A single-stage dorsal inlay buccal mucosal graft placement through subcoronal vertical sagittal ventral urethrotomy without glansplasty for reconstruction of meatal stenosis, fossa navicularis, and distal penile urethral stricture: Our initial experience.

Introduction: Reconstruction of fossa navicularis stricture (FNS) poses a challenge in providing acceptable functional and cosmetic outcomes. We describe our novel surgical technique and its short-term results. Methods: This urethroplasty technique is a single-stage dorsal inlay buccal mucosal graft placement with subcoronal vertical sagittal ventral urethrotomy without glansplasty. Twenty-one operated patients were followed up at 2 months and 6 months postoperatively. We studied the functional outcome of the International Prostate Symptom Score, quality of life (QoL) score, maximum flow rate, postvoid residual (PVR) urine, and reconstructed urethral luminal caliber. Sexual function was studied via a brief male sexual function inventory. Hypospadias objective score evaluation (HOSE) was used to assess the cosmesis. Patient satisfaction was evaluated using the global response assessment score (GRA). Results: FNS is seen commonly associated with lichen sclerosus (n = 12). Nine patients had stricture that extended into the distal penile urethra. The mean stricture length was 2.76 cm. At the end of the study, a significant improvement in mean IPPS (18.81), mean QoL score (2.25), mean Qmax (20.94 mL/s), mean PVR (103.05 mL), and mean urethral caliber (16.06 Fr) were noted. No difference in sexual drive and erectile function but significant improvement in ejaculation was noted. All patients had single-stream urine, reconstructed urethral caliber ≥16Fr, HOSE ≥14, and GRA ≥2 at 6 months. Except for two patients, all had vertical slit-like meatus. Conclusion: This technique is feasible, with good cosmetic, functional, and subjective outcomes with marked patient' satisfaction.

Low-intensity extracorporeal shockwave therapy for Peyronie's disease: An Indian experience.

Introduction: Efficacy of low-intensity extracorporeal shockwave therapy (LiESWT) in Peyronie's disease (PD) has not been studied in an Indian population. Here, we studied the effect of LiESWT in Indian PD patients. Methods: This prospective study was conducted on 25 patients who completed weekly sessions of LiESWT for 6 weeks with a follow-up of 6 months. Patients were evaluated using International Index of Erectile Function (IIEF)-5 questionnaire for erectile dysfunction and visual analog scale for pain. Baseline and follow-up examinations included measurement of plaque size and curvature. The primary outcome was to assess remission of pain and reduction of plaque size along with improvement of penile curvature and erectile function as the secondary outcome. Results: Primary goal of pain reduction and ≥50% reduction of plaque size was achieved in 64% and 20% of patients, respectively. Improvement in vaginal penetration during sexual intercourse and IIEF-5 score increase of ≥3 was achieved 20% and 36% cases, respectively. The mean reduction of penile curvature was more with plaque calcification (PC), but the difference was not statistically significant (P = 0.26). The difference in mean visual analog scale reduction was more in noncalcified plaque (P = 0.002). The mean reduction of plaque size in patients with PC was significant (P = 0.03). Conclusions: Shockwave therapy is a probable alternative treatment option. A significant improvement was observed in pain and plaque size in patients treated by LiESWT. The presence of PC may affect the outcome of LiESWT in PD.

Intratumoral PD1+CD38+Tim3+ CD8+ T Cells in Pre-BCG Tumor Tissues Are Associated with Poor Responsiveness to BCG Immunotherapy in Patients with Non-Muscle Invasive Bladder Cancer.

Intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) is a standard of care therapy for non-muscle invasive bladder cancer (NMIBC), which accounts for about 75% of newly diagnosed urothelial cancer. However, given the frequent recurrence and progression, identification of a pre-treatment biomarker capable of predicting responsiveness to BCG in NMIBC is of utmost importance. Herein, using multiparametric flow cytometry, we characterized CD8+ T cells from peripheral blood and tumor tissues collected from 27 pre-BCG patients bearing NMIBC to obtain immune correlates of bladder cancer prognosis and responsiveness to BCG therapy. We observed that intratumoral CD8+ T cell subsets were highly heterogenous in terms of their differentiation state and exist at different proportions in tumor tissues. Remarkably, among the different CD8+ T cell subsets present in the tumor tissues, the frequency of the terminally exhausted-like CD8+ T cell subset, marked as PD1+CD38+Tim3+ CD8+ T cells, was inversely correlated with a favorable outcome for patients and a responsiveness to BCG therapy. Moreover, we also noted that the intratumoral abundance of the progenitor exhausted-like PD1+CD8+ T cell subset in pre-BCG NMIBC tumor tissues was indicative of better recurrence-free survival after BCG. Collectively, our study led to the identification of biomarkers that can predict the therapeutic responsiveness of BCG in NMIBC.