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   2014| April-June  | Volume 6 | Issue 2  
    Online since April 15, 2014

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Laparoscopic repair of massive inguinal hernia containing the urinary bladder
Atif Khan, Ian Beckley, Brian Dobbins, Karol M Rogawski
April-June 2014, 6(2):159-162
DOI:10.4103/0974-7796.130654  PMID:24833832
Inguinal herniation of the urinary bladder is an extremely rare occurrence involving less than 5% of inguinal hernias reported in literature. These hernias require a high index of suspicion for their diagnosis and pose significant challenges to the operating surgeon. The majority of these hernias have been repaired by an open technique. We report two cases managed laparoscopically.
  3,885 299 -
Extended-spectrum beta-lactamase-positive Escherichia coli causing complicated upper urinary tract infection: Urologist should act in time
Stefano C.M. Picozzi, Stefano Casellato, Mattia Rossini, Gaia Paola, Milvana Tejada, Elena Costa, Luca Carmignani
April-June 2014, 6(2):107-112
DOI:10.4103/0974-7796.130536  PMID:24833818
Objective: Recently, many articles reported increased incidence of urinary tract infection (UTI) due to Extended-Spectrum Beta-Lactamase (ESBL)-producing E. coli. No data are available to date regarding patients presenting with complicated upper ESBL-positive E. coli UTI and sepsis. We report the clinical presentation, management, and outcomes in seven cases. Materials and Methods: This prospective study was carried out between January 2008 and September 2011. Follow-ups varied in patients according to their disease presentation and clinical outcomes. All strains were cultured and identified by the Clinical Microbiology Laboratory and were recovered from blood and urine cultures. In-vitro presence of ESBL was confirmed with Clinical and Laboratory Standard Institute double disc method. Results: In the study period, 49 patients needed hospitalization for upper UTI. Overall, in 25 patients (51%), cultures were negative. In the remaining, seven patients (14.3%) presented positive blood and urine-culture for ESBL + E. coli . Of these, four were female and three were male. Their median age was 73 years (range 66-84). The median hospital stay of these patients was 23 days (range 13 to 45 days). Conclusions: The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI. Multi-drug-resistant E. coli can be readily encountered in hospital settings during daily clinical practice, and urologist should act timely. The management of such infections is extremely important for the future, with particular reference to prevention of new antibiotic resistance patterns.
  3,360 683 1
Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture
Ahmed Ali, Ghulam Nabi, Satchi Swami, Bhaskar Somani
April-June 2014, 6(2):166-168
DOI:10.4103/0974-7796.130657  PMID:24833834
A 49-year-old man following a road traffic accident (RTA) had an unstable pelvic fracture with urethral injury. Internal pelvic fixation with Supra-pubic catheter (SPC) drainage of his bladder was done. This failed to stop the bleeding and a pelvic angiography with bilateral internal iliac embolization using steel coils was performed successfully controlling the bleeding. After 4 weeks, the patient developed wound infection (Clavien Grade III) and on exploration, bladder necrosis was found. A urinary diversion using ileal conduit with excision of bladder was performed. A biopsy of the excised bladder confirmed bladder necrosis with a foreign material (coil) in one arterial lumen.
  2,595 357 -
Raised white cell count in renal colic: Is there a role for antibiotics?
