External iliac artery pseudoaneurysm following radical cystectomy: A report of two cases.

External iliac artery pseudoaneurysm is a rare complication following radical cystectomy and pelvic lymph node dissection. We report two cases that developed external iliac artery pseudoaneurysm following radical cystectomy and pelvic lymph node dissection with an ileal conduit. Survival in these patients is dependent on early diagnosis and prompt intervention. Mortality in such cases remains high even with aggressive management.

Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience.

INTRODUCTION: Prostate cancer is now the second-most common cancer in many parts of India. Despite being the second-largest population in the world, data regarding outcomes of biopsy in Indian men are limited. We report the correlation of biopsy finding with prostate-specific antigen (PSA) level in Indian men undergoing biopsy for either elevated PSA and/or abnormal digital rectal examination (DRE) findings. MATERIALS AND METHODS: We retrospectively analyzed data of 853 men who underwent TRUS-guided prostate biopsy in a single institution from January 2014 to October 2019. The biopsy was performed when serum PSA was more than 4.00 ng/mL and/or DRE findings were suspicious for malignancy. RESULTS: Overall cancer detection rate was 38.8%. Patients were classified in five groups based on PSA levels, irrespective of DRE findings (0-3.99 ng/mL, 4.00-9.99 ng/mL, 10.00-19.99 ng/mL, 20.00-39.99 ng/mL, and ≥40 ng/mL). Overall prostate cancer detection rates at corresponding at PSA levels were 3/23 (13%), 62/282 (21.9%), 86/226 (38.05%), 66/126 (52.3%), and 165/196 (84.18%), respectively. 331 (38.8%) patients of the total 853 had suspicious DRE, the cancer detection rate in corresponding PSA groups, based on DRE alone was 3/23 (13.04%), 23/42 (54.76%), 39/56 (69.64%), 43/52 (82.69%), and 157/160 (98.13%), respectively. CONCLUSION: The overall prostate cancer detection rate at our center was 38.8%, which is much higher as compared to other Indian data. Our study also emphasizes the role of DRE in Indian men presenting with elevated PSA.

Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients.

OBJECTIVE: To report procedure process improvements and confirm the preserved safety and short-term effectiveness of a second-generation Aquablation device for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) in 47 consecutive patients at a single institution. PATIENTS AND METHODS: Aquablation was performed in 47 patients with symptomatic BPH at a single institution. Baseline, peri-operative and 3-month urinary function data were collected. RESULTS: The mean (range) patient age was 66 (50-79) years, and transrectal ultrasonography-measured prostate volume was 48 (20-118) mL. A median lobe was present in 25 patients (53%) and eight patients had catheter-dependent urinary retention. The mean (range) total procedure time was 35 (13-128) min and the tissue resection time was 4 (1-10) min. Five Clavien-Dindo grade I/II and five Clavien-Dindo grade III complications were recorded in eight patients. The mean (range) hospital stay was 3.1 (1-8) days and the mean (range) duration of urethral catheterization was 1.9 (1-11) days. The mean International Prostate Symptom Score (IPSS) decreased from 24.4 at baseline to 5 at 3 months; IPSS quality-of-life score decreased from 4.5 to 0.3 points; peak urinary flow rate increased from 7.1 to 16.5 mL/s and post-void residual urine volume decreased from 119 to 43 mL (all P < 0.01). CONCLUSIONS: This study confirmed procedure process improvements resulting from system enhancements, with preservation of safety and effectiveness during use of a second-generation device for the treatment of LUTS attibutable to BPH in the largest single-institution study conducted to date.

Pathological outcomes and biochemical recurrence-free survival after radical prostatectomy for high-risk prostate cancer in the Indian population.

INTRODUCTION: We analyzed the biochemical recurrence-free survival (BRFS) of patients with high-risk prostate cancer (HRCaP) as per the D'Amico classification undergoing radical prostatectomy (RP) at our center. We aimed to determine whether the number and type of risk factors (cT2c-T3b, prostate-specific antigen >20 ng/ml, Gleason score >7) are associated with biochemical recurrence (BCR) in HRCaP patients undergoing RP in the Indian population. METHODS: Between 2006 and 2017, 192 patients underwent RP (open RP [ORP], laparoscopic RP [LRP], and robotic RP [RRP]) at our center, of which 109 had D'Amico HR disease. Preoperative, postoperative, and pathological outcome data were analyzed for patients with HR disease as per the D'Amico classification. Subgroups were formed to determine whether an increasing number of risk factors (1, 2, or 3) were associated with poorer oncological results and early BCR. The Kaplan-Meier method with log-rank test was used to test the difference in BRFS between the groups. Univariate and multivariate analyses were done to find significant variable against BCR. RESULTS: According to the D'Amico criteria, 109 patients had HR, 63 patients had intermediate-risk, and 19 patients had low-risk disease. These 109 patients with HR disease were analyzed in our study (50 RRP, 33 ORP, and 26 LRP). A total of 59 (54.1%) patients had one HR factor (1HR), 44 (40%) had two HR factors (2HR), and 6 (5.5%) had three HR factors (3HR). The mean follow-up for our patient population was 21.5 ± 19 months (median 18 months; range, 0-108). Overall, the 2-year and 5-year BRFS was 45% and 35%, respectively (mean BRFS 46 ± 6 months). Two-year BRFS was 63%, 23%, and 22%, respectively, for 1HR, 2HR, and 3HR (logrank, P < 0.0001). The prognostic substratification based on the three risk factors was significantly predictive for adverse pathologic features and oncologic outcomes. CONCLUSION: Substratification based on the three well-defined criteria leads to a better identification of the more aggressive cancers and prediction of need for additional treatment modalities. Localized HRCaP includes a heterogeneous population of patients with variable oncological outcomes.

