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   2011| September-December  | Volume 3 | Issue 3  
    Online since September 15, 2011

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Dog bite injuries of genitalia in male infant and children
Robin Bothra, Amilal Bhat, Gajendra Saxena, Gautam Chaudhary, Vishrut Narang
September-December 2011, 3(3):167-169
The aim of the study is to highlight genital dog bites in male infant and children in developing countries and their management. We managed three cases (9 months, 5 years, and 8 years) of genital dog bite between January 1997 and July 2008. Two had unprovoked stray dog bites and the third was bitten by his pet dog when disturbed during eating. Extent of injury varied from small-lacerated wound to near emasculation. Primary repair was done after thorough washing and debridement under antibiotic cover. In the 9-month-old male infant who was near emasculated, scrotum was closed with the available skin and a small penile stump was reconstructed after meatoplasty. Immunization against tetanus and rabies was done for all cases.Postoperative recovery was uneventful, and the wound healed primarily in all cases. Parents of the infant were asked for feminizing genitoplasty but they refused so they were advised for hormonal replacement and penile reconstruction at adolescence. Male children are the most common victims of genital dog bites. These injuries can be repaired primarily with good outcome provided strict cleaning, debridement, wound repair, antibiotic cover, and immunization is applied.
  6,972 549 4
Congenital penile urethrocutaneous fistula: A rare anomaly and review of literature
Ram Mohan Shukla, Biswanath Mukhopadhyay, Kartik Chandra Mandal, Shib Sankar Barman
September-December 2011, 3(3):161-163
Congenital penile urethrocutaneous fistula is described as an unusual developmental anomaly in children who present with an abnormal opening on the ventral aspect of penis with a normal foreskin and an absence of chordee and hypospadias. The authors present a discussion on the etiology, embryology, and management of this entity along with a description of three cases. We emphasize meticulous clinical examination for the diagnosis and to rule out other associated anomalies.
  6,203 448 2
The new Olympus digital flexible ureteroscope (URF-V): Initial experience
Saeed M Al-Qahtani, Bogdan P Geavlette, Sixtina Gil-Diez de Medina, Olivier P Traxer
September-December 2011, 3(3):133-137
Objective: Flexible ureterorenoscopes (FURSs) are considered important additions to urology armamentarium. One of the technical drawbacks is the poor optic image provided by fiberoptic endoscope as well as the fragility of this conventional fiberoptic endoscope. This study aim is to evaluate practical performances and functional durability of the new Olympus digital flexible ureteroscope (ODF-URS) (URF-V) in a single center clinical setting. Materials and Methods: A number of 60 diagnostic and therapeutic procedures were performed over a period of 6 months in a single center (Tenon University Hospital), using a single ODF-URS (URF-V). This device provided a 275˚ maximal down-deflection (MDD) and 180˚ maximal up-deflection (MUD). Results: ODF-URS (URF-V) was used for a total time of 90 h and 30 min, with average time duration of 90.5 min per procedure. After 60 procedures, MDD decreased from 275˚ to 217˚, while the MUD decreased from 180˚ to 161˚. During six procedures (10%), URF-V failed to access inferior calyx due to a narrow lower calyx infundibulum. Conclusion: New ODF-URS (URF-V) is a reliable and durable device, with a good success rate and improved functional parameters. It is a superior device compared to predecessor generations of conventional fiberoptic endoscopes for the light source and the image quality; however, randomized comparative studies are necessary to evaluate performances and durability of this device.
  5,752 683 9
Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder
Bedeir Ali-El-Dein, Mohammed S Al-Marhoon, Mohamed Abdel-Latif, Ahmed Mesbah, Atallah A Shaaban, Adel Nabeeh, El-Housseiny I Ibrahiem
September-December 2011, 3(3):127-132
Context: The optimal time of cystectomy for nonmuscle invasive bladder cancer (NMIBC) is controversial. Aim: This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Settings and Design: Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Materials and Methods: Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients (group 1) and deferred cystectomy was done after failed conservative treatment in 70 (group 2) Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Statistical Analysis Used: Cancer-specific survival was calculated using the Kaplan-Meier method. Results: Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year (84% in group 1 vs. 79% in group 2), 5-year (78% vs. 71%) and 10-year (69% vs. 64%) cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors (TURBT) than in cases with fewer TURBTs. Conclusions: Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category.
