Bilateral giant adrenal myelolipoma: A rare scenario.

Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.

Adrenal schwannoma: An uncommon incidentaloma.

WHO classification of adrenal tumors. Only a handful of cases have been reported so far. A 30-year-old lady presented with cerebrovascular accident. CT scans of the abdomen and pelvis revealed a 3.5-cm well-defined, smooth margined, heterogeneously enhancing, mass lesion in the right adrenal gland. She had no endocrine symptoms and urinary metanephnines were normal. She underwent right adrenalectomy for incidentaloma. Histopathology of the excised mass showed features of an adrenal schwannoma. Diagnosis of adrenal schwannoma on imaging studies is difficult preoperatively and raises suspicion of other adrenal tumors. Surgical excision followed by histopathology confirms the diagnosis.

Foley catheter with noble metal alloy coating for preventing catheter-associated urinary tract infections: a large, multi-center clinical trial.

BACKGROUND: Catheter-associated urinary tract infections (CAUTI) are among the most frequent healthcare-associated infections in the world. They are associated with increased mortality, prolonged hospital stay and increased healthcare costs. The objective of this study was to evaluate the efficacy of the noble metal alloy (NMA) coated BIP Foley Catheter in preventing the incidence of symptomatic CAUTI in a large cohort of patients in India. METHODS: This multi-center, prospective study included 1000 adult patients admitted to six hospitals across India for urology, surgery and ICU requiring urethral catheterization and admission for ≥ 48 h. Patients were allocated to the NMA-coated BIP Foley Catheter group or a non-coated control catheter group, with a randomization ratio of 3:1. CAUTI surveillance was conducted at study entry, upon catheter removal, and 2 days after catheter removal. For statistical analysis, categorical data (e.g. gender) were compared using the chi-square or Fischer test, and numerical data were compared using the two-sample t-test. Associations were evaluated using logistic regression. RESULTS AND CONCLUSIONS: The incidence of symptomatic CAUTI was reduced by 69% in the BIP Foley Catheter group compared to the control group (6.5 vs 20.8 CAUTI/1000 catheter days), with an incidence rate ratio of 0.31 (95% confidence interval: 0.21-0.46; p < 0.001). A reduction in the cumulative CAUTI incidence was evident in the BIP Foley Catheter group within 3 days after catheterization; this reduction was maintained up to ~ 30 days, and the largest reductions were seen between 3 and 11 days. There were no serious adverse events related to either catheter, and the percentage of patients with ≥ 1 adverse event was significantly lower in the NMA-coated BIP Foley Catheter group than in the control group (21.6% vs. 48.4%; p = 0.001). In conclusion, the NMA-coated BIP Foley Catheter was effective in reducing CAUTI and was well tolerated, with a lower incidence of adverse events compared to the uncoated catheter. Trial registration This study was registered prospectively (28 September 2015) in the Clinical Trials Registry of India (trial number CTRI/2015/09/006220; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=12631&EncHid=&userName=bactiguard ).

Association of arsenic with recurrence of urinary bladder cancer.

Arsenic is known to be an important aetiological factor for the development of urinary bladder cancer. It is known to be found excessively in ground water in certain geographical areas, including West Bengal. We have studied patients with recurrent bladder cancer from different areas of this Indian state and correlated arsenic as a causative aetiological factor for development and aggressiveness of the biological behaviour of urinary cancer. We included 31 patients from various parts of West Bengal state with recurrent bladder cancer who were operated in our institute. Their clinical and residential data and their arsenic content of tumour tissue were measured. Statistical analysis was performed to test the association of tissue arsenic with clinicopathological features of recurrent disease. We found very high levels of arsenic in tumour tissue in all residents of the districts with high prevalence of arsenic in the drinking water. We also observed more aggressive clinicopathological progression and early recurrence in patients with high arsenic content. We conclude that arsenic is a causal factor in the clinicopathological progression of recurrent urinary bladder cancer. Measures to decrease the level of arsenic in drinking water should be taken as this may both improve clinicopathological outcomes in the recurrence of urinary bladder carcinoma, as well as reducing its overall incidence.

Laparoscopic Vesicovaginal Fistula Repair with Limited Cystotomy: A Rewarding Treatment Option.

