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   2015| January-March  | Volume 7 | Issue 1  
    Online since January 6, 2015

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Orthotopic neobladder reconstruction
Dwayne T. S. Chang, Nathan Lawrentschuk
January-March 2015, 7(1):1-7
DOI:10.4103/0974-7796.148553  PMID:25657535
Orthotopic neobladder reconstruction is becoming an increasingly common urinary diversion following cystectomy for bladder cancer. This is in recognition of the potential benefits of neobladder surgery over creation of an ileal conduit related to quality of life (QoL), such as avoiding the need to form a stoma with its cosmetic, psychological and other potential complications. The PubMed database was searched using relevant search terms for articles published electronically between January 1994 and April 2014. Full-text articles in English or with English translation were assessed for relevance to the topic before being included in the review. Patients with neobladders have comparable or better post-operative sexual function than those with ileal conduits. They also have comparable QoL to those with ileal conduits. Orthotopic neobladder is a good alternative to ileal conduit in suitable patients who do not want a stoma and are motivated to comply with neobladder training. However, the selection of a neobladder as the urinary diversion of choice requires that patients have good renal and liver functions and are likely to be compliant with neobladder training. With benefits also come potential risks of neobladder formation. These include electrolyte abnormalities and nocturnal incontinence. This short review highlights current aspects of neobladder formation and its potential advantages.
  4,685 786 -
Increasing antimicrobial resistance among uropathogens: Is fosfomycin the answer?
Asfia Sultan, Meher Rizvi, Fatima Khan, Hiba Sami, Indu Shukla, Haris M Khan
January-March 2015, 7(1):26-30
DOI:10.4103/0974-7796.148585  PMID:25657539
Introduction: Urinary tract infection (UTI) is one of the most common infectious diseases in clinical practice. The choice of antibiotics for the treatment of UTI is limited by the rising rates of antibiotic resistance. There is an urgent need to discover new effective treatment solutions. Fosfomycin may be an interesting alternative to the currently used treatments of UTIs. Materials and Methods: The study was conducted over 6 months period (January to June 2013) in Department of Microbiology, JNMCH, AMU, Aligarh. A total of 1840 urine samples were submitted. Culture and sensitivity was done as per standard microbiological procedures. Methicillin-resistant Staphylococcus aureus (MRSA), high-level aminoglycoside resistance (HLAR), extended spectrum beta-lactamases (ESBL), AmpC and metallo-beta-lactamases (MBL) production was detected. Results: Culture was positive in 504 (27.4%) cases. Gram-negative etiology was identified in 390 (73%) cases. ESBL production was detected in 154 (37.1%) while 82 (21.6%) were Amp C. No, MBL was detected. Among Gram-positive bacteria, 68 (51.5%) were MRSA, while 4 (13.3%) were vancomycin resistant enterococci (VRE). HLAR was seen in 53.3% of enterococci. Fosfomycin was effective in 100% of MRSA, VRE, ESBL, HLAR, and overall, susceptibility to fosfomycin in AmpC producers was extremely high (99%). Norfloxacin and cotrimoxazole were not proved effective as only three isolates were sensitive to norfloxacin, while all Gram-negative isolates were resistant to cotrimoxazole. Pseudomonas species showed 65% and 75% susceptibility to colistin and polymixin B, respectively. Conclusion: Fosfomycin has emerged as a promising option, especially in cases involving multi-drug-resistant pathogens in which previous antibiotics have failed to cure the infection.
  3,777 777 -
Distal ureterectomy techniques in laparoscopic and robot-assisted nephroureterectomy: Updated review
Konstantinos G Stravodimos, Christos Komninos, Ali Riza Kural, Constantinos Constantinides
January-March 2015, 7(1):8-16
DOI:10.4103/0974-7796.148575  PMID:25657536
Controversies exist about the best method for managing the distal ureter during the laparoscopic (LNU) and robot-assisted nephroureterectomy (RANU). Therefore, PubMed, Scopus and Web of Science databases were searched in order to identify articles describing the management of distal ureter during LNU or RANU in patients suffering from upper urinary tract urothelial cell carcinoma. Forty seven articles were selected for their relevance to the subject of this review. The approaches that are usually performed regarding the distal ureter management are open excision, transurethral resection of ureteral orifice (Pluck Technique), ureteric intussusception and pure LNU or pure RANU. Pure LNU and RANU with complete laparoscopic dissection and suture reconstruction of ureter and bladder cuff seems to be better tolerated than open nephroureterectomy providing equal efficacy, without deteriorating the oncological outcome, however evidence is poor. Transurethral resection of the ureteric orifice and the bladder cuff after occlusion of the ureter with a balloon catheter seems to be an attractive alternative option for low stage, low grade tumors of the renal pelvis and the proximal ureter, while stapling technique is correlated with the increased risk of positive surgical margins. The open resection of the distal ureter in continuity with the bladder cuff is considered the most reliable approach, preferred in our practice as well, however the existing data are based on retrospective and non-randomized studies.