Adam Alleemudder, Xin-You Tai, Anuj Goyal, Jhumur Pati
April-June 2014, 6(2):127-129
DOI:10.4103/0974-7796.130554  PMID:24833823
Aims: To determine the use of antibiotics in patients with renal colic and an elevated white cell count (WCC) in the absence of other features of infection. Materials and Methods: A retrospective audit of patients presenting to an emergency department with renal colic caused by a solitary ureteric stone over a 6 month period. Statistical Analysis Used: Student's t-test. Results: Fifty patients met the inclusion criteria for this study. In 42 patients (84%) the urinalysis showed hematuria only and all urine culture results were negative for microbial growth. The mean WCC was 11.5 × 10 9 (4-22.1) and was raised in 34 patients (80.9%). The mean neutrophil count was 8.75 × 10 9 /L (2.3-18.6) and C-reactive protein (CRP) 15.9 (1-192). Antibiotics were commenced in 34 patients (80.9%) based solely on the raised WCC. In eight patients (16%) there were leucocytes and/or nitrites on urinalysis and all urine cultures were positive for growth (coliforms in five, streptococcus in two and candida in one specimen). The mean WCC was 10.5 × 10 9 /L (7.7-16.5) and was raised in four patients. The mean neutrophil count was 8.4 × 10 9 /L (4.9-15.2) and CRP 40.79 (3-86). One patient had pyrexia. All eight patients were commenced on antibiotics based on the WCC and/or urinalysis result. Conclusions: Over three-quarters of the patients (80.9%) in this study who presented with renal colic were unjustifiably commenced on antibiotics based solely on an elevated WCC. Antibiotic use in renal colic should be reserved for when there are features of sepsis or the urinalysis is positive. Further work is required to determine the significance of the observed results and the threshold for starting antibiotics.
  2,568 323 -
Laparoscopic radical and partial nephrectomy: The clinical efficacy and acceptance of the techniques
Abdulrahman Al-Aown, Panagiotis Kallidonis, Stavros Kontogiannis, Iason Kyriayis, Vasilis Panagopoulos, Jens-Uwe Stolzenburg, Evangelos Liatsikos
April-June 2014, 6(2):101-106
DOI:10.4103/0974-7796.130521  PMID:24833817
The laparoscopic approach has been established as the surgical procedure of choice for radical nephrectomy during the recent years. The advantages of the laparoscopic radical nephrectomy in comparison to the open approach are well-documented. The oncological results of the laparoscopic approach are similar to the open procedure while the post-operative morbidity is lower. Laparoscopic partial nephrectomy seems to gain ground to its open counterpart, as the accumulation of experience in the technique grows. In this review, a PubMed search in the latest literature on radical and partial laparoscopic nephrectomy took place and the outcome of the search is presented. Several issues about the surgical techniques and clinical efficacy are discussed. In addition, the preliminary experience in laparoscopic nephrectomy of one of the authoring institutions is also presented.
  2,337 440 -
A novel method for salvage of malfunctioning peritoneal dialysis catheter
Ali Akbar Beig, Sayed Mahdi Marashi, Hojatollah Raji Asadabadi, Ali Sharifi, Zohre Nasiri Zarch
April-June 2014, 6(2):147-151
DOI:10.4103/0974-7796.130646  PMID:24833828
Context: Continuous ambulatory peritoneal dialysis (CAPD) has been widely used as an effective therapy in the management of patients with end-stage renal disease. Long-term use of CAPD needs methods with low incidence of catheter-related complications. Moreover, some complications may cause failure of fluid drainage and treatment interruption. Aims: We have innovated and studied a new minimal-invasive method of malfunctioning peritoneal catheter repair. Materials and Methods: Thirty-five patients agreed to undergo catheter rescue operation by this new method during 2004 and 2012. Under local anesthesia and light sedation, access to the abdominal cavity was made, the catheter and wrapped omentum grasped and the tip of catheter was released, debris were removed and the catheter was directed toward the pelvic floor with a finger guide. The patients were followed after catheter salvage up to the end of study (April 2012). PD catheter function restored to the normal level in 28 (80%) of patients, and PD was started 1-2 days after the procedure. Results: All patients had an uneventful recovery. PD catheter function was restored to the normal level in 28 (80%) patients, and PD was started 1-2 days after the procedure. Of these patients, 10 (35%) died of reasons unrelated to catheter or catheter complications; 7 (25%) were ultimately referred for kidney transplant; 8 (29%) continued PD up to the end of this study with no problem, and only 3 (11%) due to catheter complications. Catheter function did not restore to the normal level in seven patients (20%); however, six patients continued PD for 1-18 months with the catheter. Conclusions: Comparing the advantages and disadvantages of this method to the previous laparoscopically repaired catheter, we concluded that this new method is efficient, and is a suitable way for malfunctioning PD catheter salvage.
