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   2016| October-December  | Volume 8 | Issue 4  
    Online since October 12, 2016

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Role of extracorporeal shock wave therapy in management of Peyronie's disease: A preliminary report
Rajendra Kashinath Shimpi, Ravi Jineshkumar Jain
October-December 2016, 8(4):409-417
DOI:10.4103/0974-7796.192100  PMID:28057983
Introduction: Peyronie's Disease (PD) is a disease causing psycho social trauma to the patient. Multiple treatment options are available with variable results. Extra Corporeal Shock Wave Therapy (ESWT) is a new insight into the non invasive modality of management. It focuses on the mechanism of inducing angiogenesis in the penile cavernous tissue. Materials and Methods: The aim of the study is to determine the role of ESWT in the management of PD. The objectives include demonstrating the improvement in mean International Index of Erectile Function Score (IIEFS), improvement in pain score by Visual Analogue Scale (VAS), change in cavernosal artery flow on colour penile Doppler, reduction in plaque size, and improvement in penile curvature degree after the therapy. 30 patients, between 25-65 years, who were non responders to conservative line of management, were treated with ESWT. The results were evaluated at baseline and 18-24 weeks after the therapy. Results: ESWT significantly improves the cavernosal artery velocity, thereby supporting the theory of angiogenesis. ESWT improves all the domains of IIEF including Erectile Function, Sexual Desire, Sexual Satisfaction, Orgasm and Overall Satisfaction. There is a significant improvement in the pain and penile curvature, and reduction in the plaque size. No adverse effects have been recorded. Conclusion: ESWT offers a safe, minimally invasive, OPD based option to the management of the patients of PD in the stable phase of the disease. Patients who do not respond to the conservative line of management can be really benefited by ESWT.
  5,360 569 -
Primary hypospadias repair techniques: A review of the evidence
Warren Snodgrass, Nicol Bush
October-December 2016, 8(4):403-408
DOI:10.4103/0974-7796.192097  PMID:28057982
This review summarizes data regarding commonly used surgical techniques to repair distal and proximal hypospadias. We review evidence concerning indications for various procedures used in primary hypospadias repair, and their complications, urinary function and esthetic results. Available evidence suggests TIP is preferable to Mathieu for distal hypospadias correction. Current data do not identify a clear preference between TIP and onlay flap for proximal repair when there is ventral curvature <30°, or between various flap and graft options when curvature is >31°. A review of objective data helps clarify decision-making for distal hypospadias repair. Additional objective evidence is needed to identify preferred options for proximal hypospadias repair. Measuring glansplasty dimensions (meatal size and distance from meatus to corona) may improve urinary function assessments, and provide additional objective data for decision-making between various surgical techniques.
  4,533 944 -
The efficacy of noble metal alloy urinary catheters in reducing catheter-associated urinary tract infection
Alanood Ahmed Aljohi, Hanan Elkefafy Hassan, Rakesh Kumar Gupta
October-December 2016, 8(4):423-429
DOI:10.4103/0974-7796.192099  PMID:28057985
Background: Catheter-associated urinary tract infection (CAUTI) is the most common device-related healthcare-acquired infection. CAUTI can be severe and lead to bacteremia, significant morbidity, prolonged hospital stay, and high antibiotic consumption. Patients and Methods: In this study, we evaluated the CAUTI-reducing efficacy of noble metal alloy catheters in sixty patients (thirty per group) in the Intensive Care Unit (ICU) at the King Fahad Hospital in Saudi Arabia. The study was a single-blinded, randomized, single-centered, prospective investigation that included patients using urinary catheters for 3 days. Results: A 90% relative risk reduction in the rate of CAUTI was observed with the noble metal alloy catheter compared to the standard catheter (10 vs. 1 cases, P = 0.006). When considering both catheter-associated asymptomatic bacteriuria and CAUTI, the relative risk reduction was 83% (12 vs. 2 cases, P = 0.005). In addition to CAUTI, the risk of acquiring secondary bacteremia was lower (100%) for the patients using noble metal alloy catheters (3 cases in the standard group vs. 0 case in the noble metal alloy catheter group, P = 0.24). No adverse events related to any of the used catheters were recorded. Conclusion: Results from this study revealed that noble metal alloy catheters are safe to use and significantly reduce CAUTI rate in ICU patients after 3 days of use.
