Intravesical bupivacaine in reducing catheter-related bladder discomfort and lower urinary tract symptoms after transurethral surgery: A randomized controlled trial.

Introduction: The objectives of this study were to investigate the efficacy and safety of intravesical bupivacaine instillation in reducing catheter-related bladder discomfort (CRBD) and lower urinary tract symptoms (LUTS) after transurethral surgery. Methods: The study enrolled 100 American Society of Anesthesiologists (ASA) grade I-III patients aged ≥18 years undergoing transurethral resection of the prostate or transurethral resection of the bladder tumor, randomly assigned to Group B (intravesical bupivacaine) or Group S (saline). Double blinding was employed. Independent variables included demographics, surgery type, ASA grade, and intervention details. Dependent variables comprised CRBD severity, Patient Perception of Bladder Condition (PPBC), Pelvic Pain Urgency Frequency (PUF), Visual Analog Scale (VAS) for pain, need for additional analgesics, and International Prostate Symptom Score (IPSS). SPSS version 19 was used for analysis with a significance level of P < 0.05. Side effects such as hematuria were also recorded. Results: Group B reported significantly lower "moderate" CRBD immediately (2% vs. 40%, P < 0.001) and at 12 h (0% vs. 18%, P = 0.003) post-instillation compared to Group S and also required fewer additional analgesics (4% vs. 46%). The PPBC at catheter removal also favored Group B (P = 0.003) and day 1 (P < 0.001). The PUF scores were also significantly lower in Group B at catheter removal (P = 0.001) and at day 1 (P = 0.028). The IPSS was also significantly lower in the Group B on day 1 (P = 0.003) and 7 (P = 0.001). The VAS scores also favored the Group B consistently and although the side effects were higher in Group B but this was not statistically significant. Conclusion: Intravesical bupivacaine administration has the potential to alleviate CRBD and postoperative LUTS following lower urinary tract transurethral electrosurgery. The study's findings underscore the importance of personalized pain management strategies in optimizing the patient comfort during the postoperative recovery.

Robotic reconstruction of necrosed ileal ureter: Technical challenges, intra-operative difficulty, and learning points.

This video explores the challenges faced during a re-do robotic intra-corporeal ileal ureter reconstruction in a previously operated case. A 24-year-old woman presented with a 12-cm long stricture after robotic ileal ureter replacement surgery. A proper preoperative evaluation in the form of ureteroscopy and a nephrostogram is essential and the key steps include adhesiolysis, identification of the necrotic ileal ureter, and meticulous dissection. A 13-cm long segment of the ileum was isolated and was anastomosed to the renal pelvis and the bladder. The surgery lasted for 420 min with 300 ml of blood loss. Post-operatively, the patient recovered well and had a normal drainage with no complications at 1-year of follow-up. The factors such as a broad mesentery, a tension-free anastomosis, and avoiding the twisting of the pedicle are crucial for success of robotic ileal ureter replacement surgery.

Outcomes of bladder neck botulinum toxin injection for female primary bladder neck obstruction-does subjective improvement correlate with an objective assessment?

INTRODUCTION AND HYPOTHESIS: Common options for management of primary bladder neck obstruction (PBNO) in women include medications and surgical treatment. Less invasive treatment such as bladder neck botulinum toxin injection can be an alternate therapy in patients with failed conservative management. In this study, we describe the subjective and objective outcomes, patient satisfaction, and willingness for repeat treatment with bladder neck botulinum toxin injection in females with PBNO. METHODS: A retrospective analysis of ten female PBNO patients managed with bladder neck botulinum toxin injection was performed. Subjective parameters were quantified with symptom assessment, International Prostate Symptom Score (IPSS), and Quality of life (QoL) score. Objective parameters were assessed with maximum flow rate (Qmax) in uroflowmetry and postvoid residual (PVR). RESULTS: The mean pre-treatment IPSS, QoL score, Qmax, PVR was 24.2 ± 5.0, 4.8 ± 0.63, 5.73 ± 3.18 ml/s, and 210 ± 66 ml, respectively. Seven of the ten patients subjectively improved (IPSS 12.9 ± 9.6, QoL2.9 ± 1.6, p < 0.05). Three patients improved objectively (mean Qmax 17.3 ± 2.7 ml/s, PVR 42.7 ± 7.5 ml, p < 0.05). Three patients accepted repeat botulinum toxin injection. Three patients who showed no improvement underwent bladder neck incision with resolution of symptoms. CONCLUSION: Botulinum toxin can be an intermediary therapy in female patients with PBNO who want a minimally invasive procedure.

