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Background: Emphysematous pyelonephritis (EPN) is a serious suppurative infection of renal and extrarenal tissues. Most of them end up in nephrectomy, either in an emergency setting or delayed, which is increasingly favored. Laparoscopic nephrectomy is difficult in the post-EPN state due to dense adhesion around the kidney. Aims and Objectives: In this study, we want to check the feasibility of laparoscopic nephrectomy in EPN kidneys. To the best of our knowledge, our series is the single largest series as of today with 10 cases of laparoscopic nephrectomies in EPN kidneys. Materials and Methods: All patients of EPN who underwent laparoscopic nephrectomy at Institute of Kidney Diseases and Research Centre, Ahmedabad, between December 2017 and October 2019 were taken as study subjects and retrospectively reviewed. Patients in whom conservative management was successful were excluded from the study. All patients were diverted initially, either ultrasound/computed tomography-guided percutaneous nephrostomy (PCN) insertion or double J stenting, with or without PCN along with antibiotics and supportive therapy. Delayed transperitoneal laparoscopic nephrectomies were performed for poorly functioning EPN kidneys in follow-up renal scans. Results: A total of 10 patients underwent nephrectomy in this period. The male-to-female ratio was 3:7. As per Huang and Tseng’s EPN classification, one patient had Class 2, four patients had Class 3a, and five patients had Class 3b EPN disease. Mean operative time was 192 min and mean blood loss was 206 ml. Two cases had intraoperative complications managed laparoscopically. No conversion to open nephrectomy or mortality was seen. The drain was placed for a mean period of 3.1 days. The mean hospital stay was 4.8 days. Conclusion: Laparoscopy is safe and feasible for nephrectomy in EPN kidneys. Experience with laparoscopy and operating on pyelonephritis cases is important to reduce complications and extend the advantages of laparoscopy in these groups of patients. An increase in class does not increase the degree of difficulty during laparoscopy.

Background: Lymphocele formation is the most common identifiable surgical complication of renal transplant recipients, which often requires surgical deroofing. In this retrospective study, we are determining the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele. Aims and Objectives: This study aims to determine the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele. Materials and Methods: All patients who underwent surgical deroofing for post-renal transplant lymphocele at the Institute of Kidney DISEASE and Research Center, Ahmedabad, India, between January 2016 and October 2019 were included in the study and retrospectively reviewed. Information about symptomatology, clinical features, radiological findings, preoperative drainage, ultrasound-guided percutaneous nephrostomy (PCN) diversion, intraoperative, post-operative findings, and complications were retrieved and analyzed. Results: Among the 1138 open renal transplant recipients, 28 patients developed symptomatic lymphocele (incidence 2.5%). The mean interval to develop these lymphoceles was 8 weeks (3 weeks–4 months). All 28 patients underwent laparoscopic lymphatic deroofing surgery. There were no conversions to open surgery. Overrunning of cut edges was performed in six and omentopexy in two patients, rest of the 20 patients only deroofing of lymphocele was performed. Graft PCN was placed before surgery in four patients and in two patients, percutaneous drain was placed into the lymphocele. The mean operative time was 80 min. The mean hospital stay was 3.5 days. In one case, there was an injury to the ureter intraoperatively which was repaired over a DJ stent laparoscopically. There was one case with recurrence who had a prior history of continuous ambulatory peritoneal dialysis. He was explored and perivascular lymphatics were tied and omental packing was performed. Conclusion: Laparoscopic deroofing of symptomatic lymphoceles following renal transplantation appears to be safe and effective, because it has minimal post-operative morbidity, rapid convalescence, and low recurrence rate. Laparoscopy should be considered the first-line treatment for symptomatic lymphoceles.

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: The prevalence of varicocele is approximately 15% in the general population, and about 2 -10 % of them have chronic scrotal pain. Microsurgical or Laparoscopic testicular vein ligations are preferred surgical options for the patient refractory to conservative therapy. Previous studies have proved the superiority of microscopic surgeries in painful varicocele treatment but the newer HD endo-vision system has improved laparoscopic vision quality signicantly and testicular veins are identied more precisely than ever before. So there is a need to relook the results of laparoscopic varicocele ligation. We have done a prospective observational study to assess patients' perceived changes in scrotal pain scores preand-post HD laparoscopic varicocele ligation. Materials and Methods: This prospective observational study was conducted at a tertiary care referral center. All patients with scrotal pain were evaluated for varicocele between September 2017 and December 2018. Varicocele patients with normal semen count with chronic scrotal pain not responding to conservative therapy were included in the study. The Laparoscopic varicocele ligation surgeries were done by HD endo-vision system under general or spinal anesthesia. Preoperative and post-operative universal pain scores were compared by Student's pair t-test. Result: A total of 34 patients (mean age, 26.2±3.9 years) underwent Laparoscopic varicocele ligation for scrotal pain symptoms. Thirty-two patients (94.11%) reported complete or marked resolution of pain at 3 months follow-up. There was no early or late postoperative complication reported in any study patient. There was a marked improvement in the mean universal pain score, from 5.6 preoperatively to 1.1 postoperatively (p=0.00011). Conclusion: HD Laparoscopic varicocele ligation has a very high success rate with minimal post-operative complications in painful varicocele management.

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.

Introduction: Radical perineal prostatectomy was the first surgery described for prostatic carcinoma (Young, 1904) but it lost its eminent status after Walsh's description in 1982 of anatomic radical retropubic prostatectomy followed by the enthusiasm in laparoscopy and now robotics. It made resurgence after it was realized in early 1990s that the pelvic lymph node dissection is needed only in selected cases. Last decade witnessed over 80 publications addressing the results and advances in the perineal approach. Strangely, centres from the subcontinent have chosen to ignore this resurgence. We describe our early experience with the technique in 35 patients and present the case for its more widespread usage. Patients and Methods: Thirty five patients of clinically localized carcinoma prostate were operated by perineal route in our institution from December 2006 onwards. All patients had serum prostate specific antigen levels less than 10 ng/ml. Results: Operating time was 2 to 3.5 hours (mean 2.5 hours). Rectal injury occurred in three patients but was closed primarily in all and none required a colostomy. Mean duration of hospital stay was four days. The disease was organ confined in 25(71%). Positive margins were seen in 5(14%) patients. Biochemical recurrence occurred in 17% patients at one year. Seventy six percent patients had achieved continence at one year. Conclusions: As the world is taking note of radical perineal prostatectomy again, with a very small learning curve, minimal invasion and good oncological control urologists from Indian subcontinent should also embrace this procedure in view of the relative limited resources available.