  3,241 550 -
Male urethral diverticulum uncommon entity: Our experience
Naveen Thakur, Vilas Pandurang Sabale, Deepak Mane, Abhirudra Mullay
October-December 2016, 8(4):478-482
DOI:10.4103/0974-7796.192094  PMID:28057997
Out pouching of the urethral wall could be congenital or acquired. Male urethral diverticulum (UD) is a rare entity. We present 2 cases of acquired and 1 case of congenital male UD. Case 1A: 40 year male presented with SPC and dribbling urine. Clinically he had hard perineal swelling. RGU revealed large diverticulum in proximal bulbar, irregular narrow distal urethra and stricture just beyond diverticulum. Managed with perineal exploration, stone removal, diverticulum repair and urethroplasty using excess diverticular wall. Case 2A: 30 year male with obstructive lower urinary tract symptoms (LUTS). Retrograde urethrogram (RGU) revealed bulbar urethral diverticulum akin to anterior urethral valve, managed endoscopically. 1 year follow up urine stream satisfactory. Case 3A: 27 year male previously operated large proximal bulbar urethral stone with incontinence. RGU large proximal bulbar UD with wide open sphincter. Treated with excision of excess diverticular wall and penile clamp with pelvic exercises for incontinence. Congenital UD develops due to imperfect closure of urethral fold, Acquired UDs occurs secondary to stricture, infection, trauma, long standing impacted urethral stones or scrotal / skin flap urethroplasties. RGU and MCU are the best diagnostic technique to confirm and characterize the UD. Urethral diverticulectomy with urethral reconstruction is the recommended treatment for UD. UD is a rare entity. Especially in males, congenital are even more rare. Management should be individualized. Surgery can involve innovation and/or surgical modifications. We used excess diverticular flap for stricture urethroplasty in one case.
  2,544 305 -
Factors predicting infectious complications following percutaneous nephrolithotomy
Kuldeep Sharma, Satya Narayan Sankhwar, Apul Goel, Vishwajeet Singh, Pradeep Sharma, Yogesh Garg
October-December 2016, 8(4):434-438
DOI:10.4103/0974-7796.192105  PMID:28057987
Objective: To determine the predictors of infectious complications following percutaneous nephrolithotomy (PCNL) in a prospective study. Materials and Methods: A total of 332 patients with renal or upper ureteric calculi who underwent PCNL between January 2013 and June 2014 were included in the study. Infectious complications included febrile urinary tract infection and septicemia. The patients were divided into Group A and B depending on whether they developed or did not develop infectious complications. Patient, stone, renal, and procedure-related factors were compared between the two groups. Results: There was no significant (P > 0.05) correlation among age (37.03 ± 16.24 vs. 36.72 ± 14.88), sex, and body mass index (21.00 ± 1.77 vs. 21.03 ± 2.25) between Group A and B. The patients in Group A were found to have significantly higher incidence of renal failure (39.5% vs. 9.2%,P= 0.0001), diabetes mellitus (12 [31.5%] vs. 33 [11.2%],P= 0.0001), previous percutaneous nephrostomy (PCN) tube placement (11 [28%] vs. 21 [7.1%]P= 0.0001), moderate to severe hydronephrosis (HDN), larger stone surface area (812.68 ± 402.07 vs. 564.92 ± 361.32,P= 0.0001), mean number of punctures (1.57 ± 0.50 vs. 1.20 ± 0.47,P= 0.002), and mean duration of surgery (94.28 ± 18.23 vs. 69.12 ± 21.23,P= 0.0001) than Group B. Conclusion: Post-PCNL infectious complications were found to be more common in patients with renal failure, diabetes mellitus, preoperative PCN placement, staghorn calculi, severe HDN, multiple punctures, and prolonged duration of surgery.
