A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update.

INTRODUCTION: Owing to certain inherent limitations of earlier reporting systems, "The Paris System for Reporting Urinary Cytology (TPS)" was implemented in 2015 to standardize reporting urine cytology with more stringent cytomorphologic criteria. We share our post-TPS experience, comparing it with the conventional system (CS). AIM: To assess and compare the cyto-histopathologic/cystoscopic agreement between the conventional and the Paris systems (CS and TPS) for reporting urine cytology. MATERIALS AND METHODS: It is a cross-sectional study involving urine samples from 170 patients divided into two groups (CS and TPS). Of the 170 cases, 85 were reported according to the CS, and 85 were reported according to TPS with all the relevant clinical, radiologic, and cystoscopic findings. Using the kappa statistics, both groups were statistically analyzed for sensitivity, specificity, predictive values, and agreement. RESULTS: The sensitivity and specificity for high-grade urothelial carcinoma (HGUC) as per TPS were 83.33% and 94.59%, respectively, while they were 73.47% and 80.56% for the conventional system. The agreement for HGUC with TPS was 87.06% with a kappa value of 0.7416, while it was 76.5% with a kappa value of 0.53 for the CS. Implementing the TPS minimized usage of the atypical urothelial cells (AUC) category, increasing the clarity in detecting HGUC. CONCLUSION: TPS provides better agreement with histopathology than the CS for diagnosing HGUC, which is attributable to stringent TPS criteria that prompt cytopathologists to look more diligently for morphologic and numeric criteria.

Does successful urethral calibration rule out significant female urethral stenosis? confronting the confounder- an outcome analysis of successfully treated female urethral strictures

ABSTRACT Objective: The diagnosis and treatment of female urethral stricture disease (FUSD) are practiced variably due to the scarcity of data on evaluation, variable definitions, and lack of long-term surgical outcomes. FUSD is difficult to rule out solely on the basis of a successful calibration with 14F catheter. In this study, we have tried to characterize the variable clinical presentation of FUSD, the diagnostic utility of calibration, videourodynamic study(VUDS), and urethroscopy in planning surgical management. Materials and Methods: A retrospective review of records of 16 patients who underwent surgical management of FUSD was analyzed. The clinical history, examination findings, and the results of all the investigations (including uroflowmetry, VUDS findings, urethroscopy) they underwent, the procedures they had undergone, and the follow-up data were studied. Results: A total of 16 patients underwent surgical management of FUSD. 13 out of 16 patients had successful calibration with 14F catheter on the initial presentation. These 13 patients on VUDS demonstrated significant BOO and had variable stigmata of stricture on urethroscopy. The mean IPSS, flow rate, and PVR at presentation and after urethroplasty were 23.88±4.95, 7.72±4.25mL/s, 117.06±74.46mL and 3.50±3.44, 22.34±4.80mL/s, and 12.50±8.50mL, respectively. (p <0.05). The mean flow rate after endo dilation(17F) (n=12) was 11.4±2.5mL/s while after urethroplasty improved to 20.30±4.19mL/s and was statistically significant(p <0.05). Conclusions: An adept correlation between clinical assessment, urethroscopy findings, and VUDS is key in objectively identifying FUSD and planning surgical management. A good caliber of the urethra is not sufficient enough to rule out a significant obstruction due to FUSD. Early urethroplasty provides significantly better outcomes in patients who have failed dilation as a treatment.

Does successful urethral calibration rule out significant female urethral stenosis? confronting the confounder- an outcome analysis of successfully treated female urethral strictures.

