Zero Ischemia Open Partial Nephrectomy in Crossed Fused Ectopic Kidney - A Rare but Real Challenge.

Crossed fused renal ectopia (CFRE) is a rare congenital anomaly with both kidneys located on the same side of the retroperitoneal space. Due to complex anatomy, any renal tumours arising from this congenital anomaly will require careful pre-operative planning and intra-operating management to ensure oncological clearance while maximizing renal function. In this clinical case, a 57-year-old lady was referred to our center with a left to right CFRE and a 10cmx8cmx8cm mass arising from the interpolar region of left ectopic kidney on a background of multiple medical co-morbidities including stage 3a chronic kidney disease (CKD). Careful pre-operative planning and optimization was done, including 3D reconstruction of CT images, and the decision was made to perform a zero ischemia open partial nephrectomy to give her kidneys the best fighting chance. She recovered well postoperatively with only a mild increase in creatinine and histopathology revealing a renal cell carcinoma. The case emphasizes the need for adequate pre-operative planning with the use of upcoming imaging modalities like 3D reconstruction for optimum planning to ensure the best postoperative outcomes.

The Impact of En-bloc Transurethral Resection of Bladder Tumour on Clinical, Pathological and Oncological Outcomes: A Cohort Study.

Background En-bloc transurethral resection of bladder tissue (ETURBT) has recently been proposed as a good alternative technique to trans-urethral resection of bladder tissue (TURBT) in terms of outcomes for bladder carcinoma. This study aims to assess the effectiveness of the technique in terms of clinical, pathological and oncological outcomes. Methodology In this prospective study, data was collected from patients who underwent ETURBT for bladder space-occupying lesions between June 2021 and June 2022. Demographic characteristics, tumour characteristics, and postoperative outcomes were recorded. Results A total of 52 patients were studied with the majority being male and a mean age of 50.87 years. Smoking was recorded in 22 (38.5%) patients and 8 (15.4%) were on antiplatelet therapy. The majority fell in the American Society of Anesthesiology (ASA) class I (59.6%). Most of the tumours were solitary (90.4%), primary (82.8%), papillary architecture (73.1%), and between 1-3 cm in size. The lateral wall was the most common position, and detrusor muscle was seen in 98.1% of the specimens. T1 stage (57.7%) and low grade (67.3%) were the common characteristics noted. 76.9% of the ETURBT was conducted using monopolar cautery. Recurrence was noted in 3 (5.8%) and bladder perforation in 1 patient (1.9%). Cautery artifact was seen in six patients (11.5%) and obturator jerk in nine patients (17.3%). Conclusion Our study suggests that ETURBT is a technique with a good success rate for bladder tumours less than 3 cm in size. The benefits include high chances of detrusor sampling while minimising crush artefacts and cautery damage. Specimen retrieval was challenging when the bladder tumour was solid and over 2 cm.

Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer.

Background Prostate cancer holds a substantial presence in the global cancer landscape, and a considerable proportion of diagnoses occur at late stages, particularly in India. Management of locally advanced prostate cancer necessitates a multimodal treatment strategy. A critical part of this strategy is neoadjuvant androgen deprivation therapy, typically administered via luteinizing hormone-releasing hormone (LHRH) analogs. This study explores the potential of an alternative approach: neoadjuvant therapy with degarelix, an LHRH antagonist, and its impact on perioperative and postoperative outcomes in patients undergoing radical prostatectomy for locally advanced or high-risk prostate cancer. Methodology We conducted a retrospective, non-randomized clinical study at Apollo Hospitals in Chennai, India. Patients diagnosed with locally advanced or high-risk prostate cancer who underwent radical prostatectomy were included. Participants were patients treated with neoadjuvant degarelix and subsequent radical prostatectomy between March 2020 and June 2022. We excluded patients receiving radical radiotherapy, those switching from LHRH agonists to antagonists, and those contraindicated for androgen deprivation therapy due to existing comorbidities. For comparison, we selected a group from the institutional database who received conventional treatment (i.e., without neoadjuvant therapy). Results The study compared two groups, each with 32 patients. The groups had no significant difference in total operative duration and console times. The postoperative pathological assessment showed significantly lower margin positivity rates and notable pathological downstaging in the group receiving neoadjuvant degarelix compared to the control group. The incidence of node positivity, prostate-specific antigen levels at three months postoperative, and number of pads used per day at one month did not differ significantly between the two groups. Conclusions Our study suggests that neoadjuvant degarelix could notably enhance patient outcomes in locally advanced prostate cancer management. The benefits include improved symptom control, significant reductions in margin positivity rates, and facilitated surgical procedures. Neoadjuvant degarelix therapy could potentially enhance the feasibility of the surgical intervention in locally advanced prostate cancer management, thus suggesting a promising pathway for improved patient care.

Robot-Assisted Laparoscopic Radical Prostatectomy Utilizing Hugo RAS Platform: Initial Experience.