  3,523 778 -
Long-term complications of JJ stent and its management: A 5 years review
Rajendra Prasad Ray, Rajkumar Singha Mahapatra, Partha Pratim Mondal, Dilip Kumar Pal
January-March 2015, 7(1):41-45
DOI:10.4103/0974-7796.148599  PMID:25657542
Objectives: To assess the long term complications of JJ stent, the management of complications and the role of endoscopic approach to manage these complications. Materials and Methods: Nineteen patients with indwelling JJ stent for a duration of more than 6 months were included in this study. Patients were assessed with X-ray KUB, USG KUB, blood urea, creatinine and DTPA renogram. Data were analyzed by Microsoft excel 2007 . Results: Out of 19 patients 12 (63.16%) were male and 7 (36.84%) were female. The mean age was 39.78 ± 13.69 years., Mean duration for which the stent was in situ was 29.56 months. The most common complication was broken stent, in 11 cases (57.89%). Other complications were migration in 5 (26.32%), encrustation in 2 (10.52%) and 1 case of (5.26%) stone formation. Eighteen cases were managed by endoscopic approaches. A total of 22 procedures were performed to treat the complications. Eleven cases were managed by a single procedure and 8 patients required multiple procedures. All were managed successfully with no death reported. Post-operative complications were seen in eight cases (42.11%). Conclusions: JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone.
  3,821 429 -
Female form of persistent mullerian duct syndrome: Rare entity
Shailesh Solanki, Gowrishankar , Vinay Jadhav, M Narendra Babu, S Ramesh
January-March 2015, 7(1):104-106
DOI:10.4103/0974-7796.148640  PMID:25657558
Persistent Mullerian duct syndrome (PMDS) is a rare form of Disorder of sex development in which Mullerian duct derivatives (fallopian tubes, uterus and the proximal vagina) are present in an otherwise normally differentiated 46 XY male. In the majority of cases, PMDS is a surprise finding either during orchidopexy or during inguinal hernia repair. We report a case of 4 year child with female type (Type III) PMDS. We are discussing the presentation, management and review of the literature.
  3,815 286 -
Comparative evaluation of upper versus lower calyceal approach in percutaneous nephrolithotomy for managing complex renal calculi
Rohit Singh, SP Kankalia, Vilas Sabale, Vikram Satav, Deepak Mane, Abhirudra Mulay, Bhupender Kadyan, Naveen Thakur
January-March 2015, 7(1):31-35
DOI:10.4103/0974-7796.148591  PMID:25657540
Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn and large renal stones. The success of PCNL is highly related to optimal renal access. Upper calyceal puncture being more difficult and more demanding have relatively few studies presented. Aims and Objectives: This prospective study was carried out to evaluate the effectiveness and safety of upper calyceal versus lower calyceal puncture for the removal of complex renal stones through PCNL. Materials and Methods: A total of 94 patients underwent PCNL for complex renal stone in our institute. Fifty-one of them underwent lower calyceal, while 43 underwent upper calyceal puncture. The two approaches are compared as per total duration of surgery, intraoperative blood loss, infundibular/pelvic tear, rate of complete clearance and rate of postoperative complications (pulmonary, bleeding, fever and sepsis, etc.). Observation and Results: In our study, the success rate was 76.47% for those in the lower, 90.70% for those in the upper calyceal access group. Thoracic complications (hydrothorax) occurred to 1 patient in upper calyceal supracostal access group. Bleeding requiring blood transfusion happened to 5 patients in lower calyceal access and 1 in upper calyceal group. Conclusion: In our study for the management of complex renal calculi, we conclude that in a previously unoperated kidney, upper calyceal puncture through subcostal or supra 12 th rib is a feasible option minimizing lung/pleural rupture and gives a better clearance rate. We suggest that with due precautions, there should not be any hesitation for upper calyceal puncture in indicated patients.
  3,163 557 -
Reporting ureteroscopy complications using the modified clavien classification system
Ahmed Khalil Ibrahim
January-March 2015, 7(1):53-57
DOI:10.4103/0974-7796.148611  PMID:25657545
Objective: Perioperative complications are one of the surrogate indicators of surgical outcomes. However, reporting these complications need a precise grading system. Our aim is to report and grade the complications of semirigid ureteroscopy in ureteral stone management according to the modified Clavien classification system. Materials and Methods: This is a prospective study conducted From January 2012 to June 2013. All patients with ureteral stones who were indicated for semirigid URS were evaluated. All procedures were performed by the same surgeon. The data recorded including patient demographics, clinical indication, stone size and location, operative time and complications were classified according to the modified Clavien classification system. The patients were followed for 8 weeks postoperatively. Results: 148 patients included, Stone distribution was: 89 (60.1%) lower ureteral, 26 (17.6%) mid ureteral, and 33 (22.3%) upper ureteral. the mean stone size was 8.6 mm. Urgent URS done in 23% of patient. The overall stone free rate was 88.5%, the individual stone free rate for the upper, middle and lower ureter were 87.9%, 84.6%, and 89.9%, respectively. The mean operative time was 31.9 min (20-50 min.). Complications occurred in 26.35% of patients. Grade I complications occurred in 32 patients (26.1%), grade II in 9 (6.1%), grade IIIa in 7 (4.7%), grade IIIb in 8 (5.4%), grade IVa in two patient (1.35%), and grade IVb in one patient (0.7%). No grade V complication was encountered. Conclusion: Ureteroscopy becomes the vanguard interventional therapy for ureteral stones with well-established efficacy and safety. It is of paramount importance to adopt a precise structured classification system for reporting surgical complications, that should be flexible and comprehensive in order to accommodate the various and rapidly expanding surgical fields.
