Ejaculation preserving TURP (Ep-TURP): A viable alternative in sexually active males with BOO-a single centre prospective randomized study.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common urological condition, particularly among middle-aged and elderly men. Trans urethral resection of prostate (TURP) has some drawbacks, particularly concerning ejaculatory function. Ejaculation preserving TURP (Ep-TURP) is one such technique that aims at preserving the tissues that are primarily responsible for antegrade ejaculation. METHODS AND MATERIAL: In this prospective study, patients with bothersome LUTS were randomized into Ep-TURP and standard TURP groups. Supramontal tissue was preserved in Ep-TURP while standard TURP group had resection of the entire prostatic tissue up to the verumontanum. The outcomes with regard to IPSS, Qmax, IIEF(Q9), Ejaculation and PVR were studied. Ejaculation projection score was separately calculated and assessed. RESULTS: About 60 patients were studied, with 30 in each group. At 6 months' follow-up, complication rates were the same in both groups. The IPSS, Qmax, IIEF were similar and comparable. There was no change in erection in all patients (P = 0.559). The ejaculation was well preserved in Ep-TURP (p<0.001). Ejaculation projection score was maintained at 3.77 in the Ep-TURP group while in the standard group it was 0 (P<0.001). CONCLUSIONS: Ep-TURP is a safe and a cost-effective method of preserving ejaculation in patients undergoing TURP. This procedure adds a better quality of life that greatly aids in enhancing the improving his psychological outlook towards life. Ep-TURP has now emerged as the standard procedure of choice in sexually active young males needing TURP, as the degree of ejaculation is largely well preserved in patients undergoing this procedure.

Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11-year prospective study at a tertiary referral centre.

OBJECTIVES: To define pre-morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes. PATIENTS AND METHODS: From January 2009 to December 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non-contrast computed tomography of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1, patients who survived without any intervention; Group 2, those who survived with surgical intervention; and Group 3, those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. RESULTS: Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n = 22), Group 2 (n = 102) and Group 3 (n = 7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common comorbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (P < 0.001). CONCLUSIONS: A multi-disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture-specific antibiotics with identification of prognostic indicators and risk stratification, allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Glanular Ischemia Following Circumcision: A Rare But Perilous Complication.

Circumcision is a commonly performed surgical procedure both in childhood and in adults. Acute ischemia of the glans penis after circumcision is a rare but hazardous complication. If left untreated, it can lead to severe consequences such as blackish discolouration due to ischemia, necrosis, or rare organ loss. Herein, we report a case of a 30-year-old male who underwent circumcision for phimosis, following which, he developed ischemia of the glans penis that was managed with timely diagnosis, topical application of warm saline, and oral pentoxifylline. We report the need for a prompt diagnosis and early intervention and also highlight the possibility of dreadful sequelae if left undiagnosed or untreated.

Post-transurethral resection of prostate urethral strictures: Are they often underreported? A single-center retrospective observational cohort study.

OBJECTIVES: Post-transurethral resection of prostate urethral stricture (PTS) is a well-documented delayed complication following transurethral resection of the prostate (TURP). The aim is to analyze various risk factors of PTS and see if the overall incidence is underreported. MATERIALS AND METHODS: A retrospective study was conducted in our institution between January 2017 and December 2018 in men who underwent TURP. Data obtained from the medical records department were analyzed. Statistical analysis was done using Fisher's exact test. A two-tailed P < 0.05 is considered statistically significant. RESULTS: Of the 447 men who underwent TURP, 57 developed PTS. Fifteen of 334 patients who underwent calibration before the procedure developed stricture compared to 42 of 137 without calibration (P < 0.01). There was a significantly lesser incidence of stricture with 24 Fr resectoscope compared with 26 Fr sheath (P < 0.04). Two patients with 24 Fr Foley and 30 of 35 (86%) patients with 22 Fr Foley catheter developed stricture of urethra. Distal bulbar urethra was the most common site of narrowing following TURP. Eighteen patients had Salvaris swab placed for traction and 12 patients required full-thigh traction, of which majority developed meatal stenosis. CONCLUSIONS: TURP is one of the common surgical procedures performed by urologists. Meatitis and meatal stenosis, if included as complications of TURP, would increase the overall incidence of PTS. Factors such as the size of resectoscope sheath used, size of catheter inserted, placement of Salvaris swab traction, and preoperative calibration of urethra have a significant impact on the ultimate outcome.

Supracostal Punctures for PCNL: Factors that Predict Safety, Success and Stone Free Rate in Stag Horn and Non-Stag Horn Stones: A Single Centre Experience and Review of Literature.

INTRODUCTION: Supra-costal Percutaneous Nephrolithotomy (PCNL) procedure has now become an established standard of care in patients with renal stone disease, in terms of morbidity, stone clearance, duration of stay and shorter convalescence period. Gone are the days when supracostal punctures were considered to be associated with a high morbidity. With increased expertise gained in performing multiple punctures and further refinements in focusing techniques, more and more of these procedures are being performed with an intention to achieve a maximum stone clearance with least morbidity. AIM: To prospectively analyze the various factors that predict the safety, efficacy and stone clearance rate in patients who have undergo supracostal punctures for PCNL procedures. MATERIALS AND METHODS: Three hundred seventy six patients underwent PCNL for renal stones. Ninety two (n=92) of them needed supra-costal puncture. All patients were subdivided into groups 1 and 2 based on the size, location of the stone and the stone burden. In all, 132 tracts were established. RESULTS: About 83% of patients achieved a complete stone free rate after initial PCNL. Stones more than 3 centimeters were found to be associated with significant residual stones. Radio opacity under image intensifier also had a significant impact on the ultimate stone free status. About 23% of those (n=5/22) who needed longer duration of surgery had a clinically significant residual stones, needing ancillary procedures. Fifteen patients (16%) had complications related to the procedure, of which 13 were in group 1 (87%). High percentage of complications in patients with larger stone burden was found to be statistically significant. In about 76% (n=70), the procedure required only less than 90 minutes. Also, in those 22 patients in whom the duration of procedure exceeded 90 minutes, 12 of them had complications, with a p-value of <0.0001. CONCLUSION: Supra-costal punctures are safe and effective options in a selected group of patients. The overall results are almost on par with that of the infra costal punctures, with an acceptable morbidity.

Mucinous Cystadenocarcinoma in a Horse Shoe Kidney Masquerading as Giant Hydronephrosis - A Case Report: Diagnostic Challenges, Lessons Learnt and Review of Literature.

Primary epithelial tumour of the renal pelvis is a rare entity. So far, very few cases are reported in literature. Of these, mucin secreting adenocarcinomas are distinctly rare. However, mucinous cystadenocarcinoma, that too arising in a horse shoe kidney is extremely rare to be reported. Mucinous cystadenomas and carcinomas arising from the renal pelvis are regarded to be secondary to a metaplastic change in the urothelium. Here, we present a case of a 51-year-old male, who complained of abdominal pain, palpable abdominal mass, haematuria along with passage of mucoid material in the urine, with a very poorly functioning kidney. A pre-operative diagnosis of horse shoe kidney with pelvi ureteric junction obstruction and a poorly functioning kidney was made. Intraoperative findings and frozen section biopsy were suggestive of mucin secreting cystic mass and a right heminephrectomy was done. The final histopathology was suggestive of mucinous cystadenocarcinoma of the renal pelvis of the right moiety. This case is presented for its rarity, diagnostic challenges faced and the lessons learnt, stressing on the need for having a high index of clinical suspicion in making such diagnosis.