Supine versus prone percutaneous nephrolithotomy in management of patient with complex renal stone diseases.

OBJECTIVES: Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. MATERIALS AND METHODS: This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. RESULTS: The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). CONCLUSIONS: By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL.

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.

Short time (10 min) Catheter Traction Following TURP: IS it helpful with less morbidity?

INTRODUCTION: Transurethral Resection of Prostate (TURP) is the most common treatment for Benign Prostatic Hyperplasia (BPH). Blood loss during and after transurethral resection of the prostate (TURP) is a potential cause of morbidity and clot retention. Usual practise is to apply traction in every case of TURP to reduce early postoperative hematuria and clot retention. There are very few studies in the literature and they have mainly concentrated on the effect of traction on reducing blood loss but there is scanty data regarding the morbidity associated with the use of traction. Various authors have described their method of traction application. So, in this study, we will compare the result of short term (10 min) traction with standard (4-6 h) traction. MATERIALS AND METHODS: It is a prospective comparative study with 50 participants, conducted at the department of Urology of a tertiary care hospital in eastern India after taking ethical clearance and consent from the patient. The patients attending urology O.P.D. with LUTS and diagnosed as BPH and planned for elective TURP and who had prolonged traction after TURP were excluded. Study period was one and the half year. RESULTS: Post operatively 25 patients were managed with catheter traction while 25 patients were managed with short term traction of 10 min. Pain which is assessed by visual analog scale (VAS) at 2 and 4 h post operatively is statistically significant with p value of <0.05 and cut off of 65 g prostate volume is drawn below which the successful outcome of short term traction is feasible without any complications. CONCLUSION: If hemostatsis is done properly then short term traction is preferable, safe and had fewer complications for prostate volume <65 g in comparison to standard traction TURP comparing the overall factors. Although, VAS score at 2 and 4 h post operatively shows patient experienced less pain even in prostate volume >65 g.

Genetic variants in the mTOR pathway with renal cancer risk and subtypes in East Indian population.

INTRODUCTION: Renal Cell Carcinoma (RCC), which accounts for 2%-3% of all adult malignant neoplasms with a male-to-female predominance of 1.9 to 1 with typical presentation between 55 and 75 years. The phosphoinositide-3-kinase-protein kinase B/Akt (PI3KPKB/Akt) pathway is a main pathway in control of cell growth. mTOR pathway plays a key role in the pathogenesis of RCC. MATERIAL AND METHODS: Its a prospective observational study. Tissue samples were collected and processed and DNA isolation and sequencing was done to see for any association and expression. RESULTS AND ANALYSIS: Polymorphism analysis of the sequence of three genes MTOR, AKT1, and PIK3CA done and found an intronic variant of the MTOR gene (rs3737611) and AKT1 gene (rs2498797) to be significantly associated with clear cell Renal Cell Carcinoma tumor samples. DISCUSSION: This study will help to understand the pathogenesis better and the information can be used to develop new drugs and personalized treatment strategies that are tailored to an individual's genetic makeup. The study identify individuals who are at heightened risk for developing renal cancer and could benefit from targeted screening or preventative measures. Some sample size and definite geographical sample pool remains the main limitation of the study which may not be externally validate the study results.

Calcutta position: A new modified supine decubitus for supine PCNL.