Recurrent Hemangioma of the Penile Urethra - An Unusual Etiology of Gross Hematuria Managed Successfully with Holmium Laser Coagulation.

Urethral hemangioma is a benign uncommon vascular tumor. It presents with hematuria and macroscopic urethrorrhagia. Urethrocystoscopy is the main diagnostic modality. We share the case of a 14-year-old male child who presented with recurrent massive hematuria and was treated with urethra-cystoscopic holmium laser coagulation.

Reflex anuria causing acute kidney injury following myomectomy: A case report.

Reflex anuria is a rare cause of acute renal failure, which may occur following ureteric manipulation or painful stimuli to adjacent organs during pelvic surgery. This condition, relatively unfamiliar to the general gynecologist, should be considered even when no obvious cause of anatomical obstruction is found. We present a case of reflex anuria in a 28-year-old woman for two large intramural fibroids. Evaluation did not reveal any organic obstruction of the urinary tract. Bilateral ureteric stenting and other supportive measures resulted in diuresis and improvement of renal function. Stents were removed after 10 days and patient was discharged on the 15th postoperative day with normal renal parameters. Intrarenal arteriolar spasm or ureteric spasm following pelvic manipulation can cause reflex anuria and should be considered in the differential diagnosis of acute renal failure in cases following pelvic surgery.

Does successful urethral calibration rule out significant female urethral stenosis? confronting the confounder- an outcome analysis of successfully treated female urethral strictures.

OBJECTIVE: The diagnosis and treatment of female urethral stricture disease (FUSD) are practiced variably due to the scarcity of data on evaluation, variable definitions, and lack of long-term surgical outcomes. FUSD is difficult to rule out solely on the basis of a successful calibration with 14F catheter. In this study, we have tried to characterize the variable clinical presentation of FUSD, the diagnostic utility of calibration, videourodynamic study(VUDS), and urethroscopy in planning surgical management. MATERIALS AND METHODS: A retrospective review of records of 16 patients who underwent surgical management of FUSD was analyzed. The clinical history, examination findings, and the results of all the investigations (including uroflowmetry, VUDS findings, urethroscopy) they underwent, the procedures they had undergone ,and the follow-up data were studied. RESULTS: A total of 16 patients underwent surgical management of FUSD. 13 out of 16 patients had successful calibration with 14F catheter on the initial presentation. These 13 patients on VUDS demonstrated significant BOO and had variable stigmata of stricture on urethroscopy. The mean IPSS, flow rate, and PVR at presentation and after urethroplasty were 23.88±4.95, 7.72±4.25mL/s, 117.06±74.46mL and 3.50±3.44, 22.34±4.80mL/s, and 12.50±8.50mL, respectively. (p < 0.05). The mean flow rate after endo dilation(17F) (n=12) was 11.4±2.5mL/s while after urethroplasty improved to 20.30±4.19mL/s and was statistically significant(p < 0.05). CONCLUSIONS: An adept correlation between clinical assessment, urethroscopy findings, and VUDS is key in objectively identifying FUSD and planning surgical management. A good caliber of the urethra is not sufficient enough to rule out a significant obstruction due to FUSD. Early urethroplasty provides significantly better outcomes in patients who have failed dilation as a treatment.

Managing intractable incontinence from a Yang-Monti channel in a case of enterocystoplasty with bladder neck closure - Challenges and a modified surgical technique.

Incontinence in the Mitrofanoff principle varies between 2% and 40% and is a challenging problem to treat. Incontinence is even more when a Yang-Monti channel is used with simultaneous enterocystoplasty, probably due to ineffective submucosal tunneling owing to the inferior quality of bowel mucosa. Here, we report the management options of such problems along with a novel surgical technique.

Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms.