  2,819 475 -
Complete duplication of the urinary bladder: An extremely rare congenital anomaly
Vishal Gajbhiye, Sasanka Nath, Priya Ghosh, Argha Chatterjee, Dipanjan Haldar, Sukanta K Das
January-March 2015, 7(1):91-93
DOI:10.4103/0974-7796.148629  PMID:25657554
A case of complete bladder duplication with urethra duplication, diphallus, anorectal malformation and rightsided renal agensis with ipsilateral gonadal agenesisis was reported because of its rarity. Possible deranged embryology resulting in these anomalies has been reviewed with relevant hypothesis. The patient underwent several investigations and undergoing multistage surgical intervention.
  3,009 273 -
The surgical management of urogenital tuberculosis our experience and long-term follow-up
Punit Bansal, Neeru Bansal
January-March 2015, 7(1):49-52
DOI:10.4103/0974-7796.148606  PMID:25657544
Introduction: Urogenital tuberculosis (TB) is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB). Materials and Methods: We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. Results: There were 38 males and 22 females with a mean age of 32.5 years. The most common symptom was irritative voiding symptoms. The most common organ involved was bladder in 33 cases, and next most common was kidney in 30 cases. Preoperative bacteriologic diagnosis was confirmed in only 19 cases. A total of 66 procedures were performed as some patients needed more than one procedure. These included 35 ablative procedures and 31 reconstructive procedures. All the patients were followed-up with renal function test (RFT) at 3, 6 and 12 months. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed at 3 months when indicated. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annual RFT. Conclusion: Many patients of urogenital TB present late with cicatrisation sequelae. Multidrug chemotherapy with judicious surgery as and when indicated is the ideal treatment. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow-up is necessary in patients undergoing reconstructive surgery.
  2,862 392 -
Incomplete bladder duplication with multiple congenital anomalies: A rare presentation
Nipun Kumar Awasthi, Hemantkumar Goel, Rajkumarsingha Mahapatra, Dilipkumar Pal
January-March 2015, 7(1):88-90
DOI:10.4103/0974-7796.148628  PMID:25657553
We report a rare case of incomplete bladder duplication associated with multiple congenital malformation. The patient presented with a symptomatic left pelvi-ureteric junction obstruction which was surgically managed. To the best of our knowledge, this type of bladder duplication with such syndromic association is not yet reported in literature.
  3,018 221 -
Meatotomy using topical anesthesia: A painless option
Vinod Priyadarshi, Anurag Puri, Jitendra Pratap Singh, Shwetank Mishra, Dilip Kumar Pal, Anup Kumar Kundu
January-March 2015, 7(1):67-70
DOI:10.4103/0974-7796.148622  PMID:25657548
Aim: Urethral meatotomy is an office procedure often done under local anesthesia with or without penile block or under short general anesthesia. Whatever may be the method, the patient has to bear the pain of injection. To avoid painful injections, in the present study, topical anesthesia in the form of eutectic mixture of prilocaine and lidocaine anesthetics (EMLA/Prilox) has been used to perform such procedures and its effectiveness determined. Materials and Methods: A total of 48 consecutive patients with meatal stenosis who attended urology outdoor were enrolled in this study. After exclusion, in 32 patients, 3-4 g of Prilox cream was applied over the glans and occlusive covering was maintained for 45 min before the procedure. Meatotomy was done in a standard manner with hemostat application at the stenosed segment for 2-3 min followed by ventral incision at meatus. The patient's pain perception was measured using visual analog score. Results: Out of 32, only one patient that had inappropriate application of cream, had a perception of pain during the procedure. Rest all the patient had no discomfort during the procedure. Mean visual analog score was 1.8 which is not a significant percepted pain level. No patient had any major complication. Conclusion: Use of topical anesthesia in form of Prilox (EMLA) cream for meatotomy is safe and effective method that avoids painful injections and anxiety related to it and should be considered in most of such patients as an alternative of conventional penile blocks or general anesthesia.