  4,601 508 6
Role of parenteral testosterone in hypospadias: A study from a teaching hospital in India
Reyaz Ahmad, Rajendra Singh Chana, Syed Manazir Ali, Shehtaj Khan
September-December 2011, 3(3):138-140
Objectives: To evaluate the effect of parenteral testosterone on penile length, preputial skin and side effects in patients with hypospadias. Materials and Methods: 23 patients with hypospadias were included in this study. An oily solution, each ml of which contained testosterone propionate 25 mg, and testosterone enanthate 110 mg, equivalent to 100 mg of testosterone was given deep intramuscularly 4, 3 and 2 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Increase in penile length, transverse preputial diameter, and diameter at the base of penis were noted. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. In addition, side effect such as development of pubic hair and delay in bone age was noted. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial diameter and diameter at the base of penis was 1.35±0.40 cm (P<0.001), 1.40±0.47 cm (P<0.001), and 0.72±0.47 cm (P<0.001), respectively. Serum testosterone level after injection was well within normal range for that age. Minimal side effects were noted in form of development of fine pubic hair. Conclusion: We conclude that parenteral testosterone can be safely used to improve the surgical outcome of hypospadias repair.
  4,494 559 -
Rhabdomyolysis and myogloginuric acute renal failure in the lithotomy/exaggerated lithotomy position of urogenital surgeries
Mukesh K Vijay, Preeti Vijay, Anup K Kundu
September-December 2011, 3(3):147-150
Objective: To evaluate rhabdomyolysis and it's management in lithotomy and the exaggerated lithotomy positions during urogenital surgeries. Design: Retrospective study Setting: Institute of Post Graduate Medical Education and Research (IPGME & R), Kolkata, India. Materials and Methods: Patients undergoing urogenital surgeries (lithotomy and the exaggerated lithotomy positions). Intervention(s): All four cases of rhabdomyolysis which occurred after such positional urogenital surgeries were treated with conservative management for prolonged period with hemodialysis. One case which developed compartment syndrome underwent fasciotomy and also managed with conservative approach as other cases. Main Outcome Measure: Rhabdomylysis is now a rare complication in any open or laparoscopic surgery. But prolonged lithotomy or exaggerated lithotomy position surgeries have been shown to expose patients to the risk of rhabdomylysis and acute renal failure. Results: In our institute patients undergoing urogenital surgeries in lithotomy and the exaggerated lithotomy positions only developed rhabdomyolysis and myogloginuric acute renal failure. All procedures were of prolonged duration (mean five hours and ten minutes). Three patients developed rhabdomyolysis and acute renal failure without compartmental syndrome and one with compartmental syndrome. Rhabdomyolysis with the appearance of acute renal failure is discussed. Conclusion: Overall, our cases showed that rhabdomyolysis and acute renal failure can develop in such operative positions even in the absence of compartmental syndrome, and that duration of surgery is the most important risk factor for such complications. So we should be careful regarding duration of surgery in lithotomy procedure to prevent such morbid complications.