AIM: The Actionable Bladder Symptom and Screening Tool (ABSST) is used to identify multiple sclerosis (MS) patients in possible need of evaluation for urinary symptoms. The primary objective of this study was to identify barriers experienced by MS patients in seeking evaluation for urinary symptoms. We also assessed the utility of ABSST tool in identifying patients that will follow up with urologic evaluation. METHODS: This was a prospective observational study where 100 patients with MS were enrolled from an MS center. Patients completed demographic information, questions to assess barriers to care, a short form of the ABSST, and incontinence questionnaires. An ABSST score >3 met criteria for referral and evaluation. One year after enrollment, follow up calls assessed whether patients had seen a urinary specialist. RESULTS: The most common barriers to seeking care included "Doctor never referred" (16%) and "Doctor never asked" (13%). Thirty-eight percent (n = 8/21) of men stated "Doctor never referred" compared to 10% (n = 8/79) of women (P = 0.002). Twenty-seven patients had an ABSST Score ≥3 and were more interested in seeing a specialist compared to those scoring <3 (88.9%, n = 24/27 vs. 26%, n = 19/73; P = <0.001). After 1 year, 70 patients were reached for follow up. A total of 57.9% (n = 11/19) patients who followed up for evaluation screened positive on the ABSST. CONCLUSIONS: The ABSST is a valuable tool to identify MS patients with urinary symptoms who will likely follow up for genitourinary evaluation. However, other barriers beyond awareness exist and prevent patients from being evaluated.

Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?

Objective: Ureteral stents are customarily inserted to facilitate urinary drainage, but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences. The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade (Clavien-Dindo Grade 4A or above) complications. Methods: The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed. The parameters recorded included patient demographics, indwelling time, need for percutaneous nephrostomy, hemodialysis, urine culture, blood culture, total blood counts, serum creatinine, radiologic findings, management techniques, number of surgical interventions, modified Clavien-Dindo complications, follow-up, and mortality, if any. Results: Forty patients were included in the study. The median age was 52 (range 6-85) years. Of the total, 25 (62.5%) patients had a "significant" stent load; 31 (77.5%) had renal failure or acute kidney injury on presentation; 19 (47.5%) patients had sepsis at presentation. Among the patients presented with sepsis, 11 (57.9%) patients demonstrated a positive urine culture; and 7/11 (63.6%) patients exhibited pan-resistant organisms. Twelve out of 40 (30.0%) patients in our series developed high-grade Clavien-Dindo complications. On univariate analysis, sepsis at presentation (p=0.007), stent load (p=0.031), diabetes (p=0.023), positive urine culture (p=0.007), and stent indwelling time of more than 1 year (p=0.031) were found to be significant. On multivariate logistic regression analysis, sepsis at presentation (p=0.017) and positive urine culture (p=0.016) were significant predictors for high-grade complications. Conclusion: It is prudent to identify specific risk factors, namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.

Management Outcomes of Large Renal Angiomyolipoma Presenting with Wunderlich Syndrome-Experience from a Tertiary Center.

Renal angiomyolipoma is an uncommon, benign-mixed mesenchymal tumor consisting of thick-walled blood vessels, smooth muscles, and mature adipose tissues. Twenty percent of these tumors are associated with tuberous sclerosis. Wunderlich syndrome (WS), an acute nontraumatic spontaneous perirenal hemorrhage, can be a presentation of large angiomyolipoma. This study evaluated the presentation, management, and complications of renal angiomyolipoma with WS in eight patients who presented to the emergency department between January 2019 and December 2021. The presenting symptoms included flank pain, palpable mass, hematuria, and bleeding in the perinephric space on computerized tomography. Demographic data, symptoms at presentation, comorbidities, hemodynamic parameters, the association with tuberous sclerosis, transfusion requirements, need for angioembolization, surgical management, Clavien-Dindo complication, duration of hospital stay, and 30-day readmission rates were evaluated. The mean age of presentation was 38 years. Of the eight patients, five (62.5%) were females and 3(37.5%) were males. Two (25%) patients had tuberous sclerosis with angiomyolipoma, and three (37.5%) patients presented with hypotension. The mean packed cell transfusion was three units, and the mean tumor size was 7.85 cm (3.5-25 cm). Three of them (37.5%) required emergency angioembolization to prevent exsanguination. Embolization was unsuccessful in one patient (33%) who underwent emergency open partial nephrectomy, and one (33%) patient developed post-embolization syndrome. A total of six patients underwent elective surgery-four underwent partial nephrectomy (laparoscopic - 1, robotic - 1, open - 2) and two underwent open nephrectomy. Three patients encountered Clavien-Dindo complications (Grade 1, n = 2 and IIIA, n = 2). WS is a rare, life-threatening complication in patients with large angiomyolipoma. Judicious optimization, angioembolization, and prompt surgical intervention will help deliver better outcomes.

Is a Mesh Really a Mess: A Self-Tailored Polypropylene Mesh as a Retropubic Tension-Free Vaginal Tape Under Local Anesthesia in a Tertiary Healthcare Center Experience in India.