  2,821 260 -
Effect of smoking on reproductive hormones and semen parameters of infertile Saudi Arabians
Haifa A Al-Turki
January-March 2015, 7(1):63-66
DOI:10.4103/0974-7796.148621  PMID:25657547
Objective: The purpose of this retrospective study is to look into the effect of smoking on semen and hormonal profile of Saudi Arabians attending infertility clinics. Materials and Methods: Medical record numbers of patients who attended infertility clinics and who underwent full assessment were identified rom Quadramed system and out-patient log books between January 2010 and December 2012. The standard protocol of the patients include full history, age, number of years of marriage personal habits of smoking, alcohol consumption, primary or secondary infertility. Standard laboratory tests which were performed, included, complete blood picture, random blood sugar, testosterone, follicle stimulation hormone, luteinizing hormone, prolactin level and semen analysis; volume, count, progressive motility and morphology. The data was entered in the database and analyzed. Results: During the study period, 279 patients attended and infertility clinic and only 258 gave the sample for analysis. The average age of patients in the smoking group was 34.23 ± 7.66 and in the nonsmokers 34.07 ± 7.92 years. Primary infertility was more common in smokers versus nonsmokers P < 0.001 confidence interval (CI)< −44.0705, total serum testosterone level was lower 383.8 ± 239.5 versus 422.5 ± 139.2 ng/dL (0.009 CI< −9.9415), serum prolactin level was higher 18.68 ± 13.28 versus 12.85 ± 12.34 ng/mL (0.001 CI < 8.3794). The average volume of the semen among the smokers was 2.8 ± 1.35 mL and in nonsmokers it was 3.08 ± 0.76 mL (P < 0.008 CI< −0.123). The mean progressive motility in smokers was 31.5 ± 23.1 compared to nonsmokers 40.05 ± 25.43% (0.002 CI< −3.2962) and total sperm count was 119.52 ± 114.12 and 139.71 ± 104.82 million/mL (0.07 CI < 1.4657). Conclusions: This study shows that the effect of smoking is dramatic reduction in the hormonal levels and semen parameters. It is recommended that smoking men undergoing fertility treatment should stop smoking to increase their chances of having offspring.
  2,490 403 -
Subsequent impaired fertility (with or without sperm worsening) in men who had fathered children after a left varicocelectomy: A novel population?
Giorgio Cavallini, Giovanni Beretta, Giulio Biagiotti, Roberto Mallus, Carlo Maretti, Edoardo Pescatori, Gianni Paulis
January-March 2015, 7(1):79-85
DOI:10.4103/0974-7796.148625  PMID:25657551
Objectives: The objective of this paper was to assess whether the beneficial effects of a varicocelectomy on fertility are transitory or definitive after a first fathering. Materials and Methods: This was a retrospective study which involved seven andrological centers. The files of 2223 patients who underwent subinguinal ligation of a high grade left varicocele for (oligo)΁(astheno)΁(terato)-spermia and infertility between January 1 st , 2002 and January 1 st 2013 were reviewed. Inclusion criteria for the patients were the following: Sperm count improvement and fathering a child after an uneventful left varicocelectomy; 745 patients were considered. Patients who had undergone three assessments for (in-) fertility: Before surgery, before the first fathering and after the first fathering were included in the study. Each assessment included: Clinical history, physical examination, two sperm analyses, bilateral scrotal Duplex scans, blood hormonal levels [follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL)]. Results: Forty patients were finally studied; they all had an improved sperm count and had fathered once after surgery. Fifteen had fathered twice and still had their sperm count increased after the second fathering. Twenty-five patients could not father twice; 13 patients had their sperm count decreased after the first fathering and 12 did not. A decrease in testicular volume and an increase in FSH paralleled the worsening of sperm concentration, motility and morphology after fathering. No other differences could be observed between the groups. Conclusions: Our data indicated that the beneficial effects of a varicocelectomy might be transitory in some cases.
  2,445 256 -
Solitary neurofibroma of the adrenal gland not associated with type-1 neurofibromatosis
Pallav Gupta, Riti Aggarwal, Rathindra Sarangi
January-March 2015, 7(1):124-126
DOI:10.4103/0974-7796.148661  PMID:25657564
Neurofibromas are tumors of neural origin. They can be solitary or may be associated with neurofibromatosis type-1 (NF-1). These are mostly seen in the head and neck region, upper extremities or along the nerves. Visceral neurofibromas are extremely rare. In this paper, we present an unusual case of solitary neurofibroma of the adrenal gland not associated with NF-1.
  2,367 239 -
Intravesical chemotherapy for intermediate risk non-muscle invasive bladder cancer recurring after a first cycle of intravesical adjuvant therapy
Vincenzo Serretta, Francesco Sommatino, Cristina Scalici Gesolfo, Vito Franco, Giuseppe Cicero, Rosalinda Allegro
January-March 2015, 7(1):21-25
DOI:10.4103/0974-7796.148582  PMID:25657538
Context: The therapeutic strategy in intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) recurring after intravesical therapy (IT) is not well defined. Most patients are usually retreated by Bacillus Calmette-Guerin (BCG). Aims: To evaluate the efficacy of intravesical chemotherapy (ICH) given at recurrence after the first cycle of ICH in IR-NMIBC recurring 6 months or later. Settings and Design: Retrospective analysis of the efficacy of ICH given after previous IT. Materials and Methods: The clinical files of IR-NMIBC patients recurring later than 6 months after transurethral resection (TUR) and IT and retreated by IT were reviewed. The patients should be at intermediate risk both initially and at the first recurrence. BCG should have been given at full dose. Cytology and cystoscopy were performed 3 monthly for 2 years and then 6 monthly. Statistical Analysis: The RFS was estimated by the Kaplan-Meier method and the differences between treatment groups were compared by log-rank test. Mann Whitney U-test was used to compare the parameters' distribution for median time to recurrence. Multivariate Cox proportional hazards models were used. Results: The study included 179 patients. The first IT was ICH in 146 (81.6%) and BCG in 33 (18.4%), re-IT was ICH in 112 (62.6%) and BCG in 67 (37.4%) patients. Median time to recurrence was 18 and 16 months after first and second IT (P = 0.32). At 3 years, 24 (35.8%) and 49 (43.8%) patients recurred after BCG and ICH, respectively (P = 0.90). No difference in RFS was found between BCG and ICH given after a first cycle of ICH (P = 0.23). Conclusions: Re-treatment with ICH could represent a legitimate option to BCG in patients harboring IR-NMIBC recurring after TUR and previous ICH. Prospective trials are needed.