  2,223 388 -
Clinico-pathological prognostic factors of renal cell carcinoma: A 15-year review from a single center in Greece
Nikolaos Grivas, Vasilios Kafarakis, Ioannis Tsimaris, Pavlos Raptis, Konstantinos Hastazeris, Nikolaos E Stavropoulos
April-June 2014, 6(2):116-121
DOI:10.4103/0974-7796.130552  PMID:24833821
Aim: To investigate the prognostic significance of certain clinical and pathological factors of renal cell cancer. Materials and Methods: One hundred and fourteen patients who underwent radical nephrectomy between 1996 and 2011 in our hospital were examined. Parameters including age, gender, mode of presentation, hematological and pathological parameters were evaluated for their role as predictors of disease-free and overall survival. Results: Median follow-up was 69 months. Predominant histological type, pathological stage, and nuclear grade were clear cell carcinoma, pT1, and Fuhrman II, respectively. Five-year overall and disease-free survival were 86% and 82%, respectively. Only nuclear grade ( P = 0.02) and preoperative anemia ( P < 0.01) were correlated with overall survival, while pathological stage, nuclear grade, anemia, and neutrophil-to-lymphocyte ratio of 2.7 or greater were associated with disease-free survival ( P = 0.02, P = 0.038, P < 0.01, P = 0.049, respectively). In the multivariate setting, anemia ( P = 0.04) and pathological stage ( P = 0.026) were the only independent statistically significant predictors of disease-free survival, while anemia ( P = 0.018) and neutrophil to lymphocyte ratio ( P = 0.034) were the only factors correlated with overall survival. Conclusions: Due to the wide application of various imaging studies, patients with kidney cancer are diagnosed more often with localized disease and favorable pathological features. Fuhrman nuclear grade, pathological stage, preoperative anemia, and neutrophil to lymphocyte ratio are strongly associated with survival. In localized disease, such information could be used to guide the intensity of follow-up and identify high-risk patients who can be targeted for adjuvant therapy trials.
  2,203 341 -
Robotic-assisted laparoscopic excision of gossypiboma simulating bladder wall mass after 35 years of appendectomy
Emad Sabri Rajih, Waleed Khalid Al-Khudair, Turky Al-Hussain, Mohammed Faihan Al-Otaibi
April-June 2014, 6(2):163-165
DOI:10.4103/0974-7796.130655  PMID:24833833
Gossypiboma or textiloma are terms commonly used to describe a retained sponge in the body that is composed of sponge invested within a layer of foreign body reaction in the form of an abscess or an aseptic fibrotic reaction. These cases are rarely reported despite an incidence of 1:1,000-1,500 of abdominal or pelvic surgery. We report a patient who presented with an incidental supravesical mass discovered upon work up for frequency and suprapubic pain. He had appendectomy 35 years ago. The mass was excised by robotic-assisted laparoscopic technique. The pathologic evaluation came as gossypiboma.
  2,286 246 -
Laparo-endoscopic single-site left adrenalectomy using conventional ports and instruments
Deepraj S Bhandarkar, Gaurav K Mittal, Avinash N Katara, Ramya R Behera
April-June 2014, 6(2):169-172
DOI:10.4103/0974-7796.130660  PMID:24833835
Laparo-endoscopic single-site adrenalectomy (LESS-A) is commonly performed using specialized access devices and/or instruments. We report a LESS-A in a 47-year-old woman with a left aldosteranoma via a subcostal approach utilizing conventional laparoscopic ports and instruments. The feasibility and cost-effectiveness of this approach are highlighted and the literature on the subject is reviewed.
