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  Citation statistics : Table of Contents
   2010| May-August  | Volume 2 | Issue 2  
    Online since July 3, 2010

 
 
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CASE REPORTS
A knotted ureteral stent: A case report and review of the literature
Stefano Picozzi, Luca Carmignani
May-August 2010, 2(2):80-82
DOI:10.4103/0974-7796.65108  PMID:20882161
The indications for ureteral stent placement have expanded significantly with the progress of surgical procedures and techniques. Although such stents are now an integral part of contemporary urological practice, their use is not free of complications and consequences. There are very rare descriptions of knot formation in a ureteral stent and the consequences of this occurrence, with only 12 cases previously reported. Here, we report an additional case and review all the literature concerning this urological complication with emphasis on its predisposing factors and conservative and surgical management.
  5 3,697 516
ORIGINAL ARTICLES
The efficacy of tamsulosin in lower ureteral calculi
MS Griwan, Santosh Kumar Singh, Himanshu Paul, Devendra Singh Pawar, Manish Verma
May-August 2010, 2(2):63-66
DOI:10.4103/0974-7796.65110  PMID:20882156
Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL). Aims: Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent 't' test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.
  4 6,595 1,149
Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital
Rajkumar Mathur, Nitin Joshi, Gaurav Aggarwal, Ramsharan Raikwar, Vaibhav Shrivastava, Poonam Mathur, Poonam Raikwar, Rupali Joshi
May-August 2010, 2(2):67-70
DOI:10.4103/0974-7796.65114  PMID:20882157
Introduction: The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO) has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre. Materials and Methods: 50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal) and lower segment caesarean section (LSCS) were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU). Cystoscopy along with examination under anaesthesia (EUA) were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years. Results: Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40% illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF) was seen in 64% cases of which 50% were due to obstructed labor, 19% cases post LSCS and 31% cases post total abdominal hysterectomy (TAH). 68% of urogenital fistulae were between 1 to 3 cms. We obtained a 75% cure rate in UVF, 87.5% cure rate in RVF while a 93.75% cure rate was observed in patients with VVF. 76% of all patients were cured while 8% had a recurrence, probably due to the large size of fistula. Conclusion : Genital fistula is preventable, yet it remains a significant cause of morbidity among females of reproductive age group. Despite facilities available, certain conditions like physical, social, economic, illiteracy, and a very casual attitude towards maternal health and children birth practices limit utilization of services for women. It is important that the modern health care providers should be aware of these aspects, so that they can recognize services that are appropriate and acceptable to the people. Thus, one must agree that in cases of urogenital fistulae, "prevention is better than cure".
  3 5,404 656
Biopsies of the normal-appearing urothelium in primary bladder cancer
Davor Librenjak, Zana Saratlija Novakovic, Marijan Situm, Kazimir Milostic, Mario Duvnjak
May-August 2010, 2(2):71-75
DOI:10.4103/0974-7796.65115  PMID:20882158
Aim: The aim of the study was to determine the incidence of "positive" findings in biopsies of the normal-appearing urothelium near primary cancer and their influence on therapeutic decisions. Materials and Methods: Between January 2001 and October 2008, in 230 patients with primary bladder cancer during initial resection of tumor, we also performed random biopsy of surrounding normal-appearing urothelium. We analyzed retrospectively the number and type of positive biopsy findings and their impact on further treatment. Results: There were 40% of patients (92/230) whose normal-appearing urothelium biopsy revealed pathological findings such as tumor tissue, Tis, and dysplasia. In 24.4% of patients, the stage of the primary tumor was Ta (32/131), in 50% it was T1 stage (30/61), and in 79% T2 stage (30/38). When we assessed the grade of malignancy, we found 18% of biopsies with G1 tumors (16/88), 33% with G2 tumors (19/59), and 69% with G3 tumors (57/83). Tumor tissue that was found in the normal-appearing urothelium in biopsy specimens in 13% of patients was in stage Ta (17/131), in 16% it was T1 stage (10/61), and in 39% of patients, the tumor was in T2 stage (15/38). Pathological findings of random biopsies were crucial in changing therapeutical decisions in 4.6% (9/192) of patients. Conclusion: Biopsy of the normal-appearing urothelial tissue is easy to perform and may help in identifying patients with high risk of disease progression and recurrence. Based on our results and results from the literature we recommend this simple tool as part of the routine management during transurethral resection of primary bladder cancer.
  3 2,396 432
CASE REPORTS
Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture
Reshaid Abdullah Al-Reshaid, Khaled Madbouly, Abdullah Al-Jasser
May-August 2010, 2(2):86-88
DOI:10.4103/0974-7796.65111  PMID:20882163
Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture.
  2 8,254 600
Inflammatory myofibroblastic tumor of the urinary bladder
Vipul Yagnik, Amit Chadha, Sanjay Chaudhari, Keyuri Patel
May-August 2010, 2(2):78-79
DOI:10.4103/0974-7796.65106  PMID:20882160
Inflammatory myofibroblastic tumor (IMT) of bladder is an uncommon benign tumor of bladder, which is of unknown neoplastic potential, characterized by spindle cell proliferation with characteristic fibroinflammatory and pseudosarcomatous appearance. Essential criteria for the diagnosis of IMT are: spindle myoepithelial cell proliferation and lymphocytic infiltrate. Complete surgical resection is the treatment of choice.
