Gene expression signature of castrate resistant prostate cancer.

Prostate gland is a highly androgen dependent gland and hence the first line of treatment for metastatic prostate cancer happens to be androgen ablation. This is achieved by multiple non-surgical methods. However, most of these cancers although respond well initially, become resistant to androgen ablation sooner or later. These cancers then become extremely aggressive and difficult to treat, thereby drastically affect the patient prognosis. Identification of a gene expression signature for castrate resistant prostate cancer may aid in identification of mechanisms responsible for castrate resistance, which in turn would help in better management of the disease. METHODS: Patient samples belonging to a. Control group; b. Castrate Sensitive group and c. Castrate Resistant group were collected. Gene expression profiling was performed on these samples using RNA-seq. Differentially expressed genes between control and castrate sensitive as well as control and castrate resistant groups were identified. This data was compared with data from The Cancer Genome Atlas (TCGA) in order to get relevance in prognosis. RESULTS: We have identified 481 differentially expressed genes between control and castrate sensitive groups; and 446 genes differentially expressed between control and castrate resistant groups. We have also identified 364 genes which are expressed in the castrate resistant group alone, which is of interest since these may have an implication in evolution of castrate resistance and also prognosis. When compared to prostate cancer data from TCGA, 763 genes were found in common to our dataset. With this, a CaS and CaR signature was defined. Using criteria such as overall survival, disease-free survival, progression-free survival and biochemical recurrence, we have identified genes that may have relevance in progression to castrate resistance and in prognosis. Functional annotation of these genes may give an insight into the mechanism of development of castrate resistance.

Mechanical and Wear Studies of Boron Nitride-Reinforced Polymer Composites Developed via 3D Printing Technology.

In the realm of 3D printing, polymers serve as fundamental materials offering versatility to cater to a diverse array of final product properties and tailored to the specific needs of the creator. Polymers, as the building blocks of 3D printing, inherently possess certain mechanical and wear properties that may fall short of ideal. To address this limitation, the practice of reinforcing polymer matrices with suitable materials has become a common approach. One such reinforcement material is boron nitride (BN), lauded for its remarkable mechanical attributes. The integration of BN as a reinforcing element has yielded substantial enhancements in the properties of polylactic acid (PLA). The central objective of this research endeavor is the development of polymer composites based on PLA and fortified with boron nitride. This study undertakes the comprehensive exploration of the compatibility and synergy between BN and PLA with a keen focus on examining their resultant properties. To facilitate this, various percentages of boron nitride were incorporated into the PLA matrix, specifically at 5% and 10% by weight. The compounding process involved the blending of PLA and boron nitride followed by the creation of composite filaments measuring 1.75 mm in diameter and optimized for 3D printing. Subsequently, test specimens were meticulously fabricated in adherence with ASTM standards to evaluate the ultimate tensile strength, dimensional accuracy, wear characteristics, and surface roughness. The findings from these assessments were systematically compared to the wear properties and mechanical behavior of PLA composites reinforced with boron nitride and the unreinforced PLA material. This study serves as a foundational resource that offers insights into the feasibility and methodologies of incorporating boron nitride into PLA matrices, paving the way for enhanced polymer composite development.

Is percutaneous nephrolithotomy safe in chronic kidney disease patients!!!

Introduction: Management of renal calculus in a patient of chronic kidney disease (CKD) is always challenging. Treatment options include extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). With PCNL being gold standard for renal calculus ≥1.5 cm in normal kidneys, we aimed to analyze the safety and efficacy of PCNL in CKD patients with calculus ≥1.5 cm. Materials and Methods: Sixty patients of CKD with renal calculus were included in the study: Group A with glomerular filtration rate (GFR) ≤30 ml/min/m2 and Group B with GFR >30 <60 ml/min/m2. The estimated GFR (eGFR) pre-PCNL, peak eGFR on follow-up, and eGFR at last follow-up, stone free rates, and complications were recorded. The CKD stage before and after PCNL were also compared at the last follow-up. Results: The mean age of patients was 52 years. A mean of 1.14sittings per renal unit was required for PCNL. Complete clearance was 94% after all auxiliary procedures. The mean prePCNL eGFR was 26.5 ± 4.01 and 43.6 ± 9l. 14 ml/min/1.73 m2 in Groups A and B, respectively. The mean post-PCNL eGFR was 32 ± 9.94 and 51 ± 8.85 ml/minute/1.73 m2, respectively, in Groups A and B. At a mean follow-up of 180 days, deterioration with the migration of CKD stage was seen in 13 patients (21.6%) out of which 10 patients were of Groups A and 3 in Group B. Six patients (10%) required maintenance hemodialysis. Postoperative bleeding complication requiring blood transfusions was seen in 12 (20%) and 3 (5%) required intensive care unit care postoperatively. No mortality was observed in our study. Conclusion: PCNL is an effective management strategy for renal calculus in patients with CKD with an acceptable stone clearance rates and manageable complications. Peak eGFR <30 ml/min/m2 and postprocedure complications predict deterioration and need for RRT.