Retrograde intra-vesical reconstructive surgery (RIVRS): A novel technique.

Management of distal ureter by en block resection during radical nephrectomy for upper urinary tract transitional cell carcinoma (TCC) is considered as standard of care. In this report, we describe our technique for management of lower ureter which utilizes both the endoscopic and laparoscopic approach. The nephrectomy including the dissection of the lower ureter was completed laproscopically. The ureteral orifice was scored using a hook passed through a 24 Fr nephroscope and secured .Transurethral suturing of the defect with SewRight SR5 device passed through the working channel of the 24 Fr nephroscope was done. Our report highlights the fact that management of lower ureter in TCC pelvis can be done endoscopically/laproscopically without compromising the oncological principles. Our novel technique demonstrates feasibility of intra mural resection of the ureter and primary closure of the bladder endoscopically.

Masquerader in oncology: IgG4-related kidney disease presenting as right upper ureteric mass.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition that can mimic several diseases and can present as a malignant tumor. We present a case of a 53-year-old woman who presented with a right upper ureteric mass. On pathologic evaluation, a diagnosis of IgG4-RD was made. In the absence of preoperative biopsy and other clinical manifestations, preoperative clinical diagnosis remains challenging and high index of suspicion and accurate pathological evaluation may help in avoiding misdiagnosis.

Tubulocystic Renal Cell Carcinoma in Young Adult.

Tubulocystic renal cell carcinoma is a uncommon neoplasm with unique pathological features and indolent clinical behaviour. We are reporting a case of tubulocystic renal cell carcinoma in young adult managed by partial nephrectomy.

Outcome of TRUS Biopsy with Limited Cores in Patients with PSA More Than 50 ng/dL: Can We Reduce the Number of Cores Without Affecting Outcomes?

The aims of our study were to see outcomes of limited core biopsy and compare its outcomes with standard 12-core biopsy in patients with PSA more than 50 ng/dL. We did a retrospective analysis of 149 patients undergoing prostatic biopsy with PSA more than 50 ng/dL between January 2014 and December 2018. Out of 149 patients, 49 underwent limited core (2 to 6 cores) TRUS biopsy with no systemic 12-core biopsy. Other 100 patients underwent standard 12-core biopsy under TRUS guidance. Total of 149 patient's records were analyzed and were included in the final analysis. There was no significant difference in demographics and prostate-specific antigen among the cohorts. All 49 patients in limited core TRUS biopsy had a positive biopsy with no need of re-biopsy. Fourteen out of 100 patients in TRUS biopsy had a negative biopsy. All 14 patients with negative biopsy had an average follow-up of 3.8 years with no conversion to positive biopsy. Patients with PSA more than 50 ng/dL and high clinical suspicion of prostate cancer can undergo limited core biopsy without systemic 12-core biopsy. In patients with no clinical evidence of prostate cancer, 12-core biopsy remains the gold standard for evaluation of prostate cancer.

Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: A multicentre Indian experience.

OBJECTIVE: To assess feasibility of robot-assisted laparoscopic radical nephrectomy (RALRN) and inferior vena cava thrombectomy (IVCT) in treating renal tumours with level I-III IVC thrombi and to assess their outcomes. PATIENTS AND METHODS: We conducted a retrospective analysis of RALRN-IVCTs, involving four centres across India, from September 2015 to June 2019. We analysed patients who underwent RALRN-IVCT for level I-III thrombi according to the Mayo classification. The total operative duration with console time, length of hospital stay, preoperative and postoperative creatinine, IVC clamp time and intraoperative blood loss were recorded. RESULTS: Of the 13 patients that underwent RALRN-IVCT, five had a level I thrombus, seven had level II, and one had a level III thrombus. In all, 11 of the patients had right-sided tumours and the remaining two had left-sided tumours. The mean (SD) age of the patients was 56.5 (12.3) years, the mean (SD) operative time was 329.5 (97.22) min, the mean (SD) console time was 222.5 (70) min, the mean (SD) blood loss was 395 (170) mL, and the mean (SD) IVC clamp time was 19.14 (9.5) min. The mean (SD) length of hospital stay was 7.8 (3.27) days. Of the 13 patients, 12 had clear cell renal cell carcinoma (RCC) and one had papillary RCC. The mean (range) follow-up was 19 (4-50) months. One patient had upfront metastasis and two patients developed metastasis, while 10 patients remained disease-free during the follow-up. CONCLUSION: With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level I-III IVCT is feasible and can be performed efficiently. Larger experiences, with longer follow-ups and comparisons with open surgery are needed to confirm these initial outcomes. ABBREVIATIONS: ECOG: Eastern Cooperative Oncology Group; IVC: inferior vena cava; IVCT: inferior vena cava thrombectomy; (RAL)RN: (robot-assisted laparoscopic) radical nephrectomy.

Long-term Survival in a Case of Renal Cell Carcinoma With Brain Metastases: A Case Report.

Renal cell carcinoma with brain metastases is considered to have a poor prognosis. We are reporting a case of a 63-year-old male who showed excellent long term remission with a combination treatment of radiation and tyrosine kinase inhibitor for a solitary lesion in the brain, secondary to the renal tumor.