  1 3,414 588
ORIGINAL ARTICLES
Transperineal bulboprostatic anastomotic repair of pelvic fracture urethral distraction defect and role of ancillary maneuver: A retrospective study in 172 patients
Santosh K Singh, Devendra S Pawar, Atul K Khandelwal, Jagmohan
May-August 2010, 2(2):53-57
DOI:10.4103/0974-7796.65104  PMID:20882154
Objective: We present our experience with transperineal bulboprostatic anastomosis procedure and compare the results with age of patients, length of urethral stricture, effect of previous treatment and need for ancillary procedures. Materials and Methods: We retrospectively reviewed the outcome of 172 patients who underwent perineal urethroplasty procedure for traumatic stricture in our institute. Simple perineal anastomosis was done in 92 patients. Perineal anastomosis and corporal separation were done in 52 patients. Perineal anastomosis with inferior pubectomy was done in 25 patients. Perineal anastomosis with rerouting was done in three patients. Age, prior treatment, length of stricture, and ancillary techniques required during reconstruction were compiled. The clinical outcome was considered as failure when any postoperative instrumentation was needed. Results: Out of 172 cases that underwent transperineal urethroplasty procedure, 157 (91.28%) were successful. Simple perineal urethroplasty procedure showed a success rate of 93.4%, perineal anastomosis with separation of corporal bodies had a success rate of 90.4%, perineal anastomosis with inferior pubectomy had a success rate of 88% and perineal anastomosis with rerouting of urethra around the corpora had a success rate of 66.7%. Conclusion: The success rate of delayed progressive perineal urethroplasty procedure for post-traumatic stricture urethra is excellent and majority of the failures occurs in prepubescent boys and in those undergoing secondary repair.
  1 3,405 715
Does nerve-sparing radical prostatectomy increase the risk of positive surgical margins and biochemical progression?
Sultan Saud Alkhateeb, Shabbir M Alibhai, Antonio Finelli, Neil E Fleshner, Michael A Jewett, Alexandre R Zlotta, John Trachtenberg
May-August 2010, 2(2):58-62
DOI:10.4103/0974-7796.65107  PMID:20882155
Background: Since the introduction of nerve-sparing radical prostatectomy (NSRP), there have been concerns about the increased risks of positive surgical margins (PSM) and biochemical progression (BP). We examined the relationship of NSRP with PSM and BP using a large, mature dataset. Materials and Methods: Patients who underwent RP for clinically localized prostate cancer at our center between 1997 and 2008 were identified. Patients who received neoadjuvant therapy were excluded. We examined the relation of NSRP to the rate of PSM and BP in univariate and multivariate analyses adjusting for clinical and pathological variables including age, pretreatment prostate-specific antigen (PSA) levels and doubling time, and pathological stage and grade. Results: In total, 856 patients were included, 70.9% underwent NSRP and 29.1% had non-NSRP. PSM rates were 13.5% in the NSRP group compared to 17.7% in non-NSRP (P=0.11). In a multivariate analysis, non-NSRP was preformed in patients with a higher pathological stage (HR 1.95, 95% CI 1.25-3.04, P=0.003) and a higher baseline PSA level (HR 1.04, 95% CI 1.01-1.08, P=0.005). With a median follow-up of 41 months, BP-free survival was 88% for non-NSRP compared to 92% for the NSRP group (log rank P=0.018); this difference was not significant in a multivariate Cox regression analysis (HR 0.54, 95% CI 0.28-1.06, P=0.09). Conclusion: When used in properly selected patients, NSRP does not seem to increase the risk of PSM and disease progression. The most effective way of resolving this issue is through a randomized clinical trial; however, such a trial is not feasible.
  1 4,086 547
CASE REPORTS
A case of infective endocarditis after transurethral prostatic resection
Takashi Kawahara, Hiroki Taguchi, Takuya Yamagishi, Koichi Udagawa, Hideki Ouchi, Hioshi Misaki
May-August 2010, 2(2):83-85
DOI:10.4103/0974-7796.65109  PMID:20882162
We report a case of infective endocarditis (IE) after transurethral prostatic resection (TUR-P). A 63-year-old man who had underwent TUR-P for benign prostatic hyperplasia. After 40 days of surgery, he developed a fever. A diagnosis of IE was established by cardiography which detected large vegetation at mitral valve. After intravenous antibiotics therapy, he underwent mitral valve replacement surgery.
  - 2,459 339
Primary malignant melanoma of prostate
M Doublali, A Chouaib, A Khallouk, MF Tazi, MJ El Fassi, My H Farih, H Elfatmi, M Bendahou, A Benlemlih, O Lamarti
May-August 2010, 2(2):76-77
DOI:10.4103/0974-7796.65105  PMID:20882159
Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate.
  - 2,294 393
LETTERS TO EDITOR
Primary hydatid of psoas muscle
Imtiaz Wani, Rauf A Wani, Khusrheed Alam Wani
May-August 2010, 2(2):89-89
DOI:10.4103/0974-7796.65112  PMID:20882164
  - 2,314 337
Prostatic abscess
Ramen Kumar Baishya, Jigish Vyas, Ravindra B Sabnis, Mahesh R Desai
May-August 2010, 2(2):89-90
DOI:10.4103/0974-7796.65113  
  - 2,026 423
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