  2,346 467 -
Secondary hemorrhage after bipolar transurethral resection and vaporization of prostate
Chi-Hang Yee, Joseph Hon-Ming Wong, Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, Chi-Kwok Chan, Eddie Shu-Yin Chan, See-Ming Hou, Chi-Fai Ng
October-December 2016, 8(4):458-463
DOI:10.4103/0974-7796.192110  PMID:28057992
Introduction: We evaluated the factors associated with secondary hemorrhage after bipolar transurethral resection of prostate (TURP) and vaporization of prostate. Materials and Methods: The perioperative data of patients undergoing endoscopic surgery for benign prostatic hyperplasia (BPH) were prospectively collected. Procedures involved included bipolar TURP, bipolar vaporization of prostate, and hybrid bipolar TURP/vaporization of prostate. Secondary hemorrhage was defined as bleeding between 48 h and 30 days postsurgery requiring hospital attendance with or without admission. Risk factors for secondary hemorrhage were analyzed. Results: From 2010 to 2013, 316 patients underwent bipolar surgery for BPH. Bipolar TURP accounted for 48.1% of the procedures, bipolar vaporization accounted for 20.3% of the procedures, and the rest were hybrid TURP/vaporization of prostate. Among this cohort of patients, fifty patients had secondary hemorrhage with hospital attendance. Consumption of platelet aggregation inhibitors (PAIs) was found to be associated with secondary hemorrhage (P < 0.0005). Age, prostate volume, operation type, the use of 5-alpha reductase inhibitors, and being with a urethral catheter before operation were not found to be statistically significant risk factors for secondary hemorrhage. Conclusions: Secondary hemorrhage after bipolar surgery for BPH is a common event. Consumption of PAI is a risk factor for such complication.
  2,504 301 -
A completely calcified prostate
Vinod Priyadarshi, Nidhi Sehgal
October-December 2016, 8(4):468-470
DOI:10.4103/0974-7796.192103  PMID:28057994
Prostatic calcification and prostatic calculus formation is commonly seen in adult population with chronic prostatitis, however, gross prostatic calcification which involves more than 3 cm2 of the gland is quite rare. We are presenting here one such case in which almost whole glandular prostate was converted into stone which is never reported so far.
  2,412 239 -
Paraurethral cyst with multiple stones: A rare case report
Gaurav Prakash, Shreya Karan, Satya Narayan Sankhwar, Sangeeta Karan
October-December 2016, 8(4):509-511
DOI:10.4103/0974-7796.192088  PMID:28058006
Paraurethral cyst is a benign cystic disorder of anterior vaginal wall. Many secondary complications have been described in literature, but stone formation in the cyst is a rare phenomenon. We are reporting a case of a 35-year-old multiparous woman who presented with lower urinary tract symptoms, dysuria, and dyspareunia. She was diagnosed as a case of the paraurethral cyst with stones and was managed successfully. Various differential diagnoses have been suggested, most important being urethral diverticulum, ruled out by urethroscopy. Many imaging modalities have been described, but physical examination plays the key role in reaching the diagnosis of stone. For definitive management incision over the cyst with stone removal followed by marsupialization is performed to prevent recurrence.
  2,142 178 -
Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy
Karunamoorthy Ramaraju, Arun Kumar Paranjothi, Dhinakar Babu Namperumalsamy, Ilamparuthi Chennakrishnan
October-December 2016, 8(4):449-453
DOI:10.4103/0974-7796.192108  PMID:28057990
Introduction and Objectives: Sepsis remains one of the dreaded complications of percutaneous nephrolithotomy (PCNL). To analyze prospectively the preoperative and intraoperative factors that predict the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing PCNL so that we can aggressively manage those patients from the preoperative period itself and avert the dangerous complications. Materials and Methods: A prospective study was carried out between August 2012 and March 2013 including all patients who underwent PCNL. Patients with infected collecting system, synchronous ureteric stones, stents, or percutaneous nephrostomy drainage were excluded from the study. Patients were evaluated with physical examination, urine analysis, urine culture and sensitivity, complete blood count, renal function test, X-ray kidney, ureter, and bladder (KUB), and plain and contrast-enhanced computerized tomography KUB. Patients who developed any two or above of the following in the postoperative period were considered to have developed SIRS. (1) Temperature >100.4°F (38°C) or <96.8°F (36°C). (2) Pulse rate >90/min. (3) Respiratory rate >20/min. (4) White blood cell count >12,000/ml or <4000/ml. Results: Of the 120 patients who underwent PCNL 29 (24.1%) developed features of SIRS. On univariate analysis, gender, diabetes mellitus, bladder urine culture, and serum creatinine were found to be statistically insignificant. Blood transfusion (P = 0.009), no of access tracts (P = 0.001), pelvic urine culture (P = 0.04), stone culture (P = 0.003), stone size (P = 0.001), age (P = 0.019), and operative time (P = 0.004) were found to be statistically significant. On multivariate regression analysis stone size, no of access tracts, operative time, and stone culture were found to be statistically significant with regard to the occurrence of SIRS. Conclusion: Patients with above-identified risk factors must be aggressively treated to prevent the occurrence of sepsis postoperatively.