  4,451 529 7
Long-term prognostic value of the combination of EORTC risk group calculator and molecular markers in non-muscle-invasive bladder cancer patients treated with intravesical Bacille Calmette-Guérin
Sultan S Alkhateeb, Mischel Neill, Sas Bar-Moshe, Bas Van Rhijn, David M Kakiashvili, Neil Fleshner, Michael Jewett, Michel Petein, Claude Schulman, Sally Hanna, Peter J Bostrom, Thierry Roumeguere, Shahrokh F Shariat, Sandrine Rorive, Alexandre R Zlotta
September-December 2011, 3(3):119-126
Background and Objectives: To evaluate the long-term prognostic value of the combination of the EORTC risk calculator and proapoptotic, antiapoptotic, proliferation, and invasiveness molecular markers in predicting the outcome of intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) treated with intravesical Bacille Calmette-Guérin (BCG) therapy. Materials and Methods: This study included 42 patients accrued prospectively presenting with intermediate- to high-risk NMIBC (high-grade T1 tumors or multiple rapidly recurrent tumors refractory to intravesical chemotherapy) treated with transurethral resection (TUR) and BCG. TUR samples were analyzed for the molecular markers p53, p21 waf1/cip, Bcl-2, CyclinD1, and metallothionein 9 (MMP9) using immunohistochemistry. Frequency of positivity, measured as a percentage, was assessed alone or in combination with EORTC risk calculator, for interaction with outcome in terms of recurrence and progression using univariate analysis and Kaplan-Meier survival curves. Results: Median follow-up was 88 months (mean, 99; range, 14-212 months). The overall recurrence rate was 61.9% and progression rate was 21.4%. In univariate analysis, CyclinD1 and EORTC risk groups were significantly associated with recurrence (P value 0.03 and 0.02, respectively), although none of the markers showed a correlation to progression. In combining EORTC risk groups to markers expression status, high-risk group associated with positive MMP9, Bcl-2, CyclinD1, or p21 was significantly correlated to tumor recurrence (log rank P values <0.001, 0.03, 0.02, and 0.006, respectively) and when associated with positive MMP9 or p21, it was significantly correlated to progression (log rank P values 0.01 and 0.04, respectively). Conclusion: Molecular markers have a long-term prognostic value when combined with EORTC scoring system and they may be used to improve the predictive accuracy of currently existing scoring system. Larger series are needed to confirm these findings.
  4,020 762 11
Teratoid Wilms' tumor - A rare renal tumor
Biswanath Mukhopadhyay, Ram Mohan Shukla, Madhumita Mukhopadhyay, Sabitri Mandi, Dipankar Roy, Malay K Bhattacharya
September-December 2011, 3(3):155-157
Teratoid Wilms' tumor is an extremely rare renal tumor. We report a case of unilateral teratoid Wilms' tumor in a 4-year-old girl. The patient was admitted with a right-sided abdominal mass. The mass was arising from the right kidney. Radical nephrectomy was done and the patient had an uneventful recovery. Histopathology report showed teratoid Wilms' tumor.
  4,258 438 -
Partial orchiectomy and testis intratubular germ cell neoplasia: World literature review
Wassim M Bazzi, Omer A Raheem, Sean P Stroup, Christopher J Kane, Ithaar H Derweesh, Tracy M Downs
September-December 2011, 3(3):115-118
Approximately 5% of all patients diagnosed with testicular cancer may have contralateral intratubular germ cell neoplasia (ITGCN) and may develop contralateral germ cell tumor. Here, we present a historical review and current literature regarding ITGCN and partial orchiectomy. The PubMed world literature search was performed for articles written in the English language. Search terms used were: Partial orchiectomy and ITGCN, with a return of 322 articles. Articles obtained were from the United States, Germany, Denmark and the Netherlands as well as a few case reports from Australia, France, Turkey and Spain. A critical review of the literature was performed. Partial orchiectomy is an option for the management of testicular malignancy in a select group of patients in whom radical orchiectomy is not desirable, including those with a solitary testicle, bilateral concurrent malignancies and a desire for paternity or being independent from androgen supplementation. Reports have demonstrated the feasibility of partial orchiectomy, but there are strict surgical criteria; tumor less than 2 cm in size, maintenance of cold ischemia, meticulous dissection to maintain testicular blood supply and biopsying of adjacent testicular parenchyma to ensure negative margins and absence of concurrent ITGCN. Partial orchiectomy is followed by testicular irradiation of 18-20 Gy; this radiation dose reduces fertility but maintains leydig cell function with androgen independence. Patients with a history of testicular carcinoma have a 5% chance of developing a metachronous contralateral tumor. Partial orchiectomy is a technically challenging procedure that requires close follow-up, but may represent a reasonable management option in selected patients.
