portrayed Man as the stronger sex and focused on his sexual abilities. Current studies point to the deficiencies that are inherent to men and suggest reasons for the poor health of men when compared to women. The present article focuses on what has been proposed and established and provides suggestions regarding what can be done further to bring the health of men to the same status as enjoyed by women.

Introduction: Relationship between Testosterone and Prostate Specific Antigen (PSA) in patients with Lower urinary Tract Symptoms (LUTS) is ambiguous. The present study aims to establish the relationship of these variables in patients with LUTS, with a larger study cohort. Methods: A retrospective study was done over a period of 4 years at a tertiary care center. Free and total PSA were correlated with age, prostate volume and Testosterone using appropriate statistical tests in 1156 patients. Patients were stratified into two groups based on PSA level of 4 ng/ml and correlation was studied separately. Results: A weak negative correlation was present between free PSA and Testosterone levels (-0.182, p 4 ng/ml but a weak negative correlation was found between free PSA and Testosterone (-0.156, p

Schwannoma is a benign soft tissue tumor of neural origin arising from the Schwann cells of the neural sheath. It has rarely been reported in renal or perirenal region. The preoperative diagnosis has mostly been confused with renal cell carcinoma in this location in most previous reports. We report a case that presented with a large "simple cystic" mass at the renal hilum. The preoperative differential diagnosis included hilar renal cortical cyst, renal sinus cyst, ureteropelvic junction obstruction (UPJO), or even a hydatid cyst. The final diagnosis was clinched only on histopathological examination.