  1,946 366 -
Intraoperative ultrasound control of surgical margins during partial nephrectomy
Feras M Alharbi, Charles K Chahwan, Sophie G Le Gal, Kerem M Guleryuz, Xavier P Tillou, Arnaud P Doerfler
October-December 2016, 8(4):430-433
DOI:10.4103/0974-7796.192107  PMID:28057986
Aims: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. Subjects and Methods: This study was conducted for patients undergoing partial nephrectomy (PN) with T1–T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. Results: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.
  1,882 343 -
Prospective randomized comparison between fluoroscopy-guided ureteroscopy versus ureteroscopy with real-time ultrasonography for the management of ureteral stones
Vishwajeet Singh, Bimalesh Purkait, Rahul Janak Sinha
October-December 2016, 8(4):418-422
DOI:10.4103/0974-7796.192098  PMID:28057984
Context and Aims: Ureteroscopy is the definitive management for ureteric stone. Conventional ureteroscopy uses fluoroscopy guidance which has radiation exposure to patients as well as hospital staff. Ultrasound is a good radiation-free alternative for using in the urological procedure. With this background, we executed a prospective randomized trial comparing fluoroscopy-guided ureteroscopy versus ultrasound-guided ureteroscopy. Subjects and Methods: Patients were randomized into two groups (41 into fluoroscopy and 41 into ultrasound group after exclusion) in a single center from July 2014 to March 2015. Semi-rigid ureteroscopy was used in all cases. Ultrasound was used to place guide wire and postprocedure stents placement in ultrasound group. Patient's characteristics; intra- and post-operative parameters were compared between the two groups. Statistical Analysis Used: SPSS version 16.0 (Chicago, IL, USA) was used for statistical analysis. The results were presented as percentages and means (± standard deviation). The categorical/dichotomous variables were analyzed using Chi-squared test. Continuous variables were analyzed using unpaired t-test. Results: A total of 102 adult patients were randomized in this trial and eighty patients undergo the final analysis. Mean stone burden was 41.75 ± 13.44 (17.94–79.20 mm2). Mean operative time was 43.90 ± 12.99 (25–82 min) in fluoroscopy group versus 45.61 ± 11.62 (28–78 min) in ultrasound group. The initial success rate was 93.75% (92.30% in fluoroscopy vs. 95.12% in ultrasound group). Overall complications noted in 8.75% and most of the complications were minor in nature. Conclusions: Ultrasound-guided ureteroscopy is safe and effectively for ureteric stone. Fluoroscopy can be avoided during ureteroscopy for uncomplicated stone. No radiation ureteroscopy is feasible with good success and minimal complication. Larger sample size with multicentric trial needed for its greater applicability.