Objective The primary objective of this study was to evaluate the feasibility of performing retropubic mid-urethral transvaginal tape (TVT) with self-tailored ordinary polypropylene mesh (STOM) under sedation and local anesthesia in female patients with stress urinary incontinence (SUI). The second objective was to evaluate perioperative and immediate postoperative complications, success rates, and cost-effectivity. Materials and methods Forty-two subjects treated for stress urinary incontinence using STOM under local anesthesia were reviewed. Pre- and postoperative evaluation included assessment of valid questionnaires such as the urogenital distress inventory (UDI) and medical, epidemiologic, and social aspects of aging incontinence questionnaire (MESA), uroflowmetry in all cases, and urodynamics in some instances. Success rates and complications were compared with published studies. Results The mean operating time was 27 mins, and the median visual analog scale (VAS) score at 12 hours was three. Postoperative MESA and UDI scores had significant improvement. The mean hospital stay was 18 hours. Mean preoperative and postoperative Q max had no significant difference. With a mean follow-up of 27.32±3.29 months, the cure was seen in 38 patients (90.4%), improvement in three patients (0.07%), and failure in one patient (0.02%). Mesh-related complications (extrusion) occurred in one patient. The sling cost was reduced from approximately $500 (Gynecare TVT sling; Ethicon Inc., Somerville, NJ, USA) to $12.44 (Ethicon 15 x 7.6 cm Prolene (polypropylene mesh); Ethicon Inc., Somerville, NJ, USA) in our study. Conclusion Performing TVT with STOM under sedation and local anesthesia as a daycare procedure was feasible and cost-effective, has a high success rate, and was associated with minimal complications. It should be considered in developing countries with vast patient burdens, such as India.

Robot-assisted complex urinary tract reconstruction using intestinal segments: redefining the paradigm.

Complex urinary tract reconstruction has significantly advanced with the increasing use of robot-assisted procedures. Robotic surgery aims to achieve the same outcomes as open surgery while minimizing morbidity by causing less blood loss, faster postoperative recovery, and reducing complications. This article shares our technique, challenges encountered, and experience of robot-assisted complex urinary tract reconstruction using intestinal segments. Between January 2020 to March 2022, 6 patients who underwent robot-assisted complex urinary tract reconstruction using intestinal segments at our centre were retrospectively reviewed. Demographic, clinical, and operative data were recorded. Patients underwent renal function tests, blood gas analysis, and radiographic imaging in the follow-up. Symptomatic and radiologic relief were the criteria for success. Out of 6 cases, three patients underwent ileal ureter replacement, two combined ileal ureter with augmentation ileo-cystoplasty and one augmentation ileo-cystoplasty alone. The mean age, estimated blood loss, length of hospital stay, and follow-up period were 32.6 years, 110 ± 13.1 mL, 7.0 ± 1.1 days, and 11.3 months, respectively. The indications for surgery were either benign ureteral stricture following lithotripsy or sequelae of genitourinary tuberculosis. No intra-operative complications were found. Clavien-Dindo grade-II and Grade-IIIa were found in three and one patient, respectively. During follow-up, none had compromised renal function or acidosis. Robot-assisted complex urinary tract reconstruction using intestinal segments is safe and offers the advantages of minimally invasive techniques. Techniques demonstrated in this article make these reconstructions feasible with good surgical and clinical outcomes.

Sarcomatoid Urothelial Carcinoma of the Urinary Bladder With Chondrosarcomatous and Concurrent Divergent Squamous Cell Carcinoma Differentiation- A Rare Entity.

We present an extremely rare case where the sarcomatoid urothelial carcinoma of the urinary bladder was present with chondrosarcomatous and squamous cell differentiation. A 74-year-old male smoker presented with intermittent hematuria with the passage of clots. On imaging, an irregular polypoidal lesion was diagnosed near the right vesicoureteric junction, and transurethral resection of the bladder tumor was performed. Histopathological examination showed sarcomatoid urothelial carcinoma with chondrosarcoma and squamous cell differentiation. He refused the surgical treatment of radical cystectomy and underwent Gemcitabine and Cisplatin chemotherapy. He died nine months after the diagnosis. Sarcomatoid urothelial carcinoma is a high-grade biphasic neoplasm with malignant epithelial and mesenchymal components. Its association with squamous cell carcinoma is infrequent. It is very aggressive, and there is no standard treatment for this disease. The radical surgical option appears to be the main form of treatment. It is scarce with a grave prognosis.

"Labia Majora Fasciocutaneous Flap Reconstruction in Complex Urogynecological Fistulas With Vaginal Deficit - A Versatile Approach".