INTRODUCTION: PCNL (percutaneous nephrolithotripsy) is considered the gold standard treatment for renal stone more than 2 cm. In today's scenario, supine PCNL is considered equally effective as prone PCNL. The ideal position for supine PCNL is still debatable. We hereby describe our initial experiences of supine PCNL in a novel position. METHODS AND MATERIALS: This prospective study includes 60 patients who underwent supine PCNL in the 'Calcutta position' in our institute from August 2021 to August 2022. Successful procedure was defined as a complete stone free rate or a clinically insignificant residual stone (<4 mm). RESULTS: Average Operative room (OR) occupancy time was 130.9 ± 19.63 min. The immediate stone free rate was 84.2%, 71.4% and 37.5% for single, multiple and staghorn calculus respectively. Complications include fever, requirement of blood transfusions and renal colic. The average hospital stay was 83.6 ± 17.42 h. Eight patients (13.3%) required secondary procedures like extracorporeal shock wave lithotripsy (ESWL) or relook PCNL. At 3 months average stone free rates were 92%, 85%, 75% for single, multiple and staghorn calculus respectively. We performed supine PCNL in Calcutta position in obese, kyphoscoliosis, poliomyelitis, autosomal polycystic kidney disease (ADPKD), malrotated kidney and diverticular stone with comparable success. CONCLUSION: Supine PCNL in Calcutta position is a safe and effective option for nephrolithiasis management. Apart from the inherent advantages of supine PCNL it also has the advantages of better C-Arm and nephroscope manoeuvrability. Supine PCNL in Calcutta position was performed in a variety of scenarios with comparable results.

Role of multiparametric MRI in predicting muscle invasiveness in urinary bladder neoplasms with pathological correlations.

Urinary bladder cancer (BC) is one of the most frequent malignancies and the ninth most common malignancy worldwide. The objective of this study is to assess the role of multiparametric magnetic resonance imaging (mp-MRI) in predicting the invasiveness of urinary bladder space occupying lesions. Thirty-five patients diagnosed with bladder masses underwent an mp-MRI study. The results of three image sets were analysed and compared with the histopathological results as a reference standard: T2-weighted image (T2WI) plus dynamic contrast-enhanced (DCE), T2WI plus diffusion-weighted images (DWI), and mp-MRI, including T2WI plus DWI and DCE. The diagnostic accuracy of mp-MRI was evaluated using receiver operating characteristic curve analysis. We discovered a highly significant correlation between muscle invasiveness as staged by HPE (Histopathological examination) and mp-MRI utilising a VI-RADS score >3 (p 0.001) with a sensitivity of 100% and a specificity of 85.7%. With a diagnostic accuracy of 77.14%, a sensitivity of 92.31%, a specificity of 72.72%, a positive predictive value of 66.67%, and a negative predictive value of 94.11%, In terms of muscle invasiveness, there is good concordance between HPE staging and mp-MRI utilising the VI-RADS score. The mean apparent diffusion coefficient (ADC) values were higher in low grades than in high grades. The ROC curve study revealed a very strong correlation between HPE grade and ADC (p = 0.045). In 77.14% of patients, Mp-MRI correctly identified the local T stage. Mp-MRI is imaging biomarker for invasiveness and grade of tumour. The tumours with high grade are more invasive. However, the diagnostic accuracy of mp-MRI in determining muscle invasiveness is not very high and it overstages the disease in some cases (33.3%). Its clinical usefulness in determining muscle invasiveness before TURBT and histopathological examination can be questioned.

Dysregulation of DNA epigenetic modulators during prostate carcinogenesis in an eastern Indian patient population: Prognostic implications.

The role of epigenetic alteration in prostate cancer pathogenesis was reported. We aimed to analyze dysregulation of DNA methylase (DNA methyl transferase/DNMT) and demethylase (ten eleven translocase/TET) and the associated interplay between them during prostate tumorigenesis. Promoter methylation and RNA/protein expression of selected DNMT and TETs were analysed in normal prostate, benign prostatic hyperplasia (BPH), and prostate cancer (PCa). Genomic 5-hydroxymethylcytosine (5hmC) level was detected and correlated with DNMT and TET proteins. Clinicopathological association of molecular data was done. Our data revealed a very low frequency of promoter methylation for DNMT1 (5-3% and high frequency for TET1 (22-38%), TET2 (68-90 %), and TET3 (43-32 %) in BPH and PCa. The promoter methylation of DNMT1 (p = 0.019) showed a significantly decreasing trend, while that of TET1 (p = 0.0005) and TET2 (p < 0.0001) showed an increasing trend from normal prostate to BPH to PCa, indicating their epigenetic dysregulation during prostate tumorigenesis. RNA/protein overexpression of DNMT1 and reduced expression of TET1 and TET2 in PCa compared to BPH were associated with the promoter methylation status of genes. The 5hmC level was significantly lower in PCa than in BPH and correlated negatively with DNMT1 but positively with TET1 and TET2 proteins, suggesting dysregulation of DNA methylase and de-methylase activities during prostate tumorigenesis. Lastly, tumors having methylated TET1 and TET2 promoters showed advanced clinicopathological features (a higher PSA level/Gleason score) and increased risk of bone metastasis. In conclusion, DNMT1 upregulation and epigenetic silencing of TET1 and TET2 was seen during PCa development. TET1 and TET2 promoter methylation has prognostic importance.

