Grafted tubularised incised plate: A right option in the management of failed mid-penile and distal hypospadias.

Introduction: Hypospadias is a common congenital anomaly of the urogenital system. The goal of the initial repair is to correct any curvature, ensuring that the penis is straight, allowing for successful intercourse, to create a functional neourethra to direct the urinary stream in a forward direction and to produce a cosmetically normal-appearing penis with a slit-like meatus at the tip of the glans. Failures and complications do occur. Failed hypospadias repair is often associated with penile skin loss or deficient local tissue, which leaves the penis short, scarred and hypovascular. Repair of a failed hypospadias surgery represents one of the most challenging and difficult tasks. We retrospectively evaluated our series of children who underwent reoperative grafted tubularised incised plate (G-TIP) repair for a mid-penile or distal penile hypospadias. Materials and Methods: With permission obtained from the university/institutional ethics committee, we retrospectively reviewed the inpatient and outpatient records of all children ≤18 years of age who underwent a reoperative G-TIP hypospadias repair. Results: During the study period, a total of 22 children (mean age: 6.8 years) underwent reoperative G-TIP repair. The mean number of previous repairs was 1.36. Nine (40.9%) of the children had persisting chordee. Complications were noted in five (22.7%) children. Conclusion: G-TIP is a good option in the management of mid-penile or distal penile failed hypospadias repairs. Although complications are noted, they are easily manageable.

Role of color Doppler assessment in predicting outcomes of wrist Brescia-Cimino arteriovenous fistula creation: A single-center prospective study.

Introduction: The most common reason for constructing an arteriovenous fistula (AVF) is chronic kidney disease. Various factors are associated with nonmaturation or failure of AVF, which can be evaluated using color Doppler/duplex ultrasound (DUS). We carried out this study to evaluate the role of pre- and postoperative DUS for the prediction of outcomes of wrist radiocephalic (RC) AVF. Methods: In our prospective observational study, dialysis-dependent patients between 20 and 70 years of age undergoing primary RC-AVF from May 2019 to July 2020 were included. All patients underwent pre- and postoperative DUS examination after obtaining consent. Results: Among 104 participants, 87 (83.7%) were male and 17 (16.3%) were female. Successful maturation was seen in 68 (65.4%) participants, whereas 90 (86.53%) had functional maturation. Radial artery diameter (RAD) ≥1.6 mm, cephalic vein diameter (CVD) ≥2.0 mm, vein distensibility (VD) ≥0.5 mm, and peak systolic velocity (PSV) RAD ≥30 cm/s were associated with higher successful maturation of AVF with statistically significant results (P < 0.05). RAD ≥1.6 mm, CVD ≥2.0 mm, VD ≥0.5 mm, and PSV RAD ≥30 cm/s were related to a greater probability of RC-AVF maturation. Among them, VD and PSV-RA were the most influencing factors predicting RC-AVF successful maturation. Conclusions: If we consider the rule of six for AVF maturation, then the results will be much less than the actual fistulas which are dialyzable with adequate blood flow as per functional maturation criteria. Thus, more randomized studies are needed to define maturation criteria for the Indian population and to identify the effect of papaverine on successful AVF maturation.

Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study.

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing. Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer. Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019. Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS. Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software. Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion ( p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer ( p <0.05). Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.

Detection of bladder cancer using voided urine sample and by targeting genomic VPAC receptors.