  3,795 789 3
Mucinous adenocarcinoma of the renal pelvis with adenocarcinoma in situ of the ureter
Vandana Raphael, Stephan Sailo, Ashim Bhuyan, Mandeep Phukan
September-December 2011, 3(3):164-166
Primary epithelial tumor of the renal pelvis is rare, and adenocarcinomas account for less than 1% of malignancies arising from the epithelium of the renal pelvis. We describe in this study a case of a 56- year old male patient who presented with an abdominal mass and dull aching pain for one year. A diagnosis of hydronephrosis of the right kidney was made based on imaging studies. Grossly, the entire kidney was converted into a cystic mass measuring 16 × 12 × 10 cm and filled with gelatinous material along with staghorn calculi in the pelvis measuring 7 × 4 × 3 cm. Histological examination of the tumor showed glands, cysts, and papillae lined by pseudostratified columnar epithelium with hyperchromatic nuclei. Scattered signet ring-type cells were also seen floating in large pools of extracellular mucin. Sections from the ureter showed a component of adenocarcinoma in situ. No invasive tumor was identified in ureteric tissue. Thus, a diagnosis of mucinous adenocarcinoma of the renal pelvis with in situ adenocarcinoma of the ureter was made.
  4,189 384 3
Clear cell adenocarcinoma of urinary bladder: A case report and review
Somika Sethi, Shashi Dhawan, Prem Chopra
September-December 2011, 3(3):151-154
Clear cell carcinoma is an uncommon but distinct variant of urinary bladder carcinoma histologically resembling the neoplasm in the female genital tract. The histogenesis of this neoplasm is uncertain. The clinicopathologic and histologic features are suggestive of a mullerian origin in some tumors, while some believe it to be glandular differentiation of urothelium or a unique vesicular adenocarcinoma of non-mullerian origin. [1] We present a case of clear cell adenocarcinoma in a 74-year-old woman with review of literature along with its differential diagnosis.
  3,370 480 -
Histomorphometric and sympathetic innervation of the human renal artery: A cadaveric study
Sreenivasulu Reddy, Pramod Kumar, Keerthana Prasad
September-December 2011, 3(3):141-146
Background and Aim: Renal artery stenosis (RAS) and acute renal failure may be due to the intimal hyperplasia and sympathetic fibers of the renal artery (RA), respectively. The purpose of this study was to characterize arterial wall and sympathetic innervation of the human RA. Materials and Methods: Fifty-two fresh human RA samples (proximal part) were collected from 26 cadavers (19 males and 7 females), between the ages of 19 and 83 years, during autopsy. Samples were divided into three age groups: Group 1, 19-40 years; Group 2, 41-60 years; Group 3, over 61 years. 5-μm thick sections of each sample were taken and stained with hematoxylin-eosin and Verhoeff-Van Gieson. Five out of 52 samples were processed for tyrosine hydroxylase (TH) immunostaining. Results: Our histological studies revealed that tunica media of RA showed smooth muscle cells and fine irregularly arranged elastic fibers. Intimal hyperplasia was the most common finding. The present study showed that thickness of tunica intima and media were found to increase with age. Sympathetic nerves were present in the tunica adventitia and outer media of the RA. The mean adventitial and sympathetic nerve fiber areas were found to be 0.595 and 0.071 mm2, respectively. Sympathetic index (SI) to RA was calculated by dividing the sympathetic fiber area by the adventitial area of the RA. SI of RA was found to be 0.140. Conclusion: We conclude that RA showed the structure of musculo-elastic artery. SI may be used for the analysis of sympathetic fiber related problems of the human RA or kidneys.
  2,953 412 3
A case of solitary fibrous tumor of the kidney
HN Naveen, Girish N Nelivigi, GK Venkatesh, V Suriraju
September-December 2011, 3(3):158-160
A solitary fibrous tumor (SFT) is an unusual spindle cell neoplasm that usually occurs in the pleura but has recently been described in diverse extrapleural sites. Urogenital localization is rare and to our knowledge, only 39 cases of SFT of the kidney have been described. Although SFT of the kidney is extremely rare, this tumor must be included in the differential diagnosis, whenever a renal tumor consisting of mesenchymal elements is encountered. We report a case of a large SFT of the right kidney which was clinically and radiologically thought to be renal cell carcinoma and a final diagnosis of SFT was made only after immunohistochemical study.
  2,888 421 2