Quest to develop a standard screening method for urothelial carcinoma using liquid-based cytology (The Paris System) and CK20.

Background: Bladder cancer, the most common malignancy of the urinary tract is a leading cause of morbidity and mortality. But cystoscopy, which is till now the mainstay of screening, is an invasive, high-cost method with low sensitivity especially for flat lesions. Aim: To find a non-invasive and effective screening method with liquid-based cytology (LBC) using The Paris System (TPS) and CK20 immunocytochemistry. Materials and Methods: It was a prospective study including the patients with clinical or cystoscopic diagnosis of urinary bladder space occupying lesions (SOL). Both conventional (CC) and liquid-based cytology slides were prepared from urine samples. Slides were evaluated by two trained pathologists and categorized according to TPS guidelines. CK20 immunocytochemistry (ICC) was also performed. Consequent formalin-fixed paraffin embedded sections were blindly examined by another pathologist and was taken as gold standard for comparison. Statistical Analysis: All the statistical analysis were done using MedCalc version 15.8 [Mariakerke, Belgium: MedCalc Software 2015]. Results: The study included 150 cases with a mean age of 62.4 years. Five cases revealed unsatisfactory smears. Rest of the cases were categorized as the following: 18.1% as NH-GUC, 8% as LGUN, 22.1% as AUC, 15.4% as SH-GUC, 32.9% as HGUC. Kappa value of CC and LBC were strong (0.854). LBC alone showed very low specificity (58%) and PPV (74.8%) which improved on application of ICC (specificity: 97.4%, PPV: 96.3%). Conclusion: We conclude that CK20 ICC offers potential for accurate, non-invasive detection and surveillance of bladder cancer and is a better tool when combined with liquid-based cytology, reported using The Paris System.

Evaluation of psychosocial status of CKD patients on renal replacement therapy and post renal transplant patients: An observational study.

INTRODUCTION: Recent studies have shown a high prevalence of depression and anxiety in patients with end-stage renal disease (ERSD) and renal transplant recipients. AIM: The aim of this observational study is to asses prevalence of depression and anxiety symptoms in CKD patients and post renal transplant patients. METHODS: In this study 100 patients divided in 50-50 each group. Group 1 with CKD patients on dialysis and group 2 with post renal transplant patients. Each group evaluated for depression and anxiety symptoms using BDI (Beck's Depression Inventory) and STAI (State-Trait Anxiety Inventory) score which is divided into STAI-X1 and STAI-X2, respectively. RESULTS: Our study revealed in group 1 48% patient versus group 2 34% patients present with depressive symptoms whereas in case of anxiety symptoms STAI-X1 and STAI-X2. Group 1 24% and 18% whereas group 2 34% and 28% patients, respectively. CONCLUSION: It is observed that depressive symptoms are more common in CKD patients on dialysis whereas anxiety symptoms observed more in patients after renal transplant. The obtained results indicate that screening tests and monitoring of the emotional state of patients with CKD are necessary, regardless of the disease stage and treatment; this includes patients after kidney transplantation.

Integration of bioinformatics analysis to identify possible hub genes and important pathways associated with clear cell renal cell carcinoma.