Challenges and gender-based differences for women in the Indian urological workforce: Results of a survey.

Introduction: Entry of women into urology has not kept pace with that in other surgical branches with only 1% of Urological Society of India (USI) members being female. The objective of this study was to explore the personal and professional challenges, practice barriers, and level of satisfaction among female urologists/urology trainees in India. Methods: A strictly confidential and anonymous 26-item questionnaire with respect to professional and personal challenges, workplace discrimination, and family satisfaction was circulated as a Google form through email and WhatsApp to all the female members of the USI (full and associate) and trainees (n = 48) based on identification from the USI directory. Results: Thirty-three out of 48 female urologists responded (68%). Among the respondents (n = 33), majority had <5 years of experience (60.6%), of which 30.3% were residents, which reflected a recent surge in women joining urology. Majority (57.7%) chose to subspecialize, commonly in "female urology". Many (72.7%) were encouraged to take this subspecialty. Gender discrimination at workplace was reported by 54.5%, commonly by patients and consultants. 68% of respondents had conceived either before or during residency, leading to additional domestic responsibilities. 9.1% suffered a pregnancy-related complication, which they believed was a direct consequence of their work environment. These obstacles led to 30.3% of women reporting that their personal life had compromised their careers. Professional dissatisfaction was reported by 60.1% of women, with common causes being less operative time than male counterparts and lack of mentorship. Despite these challenges given a chance, 78.7% would choose urology again, and 66.7% would encourage their daughter to pursue a career in urology. Conclusion: Professional and personal challenges as perceived by women responding to our survey include gender discrimination in training and work, lack of mentorship, pregnancy-related compilations, and compromised career due to family responsibilities. Despite these, most would choose this specialty again.

Is simple nephrectomy the right nomenclature? - Comparing simple and radical nephrectomy to find the answer.

Introduction: The word "simple" means "easily done" or "presenting no difficulty." Hence, the "Simple Nephrectomy" (SN) operation should be "easy to perform." However, in clinical practice, we have noticed that SN can be equally or more challenging surgery than radical nephrectomy (RN). This study assesses the need to modify the terminology of simple nephrectomy and identify the level of difficulty between SN and RN by comparing various intraoperative and postoperative factors. Methods: Patients undergoing open SN for benign renal disease (Group A) and RN for T1/2 renal tumors (Group B) were included in the study. Two groups were compared for operative time, estimated blood loss, postoperative complications, blood transfusion rate, and length of hospital stay. Results: A total of 114 patients were analyzed (82 in Group A and 32 in Group B). Mean age of the patients was higher in Group B (41.2 vs 53.6 years, P < 0.01). Mean operative time (136.8 vs 125.5 min, P = 0.08), incidence of postoperative complications (32.9% vs 25%, P = 0.50), length of hospital stay (7.2 vs 6.5 days, P = 0.09), estimated blood loss more than 500 ml (13.4% vs 9.3%, P = 0.75), and requirement of blood transfusion (10.9% vs 6.2%, P = 0.72) were higher in group A. Conclusion: The application of correct terminology is important to understand the subject and to convey the information. Simple nephrectomy is not an appropriate term as it is equally challenging to perform than its radical counterpart.

Is sterile pyuria another minor diagnostic criterion in urinary tuberculosis?