  2,167 333 -
Chemical cystitis developed in experimental animals model: Topical effect of intravesical ozone application to bladder
Omer Bayrak, Sakip Erturhan, Ilker Seckiner, Ahmet Erbagci, Abdulkerim Ustun, Metin Karakok
April-June 2014, 6(2):122-126
DOI:10.4103/0974-7796.130553  PMID:24833822
Aims: To demonstrate the effects of intravesical ozone treatment on inflammation and epithelial cell damage in chemical cystitis animal model. Materials and Methods: A total of 30 New Zealand rabbits were divided into six groups. Cystitis was conducted with transurethral intravesical hydrochloric acid instillation on the subjects in Groups IA, IB, IIA, and IIB. Then, Group IA-IB subjects were transurethrally administered intravesical ozone therapy twice a week, while Group IIA-IIB subjects were only given intravesical isotonic NaCl instillation. Group IIIA-IIIB subjects were administered intravesical isotonic NaCl instillation without conducting chemical cystitis in order to create the same stress. Treatment schemes of all groups were arranged in the same manner. Following a 3-week (early period) and 6-week (late period) therapy, the rabbits were sacrificed and histopathologic investigations were carried out in order to demonstrate changes in the urinary bladder. Results: In our study, we observed that the basal membrane and mucosal integrity were maintained, inflammatory cells were suppressed in Group IA-IB (Early and late period), which received ozone therapy. However, it was also observed that mucosal integrity was spoiled, numerous inflammatory cells were accumulated in Group IIA-IIB, which was administered isotonic NaCl. Conclusion: Due to its low cost and minimal side effects; ozone therapy could be a new therapeutic approach in the treatment of interstitial cystitis.
  2,097 343 -
Extraperitoneal robot-assisted laparoscopic radical prostatectomy: Initial experience
Prem Nath Dogra, Ashish Kumar Saini, Prabhjot Singh, Girdhar Bora, Brusabhanu Nayak
April-June 2014, 6(2):130-134
DOI:10.4103/0974-7796.130555  PMID:24833824
Objectives: To report our initial experience and technique of performing robot-assisted laparoscopic radical prostatectomy (RALP) with the extraperitoneal approach. Materials and Methods: Twenty-seven patients, between September 2010 to January 2012, were included in the study. All patients underwent extraperitoneal robot-assisted radical prostatectomy. Patients were placed supine with only 10-15 0 Trendelenburg tilt. The extraperitoneal space was developed behind the posterior rectus sheath. A five-port technique was used. After incision of endopelvic fascia and ligation of the deep venous complex, the rest of the procedure proceeded along the lines of the transperitoneal approach. Results: The mean patient age, prostate size and Gleason score were 67 ± 1.8 years, 45 ± 9.55 g and 6, respectively. The mean prostate-specific antigen (PSA) was 6.50 ng/mL. The mean time required for creating extraperitoneal space, docking of robot and console time were 22, 7 and 94 min, respectively. The mean time to resume full oral feeds was 22 ± 3.45 h. There were no conversions from extraperitoneal to transperitoneal or open surgery in our series. Pathological stage was pT1, pT2a and pT3b in 11 (40.74%), 14 (51.85%) and two (7.4%) patients, respectively. Two patients had positive surgical margins and two had biochemical recurrence at the last follow-up. Our mean follow-up was 12 ± 3.30 (2-17) months. The overall continence rate was 83.33% and 92.4% at 6 and 12 months, respectively. Conclusions: Extraperitoneal RALP is an efficacious, minimally invasive approach for patients with localized carcinoma of the prostate.