INTRODUCTION: Cells exfoliated into urine from the bladder can help to diagnose the cancer. The objective of this study was to validate the hypothesis that bladder cancer could be detected noninvasively by a simple and reliable assay targeting genomic VPAC (combined vasoactive intestinal peptide and pituitary adenylate cyclase-activating peptide family of cell surface receptors) receptors expressed on the malignant bladder cancer cells shed in the voided urine. METHODS: Patients ≥18 years of age with either imaging (ultrasonography/computed tomography [CT])-confirmed bladder tumors or those who have been previously treated for nonmuscle invasive bladder tumors and were visiting the department for check cystoscopy, formed the study group. Freshly voided urine sample was collected from these patients and sent for conventional cytology examination, 5-aminolevulinic acid (ALA) fluorescent urine cytology, and for positivity of VPAC receptors. RESULTS: A total of 103 patients were prospectively included in the study. Of these, 65 patients (Group I) presented with image-diagnosed (ultrasonography and/or CT) bladder cancer. The remaining 38 patients (Group II) were previously diagnosed cases of nonmuscle invasive bladder cancer and presented for follow-up and check cystoscopy. The sensitivity for VPAC receptor positivity was 89.23% compared to conventional cytology (63.07%) and 5-ALA fluorescent urine cytology (87.69%). The specificity of VPAC receptor positivity was 100% compared to conventional cytology (100%) and 5-ALA-induced fluorescent cytology (90.47%). CONCLUSIONS: Our preliminary study shows encouraging results with VPAC receptor positivity studies, which has a high sensitivity when compared to the conventional cytology.

5-ALA-Induced Fluorescent Cytology in the Diagnosis of Bladder Cancer-a Preliminary Report.

5-Aminolevulinic acid (ALA)-induced fluorescence cystoscopy has established itself in the detection of flat and/or small lesions. This is explained by the simple fact that there is increased uptake of ALA, altered activity of certain enzymes, and altered intracellular redistribution and storage of protoporphyrin IX (PPIX) in the malignant cells. Intracellular PPIX allows red fluorescence detection. In this preliminary study, the efficacy of 5-ALA-induced fluorescent urine cytology was compared with conventional cytology in the diagnosis of bladder tumours. In this prospective study, patients ≥18 years of age admitted to the department of urology with non-malignant conditions formed the controls and patients ≥18 years of age with imaging confirmed bladder tumours formed the study group. Freshly voided urine sample was collected from these patients and divided into two samples of 50 cc each. One of these samples was sent in for conventional cytology examination, whereas the other sample was sent in for 5-ALA fluorescent photo dynamic diagnosis. Conventional cytology and 5-ALA-induced fluorescent cytology were evaluated by the same pathologist. A total of 100 patients were included in the study of which 75 patients were controls and the remaining 25 were patients with bladder tumours. The sensitivity of conventional cytology and 5-ALA-induced fluorescent cytology was 64% and 100% respectively, whereas the specificity was 96% and 98.67% respectively. The sensitivity of conventional cytology was 61.19% in low-grade cancers as compared to 75% in high-grade cancers, whereas the sensitivity was 100% with 5-ALA-induced fluorescent cytology both in low- as well as high-grade cancers. Our study shows that 5-ALA-induced fluorescent cytology is highly sensitive test to diagnose bladder cancer and shows a significant difference especially in low-grade bladder cancer when compared to conventional cytology.

Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age.

PURPOSE: The management of urinary tract calculi has evolved dramatically in children with the development of smaller and more durable endoscopic equipment. The indications for therapeutic ureteroscopy in children have significantly expanded with the availability of smaller caliber endoscopes and Holmium:YAG laser. In this paper, we review our experience of the management of urolithiasis and report outcomes of therapeutic ureterorenoscopy (URS) in children younger than 60 months. METHODS: We retrospectively reviewed the inpatient, outpatient records, and imaging data of our hospital, of all children ≤ 60 months of age undergoing URS for the treatment of urinary stones. RESULTS: During the study period; 77 children, mostly male (70.1%) presenting with a single calculus and a mean age of 28.97 ± 2.44 months underwent therapeutic URS. A majority of children (71.4%) had lower or mid-ureteric calculi. Pre URS double J (DJ) stenting was necessary for 21 (27.2%) children. A total of 24 (31.1%) children needed ureteric dilatation before the ureteroscopy. Post URS DJ stenting was necessary in 41 (53.2%) children. Stents were retrieved within 10 days of the procedure. Stone clearance rate following a single-stage URS procedure was 94.8%, and 4 (5.2%) children needed additional shockwave lithotripsy (SWL) to achieve stone clearance. Overall complication rate including hematuria and fever was 12.9% (10 patients). CONCLUSION: Therapeutic ureterorenoscopy in the management of ureteric and selective renal pelvic calculi is safe and effective. It can be considered as the first-line therapy in young children.