  2,214 330 -
Does prostate size impact upon perioperative outcomes associated with photoselective vaporization of the prostate using the 180W lithium triborate laser?
Kellie E West, Henry H Woo
January-March 2015, 7(1):17-20
DOI:10.4103/0974-7796.148579  PMID:25657537
Introduction: Photoselective vaporization of the prostate (PVP) has been widely adopted as a surgical treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Recently, a high-powered 180 W lithium triborate (LBO) laser has become commercially available and there is relatively little information on the impact of this very high-powered laser on perioperative outcomes. Even more so is the impact of the laser on outcomes according to prostate size. Objectives: The objective of this study was to evaluate perioperative outcomes after PVP with the 180W laser, relative to prostate size. Patients and Methods: A prospectively maintained institutional ethics approved database was retrospectively reviewed. Subjects were analyzed according to transrectal ultrasound and categorized into groups namely 0-39 mL, 40-79 mL, 80-120 mL and >120 mL. Perioperative measures included energy utilized, length of operation, duration catheterization, post operative length of stay (POLOS), Clavien-Dindo adverse events and number discharged home within 24 hours catheter free. Results: With increasing prostate size, there was a statistically significant increase in energy utilization and operation time (P < 0.01 between groups). Duration of catheterization, POLOS, incidence of Grade 3 and above Clavien-Dindo adverse events and discharge home catheter free within 24 hours was not statistically significant across groups. Conclusions: Prostate volume impacts upon energy utilized with PVP surgery. Prostate volume does not influence duration of catheterization or POLOS. Clavien-Dindo Grade 3 or greater adverse events were low and do not appear to be influenced by prostate size. The ability to be discharged home catheter free within 24 hours likewise does not appear to be influenced by prostate size.
  2,241 291 -
A comparison of the efficacy of naftopidil and tamsulosin hydrochloride in medical treatment of benign prostatic enlargement
Chenthil Perumal, Puskar Shyam Chowdhury, N Ananthakrishnan, Prasant Nayak, Srinivasan Gurumurthy
January-March 2015, 7(1):74-78
DOI:10.4103/0974-7796.148624  PMID:25657550
Introduction: Lower urinary tract symptoms in men, over age of 50 years is suggestive of benign prostatic enlargement (BPE). Different alpha-blockers have been evaluated for the treatment of benign prostatic hyperplasia for over last 30 years. This study was conducted in a tertiary care institution during the period of year between June 2011 and August 2013 to compare the effect of naftopidil and tamsulosin in reducing the obstructive and irritable symptoms of BPE. Subjects and Methods: A prospective randomized comparative study was carried on 60 patients of BPE by assigning half of them to treatment with tamsulosin and rest with naftopidil. Pre- and post-treatment uroflowmetry (UFM), post-void residue (PVR), International Prostate Symptoms Score (IPSS), were obtained at 15 and 30 days after starting treatment. Results: The age of patients ranged from 51 to 78. At base line there was no statistical difference between UFM parameter, PVR and IPSS in the two groups. UFM and PVR showed significantly better response at both intervals with naftopidil. Comparison of IPSS showed better improvement in Group A both at 15 and 30 days. It was seen that the obstructive symptoms showed a significantly better response with tamsulosin and symptoms of irritability was seen better response with naftopidil. Conclusion: It was seen that during the period of follow-up of 30 days naftopidil had a better effect on UFM, PVR, IPSS compared with tamsulosin. In general, obstructive symptoms showed better improvement in tamsulosin and irritative symptoms showed better improvement in naftopidil.