Background: The Hugo RAS™ is a newly launched robotic system for clinical use. This article provides the initial outcomes of patients undergoing radical prostatectomy with Hugo RAS. It also attempts to compare the outcomes with a similar set of patients undergoing the procedure with the DaVinci robotic systems. Methodology: Patients undergoing radical prostatectomy for biopsy-proven prostate cancer were included in this study. Institutional ethical approval was obtained, and patients were counseled preoperatively with informed consent. Both intra- and postoperative data were carefully recorded for the Hugo RAS. Patients who underwent radical prostatectomy in DaVinci robotic systems during a similar period were chosen to compare the outcomes of the Hugo systems in a nonrandomized study. Results: A total of 34 patients were included in this study wherein 17 radical prostatectomies were done in the Hugo RAS system and 17 in the DaVinci system were chosen to compare. The total operative time (210 vs 195 minutes) and dock time (190 vs 170 minutes) were similar between the two groups. An R0 or R1 resection and vesicourethral anastomosis were achieved in all cases. There were no notable intra- or postoperative complications in up to 1-month follow-up. Conclusion: The authors believe that the Hugo RAS platform is a safe robotic system for pelvic procedures such as radical prostatectomy, provides comparable results with existing robotic systems, and is a good addition to the existing arsenal of surgical robots.

Evaluation of Hugo RAS System in Major Urologic Surgery: Our Initial Experience.

Background: The Hugo RAS is a newly launched robotic system for clinical use. This article provides the initial experience of the authors using Hugo RAS in urologic procedures. Methodology: Patients undergoing major urologic procedures, including nephrectomy and prostatectomy, were included in this prospective clinical trial. Institutional ethical approval was obtained, and patients were counseled preoperatively with informed consent. Both intraoperative and postoperative data were carefully recorded. Results: A total of seven patients were included in this initial study. This includes radical prostatectomy (n = 3), simple prostatectomy (n = 1), radical nephrectomy (n = 1), and simple nephrectomy (n = 2). The total operative time, port placement time, time to dock the ports, blood loss and length of hospital stay, and 30-day morbidity and mortality were recorded. There were no intraoperative or postoperative complications up to 1 month follow-up. Conclusion: From the early experience with the Hugo RAS™ platform, it appears to be a safe robotic platform for major urologic procedures and is a good addition to the existing arsenal of surgical robots.

Prevalence of Musculoskeletal Pain and Its Relation With Weight of Backpacks in School-Going Children in Eastern India.

Background: Recently, heavy school backpacks have become a significant concern among parents and health professionals, as well as the media, but evidence for the same is limited in the Indian context. Aim: To find the prevalence of musculoskeletal pain among school-going children and its relationship with backpack weight. Design: Cross-sectional study. Method: This study was carried out among school-going children from grade 6 to 10 with age of 10 to 16 years from an urban and rural location. Schools were selected randomly from all enlisted schools in the district of Khurdha, Odisha state of India. A structured questionnaire was administered to assess symptoms of musculoskeletal pain. Anthropometric measurements along with backpack weight were taken. Statistical Analysis: Chi-square test was performed for categorical variables and Student's t-test for continuous variables. Multivariate regression analysis was performed to identify factors with maximum effect on musculoskeletal pain. Results: The prevalence of musculoskeletal pain was 18.8% in the preceding year. Backpacks weights were higher among children of urban schools as compared with rural areas. Children from urban schools were more likely to have pain than those from rural schools (OR 1.88, 95% CI 1.41-2.49). Those children with a backpack weight more than 10% of body weight had almost twice the risk of musculoskeletal pain compared to backpack weight less than 10% (OR 1.91, 95% CI 1.4-2.6) in univariate analysis where as no significant association was found on multivariate analysis. Conclusion: The prevalence of musculoskeletal pain was high in school-going children. In children, carrying higher backpack weight, and a higher percentage of the backpack to bodyweight had a significant association with musculoskeletal pain. Gender, height, body mass index, and backpack weight to body weight > 10% had no association with musculoskeletal pain.

Effect of Iodinated Contrast Media on Serum Electrolyte Concentrations in Patients Undergoing Routine Contrast Computed Tomography Scan Procedure.

BACKGROUND AND OBJECTIVES: Being hypertonic solutions, iodinated contrast media such as iohexol can cause a shift of fluids and electrolytes between different compartments of the body, but there is an ongoing discrepancy in data and current studies as to the effect of iodinated contrast media on serum electrolytes. Hence, this hospital-based prospective clinical observational study was carried out with objectives of evaluating the changes in serum electrolyte concentrations with intravenous iodinated contrast media administration in adult population and to correlate the changes in electrolyte concentrations, if any, with the demographic profile of the patients. MATERIALS AND METHODS: We analyzed 103 numbers of adult patient samples over a period of 2 months by collecting blood both before administration of contrast and after 24 h of the contrast-enhanced computed tomography scan procedure. Serum concentrations of sodium, potassium, chloride, and ionized calcium were measured using Eschweiler Combiline analyzer based on ion-selective electrode principle. RESULTS: The mean age of the study population in our study was 40.11 ± 20.51 years. We found that changes in serum sodium and chloride concentration after administration of contrast media are significant (sodium: 136.29 ± 3.53 vs. 132.49 ± 6.36 mmol/L and chloride: 100.03 ± 0.70 vs. 97.53 ± 0.70 mmol/L). Sodium concentration shows more decrease in females compared to males after administration of iodine contrast. The most probable reason for this decrease in serum electrolytes was secondary changes to hemodilution due to high osmolality of the contrast. CONCLUSIONS: Attending physicians must be alert for such possibilities of changes in electrolytes after contrast administration and be prepared to treat any adversity if one occurs.