Postpercutaneous Nephrolithotomy Ureteropelvic Junction Obstruction.

Percutaneous endoscopic renal surgery such as percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for patients with large and/or complex renal calculi. However, a unique set of complications can occur with this surgical approach that may involve the targeted kidney and surrounding structures. Renal collecting system obstruction after PCNL is rare, but may result from ureteral avulsion, stricture formation, transient mucosal edema, blood clot, or infundibular stenosis. Impaction of stone and trauma during PCNL could induce stricture formation and obstruction. Use of proper percutaneous and endoscopic techniques and instruments will help to reduce the chances of developing such strictures and obstruction.

Percutaneous Nephrolithotomy in an Elderly Female with Severe Kyphoscoliosis: Modified Prone Position.

Percutaneous nephrolithotomy (PCNL) is one of the important options in the management of large (>2 cms) and complex renal calculi. Traditionally the prone position has been used to access the pelvicaliceal system as well as to remove renal calculi. Several modifications to this position have been suggested and reported by several urologists. We performed PCNL in an elderly female with a severe kyphoscoliosis by modifying the classical prone position.

Bladder Invasion in Patients with Advanced Colorectal Carcinoma.

Involvement of the bladder by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. Extirpative procedures for advanced colorectal cancers can involve partial/total bladder resections. In patients without evidence of distant metastatic disease, a reasonable therapeutic effect can be expected when negative surgical margins are obtained. The decision to perform a bladder-sparing procedure or a total pelvic exenteration (TPE) will be based on the extent of the primary lesion as well as patient characteristics. In this study, we report our experience in the management of operable locally advanced colorectal carcinomas involving the urinary bladder. We retrospectively reviewed the hospital records of all patients with advanced colorectal cancer invading the urinary bladder. The age, gender, clinical presentation, physical examination findings, and imaging records were noted. Colonoscopy reports and images were noted and biopsy findings recorded. Similarly, cystoscopy findings and biopsy reports were noted and analyzed. Eight (88%) patients had a primary sigmoid tumor and one (11%) had primary rectal tumor. The clinical staging of the primary tumor was T3 in three (33%) and T4 in six (66%). A biopsy taken during cystoscopy confirmed the malignant lesion in all the nine patients. Four (44%) patients received neoadjuvant chemotherapy with 5-fluorouracil. Eight (88%) patients underwent bladder-sparing resection and the remaining one underwent total pelvic exenteration with ileal conduit for urinary drainage. The mean overall survival was 44 months. The wide spectrum of possible bladder involvement by colorectal cancer requires individual patient-specific and disease-specific approaches. En bloc bladder resection for adherent or invading colorectal cancers achieves good local control and prognosis. The potential for cure in completely excised, node-negative tumors is good. Bladder reconstruction is achievable in most patients.

Retained Double J Stent with Huge Renal and Bladder Calculi Extracted by Percutaneous Nephrolithotomy and Percutaneous Cystolitholapaxy in a Single Encounter.

We report a case of retained Double J ureteral stent with huge, multiple calculi at both ends in a 10-year-old female child. The renal and bladder calculi were managed by percutaneous nephrolithotomy and percutaneous cystolitholapaxy in a single sitting.

In vitro antioxidant and anticancer activity of Leea indica leaf extracts on human prostate cancer cell lines.