  2,151 324 -
An observational study to monitor the efficacy and tolerability of levofloxacin 500 mg once daily for treatment of chronic bacterial prostatitis in Saudi Arabia
Amr Ismail El Meliegy, Mohammed Torky
January-March 2015, 7(1):71-73
DOI:10.4103/0974-7796.148623  PMID:25657549
Introduction: Chronic prostatitis is a common urological problem in men <50-year-old. Untypical uropathogens and an intact blood prostate barrier cause difficulty in using antibiotics to treat the infection. Patients and Methods: In this open-label, observational study, levofloxacin 500 mg was given once daily for 28 days for treatment of chronic prostatitis. The primary efficacy measurement was the disappearance of all pre-treatment symptoms. Efficacy analysis is based on the per protocol population (PPP), all other analyses use the intent to treat (ITT) population. Results: The ITT included 154 men and the PPP included 151 (results are for the ITT unless otherwise indicated). Mean age was 42 ΁ 9 years, common concomitant conditions were diabetes mellitus (7%) and hypertension (5%). All symptoms decreased at day 28. Notably, the rate of dysuria decreased from 86.1% to 10.6%, painful ejaculation from 71% to 2.6% and perineal discomfort from 60.3% to 7.3%. A cure of condition was identified in 58.9%. No treatment failures were reported. Physician-reported adherence to study medication was 96.8%. Conclusion: Levofloxacin appears to be an effective antibiotic for treating symptoms of chronic bacterial prostatitis. Levofloxacin was well-tolerated in this population.
  2,189 285 -
Resolution of hypercalcemia of malignancy following radical cystectomy in a patient with paraneoplastic syndrome associated with urothelial carcinoma of the bladder
Alfredo Harb-De La Rosa, Ahmed Ali, Sanjaya Swain, Murugesan Manoharan
January-March 2015, 7(1):86-87
DOI:10.4103/0974-7796.148627  PMID:25657552
Hypercalcemia of malignancy is a common finding associated with different types of cancers; however, its association with urothelial carcinoma of the bladder is rare. We report a case of a 69-year-old male with nonmetastatic urothelial carcinoma of the bladder who developed hypercalcemia that failed to respond to medical management, but resolved completely after undergoing resection of the tumor through radical cystectomy.
  2,125 260 -
The accuracy of noncontrast spiral computerized tomography in detecting lucent renal stones: A case report and literature review
Ayman Adwan, Saleh Binsaleh
January-March 2015, 7(1):109-111
DOI:10.4103/0974-7796.148649  PMID:25657560
Renal stones are one of the most common diseases in the urology field that are easily diagnosed by one of the standard imaging techniques. Noncontrast spiral computerized tomography (CT) can detect up to 95% of the renal, ureteric and bladder stones, especially those with calcium composition, and considered nowadays one of the most accurate methods for detecting undetectable stones by other modalities. We report a case of a 60-year-old female who presented with colicky right flank pain due to large calcium oxalate renal stone that is undetected by standard imaging technique including spiral CT scan. Uretroscopy diagnosed and ultimately treat this patient problem.
  2,122 215 -
Shock wave lithotripsy outcomes for lower pole and non-lower pole stones from a university teaching hospital: Parallel group comparison during the same time period
Robert Geraghty, Jacob Burr, Nick Simmonds, Bhaskar K Somani
January-March 2015, 7(1):46-48
DOI:10.4103/0974-7796.148601  PMID:25657543
Introduction: Shock wave lithotripsy (SWL) is a treatment option for all locations of renal and ureteric stones. We compared the results of SWL for lower pole renal stones with all other non-lower pole renal and ureteric stones during the same time period. Material and Methods: All SWL procedures were carried out as day case procedures by a mobile lithotripter from January 2012 to August 2013. The follow-up imaging was a combination of KUB X-ray or USS. Following SWL treatment, the stone free rate (SFR) was defined as ≤3 mm fragments. Results: A total of 148 patients with a mean age of 62 years underwent 201 procedures. Of the 201 procedures, 93 (46%) were for lower pole stones. The non-lower pole stones included upper pole (n = 36), mid pole (n = 40), renal pelvis (n = 10), PUJ (n = 8), mid ureter (n = 3), upper ureter (n = 5) and a combination of upper, middle and/or lower pole (n = 6). The mean stone size for lower pole stones (7.4 mm; range: 4-16 mm) was slightly smaller than non-lower pole stones (8 mm; range: 4-17 mm). The stone fragmentation was successful in 124 (62%) of patients. However, the SFR was statistically significantly better (P = 0.023) for non-lower pole stones 43 (40%) compared to lower pole stones 23 (25%). There were 9 (4%) minor complications and this was not significantly different in the two groups. Conclusions: Although SWL achieves a moderately high stone fragmentation rate with a low complication rate, the SFR is variable depending on the location of stone and the definition of SFR, with lower pole stones fairing significantly worse than stones in all other locations.