INTRODUCTION: One of the most fatal urological malignancies is clear cell renal cell carcinoma (ccRCC), yet little is known about its pathophysiology or prognosis. This study is aimed at obtaining some novel biomarkers with diagnostic and prognostic meaning and may find out potential therapeutic targets for ccRCC. MATERIAL AND METHODS: Using three publically accessible ccRCC gene expression profiles acquired from the Gene Expression Omnibus database, differentially expressed genes (DEG) were discovered and function enrichment analyses were carried out. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were conducted by using the DAVID tool and a protein-protein interaction (PPI) network was constructed and visualized by Cytoscape. Then we identified 10 hub genes using the cytohubba plugin of Cytoscape based on degree score. The mRNA and protein expression of hub genes was analyzed by GEPIA and Human Protein Atlas (HPA) database. Then, prognosis analysis of hub genes was conducted using GEPIA 3.0 which consists of data from The Cancer Genome Atlas (TCGA). RESULTS: We discovered 293 DEG which is highly enriched in several biological processes connected to immune-regulation and pathways linked to tumors, including HIF-1, PI3K-AKT, and metabolic pathways. In particular, C1QA, C1QB, FCER1G, and TYROBP were related to advanced clinical stage, high pathological grade, and poor survival in patients with ccRCC. CONCLUSIONS: Further molecular biological studies are required to confirm the role of the putative biomarkers in human ccRCC. Our work highlighted the hub genes and pathways involved in the progression of ccRCC.

Changes in renal volume post Percutaneous nephrolithotomy based on ultrasonography and its correlation with glomerular filtration rate (GFR).

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered to be the gold standard management for renal calculi. The purpose of this study is to comprehend the overall alterations in renal volume occurring after PCNL. The changes in the kidney's total volume in individual patients will be examined by ultrasonography pre and postoperatively, and it will be correlated with GFR. MATERIALS AND METHODS: It was a prospective observational study performed over 70 participants, conducted at the department of Urology of a tertiary care hospital in Eastern India. Each patients were evaluated with pre and post PCNL USG for kidney volume and GFR. The data was statistically evaluated by SPSS software. RESULTS: The preoperative and post operative calculated mean GFR was 96.030 ± 18.922 ml and 86.681 ± 16.938 ml,volume was 127.258 ± 25.705 and 123,678 ± 26.357 respectively . There was statistically significant decrease in GFR and volume following PCNL. It also shows that patients who underwent single puncture PCNL had significantly less decrease in GFR and kidney volume compared to multiple puncture PCNL. Moreover, the calculated mean change in GFR and volume were significantly less seen in single puncture-one step dilatation and single puncture-serial dilatation as compared to multiple puncture-one step dilatation and multiple puncture-serial dilatation. CONCLUSION: Our study showed that there was significant changes in the renal volume and GFR following PCNL . So, a sonographic estimation of renal dimensions and GFR calculation after PCNL will help in the prognosis and further follow up of patients. A Single puncture had a better operative outcome and less adverse consequences with respect to GFR, volume change and for renal function as compared to multiple puncture.

HAGLR, A Long Non-coding RNA of Potential Tumor Suppressive Function in Clear Cell Renal Cell Carcinoma: Diagnostic and Prognostic Implications.

Research works suggested the role of long non-coding RNAs (lncRNAs) in pathogenesis of clear cell renal cell carcinoma (ccRCC). lncRNA HAGLR is studied in several malignancies, but not in ccRCC. From The Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) dataset, we analyzed molecular alterations of HAGLR and constructed a competitive endogenous RNA (ceRNA) network with related miRNAs and mRNAs. Gene Ontology analysis was done to identify important pathways enriched with HAGLR recovered mRNAs. Clinical importance of HAGLR and related mRNAs was assessed and, the impact of selected mRNA-encoding genes on tumor immune infiltration was studied using TIMER. HAGLR expression was reduced in ccRCC than in normal kidneys, and correlated significantly with gene promoter methylation. Low HAGLR level in tumors showed diagnostic potency, and was associated with clinicopathological parameters (stage/grade/metastasis) and poor patient survival. The HAGLR-associated ceRNA network constituted 13 miRNAs and 23 mRNAs differentially expressed in the TCGA-KIRC dataset. From HAGLR recovered mRNA-encoding genes, we developed a 5-gene (PAQR5, ARHGAP24, HABP4, PDLIM5, and RPS6KA2) prognostic signature in the training dataset and validated it in testing as well as entire datasets. The expression level of signature genes showed negative correlation with tumor infiltration of immune cells having adverse impact on ccRCC prognosis and also with tumor derived chemokines facilitating the infiltration. In conclusion, HAGLR seemed to play a tumor suppressive role in ccRCC. HAGLR and associated gene signature may have implementation in improving existing prognostic measure and developing effective immunotherapeutic strategies for ccRCC.