BACKGROUND: To determine the phytochemical constituents, antioxidant, and anticancer activities of Leea indica leaf extracts on DU-145 and PC-3 human prostate cancer cell lines. METHODS: Leaf sample was subjected to Soxhlet extraction method with increasing polarity of solvents, namely, chloroform, ethyl acetate, methanol, ethanol, and aqueous. Phytochemical screening was done using different biochemical tests. Quantitative analysis for phenol was determined by Folin-Ciocalteu reagent method. The antioxidant activity was tested using 2,2-diphenyl-1-picrylhydrazyl, ferric ion reducing power assay, and phosphomolybdenum assay. In vitro anticancer activity on DU-145 and PC-3 human prostate cancer cell lines was evaluated by (3-(4, 5-dimethyl thiazole-2yl)-2, 5-diphenyl tetrazolium bromide) MTT assay. RESULTS: Phytochemical screening confirmed the presence of phyto-constituents like alkaloids, flavonoids, glycosides, phenols, lignins, saponins, sterols, tannins, anthraquinone, and reducing sugar. Methanol and ethanol extracts exhibited higher phenolic content as compare to aqueous extract. Antioxidant capacities were shown highest in methanol and ethanol extracts based on the test performed. The methanol and ethanol leaf extracts were found to be selectively cytotoxic in vitro to (DU-145 and PC-3) prostate cancer cell lines with IC50 values 529.44 ± 42.07 µg/mL and 677.11 ± 37.01 µg/mL for DU-145 and 547.55 ± 33.52 µg/mL and 631.99 ± 50.24 µg/mL for PC-3 respectively, while it had no cytotoxic effect on normal mice embryo fibroblast cells. CONCLUSION: The results indicate that Leea indica was a promising antioxidant and anticancer agent for DU-145 and PC-3 human prostate cancer cell lines. However, further studies are needed to conclude its therapeutic use.

A Series of Primary Signet Ring Cell Carcinoma of the Urinary Bladder.

Primary signet ring cell carcinomas of the bladder (PSRCCB) are extremely rare tumors. These tumors generally present as high-grade, high-stage tumors and have a uniformly poor prognosis. PSRCCB need to be differentiated from metastases from other primary sites. Clinical, imaging, and immune-histochemical findings may help in identifying the primary source of signet cell cancer. We retrospectively reviewed our series of patient identified to have primary signet cell carcinoma of the bladder. We retrospectively reviewed all case records of patients with carcinoma bladder. Only patients with a histopathological report of signet ring cell carcinoma of the bladder were included in this study. During the period Sept 1991 to Aug 2016, a total five patients (0.18%) were diagnosed to have had PSRCCB. Hematuria was the main symptom in four of the five patients. Cystoscopy/TURBT was done in all patients, and histological examination confirmed signet cell carcinoma. All the patients were counseled and underwent radical cystectomy. The mean overall survival was 28.2 ± 3.7 months. We report a small series of primary signet cell carcinoma presenting over a 25-year period with an overall incidence of 0.18%. Post radical cystectomy local recurrence/distant metastases are common and response to chemotherapy was poor. The overall outcome for signet-ring cell cancers in general is very poor.

Evaluation of in vitro antioxidant and anticancer activity of Allophylus cobbe leaf extracts on DU-145 and PC-3 human prostate cancer cell lines.

Allophylus cobbe (L.) Raeusch. belonging to the family Sapindaceae, is a commonly distributed small shrub in Western Ghats of India previously reported for its traditional medicinal properties. It is used for the treatment of various ailments. The present study is aimed at investigating preliminary phytochemicals, inducing the determination of the total phenolic contents, antioxidant assays and anticancer activity of A. cobbe leaf extracts on (DU-145) and (PC-3) cell lines. Preliminary phytochemical screening showed a broad spectrum of secondary metabolites. Highest amount of phenolic content was present in aqueous extract (91.96 ± 0.61 mg/g GAE) and it also proved to have the most potent antioxidant activity at a concentration of 100 mg/ml (64.71 ± 0.15%). IC50 value was (431.10 ± 15.05 µg/mL) for DU-145 and (362.08 ± 24.17 µg/mL) for PC-3 cell lines while the standard drug paclitaxel showed an IC50 value of 0.3 µM/mL. Morphological changes was observed in cancerous cells undergoing apoptosis in human prostate cancer cell lines (DU-145 and PC-3) while the extract showed no cytotoxicity towards normal cells (MEF-L929). It can be concluded that the tested extracts holds significant antioxidant and anticancer activities. However further investigation on lead compounds of A. cobbe will enable its therapeutic use.