  1,911 286 -
Penile constriction injury: An experience of four cases
Ajit Somaji Sawant, Sunil Raghunath Patil, Vikash Kumar, Gaurav Vinod Kasat
October-December 2016, 8(4):512-515
DOI:10.4103/0974-7796.192101  PMID:28058007
Penile injury due to constriction by a foreign object is a rare known complication, commonly seen in pediatric age group. We report four cases of penile constriction injury in adults due to various foreign objects and different indications. Between October 2014 and March 2016, four patients (mean age 42.5 years) presented with penile constriction injury with duration at presentation ranging from 18 h to 2 months. One patient had complete transection of the corpus and penile urethra. Three patients were managed successfully with daily dressings followed by split-skin grafting in one patient. One patient required delayed primary suturing after the resolution of local edema. The outcome was satisfactory in all patients with retained erectile function. Early medical attention and management is the key to success in penile constriction injury cases and to avoid complications and morbidity. Prompt removal can be challenging in cases of metal foreign bodies.
  1,839 216 -
A case report on buccal mucosa graft for upper ureteral stricture repair
Vilas Pandurang Sabale, Naveen Thakur, Sharad Kumar Kankalia, Vikram Pramod Satav
October-December 2016, 8(4):474-477
DOI:10.4103/0974-7796.192092  PMID:28057996
Management of ureteric stricture especially long length upper one-third poses a challenging job for most urologists. With the successful use of buccal mucosa graft (BMG) for stricture urethra leads the foundation for its use in ureteric stricture also. A 35-year-old male diagnosedcase of left upper ureteric stricture, postureteroscopy with left percutaneous nephrostomy (PCN) in situ. Cysto-retrograde pyelography and nephrostogram done simultaneously suggestive of left upper ureteric stricture of 3 cm at L3 level. On exploration, diseased ureteral segment exposed, BMG harvested and sutured as onlay patch graft with supportive omental wrap. The treatment choice for upper ureteric long length stricture is inferior nephropexy, autotransplantation, or bowel interposition. With PCN in situ, inferior nephropexy becomes technically difficult, other two are morbid procedures. Use of BMG in this situation is technically better choice with all the advantages of buccal mucosa. Onlay BMG for ureteral stricture is technically easy, less morbid procedure and can be important choice in future.
  1,720 260 -
Primary tuberculosis of urethra presenting as stricture urethra and watering can perineum: A rarity
Gaurav Prakash, Vishwajeet Singh, Rahul Janak Sinha, Suresh Babu, Ankur Jhanwar, CN Mehrotra
October-December 2016, 8(4):493-495
DOI:10.4103/0974-7796.192093  PMID:28058001
A young man presented with irritative lower urinary tract symptoms and multiple fistulae (watering can) in the perineum since 6 months. Micturating cystourethrogram and retrograde urethrogram was performed after 12 weeks following suprapubic cystostomy which showed bulbar urethral stricture with multiple urethrocutaneous fistulae. He underwent anastomotic urethroplasty and excision of the urethrocutaneous fistulae. Histopathology of the excised fistulous tract showed granulomatous pathology suggestive of tuberculosis. Antitubercular treatment was given for 9 months. The patient is voiding well at 12 months follow-up.
  1,758 194 -
Multilocular cystic renal cell carcinoma in a 23 year old female
Shivakumarswamy Udasimath, J Niranjan, R Puruhotham, KR Nagesha
October-December 2016, 8(4):506-508
DOI:10.4103/0974-7796.192095  PMID:28058005
Multilocular cystic renal cell carcinoma (MCRCC) has been identified as a separate subtype of renal cell carcinoma (RCC) in the 2004 World Health Organization classification of adult renal tumors. MCRCC represents a rare variant of clear cell RCC. The common age group for this tumor is between 40 and 60 years. In our case, MCRCC occurred at the age of 23 years in a female patient. We report this case because of its rarity in this age group, sex, good prognosis, and also to avoid a misdiagnosis as conventional clear cell RCC. However, before making a diagnosis of MCRCC, it has to be differentiated from tubulocystic carcinoma, cystic nephroma, cystic clear cell carcinoma, and clear cell papillary RCC.