A comparative study between one step dilatation and serial dilatation technique in percutaneous nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the first line treatment for treating kidney stones larger than 2 cm size with the advantages of lower morbidity and faster post-operative recovery. Creation of a nephrostomy access is one of the major steps of PCNL. It can be done either by single-step dilatation or by multi-step serial dilatation technique. OBJECTIVES: To compare the outcome and evaluate the efficacy of percutaneous nephrolithotomy done by single-step versus serial dilatation technique with specific reference to access time, fluoroscopy time, rate of blood transfusion, length of hospital stay (post-op) and complication rate. METHODS: It was a prospective study with a sample size of 100 where 50 patients underwent one-step dilatation and other 50 patients underwent serial-dilatation technique. These patients were analysed on the basis of their demographic profile, renal access time, total fluoroscopy time for access, post-operative haematuria, duration of post-operative hospital stay and complications after operative procedure. Data was analysed and reported using statistical tools. RESULTS: Demographic profile of the patients and stone characteristics were equivalent between two groups. Mean access tract dilatation time, mean total fluoroscopy time were significantly less in one of the groups. Requirement of blood transfusion, and post-operative complications rate were not significant between two groups. CONCLUSION: Both methods are safe and effective for tract dilatation. However, PCNL can be successfully performed by one-step dilatation with the added advantages of lesser time of renal access, lesser radiation exposure. Blood loss and hospital stay after operative procedure were not statistically significant between two groups.

Comparative analysis of standard, tubeless and total tubeless percutaneous nephrolithotomy: A prospective study.

INTRODUCTION: This study was done to review and compare safety, effectiveness and advantages of total tubeless percutaneous nephrolithotomy (PCNL), tubeless PCNL with standard PCNL. METHODOLOGY: This prospective comparative study involving 30 patients in each total tubeless PCNL, tubeless PCNL and standard PCNL group from Feb 2021 to June 2022. RESULT: Significant difference was found in mean duration of surgery (p < 0.01), mean hospital stay (p < 0.01), mean VAS post op score (p < 0.01), mean time to return to normal activity (p < 0.01) in total and tubeless PCNL group as compared with standard PCNL. While no significant difference found in mean haemoglobin drop (p = 0.1417), blood transfusion (p = 3721), incidence of urine leak (p = 0.13), need of accessory secondary procedure (p = 0.1322) and associated complications (p = 0.5939) among three groups. CONCLUSION: Study observed that total tubeless, tubeless PCNL is a safe and efficient technique. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores. Total tubeless PCNL obviates need of second procedure of removing DJ stent. Standard, tubeless and total tubeless PCNL have similar post op complication rate. Study thus concludes that total tubeless, tubeless PCNL can be used as a substitute for traditional standard PCNL.

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.

Comprehensive study of anxiety and depression in females with urinary incontinence.