Forgotten/retained double J ureteric stents: A source of severe morbidity in children.

BACKGROUND: The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. MATERIALS AND METHODS: Hospital records of all patients' <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. RESULTS: During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. CONCLUSIONS: Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain.

Umbilical only access laparoscopic pyeloplasty in children: Preliminary report.

BACKGROUND: Over the past three decades, laparoscopic surgery has become a well-established alternative to open surgery in the management of ureteropelvic junction (UPJ) obstruction. Currently, several efforts are being made, aimed at further reducing the morbidity associated with conventional laparoscopy. We report our experience with modified umbilical port laparoscopic pyeloplasty in children. MATERIALS AND METHODS: Children presenting with hydronephrosis secondary to UPJ obstruction formed the study group. A 5 mm endoscopic port was placed on the inferior umbilical crease. The two 3 mm instruments were introduced through puncture sites created a few mm superior and lateral to the endoscopic port, under vision. Total operating time, the time taken for insertion of double pigtail catheter, time taken for pyeloplasty anastomosis and complications were noted. RESULTS: During the study period, 16 children underwent modified umbilical only access laparoscopic pyeloplasty. The total operating time and the time for insertion of double pigtail catheter were significantly more in our earlier half of cases. CONCLUSIONS: Modified umbilical port laparoscopic pyeloplasty reduces the morbidity associated with conventional multiport laparoscopy without the need of expensive multichannel cannulas, curved laparoscopic instruments and longer laparoscopic endoscopes. Though crossing instruments are a factor which prolongs the duration of surgery, it does not hinder complex suturing needed during pyeloplasty.

Priapism - A Rare Presentation in Chronic Myeloid Leukemia: Case Report.

Priapism is a complication rarely seen in leukemia. We report a 19-year-old man presented with persistent painful erection of penis for over 24 hours at home. The patient had underwent immediate irrigation and decompression of priapism by urologist at emergency services of the hospital. This approach resulted in a flaccid penis later. During hospitalization, peripheral blood smear and bone marrow aspiration confirmed the diagnosis of chronic myeloid leukemia.

A Giant Hydronephrosis Mistakenly Diagnosed as Ovarian Tumor in a Pregnant Woman.

We report a case of giant hydronephrosis that was wrongly diagnosed as an ovarian cyst and explored in a pregnant woman. Giant hydronephrosis are uncommon and need to be kept in mind as a differential diagnosis while making a clinical diagnosis.

Laparoscopic Mitrofanoff continent catheterisable stoma in children with spina bifida.

BACKGROUND: In 1980, Mitrofanoff described the creation of an appendicovesicostomy for continent urinary diversion. This procedure greatly facilitates clean intermittent catheterisation in patients with neurogenic bladder. The purpose of our study was to determine the clinical efficacy of the laparoscopic Mitrofanoff catheterisable stoma for children and adolescents with spina bifida. MATERIALS AND METHODS: Review of hospital records revealed that 11 children with spina bifida underwent a laparoscopic Mitrofanoff procedure with at least 1-year of follow-up. A four-port transperitoneal laparoscopic approach was used to create a Mitrofanoff appendicovesicostomy. The child was followed-up in the urology clinic at 6 weeks, 3 months, 6 months, 1-year, and then semiannually after that. Questionnaires were administered to determine, from the children's perspective, the level of satisfaction with catheterisation and the psychosocial implications of catheterisation before and after the creation of the Mitrofanoff continent catheterisable stoma. RESULTS: Of the 11 children, six were female, and five were male. The mean age at presentation to Paediatric urological services was 11 × 3.22 years. Overall the mean operative time was 144.09 × 17.00 min. Mean estimated blood loss was 37.36 × 11.44 cc. None of the cases needed conversion to open. Patient satisfaction with their catheterisation was measured at 2.18 × 0.98 preoperatively, Post-operatively, this improved to 4.27 × 0.46. Statistical analysis using paired t-test showed significance with P < 001. CONCLUSIONS: Laparoscopic Mitrofanoff catheterisable stoma is feasible in children with spina bifida and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.