  1,727 221 -
“Spiral-Cap” ileocystoplasty for bladder augmentation and ureteric reimplant
S Ajit Sawant, Ashwin Sunil Tamhankar, Vikash Kumar, W Pawar Prakash, V Kasat Gaurav, Sumit Bansal
October-December 2016, 8(4):464-467
DOI:10.4103/0974-7796.192087  PMID:28057993
Objective: To demonstrate the new technique of Spiral-cap ileocystoplasty for bladder augmentation and simultaneous ureteric reimplant. Materials and Methods: Seven patients with small capacity bladder and simultaneous lower ureteric involvement operated in single tertiary care institute over the last 5 years were included in this study. Spiral-cap ileocystoplasty was used in all the patients for bladder augmentation. Proximal part of the same ileal loop was used in isoperistaltic manner for ureteric reimplantation. Distal end of this ileal loop was intussuscepted into the pouch to decrease the incidence of reflux. Detubularized distal portion of the loop was reconfigured in spiral manner to augment the native bladder. Patients were analyzed for upper tract changes, serum creatinine, bladder capacity, and requirement of clean intermittent self-catheterization in follow-up over 5 years. Results: There was no evidence of any urinary or bowel leak in the postoperative period. Recovery was equivalent with those treated with other methods of bladder augmentation. Follow-up ultrasonography showed good capacity bladder. Upper tracts were well preserved in follow-up. Urinary bladder and lower ureter pathologies were addressed simultaneously. Conclusion: Spiral-cap ileocystoplasty is a useful technique in patients who require simultaneous bladder augmentation and ureteric reimplant.
  1,709 200 -
Extracorporeal shockwave lithotripsy without radiation: Ultrasound localization is as effective as fluoroscopy
Hazel Elizabeth Smith, David Alistair Bryant, Jenny KooNg, Richard Alexander Chapman, Gareth Lewis
October-December 2016, 8(4):454-457
DOI:10.4103/0974-7796.192104  PMID:28057991
Context: Extracorporeal shockwave lithotripsy (SWL) is the first-line treatment for renal calculi in most cases. Recent technology has allowed lithotriptor machines to localize stones using fluoroscopy or ultrasound (US). Aim: The aim of this study is to compare stone free rates (SFR) using two techniques. Methods: This is a single center retrospective cohort study. We have studied 95 patients with renal calculi undergoing first SWL treatment with localization using US (48 pts) and fluoroscopy (47 pts). SFR was defined as fragments ≤2 m at 4 weeks post procedure on x-ray or US. Patient records were reviewed. Results: Stone size and location, age and body mass index were comparable between groups. Stones ≤7 mm had better SFR with US 86% (18/21) compared to fluoroscopy 59% (10/17) P= 0.08. Overall the US group had similar SFR to the fluoroscopy group for stones of all sizes and locations with 60% (29/48) compared to 45% (21/47)P= 0.18. Radiation exposure was the biggest difference between techniques with a mean radiation dose (mGy/cm2) in the US group of 103 (0–233) and 2113 (241–7821) in the fluoroscopy group. Radiation use in the US group was due to the use of a single shot pre- and post-procedure, this could be reduced to zero. Conclusions: Our data show equivalent outcomes using US compared to the traditional fluoroscopy localization technique. We would encourage departments to develop the use of US localization to reduce radiation exposure to patients.
  1,683 206 -
Nephron-sparing surgery in bilateral Wilms' tumor: A report of two cases
Sohrab Arora, Sharmad Kudchadkar, Priyank Yadav, MS Ansari
October-December 2016, 8(4):486-489
DOI:10.4103/0974-7796.192102  PMID:28057999
Nephron-sparing surgery (NSS) has been proposed by many as an alternative to bilateral nephrectomies and renal replacement therapy in bilateral Wilms' tumor (BWT). NSS is not without significant recurrence, morbidity, and mortality. Long-term follow-up, especially with regard to the renal function, remains lacking. Preoperative computed tomography angiogram can help prepare a roadmap for NSS but can underestimate the salvageable parenchyma due to compression of normal adjacent parenchyma. Intraoperative ultrasound can delineate the boundary of surgical margin and help achieve negative margins. We present two cases of BWT, aged 7 and 13 months, managed with neoadjuvant chemotherapy followed by bilateral NSS and adjuvant chemotherapy and report the follow-up of the same. We also explore the role of preoperative imaging and intraoperative ultrasound in the management. Both patients are alive without recurrence at a follow-up of 12 and 8 months.