INTRODUCTION: Composite reference standard (CRS) is used for diagnosis of urinary tract tuberculosis (UTB). We examined if addition of a new 'component test' as minor criterion in the form of SP could improve the yield. METHODS: We identified patients admitted with a diagnosis of UTB from January 2009 to February 2016 from our patient database. We performed the validation of addition of a new 'component' "sterile pyuria" to the existing basic CRS. RESULTS: SP was seen in 50 patients (65.7%). Forty (52.6%) of these patients had one major criterion positive and 10 (13.1%) were diagnosed based on minor criteria. If SP was added as a minor criterion, an additional 8 (9.2%) patients would have been diagnosed based on minor criteria alone without the need for a histopathology. CONCLUSIONS: SP could improve the diagnostic yield of existing CRS by 8% with a 70% decrease in reliance on histopathology for diagnosis.

Outcomes of second-look percutaneous nephrolithotomy in renal calculi-a single centre experience.

OBJECTIVE: Percutaneous nephrolithotomy (PCNL) carries significant potential for morbidity. Scant data exists on indications and outcomes of second-look PCNL after a failure to completely clear renal stones at the first attempt. We present our experience with second-look PCNL. MATERIAL AND METHODS: This was a retrospective record review of 922 patients who underwent unilateral PCNL at a tertiary care center in South India. Baseline patient, stone characteristics and outcomes were compared between 844 patients undergoing primary PCNL and 78 patients requiring second-look PCNL. RESULTS: Increased stone complexity in terms of Guy stone score (GSS), stone size, staghorn calculi and stones in multiple locations were significantly associated with primary treatment failure (p<0.001). Operative time >75 min had a significant association with need for second-look PCNL and complications. Initial PCNL was discontinued due to bleeding (28; 35.9%), pelvicalyceal system perforation (3; 3.9%) and purulent urine leading to urosepsis and hemodynamic instability (2; 2.6%). Staged PCNL was done in 44 (56.3%) patients. During second-look PCNL, new access tracts were necessary in majority (42; 53.9%) of the patients and multiple tracts in 20 (25.6%) patients. In second-look PCNL, complications were comparable to primary PCNL (p=0.289). CONCLUSION: Second-look PCNL should be advocated in patients where the initial PCNL was discontinued due to bleeding, perforation of collecting system, prolonged operative time (>75 min) and in patients with large stone burden.

Urodynamic profile in posterior urethral valve patients following fulguration: Does age at fulguration matter?

INTRODUCTION: Children with posterior urethral valve (PUV) may develop urinary bladder (UB) dysfunction even after valve fulguration (VF). Using Urodynamics (UDS), we sought to identify whether age at VF and time elapsed since VF contributed to UB dysfunction. MATERIALS AND METHODS: Between January 2009 and July 2016, 39 PUV patients referred to a tertiary care center for UDS were classified into Groups A and B (based on age if <2 or ≥2 years at VF) and subclassified into Group A1/A2 and B1/B2 depending on time duration after VF (TVU). A1 and B1 constituted TVU ≤4 years and A2 and B2 constituted TVU >4 years, respectively. RESULTS: Median (range) ages at VF and UDS were 18 (1-108) months and 9 (1-19) years. Median (range) time between VF and UDS was 60 (6-164) months. Reduced compliance was seen in 67%, detrusor overactivity in 38.5%, and leak in 15.4% boys, respectively. Median (range) Qmax was 8 (0-28) ml/s and 25% boys had hypocontractile detrusor at voiding. Statistically significant reduction was found in compliance when comparing Group B versus Group A (P = 0.037) and in bladder capacity (P = 0.002) and compliance (P = 0.043) in Group A2 versus A1. CONCLUSIONS: Boys with VF at <2 years had better urodynamic profiles than those with fulguration over 2 years of age. As the time period since fulguration increased, there was a higher incidence of bladder dysfunction in both the groups.

Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis.