  1,898 378 -
A study to evaluate the effect of ratio of donor kidney weight to recipient body weight on renal graft function
Tanveer Iqbal Dar, Vipin Tyagi, Mrinal Pahwa, Sudhir Chada, Harsh Jauhari, Nikhil Sharma
April-June 2014, 6(2):139-141
DOI:10.4103/0974-7796.130644  PMID:24833826
Aim and Objectives: To study the effect of the ratio of donor kidney weight (dkw) to recipient body weight (rbw) on short and long term graft function in live donor kidney transplant patients. Materials and Methods: It was a prospective study of 79 live donor kidney transplant recipients. Patients were divided into three groups depending on the ratio of dkw in grams to rbw in kilograms. Serum creatinine in milligrams percent on the day of surgery, 7 th day, 1 month, 6 months, 1 year, and 3 years after the surgery was recorded and their means compared. Results: The comparison showed that the decrease in mean creatinine level was more in group three patients as compared with group 2 and one patients at 7 days (1.04,1.44 and 1.59 in group 3,2 and 1 respectively) and 30 days (1.12,1.36 and 1.45 in group 3,2 and 1 respectively), showing that higher dkw/rbw ratio is beneficial with respect to the early graft function. However this decrease was not statistically significant (P value -0.256 and 0.358 respectively on 7 th and 30 th day). Furthermore long-term function was not different among these three groups. Conclusion: The ratio of dkw to rbw does not have a significant effect on long-term graft function inspite of an early improvement in the function with increased dkw to rbw ratio.
  2,019 220 -
Occupational risk of bladder cancer among Iranian male workers
Omid Aminian, Amin Saburi, Hossein Mohseni, Hamed Akbari, Farzaneh Chavoshi, Hesam Akbari
April-June 2014, 6(2):135-138
DOI:10.4103/0974-7796.130643  PMID:24833825
Background: Approximately 5-10% of human cancers are thought to be caused by occupational exposure to carcinogens. Compare to other cancers, bladder cancer is most strongly linked to occupational exposure to chemical toxins. This study has been performed to understand which occupations and exposures are related to bladder cancer in Iran. Materials and Methods: This study is a case-control study which is conducted on cases with bladder cancer (160 cases) diagnosed in Baharlou hospital in 2007-2009. One hundred sixty cases without any occupational exposure were considered as controls matched for demographic characteristics. Demographic data and characteristics of occupation were compared. Results: Mean age of cases and controls were 63.7 and 64 years, respectively (P = 0.841). History of urinary tract stone had significantly difference in two groups (P = 0.039). Occupations such as bus and truck driving, road and asphalt making, mechanics, working in refinery and Petrochemical, plastic, metal manufactory, welding, and pipeline founded a higher risk for bladder cancer rather than controls. Conclusion: Our findings on Iranian workers are concurrent and compatible with findings of previous reports about occupational and environmental risk factors of bladder cancer. Although our study population was not little, further studies are needed to declare the risk of working in some occupations such as drivers and metal factories for bladder cancer.
  1,825 351 -
Primary neuroendocrine tumor of the testis
Shakir Alsharif, Mubarak Al-Shraim, Ahmed Alhadi, Abdulrahman Al-Aown, Fawzy Fooshang, Refat Eid
April-June 2014, 6(2):173-175
DOI:10.4103/0974-7796.130662  PMID:24833836
Testicular neuroendocrine tumor is rare. It accounts for less than 1% of all testicular neoplasms. More than 60 cases have been published in the literature. A 27-year-old man presented with left testicular mass and underwent radical orchidectomy. Histological examination showed neuroendocrine tumor, confirmed by immunohistochemistry and electron microscopy. The patient showed no evidence of metastasis over 1-year follow-up post-orchidectomy in spite of extensive tumor necrosis.
  1,870 244 -
Robotic-assisted radical nephrectomy for renal angiomyolipoma with inferior vena cava thrombus extension
Khalid A Alrabeeah, Abdullah M Alkhayal, Armen G Aprikian, Frank Bladou
April-June 2014, 6(2):176-178
DOI:10.4103/0974-7796.130663  PMID:24833837
Renal angiomyolipoma with inferior vena caval venous extension is rare with only 40 cases reported in the literature. We report a case of a 35-year-old lady with angiomyolipoma with inferior vena caval thrombus that was managed surgically with robotic-assisted radical nephrectomy.