  2,088 248 -
Prostate laser vaporization is safe and effective in elderly men
Rohit Majumdar, Hossein S Mirheydar, Kerrin L Palazzi, Charles M Lakin, Michael E Albo, J Kellogg Parsons
January-March 2015, 7(1):36-40
DOI:10.4103/0974-7796.148595  PMID:25657541
Introduction: There are few data on the safety and efficacy of laser photoselective vaporization (LVP) in elderly men. We compared the safety and efficacy of LVP for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men ≥75 years, who we defined as elderly, to those <75 years. Materials and Methods: Safety and efficacy outcomes in elderly men undergoing LVP for lower urinary tract symptoms secondary to BPH from 2005 to 2012 were compared with men <75 years. Differences between-groups in demographics, perioperative outcomes, complications, and postoperative changes in International Prostate Symptom Score (I-PSS) were calculated. Results: Of 202 patients, 49 (24%) were elderly (range: 75-95 years) and 153 (76%) were <75 years. Preoperatively, elderly men were more likely to have heart disease (35% vs. 20%, P = 0.03), gross hematuria (6.1% vs. 0.7%, P = 0.05), urinary retention (57% vs. 41%, P = 0.07), and take anti-coagulants (61% vs. 35%, P = 0.002). Elderly men had a longer median length of stay (1 day vs. 0 day, P = 0.001). There were no significant between-group differences in transfusion frequency (4.4% vs. 0.7%, P = 0.14) or Clavien III complications (2% vs. 2.6%, P = 1.0). One month postsurgery, elderly patients reported smaller median decreases in I-PSS (5.5 vs. 9, P = 0.02) and urinary bother (1 point vs. 2, P = 0.03) compared with preoperative values. At till 9 months follow-up, there were no significant between-group differences in median I-PSS or urinary bother scores. Conclusions: Despite a higher prevalence of preoperative comorbidity and urinary retention, elderly LVP patients experienced perioperative safety and shorter term efficacy outcomes comparable to younger men.
  1,984 242 -
Diffuse large B-cell non-Hodgkin lymphoma of the prostate presenting with urinary outlet obstruction: A case report
Ram Nawal Rao, Megha Bansal, Shiwanjali Raghuvanshi, MS Ansari, Zafar Neyaz
January-March 2015, 7(1):100-103
DOI:10.4103/0974-7796.148637  PMID:25657557
Large B-cell non-Hodgkin lymphoma involving the prostate accounts for 0.09% and 0.1% of non-Hodgkin lymphoma. We report a case of prostatic large B-cell non-Hodgkin lymphoma in a 77-year-old male with symptoms of urinary retention most probably due to benign prostate hyperplasia. He underwent multiple needle core biopsies through transrectal ultrasound of the prostate. Histopathological examination of the core biopsies revealed diffuse infiltration by atypical lymphoid cells in the prostatic stroma, which was strongly positive for leukocyte common antigen and CD20. CD3, CK, PSA, BCL2, k-light chain, Cyclin D1 and synaptophysin were negative. Histopathology and immunohistochemical profile in the case was consistent with the diagnosis of diffuse large B-cell non-Hodgkin lymphoma of the prostate.
  1,964 260 -
Case report of deep vein thrombosis caused by artificial urinary sphincter reservoir compressing right external iliac vein
Marcus J Yip, Ashu Jhamb, Jeremy R Goad
January-March 2015, 7(1):112-114
DOI:10.4103/0974-7796.148651  PMID:25657561
Artificial urinary sphincters (AUSs) are commonly used after radical prostatectomy for those who are incontinent of urine. However, they are associated with complications, the most common being reservoir uprising or migration. We present a unique case of occlusive external iliac and femoral vein obstruction by the AUS reservoir causing thrombosis. Deflation of the reservoir and anticoagulation has, thus far, not been successful at decreasing thrombus burden. We present this case as a rare, but significant surgical complication; explore the risk factors that may have contributed, and other potential endovascular therapies to address this previously unreported AUS complication.
  1,989 218 -
Yolk sac tumor of the seminal vesicles: A rare malignant cause of hematospermia
Jonathan D Gill, Selina Bhattarai, Chirag N Patel, Alan B Paul
January-March 2015, 7(1):107-108
DOI:10.4103/0974-7796.148646  PMID:25657559
Extra-gonadal yolk sac tumors (YSTs) are rare and generally associated with poor outcomes. Involvement of the seminal vesicles is extremely rare with only one previously described case. We report a case of a primary YST of the seminal vesicles and discuss the management strategy.
  1,868 202 -
Pheochromocytoma associated with von Hippel-lindau disease in a Pakistani family
Imran K Jalbani, Syed Muhammad Nazim, Farhat Abbas
January-March 2015, 7(1):120-123
DOI:10.4103/0974-7796.148660  PMID:25657563
Objectives: The aim was to study the presentation, disease characteristics, operative outcome, and prognosis in patients with familial Pheochromocytoma associated with von Hippel-Lindau (VHL) disease. Materials and Methods: There were six patients belonging to two generations of a single family who developed features of VHL over a period of 13 years and were treated at our institute. Patients' characteristics, that is, age, gender, presenting complaints and clinical signs, laboratory and biochemical evaluation, and the presence of associated conditions was gathered from medical records. The preoperative and postoperative radiological imaging and histopathological results were also collected. Results: Out of six cases, five were male, and one was female. The mean age at first presentation was 25 years (16-40). All patients presented with uncontrolled hypertension and were found to have Pheochromocytoma on workup. Three patients had unilateral adrenal tumor, and three had bilateral disease. None of the patients had extra-adrenal Pheochromocytoma. All patients were managed with adrenalectomy and had benign pathology. Two patients subsequently had craniotomy for excision of cerebellar hemangioma, and one patient had bilateral partial nephrectomy at the time of adrenalectomy. There was no peri- post-operative mortality and all patients are being followed by the surgeon(s) and endocrinologist. Conclusion: Pheochromocytoma can be a part of familial conditions including VHL. Other associated features should be suspected, investigated, and treated in these patients that can influence patients' clinical course and prognosis. Family members should also be screened to achieve early diagnosis.