INTRODUCTION: Emphysematous pyelonephritis (EPN) is a rare clinical entity, characterized by gas in the renal system, due to an acute, fulminant and potentially fatal necrotizing process with varying clinical presentations. It is much more aggressive than uncomplicated pyelonephritis, with the mortality of 20-40% in the contemporary meta-analysis. MATERIAL AND METHODS: A retrospective record review of inpatients at the Institute of Nephro Urology, Bangalore, India (2007-2014), who were treated after EPN was diagnosed with the aid of a CT (computed tomography) scan. RESULTS: Sixty-six patients (M:F 27:39) treated for EPN over the past seven years with the mean (±SD) age of 52.32 (±12.48) years were analyzed. Median (interquartile range) duration of hospital stay was 8 (11.25) days with 4 (6%) patients requiring intensive care unit admission (median, IQR = 5.5, 1.5 days) of whom two passed away due to septicemia. Fifty-six (84.85%) patients were diabetics, forty (60.6%) patients had estimated glomerular filtration rate (eGFR) <60 ml/min/1.7 3 m2, 6 (9.1%) patients had eGFR <30 ml/min/1.73 m2 including 3 (4.5%) with eGFR <15 ml/min/1.73 m2 requiring hemodialysis and twenty-two (33%) had thrombocytopenia. Fifty (75.76%) patients were classified as Huang and Tseng Class 2, 7 (10%) as Class 3 with perinephric abscess requiring open drainage and 9 (13.64%) had bilateral EPN (Class 4). Majority (43; 65%) responded to piperacillin-tazobactam treatment. Double J stenting was done in 17 (25.76%) patients, percutaneous drainage in 5 (7.58%) patients and nephrectomy in 2 (3%) patients. CONCLUSIONS: Although EPN historically carries high morbidity and mortality, modern day medical management with timely intervention in the form of urinary drainage is effective and curative in most patients resulting in a low mortality rate.

Tubeless Pediatric Percutaneous Nephrolithotomy: Assessment of Feasibility and Safety.

INTRODUCTION: Tubeless pediatric percutaneous nephrolithotomy (TL-PCNL) is evolving and adult criteria are being safely applied to children. We examine the feasibility, safety, and outcomes of pediatric TL. MATERIALS AND METHODS: A retrospective review of pediatric (≤18 years) PCNL patients at our institute was done. Patients eligible for TL but underwent tube (T) PCNL due to surgeon choice or protocol were compared with TL. Only children with 100% stone clearance were included, and those receiving nephrostomy for intraoperative complications were excluded from the study. Demographic, baseline, and stone characteristics were matched. Safety, outcome, and complications were assessed. Group T was classified into large bore (22F-LB) and small bore (16F-SB) based on nephrostomy size. Statistical analysis was done. RESULTS: A total of 46 children were eligible - TL in 17 (37%) and T in 29 (63%). Among T, SB was performed in 6/29 (20.7%) and LB in 23/29 (79.3%). TL had fewer complications. Urinary leak developed in 2 (6.9%) patients in T. Eight (27.6%) patients in T and 3 (17.7%) patients in TL had supracostal access with complications similar to infracostal access. SB had significantly lesser and analgesic requirement than LB. SB and TL had similar LOH and analgesic requirement. Adult expanded criteria such as supracostal access, 2 punctures, prior renal surgery, and larger tract size were feasible. CONCLUSIONS: TL is safe, feasible, and less morbid alternative to T in uncomplicated pediatric nephrolithiasis. TL is feasible with supracostal access, 2 punctures, adult tract size (24F), and anomalous kidneys. SB nephrostomy is reasonable when tube is indicated.

UWIN (Urgency, Weak stream, Incomplete Void, Nocturia) Score for Assessment of Lower Urinary Tract Symptoms: Could it Replace the American Urology Association Symptom Index Score? An Open Label Randomized Cross over Trial.

OBJECTIVE: The American Urology Association symptom index (AUASI) is the most accepted tool to assess lower urinary tract symptoms (LUTS). UWIN (urgency, weak stream, incomplete void, nocturia) score is a simplified questionnaire with fewer and more distinctive options omitting three questions from AUASI. We sought to identify if UWIN is equally efficient in capturing LUTS and could replace the gold-standard AUASI. METHODS: Consecutive consenting male patients with benign prostatic hyperplasia (BPH)-LUTS were randomized to receive either UWIN/AUASI questionnaire first followed by the other. Education levels, time taken to complete, need for assistance, ease of comprehension and satisfaction to symptom assessment were assessed for each questionnaire. Correlation analysis was done for corresponding items, total and QoL scores on both questionnaires. RESULTS: Total of 294 completely filled questionnaire pairs were analyzed. Between corresponding UWIN and AUASI items, there was 93-97% correlation. When obstructive and irritative scores were added, correlation was 85% and for QOL scores 89%. Overall, AUASI required more assistance (58 vs 34%, P < 0.001), took longer to complete (11.2 vs 4.8 min, P < 0.001) and required higher educational level for comprehension (P = 0.02). Significantly higher percentage of patients preferred the UWIN and more comprehensible. CONCLUSION: UWIN is as effective in capturing LUTS as the gold-standard AUASI in spite of three questions of AUASI being omitted in UWIN. Severity of obstructive and irritative nature of LUTS and quality of life are interpreted similar to AUASI. UWIN is easier to comprehend and rapid, needing lesser assistance even with lower educational status.