BACKGROUND: Anxiety and depression are commonly seen with urinary incontinence (UI) and its association is strongest for urgency and mixed UI. It affects the quality of life and functional status. AIMS: To assess the prevalence and severity of anxiety and depression in SUI (Stress urinary incontinence) and UUI/MUI (Urge or mixed urinary incontinence), to assess the severity of SUI and UUI/MUI and its association with anxiety and depression and to identify various factors associated with anxiety and depression. MATERIALS AND METHODS: An observational study using various tools as history regarding urinary incontinence, history of other prior events which can lead to anxiety or depression, age, educational level, BMI (Body mass index), HADS scale (Hospital anxiety and depression scale) for anxiety and depression and ICIQ-UI-SF score (International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form). RESULTS: The Prevalence of anxiety and depression in UUI/MUI was higher. More women were overweight (BMI > 25) in the UUI/MUI group. Higher prevalence of anxiety and depression in the very severe urinary incontinence group. No association of the level of education with anxiety and depression in women with urinary incontinence. CONCLUSION: Anxiety and depression are more in UUI/MUI patients compared to SUI. In obese ladies, UUI is more prevalent compared to SUI. Anxiety and depression are more with increasing severity of incontinence. Anxiety and depression have no association with the educational status of the patients.

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.

Comparative effect of intraurethral clobetasol and tacrolimus in lichen sclerosus-associated urethral stricture disease.

Background: Management of urethral stricture related to lichen sclerosus (LS) is now gradually changing from surgical to nonsurgical due to availability of anti-inflammatory agents such as corticosteroids and calcineurin inhibitors. We determined the clinical impact of these agents in such patients on outpatient department basis in terms of improvement in symptoms on International Prostate Symptom Score (IPSS), external skin appearance, and maximum urinary flow rate (Qmax). Materials and Methods: Eighty patients of meatal stenosis and penile urethral stricture with histopathologically proven LS were divided into two groups, and clinical and predetermined parameters such as Qmax, IPSS, and changes in external appearance were compared between these groups after 3 months of topical and intraurethral application of clobetasol and tacrolimus with self-calibration. Results: A significant intragroup difference was noted in IPSS (P < 0.001) as well as Qmax (P < 0.001); postintervention intergroup difference in IPSS was not significant (P = 0.94) and however postintervention intergroup difference in Qmax was significant in favor of clobetasol (P = 0.007). A significantly increased number of additional procedures were done in the group receiving intraurethral tacrolimus (P = 0.0473) with significantly less number of skin complication in the group with topically applied clobetasol (P = 0.003). Conclusion: Though both clobetasol and tacrolimus, improved symptom score, Qmax and local external appearance yet topical and intra-urethral clobetasol application via urethral self calibration seems to be better option for lichen sclerosus related urethral stricture in terms cost and local complications.

Study of correlation between Visual Prostate Symptom Score and International Prostate Symptom Score in men with lower urinary tract symptoms with reference to Uroflowmetry parameters in Indian population.

PURPOSE: International prostate symptom score (IPSS) is a complex questionnaire method for objective assessment of Lower urinary tract symptoms. So, there is a need to develop a simple and easy scoring system that could be easily used for illiterates and older aged patients. MATERIALS AND METHODS: It was a prospective observational study with 202 participants, conducted at the department of urology of a tertiary care hospital in eastern India. The patients more than 50 years of age, attending urology OPD with Lower urinary tract symptoms were included in the study. Printed IPSS and VPSS questionnaires were given to the patient to answer. RESULTS: Eighty-two percent (82%) of the higher education group and 97% of the lower education group needed assistance to answer IPSS questionnaires while 18% of the higher education group and 44% of the lower education group needed assistance to answer VPSS questionnaires. Sixty-four (64%) of patients in our study belong to the high education level while 36% of patients belong to the low education group. The mean age was 60.1 years. The mean IPSS and VPSS were 19 and 11 respectively. The mean PSA was 1.5 ng/ml. The time taken to fill VPSS questionnaire was much less than IPSS questionnaires. All the patients felt that VPSS was easier. Statistically significant (p-value < 0.05) correlation was found between total IPSS and total VPSS, Q2 IPSS and Q1 VPSS, Q7 IPSS and Q2 VPSS, Q5 IPSS and Q3 VPSS, and IPSS Qol and VPSS Qol. A negative correlation was found between Q3 VPSS and Qmax, and Q5 IPSS and Qmax. CONCLUSIONS: VPSS can be used as an alternative tool to IPSS to assess LUTS, which uses pictograms instead of questionnaires, even in patients with limited education.