OBJECTIVE: The diagnosis and treatment of female urethral stricture disease (FUSD) are practiced variably due to the scarcity of data on evaluation, variable definitions, and lack of long-term surgical outcomes. FUSD is difficult to rule out solely on the basis of a successful calibration with 14F catheter. In this study, we have tried to characterize the variable clinical presentation of FUSD, the diagnostic utility of calibration, videourodynamic study(VUDS), and urethroscopy in planning surgical management. MATERIALS AND METHODS: A retrospective review of records of 16 patients who underwent surgical management of FUSD was analyzed. The clinical history, examination findings, and the results of all the investigations (including uroflowmetry, VUDS findings, urethroscopy) they underwent, the procedures they had undergone ,and the follow-up data were studied. RESULTS: A total of 16 patients underwent surgical management of FUSD. 13 out of 16 patients had successful calibration with 14F catheter on the initial presentation. These 13 patients on VUDS demonstrated significant BOO and had variable stigmata of stricture on urethroscopy. The mean IPSS, flow rate, and PVR at presentation and after urethroplasty were 23.88±4.95, 7.72±4.25mL/s, 117.06±74.46mL and 3.50±3.44, 22.34±4.80mL/s, and 12.50±8.50mL, respectively. (p < 0.05). The mean flow rate after endo dilation(17F) (n=12) was 11.4±2.5mL/s while after urethroplasty improved to 20.30±4.19mL/s and was statistically significant(p < 0.05). CONCLUSIONS: An adept correlation between clinical assessment, urethroscopy findings, and VUDS is key in objectively identifying FUSD and planning surgical management. A good caliber of the urethra is not sufficient enough to rule out a significant obstruction due to FUSD. Early urethroplasty provides significantly better outcomes in patients who have failed dilation as a treatment.

Emphysematous Prostatitis With Secondary Psoas Abscess-A Lethal Outcome Following Prostate Biopsy.

Emphysematous prostatitis is a rare, clinical condition characterized by gas and abscess formation in the prostate often associated with features of sepsis. We report a case of 60-year-old gentleman presenting with emphysematous prostatitis complicated with secondary psoas abscess and florid sepsis following prostate biopsy.

Outcomes of Robot-Assisted Ureterocalicostomy in Secondary Ureteropelvic Junction in Adults: Initial Experience Using Da Vinci Xi System with Near-Infrared Fluorescence Imaging.

Aim: To report the surgical technique and early outcomes of robot-assisted ureterocalicostomy (RAUC) with near-infrared fluorescence (NIRF) in the management of secondary pelvi-ureteric junction obstruction (PUJO) in adults. Materials and Methods: The data of 6 patients who underwent RAUC using Da Vinci Xi system with NIRF technology between November 2017 and April 2019 were retrospectively reviewed. Indication was secondary PUJO due to previous failed pyeloplasty. The outcome variables evaluated include operative time (total and console), length of hospital stay, blood loss, and complications. Success was defined as the absence of pain and radionuclide scan demonstrating nonobstructive drainage and improvement/stabilization of split function of the renal moiety. Results: The mean (range) patient age was 33.7 (18-41) years. Total mean (range) operating time was 178 (140-240) minutes and mean console time was 135 minutes. Estimated mean blood loss was 115 (50-200) mL and average hospital stay was 6.1 (5-8) days. There were no conversions to open or laparoscopic surgery. Clavien-Dindo complications occurred in 2 patients. (Grade I-1 and Grade II-1). After a median (range) follow-up of 15 (6-22) months, all 6 patients had successful clinical and radiological outcomes. Conclusion: RAUC is a safe and feasible technique with acceptable outcomes in the setting of secondary PUJO. The utility of NIRF in determining vascularity of the ureter seems to be promising in this setting. Multi-institutional prospective studies with large patient cohort are necessary to validate the role of robotic platform in ureterocalicostomy in the reoperative settings.

Emergency urethroplasty for penile urethral injury in a case of blunt trauma of the penis: challenges and dilemmas during management.

Penile urethral injury may be associated with cavernosal rupture due to distractive force during coitus. Non-coital penile injury due to direct blow to the penis causing penile urethral and cavernosal rupture is rare. Definite management of urethral injury in such cases can be deferred as extent of devitalised tissue can be deceptive in acute conditions.