  1,797 237 -
Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management
Raman Tanwar, Kirti Vijay Rathore, Mahesh Kumar Rohilla
January-March 2015, 7(1):94-96
DOI:10.4103/0974-7796.148632  PMID:25657555
Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients.
  1,798 225 -
Can intracutaneous sterile water injection be used as a possible treatment for acute renal colic pain in the emergency department? A short literature review
Seyed Mohammad Hosseininejad, Amir Emami Zeydi
January-March 2015, 7(1):130-132
DOI:10.4103/0974-7796.148669  PMID:25657569
  1,780 205 -
Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations?
Emmanuel Patris, Konstantinos Giakoumidakis, Vasileios Patris, Manoj Kuduvalli, Mihalis Argiriou, Christos Charitos, Christos Kalaitzis, Stavros Touloupidis
January-March 2015, 7(1):58-62
DOI:10.4103/0974-7796.148619  PMID:25657546
Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4 th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately , postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction.
  1,760 218 -
Medullary sponge kidneys and the use of dual-energy computed tomography
Wisit Cheungpasitporn, Stephen B Erickson
January-March 2015, 7(1):129-129
DOI:10.4103/0974-7796.148666  PMID:25657567
  1,712 217 -
Primary apocrine adenocarcinoma of scrotum suspected as urothelial carcinoma metastasis: A clinical and pathological dilemma
Sean Huang, Mark Frydenberg, Alan Pham, Jeremy P Grummet
January-March 2015, 7(1):97-99
DOI:10.4103/0974-7796.148634  PMID:25657556
A 78-year-old man presented with an enlarging, tender mass in the scrotum separate to the testes. This was on the background of radical cystoprostatectomy, urethrectomy, and ileal conduit formation for high-grade urothelial carcinoma of the bladder invading submucosa 3 years prior. Examination revealed a 4 × 5 cm lesion, which was hard, fixed to the overlying skin and nodular to palpation. Ultrasound confirmed a solid mass in the scrotum extending into the perineum. Computerized tomography of the chest, abdomen, and pelvis revealed enlargement of inguinal lymph nodes but no other metastases. Complete resection of the scrotal lesion and selective removal of regional lymph nodes was performed. Rather than a cutaneous scrotal metastasis from the bladder urothelial carcinoma, histological examination suggested a primary apocrine adenocarcinoma of the scrotum. This case report explores the clinical and pathological features associated with both of these unusual differential diagnoses.
  1,713 203 -
A case of recurrent retroperitoneal lymphangioleiomyomatosis treated with progesterone therapy
Alina Basnet, Hamid Shaaban, William Kessler
January-March 2015, 7(1):127-128
DOI:10.4103/0974-7796.148664  PMID:25657565
  1,568 171 -
Vesicoureteric reflux in children
Mahmood Dhahir Al Mendalawi
January-March 2015, 7(1):130-130
DOI:10.4103/0974-7796.148668  PMID:25657568
  1,355 190 -
Antenatal diagnosis, prevalence, and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia
Mahmood Dhahir Al Mendalawi
January-March 2015, 7(1):132-133
DOI:10.4103/0974-7796.148671  PMID:25657570
  1,315 174 -
Prostate-specific antigen obtained from fresh and dried urine
Beuy Joob, Viroj Wiwanitkit
January-March 2015, 7(1):128-128
DOI:10.4103/0974-7796.148665  PMID:25657566
  1,312 152 -
Primary spindle cell sarcoma of the prostate and 18 F-fluorodeoxyglucose-positron-emission tomography/computed tomography findings
Hakan Öztürk
January-March 2015, 7(1):115-119
DOI:10.4103/0974-7796.148657  PMID:25657562
Background: Primary sarcoma of the prostate is extremely rare and accounts for 0.1% of all prostate cancers. This type of cancer is associated with poor prognosis due to aggressive biological behavior. The World Health Organization histologically classified prostate sarcomas as stromal tumor of unknown malignant potential (STUMP) and stromal sarcoma. Patients and Methods: A 39-year-old patient presented with lower urinary tract symptoms over the last few months. On digital rectal examination, the right lobe of the prostate was diffusely hard on palpation. Prostate-specific antigen was 0.5 ng/ml. A biopsy specimen was obtained with the guidance of transrectal ultrasonography. Immunohistochemical examination revealed positive staining for vimentin, actin, and desmin. Results: 18 F-fluorodeoxyglucose-positron-emission tomography/computed tomography scans obtained for staging purposes with the diagnosis of primary spindle cell carcinoma of the prostate revealed widespread lung and liver metastases. A doxorubicin-based systemic chemotherapy (CTx) was initiated. Conclusion: Spindle sarcomas of the prostate have quite aggressive nature and they have high potential to metastase. Average life expectancy is <1 year and the prognosis is poor. CTx and radiation therapy can't yield curative effects due to poor differentiation.
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