Nasogastric tube as abdominal pressure sensor in urodynamics-Proof of concept of a novel approach.

AIMS: The standard sensor for abdominal pressure (Pabd) measurement in urodynamics (UD) is a rectal sensor. In patients where the rectum is not available due to prior surgery or when external anal sphincter (EAS) tone is poor, rectal sensor may slip, making Pabd recording unreliable. Vaginal Pabd measurement and wireless vaginal sensors have been tried. We present our preliminary series of a novel nasogastric tube (NG) sensor for Pabd measurement. METHODS: We identified patients undergoing UD with a NG Pabd sensor from a prospectively maintained UD database of a tertiary care urological center between July 2013 and December 2016. RESULTS: Out of 1325 urodynamic procedures done, 46 (3.5%) were performed using NG Pabd sensor. The median (IQR) age was 44 (12) years. Indications for UD in these patients were neurogenic bladder in 22 (47.8%), urinary retention in 17 (37%), post-meningomyelocele repair in four (8.7%), traumatic paraplegia in two (4.3%), and cervical myelopathy in one (2.2%). The indications for NG Pabd sensor were lax EAS tone (40; 86.9%), post-abdominoperineal resection (2; 4.3%), and painful thrombosed hemorrhoids (4; 8.7%). It was possible to make definitive urodynamic diagnosis in all patients using NG Pabd sensor. Initial calibration and NG Pabd excursions throughout the study were similar to that of rectal Pabd sensor. There were no problems with NG tube tolerance. CONCLUSION: Use of nasogastric sensor is feasible, accurate, cost-effective, and viable alternative for Pabd measurement in patients with poor anal tone or absent rectum due to postoperative status.

Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis: A prospective observational study.

Purpose: Urosepsis implies clinically evident severe infection of urinary tract with features of systemic inflammatory response syndrome (SIRS). We validate the role of a single Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 24 hours after admission in predicting mortality in urosepsis. Materials and Methods: A prospective observational study was done in 178 patients admitted with urosepsis in the Department of Urology, in a tertiary care institute from January 2015 to August 2016. Patients >18 years diagnosed as urosepsis using SIRS criteria with positive urine or blood culture for bacteria were included. At 24 hours after admission to intensive care unit, APACHE II score was calculated using 12 physiological variables, age and chronic health. Results: Mean±standard deviation (SD) APACHE II score was 26.03±7.03. It was 24.31±6.48 in survivors and 32.39±5.09 in those expired (p<0.001). Among patients undergoing surgery, mean±SD score was higher (30.74±4.85) than among survivors (24.30±6.54) (p<0.001). Receiver operating characteristic (ROC) analysis revealed area under curve (AUC) of 0.825 with cutoff 25.5 being 94.7% sensitive and 56.4% specific to predict mortality. Mean±SD score in those undergoing surgery was 25.22±6.70 and was lesser than those who did not undergo surgery (28.44±7.49) (p=0.007). ROC analysis revealed AUC of 0.760 with cutoff 25.5 being 94.7% sensitive and 45.6% specific to predict mortality even after surgery. Conclusions: A single APACHE II score assessed at 24 hours after admission was able to predict morbidity, mortality, need for surgical intervention, length of hospitalization, treatment success and outcome in urosepsis patients.

Complications after prone PCNL in pediatric, adult and geriatric patients - a single center experience over 7 years.

INTRODUCTION: CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT). MATERIALS AND METHODS: Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year. RESULTS: Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR - 4.549), OT (adj. OR - 1.364) and supracostal access (adj. OR - 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001). CONCLUSIONS: Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.

Complications after prone PCNL in pediatric, adult and geriatric patients - a single center experience over 7 years

ABSTRACT Introduction CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT). Materials and Methods Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year. Results Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR - 4.549), OT (adj. OR - 1.364) and supracostal access (adj. OR - 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001). Conclusions Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.

Safety and efficacy of tamsulosin, alfuzosin or silodosin as monotherapy for LUTS in BPH - a double-blind randomized trial.