  1,862 237 -
Robot-assisted laparoscopic augmentation ileocystoplasty in a tubercular bladder
Prem Nath Dogra, Subodh K Regmi, Prabhjot Singh, Girdhar Bora, AK Saini, Sandeep Aggarwal
April-June 2014, 6(2):152-155
DOI:10.4103/0974-7796.130647  PMID:24833829
Some of the patients with genitourinary tuberculosis (GUTB) present to the urologist with small contracted bladders or with significant renal damage. [1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine.
  1,764 314 1
Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy
Anil A Thomas, Brian Kim, Armen Derboghossians, Allen Chang, David S Finley, Gary W Chien, Jeffrey Slezak, Steven J Jacobsen
April-June 2014, 6(2):142-146
DOI:10.4103/0974-7796.130645  PMID:24833827
Objectives: Since its introduction, there have been many refinements in the technique and implementation of robotic-assisted radical prostatectomy (RARP). However, it is unclear whether operative outcomes are influenced by surgical case order. We evaluated the effect of case order on perioperative outcomes for RARP within a large health maintenance organization. Materials and Methods: We conducted a retrospective review of RARP cases performed at our institution from September 2008 to December 2010 using a single robotic platform. Case order was determined from surgical schedules each day and surgeries were grouped into 1 st , 2 nd and 3 rd round cases. Fourth round cases (n = 1) were excluded from analysis. We compared clinicopathological variables including operative time, estimated blood loss (EBL), surgical margin rates and complication rates between groups. Results: Of the 1018 RARP cases in this cohort, 476 (47%) were performed as 1 st round cases, 398 (39%) 2 nd round cases and 144 (14%) 3 rd round cases by a total of 18 surgeons. Mean operative time was shorter as cases were performed later in the day (213 min vs. 209 min vs. 180 min, P < 0.0001) and similarly, EBL also decreased with surgical order (136 mL vs. 134 mL vs. 103 mL, P = 0.01). Transfusion rates, surgical margin rates and complication rates did not significantly differ between groups. Patients undergoing RARP later in the day were much more likely to have a hospital stay of 2 or more days than earlier cases (10% vs. 11% vs. 32%, P = 0.01). Conclusions: Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3 rd round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.
  1,584 224 -
Rare synchronous metastases of renal cell carcinoma
Nieroshan Rajarubendra, David Pook, Mark Frydenberg, Sree Appu
April-June 2014, 6(2):157-158
DOI:10.4103/0974-7796.130652  PMID:24833831
Renal cell carcinoma can metastasize to any region of the body. We review a patient who presents fourteen years after initial resection of the primary tumor with distant metastatic disease. This included spread to the bladder and penis that manifested as frank haematuria and malignant priapism respectively. We discuss the mechanism of spread and the management options available.
  1,553 221 -
Extended spectrum beta-lactamase urinary tract infections
Omar M Aboumarzouk
April-June 2014, 6(2):114-115
  1,343 284 -
Complicated urinary tract infection caused by extended spectrum β-lactamase-producing Escherichia coli
KP Ranjan, Neelima Ranjan
April-June 2014, 6(2):112-113
  1,309 274 -
Multiple ingredients and not just spoonful of humanities
Satendra Singh
April-June 2014, 6(2):180-180
DOI:10.4103/0974-7796.130665  PMID:24833839
  1,307 155 -
Other considerations for treating bladder tuberculosis
Amin Saburi, Mahdi Safiabady
April-June 2014, 6(2):155-156
  1,128 208 -
Robotic nephrectomy for angiomyolipoma
Omar M Aboumarzouk
April-June 2014, 6(2):178-179
  1,040 165 -