  1,679 208 -
Vesicovaginal fistula presenting as a large abdominal pseudocyst: A rare case
Gaurav Vinod Kasat, Prakash W Pawar, Ajit S Sawant, Ashwin S Tamhankar
October-December 2016, 8(4):490-492
DOI:10.4103/0974-7796.192106  PMID:28058000
We present a rare case of indirect vesicovaginal fistula (VVF) in a patient with small capacity bladder. The fistula was between abdominal pseudocyst (APC) arising from bladder and vagina – and hence, an indirect VVF. A 35-year-old female had a history of emergency obstetric hysterectomy with iatrogenic bladder injury. Postoperatively, the patient developed VVF and large APC. Patient's micturating cystourethrogram was suggestive of small capacity bladder with bilateral Grade IV vesicoureteral reflux with a well-defined APC arising from superior surface of bladder to L4–L5 lumbar vertebrae. Large APC arising from bladder and associated with an indirect VVF is very rare, and to the best of our knowledge, this is the first case reported in literature. The patient was successfully managed with exploratory laparotomy and excision of fistula tract and pseudocyst, adhesiolysis, and ileal augmentation cystoplasty. Multiple intraoperative adhesions should be suspected in APC. We would like to conclude that ileal augmentation cystoplasty is a safe procedure in a case of VVF with APC and small capacity bladder.
  1,619 210 -
An undiagnosed giant right renal hydatid cyst treated laparoscopically: Case report and review of literature
Elsawi Osman, Ziauddin Khan, Abdulmenem Abualsel, Tanweer Bhatty
October-December 2016, 8(4):471-473
DOI:10.4103/0974-7796.192089  PMID:28057995
Hydatid disease caused by the tape worm Echinococcus granulosus is a rare occurrence in the urinary system in general. We are hereby presenting a case of a gentleman in his fourth decade with a giant right renal hydatid cyst. The clinical manifestations, radiological features, and serology were all not suggestive of hydatid disease; however, typical Echinococcus scolices were detected histologically following cyst aspiration. The giant cyst was successfully treated laparoscopically.
  1,625 199 -
Cisplatin and bleomycin-induced acute peripheral-vascular stenosis in patient with testicular cancer
Tayyar Alp Ozkan, Ufuk Aydin, Derih Ay, I Oguz Ozden Cebeci
October-December 2016, 8(4):483-485
DOI:10.4103/0974-7796.192096  PMID:28057998
After cisplatin and bleomycin-containing chemotherapy (CTx) for testicular cancer, part of the patients may develop acute or long-term cardiovascular toxicity. In the present case, we reported that a 58-year-old male patient presenting with testicular tumors who developed acute peripheral arterial disease during combination CTx with bleomycin, etoposide, and cisplatin. Superficial femoral artery occlusion not responded to structure thrombolytic and anticoagulators treatment. Left lower extremity was amputated below knee. In patients with high risk of cardiovascular disease, prophylactic anticoagulation may be recommended. The risk of causing factors of thromboembolism in patients with testicular cancer under cisplatin and bleomycin-containing CTx should be evaluated.
  1,591 232 -
Testicular cancer in Down syndrome with spinal cord metastases
Turky Almouhissen, Hattan Badr, Bassam AlMatrafi, Noor Alessa, Anmar Nassir
October-December 2016, 8(4):503-505
DOI:10.4103/0974-7796.192109  PMID:28058004
A 22-year-old male patient with Down syndrome was referred to our hospital with a vast left testicular mass. He underwent a left radical inguinal orchiectomy, and a histopathological examination of the mass showed a yolk sac tumor invading the epididymis. The patient was discharged in a satisfactory condition. Sixteen days later, the patient presented again complaining of lower limb weakness. Magnetic resonance imaging of the spine showed metastatic lesions compressing the dorsal spine, and he underwent emergency surgical decompression. The histopathology of the metastatic lesions revealed a yolk sac subtype which was identical to his primary testicular tumor.