INTRODUCTION: Vesicovaginal fistula (VVF) is the most common type of urogenital fistula. Gynecologic surgery is the most common cause associated with it. Laparoscopic approach for VVF repair gives the benefit of minimally invasive surgery with principles similar to open transabdominal approach. MATERIALS AND METHODS: We retrospectively reviewed data of 13 patients who underwent laparoscopic vesicovaginal repair at our department from December 2012 to December 2014. Transperitoneal transvesical laparoscopic vesicovaginal repair using 4 ports was performed in all cases. Small cystotomy was performed instead of classical bivalving of the bladder. In most of the cases, the sigmoid epiploic appendix was used for augmentation. Per urethral catheter was kept for 10 days. RESULTS: In all patients, the procedure was successfully completed. Repairs were performed between 8 and 28 weeks (mean 15.8 ± 5.7) following the injury. All fistulas were at supratrigonal region. Fistula size ranged from 1 to 3.5 cm (mean 2.2 ± 0.9). Mean operative time was 157 ± 29.8 min (range 110-210), and estimated blood loss was 73.8 ± 18.2 ml (range 45-110). Average hospital stay was 4.6 days. In the postoperative period, three patients had urinary tract infection, which was treated with oral antibiotics. Apart from these, no major complications were seen. Follow-up time ranged from 4 to 27 months (mean 15.7). During the follow-up, no patient had recurrence or voiding symptoms. CONCLUSIONS: Laparoscopic transabdominal transvesical VVF repair with limited cystotomy and sigmoid epiploic appendix flap coverage can be performed safely with short operative time, good success rate, less morbidity, and quick convalescence.

Successful management of auto knotted intravesical infant feeding tube by minimal invasive technique.

We report a case of acute urinary retention due to intravesical auto knotting of infant feeding tube in a child treated successfully by endoscopic approach.

Prostatic abscess: diagnosis and management in the modern antibiotic era.

This retrospective study was aimed at analyzing the clinical findings and therapeutic strategies in 24 patients who were admitted with prostatic abscess, during the period from 1999 to 2008. The diagnosis of prostatic abscesses was made clinically by digital rectal palpation based on the presence of positive fluctuation with tenderness. All cases were confirmed by trans-rectal ultrasound (TRUS), and only positive cases were included in this study. The diagnostic work-up included analysis of midstream urine and abscess fluid culture for pathogens. Therapeutic options included endoscopic trans-urethral incision or trans-perineal aspiration under ultrasound guidance, or conservative therapy. Of the 24 patients studied, 45.83% of the cases had a pre-disposing factor, and diabetes mellitus (37.50%) was the most common. Digital rectal palpation revealed fluctuation in 70.83% of the cases. Trans-abdominal ultrasonography missed the condition in 29.16% of the cases. On TRUS, all the study patients showed hypo-echoic zones, while nine others showed internal septations. In most of the cases, the lesion was peripheral. A causative pathogen could be identified in 70.83% of the cases. Surgical drainage of the abscess by trans-urethral deroofing was performed in 17 cases (including one with failed aspiration), trans-perineal aspiration under TRUS guidance was performed in three cases and conservative therapy was followed in five cases. Our data confirms the importance of predisposing factors in the pathogenesis of prostatic abscess. In most of the cases, the clue to diagnosis is obtained by digital rectal palpation. TRUS gives the definite diagnosis and also helps in follow-up of patients. Trans-urethral deroofing is the ideal therapy where the abscess cavity is more than 1 cm, although in some selected cases, TRUS-guided aspiration or conservative therapy does have a role in treatment.

Intravesical wire as foreign body in urinary bladder.

Foreign bodies in the urinary bladder are frequently the objects of jokes among doctors, but they may sometimes cause serious implications to the patients. Here we present our experiences in 3 such cases where long segments of wire were introduced into the urinary bladder through the urethra.

Intravesical wire as foreign body in urinary bladder

Foreign bodies in the urinary bladder are frequently the objects of jokes among doctors, but they may sometimes cause serious implications to the patients. Here we present our experiences in 3 such cases where long segments of wire were introduced into the urinary bladder through the urethra.