What after BCG Fails in Non-muscle Invasive Bladder Cancer?

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Iatrogenic trauma following percutaneous and minimally invasive surgical interventions.

Technological progress has changed the landscape of surgical practice. Minimally invasive surgery (MIS) and percutaneous interventions (PC) are constantly replacing open procedures. This reduces hospital stay and allows quicker recovery. The application of MIS should follow the good medical practice dictum by Hippocrates i.e. "First do no harm". To remain abreast with new procedures, the medical personnel are required to update and enhance their knowledge and skill. To ensure safety, the innovations are rigorously tested and tried. The learning curve of MIS is shortened by simulator training and proctorship. Credentialing processes are in place to enhance safe delivery of care. Despite of all these measures MIS and PCI are associated with adverse effects. The purpose of this article is to overview the iatrogenic trauma associated with MIS and PCI in major surgical subspecialties.

Does male factor infertility impact on self-esteem and sexual relationship?

Nonsomatic factors play a significant role in erectile dysfunction. We assessed the impact on men suffering from male factor infertility by employing the validated Self-Esteem and Relationship questionnaire (SEAR) and compared the scores with controls. Men with primary infertility were asked to fill SEAR questionnaire. Normal fertile men visiting clinic for unrelated problem or normal male accompanying infertile patients constitute the control group. Transformed score of each domain and total score of SEAR questionnaire and means were compared. Data were analysed by R version 5.2. Univariate and multivariate analyses were done to determine factors predicting self-esteem and total relationship score. There were 45 men each in the study and control groups. The mean transformed self-esteem score and total score of infertile men were significantly lower as compared to controls (74.44 versus 95.83) and (73.54 versus 95.86) p-value of <.0001. Longer duration of infertility, advanced age, diabetes and higher education were factors significantly lowering the scores on univariate analysis, and on multivariate analysis, diabetes was the only significant predictor of total SEAR score in infertile men. Infertility leads to lower self-esteem, sexual performance and confidence among infertile men as compared to controls. The relationship score worsens with increasing duration of infertility.

Surgical grand rounds at a University Hospital. Applying "publication presentation index" to evaluate outcomes.

BACKGROUND AND OBJECTIVE: Surgical grand rounds (SGR) are an important educational activity in all teaching hospitals however each institute has its own way of conducting them. At our institute, grand rounds in the Department of Surgery include an original research presentation by residents. The publication of the research work acts as a measure of its success. In this study we analyzed the outcome of this activity and review factors affecting their progression to publication. METHODOLOGY: We conducted a retrospective review of a prospectively maintained database of all presentations made at the Surgical Grand Round at a University Hospital from January 2001 to December 2010. Presentations with incomplete follow up records were excluded from analysis. A Publication-Presentation Index (PPI) was used to evaluate outcomes of SGRs and to study factors influencing outcomes. Differences in PPI in each category were calculated using the chi square test. RESULTS: Total of 470 presentations were made. Majority presented retrospective studies (73%). Majority of the presentations were made by junior residents (year 1-3, 62%). Following presentation, 279 (59.4%) studies were presented at a national conference, 80 (17%) were presented at an international forum while only 99 (21.1%) studies were published. Mean presentation to publication time was 34.8 months. Study design, level of resident, section of surgery, sample size and national/international presentation were associated with conversion to a publication (all p < 0.05). Overall PPI was 0.32. Randomized controlled trials had the highest PPI (0.67). CONCLUSION: The proportion of SGR presentations converted into national/international presentations and/or publications was found to be low. The PPI has a potential to be used as a tool to study the association of presentation to publication.

"Latex glove" laparoscopic pyeloplasty model: a novel method for simulated training.

PURPOSE: To present a 'latex glove' laparoscopic pyeloplasty (LPP) training model and determine its construct validity for its effective use in resident training. MATERIALS AND METHODS: The 'latex glove' model was used to perform LPP by five operators with variable level of experience, ranging from an experienced (> 20 independent LPPs) to minimal operative experience (year 5 medical student). The palm of the glove was considered the renal pelvis with finger of the glove as the proximal ureter. A knot at the junction of the two was considered as ureteropelvic junction obstruction. A basic lap trainer was used to simulate the LPP. Operation time was noted in minutes and quality of continuous suturing was determined for each operator, using a previously described nonvalidated scoring system by a blinded reviewer. RESULTS: The operation time varied from 47 to 160 minutes for the most to the least experienced operator, and the difference was statistically significant (P = .043), while the quality of suturing score ranged from 1 to 6 for the most to the least experienced operator, respectively (P = .038). The operation time and quality of suturing were negatively correlated with the level of experience (-0.962 and -0.987, respectively), which were statistically significant (P = .009 and P = .002, respectively). CONCLUSION: This novel training model has proven its validity, as a cost-effective and readily available option for LPP training.

Chromogranin A--serum marker for prostate cancer.

Prostate Cancer is the second most prevalent neoplasm after lung cancer in men. It commonly presents in patients with a strong family history. The measurement of Prostate Specific Antigen (PSA) in free and bound forms is one of the methods to diagnose it. It is very much useful for monitoring the therapeutic efficacy, staging, prognosis, tumour volume evaluation, detection of recurrent disease, screening and early diagnosis. Chromogranin A (CgA) is an acidic glycoprotein that is commonly expressed by neuroendocrine cells and constitutes one of the most profuse components of secretory granules. When a tumour develops in an endocrine tissue, it becomes the main source of circulating CgA. Its concentration is thought to be elevated in relation to neuroendocrine differentiation of prostate cancer. CgA is a useful predictive marker in patients with prostatic cancer who have lower PSA. It is known that neuroendocrine cells in the prostate do not contain androgen receptors and are not regulated by androgens. PSA expression was stimulated by androgen through androgen receptors, so it is suggested that cases of prostate cancer associated with low serum PSA and high serum CgA, which would have more neuroendocrine cells with less androgen receptors, may show resistance to endocrine therapy and a poor prognosis. Therefore serum CgA tends to be elevated in high grade prostate cancer cases. Hence it can be used to fill the gap if any left by PSA when combined with serum PSA, the serum marker may effectively predict the prognosis after endocrine therapy. CgA expression in prostate cancer biopsies is an independent extrapolative factor of hormone refractory disease in patients with newly diagnosed prostate cancer on early androgen deprivation therapy.

Unenhanced helical computed tomography in the evaluation of acute flank pain.

OBJECTIVES: The purpose of this study was to determine the value of unenhanced helical computed tomography (UHCT) in the diagnosis of acute flank pain at our institution. METHODS: Two hundred and thirty-three consecutive UHCT examinations, performed for suspected renal/ureteral colic between July 2000 and August 2001 were reviewed, along with pertinent medical records. RESULTS: Ureteral calculi were identified in 148 (64%) examinations, evidence of recent passage of calculi was found in 10 (4%) and no calculi were found in 75 (32%). Thirty-two of the conservatively managed patients were excluded for inadequate follow-up. In the remaining 201 patients, sensitivity of UHCT in diagnosing calculi was 99% and specificity was 98%, while the positive predictive value was 99% and negative positive predictive value was 98%. Overall, an alternative or additional diagnosis was established in 28 (12%) patients. Upon diagnosis of ureterolithiasis on UHCT, none of the patients required additional imaging studies for confirmation. CONCLUSION: UHCT is a highly sensitive imaging modality for the detection of urinary tract calculi and obstruction.