  1,602 210 -
The diagnostic yield of fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography in recurrent testicular seminoma
Athanasios Bantis, Petros Sountoulides, Linda Metaxa, Pavlos Pavlidis, Eleni Aggelonidou, Halil Arif, Athanasios Zisimopoulos
October-December 2016, 8(4):496-499
DOI:10.4103/0974-7796.192090  PMID:28058002
The use of positron emission tomography-computed tomography (PET-CT) scan imaging is undoubtedly a significant evolution in oncological urology, although at present of limited use in every day urology practice. The aim of this study is to highlight the indication and diagnostic accuracy of fluorine-18 fluorodeoxyglucose PET/CT in the staging of a patient with metachronous bilateral testicular seminoma, elevated tumor markers, and equivocal conventional imaging findings.
  1,575 190 -
Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients
Bora ÷zveren, Selçuk Keskin
October-December 2016, 8(4):444-448
DOI:10.4103/0974-7796.192111  PMID:28057989
Objectives: Acute urinary retention (AUR) in females is a poorly defined condition with undetermined epidemiology. This study aimed to evaluate female AUR in an outpatient population. Patients and Methods: One hundred and thirty-eight adult female outpatients who presented to the emergency room with symptoms of urinary retention were retrospectively analyzed. The women who were ultimately diagnosed with true, complete AUR were systematically reviewed for clinical characteristics and management. Results: In this outpatient cohort with urinary retention complaints, only 23% of the patients were diagnosed with objective AUR. Detailed medical and urological history in addition to urogenital, neurological, and pelvic examinations was essential; urine analysis and pelvic ultrasonography were necessary as baseline investigations. Further radiological and urodynamic tests were required in a minority. Specific etiology was established in 77% of the patients, whereas there was more than one probable cause in 16% of the patients, and no specific cause was found in 6.5% of the patients. Bladder decompression and correction of the underlying cause helped 92.6% of the reviewed patients to eventually achieve spontaneous micturition. Conclusions: The proportion of true, complete AUR among female outpatients presenting to the emergency department was 23% following urological evaluation. Acute condition was resolved by urgent catheterization in all, and the majority of women had eventually resumed spontaneous voiding.
  1,600 93 -
Ruptured emphysematous renal cyst
Abdelrahman Yahya Mohamed, Fahad Quhal
October-December 2016, 8(4):500-502
DOI:10.4103/0974-7796.192091  PMID:28058003
Renal Cyst infections are rare, account for approximately 10% of causes for hospitalization in patients with adult polycystic kidney disease. We reported a rare case of ruptured emphysematous renal cyst with infection extending into the right perinephric space with gas forming organism involving the renal collecting system and the urinary bladder.
  1,483 167 -
Holmium laser transurethral resection of bladder tumor: Our experience
Nischith Dísouza, Ashish Verma
October-December 2016, 8(4):439-443
DOI:10.4103/0974-7796.190815  PMID:28057988
Purpose: To compare the safety and efficiency of conventional monopolar and holmium laser en bloc transurethral resection of bladder tumor (CM-TURBT and HoL-EBRBT) while managing primary nonmuscle-invasive bladder cancer. Materials and Methods: From January 2012 to October 2015, fifty patients with primary nonmuscle-invasive bladder cancer underwent endoscopic surgery. Among them, 27 patients underwent CM-TURBT and 23 patients underwent HoL-EBRBT. Clinical data, included preoperative, operative, and postoperative management and follow-up, were recorded. Results: Patient demographics and tumor characteristics in both groups were compared before surgery. There was no significant difference in operative duration among the groups. Compared with the CM-TURBT group, HoL-EBRBT group had less intraoperative and postoperative complications, including obturator nerve reflex (P < 0.01), bladder perforation (P < 0.01), as well as bleeding and postoperative bladder irritation (P < 0.01). There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoL-EBRBT group had less catheterization and hospitalization time than those in the CM-TURBT group (P < 0.01), and there were no significant differences in each risk subgroup as well as the overall recurrence rate among the CM-TURBT and HoL-EBRBT groups. Conclusions: HoL-EBRBT might prove to be preferable alternatives to CM-TURBT management of nonmuscle-invasive bladder cancer. HoL-EBRBT however did not demonstrate an obvious advantage over CM-TURBT in tumor recurrence rate.
  1,208 12 -