INTRODUCTION: Currently alpha1-adrenoceptor blockers (AB) are widely used as first-line therapy to improve lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). We compared the efficacy and safety profile of tamsulosin, alfuzosin and silodosin in LUTS due to BPH. MATERIAL AND METHODS: Consecutive consenting male patients (N = 269) undergoing medical management of BPH with AB from February 2012 to October 2015 were enrolled. Patients were randomized to a 0.4 mg tamsulosin (group T), 10 mg alfuzosin (group A) or a 8 mg silodosin (group S) by double-blind randomization. All patients were assessed for improvements and post-void residual urine (PVR) and for adverse drug events (ADE). RESULTS: IPSS showed significant improvement in Group S at the first week (11.7 ±4.18, p = 0.027) and at 3 months (7.97 ±3.84, p = 0.020). QOL showed significant improvement at 1 (2.2 ±0.76, p = 0.020), 4 (1.47 ±0.63, p <0.001) and 12 (1.2 ±0.66, p <0.001) weeks in Group S. The mean Qmax improvement was the maximum (13.76 ±2.44, p = 0.028) in Group S at 1 week. Reduction in PVR was the maximum in Group S, but it was not statistically significant. Adverse drug events (ADE) were observed in 20.07% (54/269) patients and distribution was similar in the three groups with decreasing incidence with progression of time. CONCLUSIONS: Silodosin is the most efficacious AB with rapid onset of action. Silodosin also improves the quality of life in patients with LUTS due to BPH and objectively improves maximum flow rate. However, silodosin has more adverse events when compared to tamsulosin and alfuzosin.

Anatrophic Nephrolithotomy in the Management of Large Staghorn Calculi - A Single Centre Experience.

INTRODUCTION: With advances in endourology, open stone surgery for staghorn calculi has markedly diminished. Anatrophic Nephrolithotomy (AN) is performed for complex staghorn stones which cannot be cleared by a reasonable number of Percutaneous Nephrolithotomy (PNL) attempts. AIM: To assess the indications and outcomes of AN in the modern era. MATERIALS AND METHODS: Between April 2008 and July 2015, AN was done in 14 renal units in 13 patients. In this retrospective study, demography, stone characteristics, operative details, clearance and long term outcomes were assessed. RESULTS: AN was performed for complex staghorn calculi involving pelvis and all calyces in 10 patients, infundibular stenosis in two patients and failed PNL in one patient. Mean (SD) in situ cold ischemia time was 47.64 (5.27) minutes. Retroperitoneal drain and double J stent were placed in all 13 patients. Median (IQR) estimated blood loss was 130 (75) ml. There was no perioperative mortality. Surgical site infection was seen in 2 patients and urosepsis in 2 patients. Drain was removed at a mean (SD) of 9.11 (6.15) days. Mean (SD) postoperative length of hospitalization was 15.44 (7.14) days. Stent removal was done in all patients between 2-8 weeks. Median (IQR) clearance was 95 (7.5%). There was no renal failure or new calculi during the follow up period {median (IQR): 1(3) years}. CONCLUSION: AN is effective in management of large staghorn calculi failed minimally invasive approaches and achieves 80%-100% clearance without much need for secondary interventions. Renal function is preserved and with emergence of laparoscopy and robotics, postoperative stay is minimized with expedited recovery and comparable results with open surgery.

Efficacy of preprocedural diclofenac in men undergoing double J stent removal under local anesthesia: A double-blind, randomized control trial.

INTRODUCTION: Double J (DJ) stents are often removed under local anesthesia using a rigid cystoscope. Patients experience significant pain during this procedure and also continue to have discomfort during voiding for a few days. We assessed the efficacy and safety of preemptive oral diclofenac in pain relief in patients undergoing DJ stent removal (DJSR) by rigid cystoscopy compared to placebo. METHODS: Consecutive consenting male patients undergoing DJSR under local anesthesia between March 2014 and July 2015 were enrolled. Patients were randomized to receive 75 mg oral diclofenac (Group A) or placebo (Group B) 1 h before procedure by double-blind randomization. Intraurethral 2% lignocaine gel (25 ml) was used in both groups. Pain during rigid cystoscopy, pain at the first void, and at 24 h after cystoscopy was assessed using visual analog scale (VAS) (0-100). Adverse reactions to diclofenac and episodes of acute urinary retention, if any, were assessed (Trial registered at clinicaltrials.gov: NCT02598102). RESULTS: A total of 121 males (Group A [n = 62]; Group B [n = 59]) underwent stent removal. The median (Interquartile range) VAS during the procedure in Group A was 30 (30) and Group B was 60 (30) (P < 0.001), at first void was 30 (30) and 70 (30) (P < 0.001) and at 24 h postoperatively was 20 (20) and 40 (20) (P < 0.001). The incidence of epigastric pain, nausea, vomiting, and acute urinary retention was comparable in the two groups (P > 0.05). CONCLUSIONS: A single oral dose of diclofenac administered 1 h before DJSR using rigid cystoscope under intraurethral lignocaine anesthesia decreases pain significantly during and up to 24 h postprocedure with minimal side effects.

Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study

PURPOSE: De novo erectile dysfunction (ED) is a known complication after urethroplasty. Incidence and natural history of de novo ED after urethroplasty is underreported. We assessed the incidence of de novo ED after urethroplasty. MATERIALS AND METHODS: Consecutive consenting urethroplasty (n=48) patients aged 21 to 50 years from February 2014 to July 2016 with normal preoperative erectile function as determined by an International Index of Erectile Function-5 (IIEF-5) score ≥22 were included and interviewed at 3, 6, and 12 months. RESULTS: In patients with anterior stricture (n=40), substitution urethroplasty (SU) was performed in 22 patients (55.0%) and end-to-end anastomotic urethroplasty (EEAU) in 18 patients (45.0%). Their mean IIEF-5 score was 24.15±0.8 preoperatively, 20.10±4.2 at 3 months (p<0.001), 22.70±2.3 at 6 months (p=0.0012), and 23.70±1.7 at 12 months (p=0.03), showing a recovery of erectile function with time. All 8 patients with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty. Their mean IIEF score was 24.0±1.2 preoperatively, 18.8±5.4 at 3 months (p=0.002), 20.9±3.5 at 6 months (p=0.37), and 22.0±1.5 at 12 months (p=0.427). The incidence of ED was similar at 1 year postoperatively between patients with anterior stricture and PFUI and between patients who underwent EEAU or SU for anterior stricture. CONCLUSIONS: Incidence of ED at 1 year after PFUI is similar to that after surgery for anterior stricture in patients with normal preoperative erectile function. Among the cases of anterior stricture, recovery was better with SU at 3 months and was similar between SU and EEAU at 1 year.

Evaluation of CROES Nephrolithometry Nomogram as a Preoperative Predictive System for Percutaneous Nephrolithotomy Outcomes.

PURPOSE: Scoring systems have been devised to predict outcomes of percutaneous nephrolithotomy (PCNL). CROES nephrolithometry nomogram (CNN) is the latest tool devised to predict stone-free rate (SFR). We aim to compare predictive accuracy of CNN against Guy stone score (GSS) for SFR and postoperative outcomes. MATERIALS AND METHODS: Between January 2013 and December 2015, 313 patients undergoing PCNL were analyzed for predictive accuracy of GSS, CNN, and stone burden (SB) for SFR, complications, operation time (OT), and length of hospitalization (LOH). We further stratified patients into risk groups based on CNN and GSS. RESULTS: Mean ± standard deviation (SD) SB was 298.8 ± 235.75 mm2. SB, GSS, and CNN (area under curve [AUC]: 0.662, 0.660, 0.673) were found to be predictors of SFR. However, predictability for complications was not as good (AUC: SB 0.583, GSS 0.554, CNN 0.580). Single implicated calix (Adj. OR 3.644; p = 0.027), absence of staghorn calculus (Adj. OR 3.091; p = 0.044), single stone (Adj. OR 3.855; p = 0.002), and single puncture (Adj. OR 2.309; p = 0.048) significantly predicted SFR on multivariate analysis. Charlson comorbidity index (CCI; p = 0.020) and staghorn calculus (p = 0.002) were independent predictors for complications on linear regression. SB and GSS independently predicted OT on multivariate analysis. SB and complications significantly predicted LOH, while GSS and CNN did not predict LOH. CNN offered better risk stratification for residual stones than GSS. CONCLUSION: CNN and GSS have good preoperative predictive accuracy for SFR. Number of implicated calices may affect SFR, and CCI affects complications. Studies should incorporate these factors in scoring systems and assess if predictability of PCNL outcomes improves.