OBJECTIVE: To appraise the pivotal points of different modifications of labia majora fasciocutaneous flap in combating the challenges of complex urogynecological fistula repair in the form of 7 cases. METHODS: Seven patients with complex urogynecological fistulas with vaginal deficit were treated over last 3 years. The challenges associated with them were non-capacious rigid vagina, irradiated and inflamed surrounding tissues, inelasticity, long-standing fistula with radiation-induced vesicovaginal fistula(VVF), an iatrogenic urethrovaginal fistula with anterior vaginal wall loss with vaginal stenosis, and a case of vesicolabial fistula with a history of forceps delivery and transvaginal VVF repair. Transvaginal repair with labia majora fasciocutaneous flap along with fat pad with relevant technical modifications was contemplated in all. RESULTS: All radiation-induced VVF patients demonstrated no leak in the postoperative period barring one who became dry after transvaginal colpocleisis later. The patient with urethrovaginal fistula and vaginal stenosis was continent, had capacious vagina, and without any leak with regular menstrual periods. The female with vesicolabial fistula remained dry at the end of 6-month follow-up. CONCLUSION: Transvaginal repair using the labia majora fasciocutaneous flap and the demonstrated technical modifications can be a feasible option in repairing complex urogynaecological fistulas associated with vaginal wall deficit.

Perioperative and oncological outcomes of renal cell carcinoma with venous tumour thrombus.

AIM: The aim of the present study is to report the perioperative and long-term surgical outcomes of renal cell carcinoma (RCC) with venous tumour thrombus (VTT). MATERIALS AND METHODS: Data of 34 patients (males = 23, females = 11) from 2009 to 2020 who underwent radical nephrectomy with thrombectomy for RCC and VTT was retrospectively analysed. The parameters recorded include tumour laterality, size, level of thrombus, surgical approach, blood loss, transfusion rates, operative time, hospital stay, Clavien complications, tumour histology, follow-up duration, local recurrence, distant metastasis, overall and cancer-specific survival rates. RESULTS: The extent of thrombus was level I in thirteen, level II in twelve, level III (a-1, b-2, c-1, d-2) in six and level IV in three patients respectively. Mean operative time was 320 (±145) min, mean blood loss was 1371.15 (±1020.8) ml and mean hospital stay was 9.6 (±7.4) days. Mean transfusion rate was 6.4 (±3.2) units. Three patients died within the first 30 days of surgery. Cardiopulmonary bypass (CPB) was utilized in three patients. Median follow-up period was 58 (Range: 4-101) months. A statistically significant correlation was found between operative time (p = 0.014) and median survival (p = 0.003) respectively and tumour thrombosis level. Nine patients died due to metastasis, and ten due to unrelated causes. The estimated actuarial survival rates at a median of 58 months were 35.3%. CONCLUSION: An accurate preoperative assessment of the thrombus extent with the involvement of a multidisciplinary team approach is crucial in achieving optimal surgical outcomes in patients of RCC with VTT, particularly with level III and IV thrombus.

Clinical and videourodynamic study characteristics in female primary bladder neck obstruction and outcomes of bladder neck resection: A tertiary care center experience in India.

Introduction: Video urodynamic study (VUDS) with clinical correlation helps in diagnosing primary bladder neck obstruction (PBNO) in women. Bladder neck incision/bladder neck resection (BNR) though effective is not commonly practiced for the fear of complications and limited literature available. Methods: The records of ten women diagnosed with PBNO between 2017 and 2019 were reviewed and data pertaining to their clinical features, laboratory results, findings on abdominal ultrasonography, uroflowmetry, and VUDS was noted. Type of operative procedure performed and outcomes on follow-up were also assessed. Results: Out of ten patients, two presented with lower urinary tract symptoms (LUTS), three with voiding LUTS and chronic retention and five had acute urinary retention. Mean serum creatinine was 3.4 mg/dl. In those able to void, mean maximum flow rate (Q max) was 7 ml/sec, and mean postvoid residual volume (PVR) was 360 ml. On VUDS, mean detrusor pressure at maximum flow (pdet@Qmax) was 54.2 cm of H20. Three patients opted conservative treatment and 7 had a successful surgical outcome with mean Q max of 26.2 ml/s (range: 13.9-41 ml/s), insignificant PVR and resolution of renal failure. Patients with pdet@Qmax <20 cm H2O (n = 3, mean 18.3 cm H2O) did equally well as compared to those with pdet@Qmax >20 cm H2O (n = 4, mean 93 cm H2O). None of the patients developed any complications on follow-up. Conclusions: Clinical assessment supported with VUDS correlation holds a key in identifying patients with PBNO. BNR is a safe and effective treatment of PBNO in women who fail or are not candidates for conservative treatment.

Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Post Radiation Female Urethral Stricture - A Technical Appraisal With Outcomes.

INTRODUCTION AND OBJECTIVES: Female urethral stricture following radiation has been reported sparsely in the literature with just a handful of case reports. Radiation to the pelvis affects the genitourinary tracts and afflicts damage by causing periurethral fibrosis, necrosis, and subsequent tissue contraction, posing as a hurdle to the reconstructive surgeon. We studied the technique and outcomes of dorsal onlay buccal mucosal graft (BMG) urethroplasty in patients of radiation-induced female urethral stricture disease (FUSD). MATERIALS AND METHODS: Three cases of radiation-induced FUSD were reviewed. The preoperative and postoperative parameters like IPSS, Flow rate (Qmax), Postvoid residue (PVR), urethroscopy findings, and Videourodynamics study parameters were analyzed. All patients underwent dorsal onlay BMG urethroplasty. The salient steps of the operative procedure are demonstrated in this video presentation. RESULTS: The mean duration after the last radiation cycle was 2.33 years. Preoperatively mean IPSS, Qmax, and PVR were 27.33 ± 1.15, 6.46 ± 0.6 mL/s, and 56.67 ± 16.07 mL, respectively. After dorsal onlay BMG urethroplasty the mean IPSS, Qmax, and PVR were 3.33 ± 1.5, 23.33 ± 6.1 mL/s, 15.67 ± 8.14 mL, respectively. None of the patients reported bothersome lower urinary tract symptoms, and stricture recurrence in the 12-month follow-up. However, one patient had transient stress incontinence, which was managed conservatively. CONCLUSION: Dorsal onlay BMG urethroplasty achieves excellent outcomes in patients with postradiation FUSD. Adequate dorsal urethrotomy should be contemplated in previously irradiated strictures.

Effect of Structured Educational Program on Practices of Radiation Safety Measures Among Health Care Providers in Urology Operation Theater.

Introduction Endourologists are at increased risk of exposure to radiations. Many studies are available that have studied awareness in doctors in general, but very few studies available regarding any intervention to improve the knowledge of radiation safety measures. We have made an attempt to study the role of an educational intervention to improve the knowledge of our Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) urology operation theater health care providers (HCPs). Materials and methods Our study was an Interventional study (prospective clinical trial), conducted in the Department of Urology, JIPMER from January 2017 to March 2018. All, that is, 40 operation theater HCPs were given a questionnaire as baseline. The baseline response was compared to the response after the Structured Education Program (SEP) by using the same questionnaire. The knowledge of participants before SEP was compared with the knowledge after SEP using the chi-square test. All statistical analysis was carried out at a 5% level of significance and p-value < 0.05 was considered as significant. Result In our study after SEP, participants use of lead apron has increased from 72.5% to 92.5%, indicating improvement. There is an increase in the use of thyroid shield from 22.5% to 95%. In our study after SEP, knowledge about background radiations improved in participants from 25% to 87.5%. Knowledge about Radiation dose of chest X-ray improved from 22.5% to 52.5%. Knowledge about ALARA (As Low As Reasonably Achievable) improved from 47.5% to 95% after SEP. Knowledge that MRI and USG do not have ionizing radiation improved from 62.5% to 97.5%, and from 75% to 92.5% for MRI and USG, respectively, after SEP. Regarding organ sensitivity, 100% HCPs had given correct answers after SEP as compared to 80 before SEP. Conclusion Our study shows that SEP at regular intervals has made significant improvements in daily practice in operation theater HCPs. SEP has increased the use of radiation protective gears among HCP. Hence we recommend SEP at regular intervals for urology operation theater HCPs for a healthy and safe working environment.

Do Primitive Neuroectodermal Tumors of the Kidney Have a Predilection for Inferior Vena Cava Involvement? A Case Series and Review of the Literature.

The primitive neuroectodermal tumor (PNET) of the kidney is an extremely rare neoplasm, the diagnosis of which mainly depends upon histopathology, immunohistochemistry (IHC), and cytogenetics. A handful of cases reported in the literature mention about aggressive features of this neoplasm. The purpose of our study was to review our experience in not only the diagnosis and management of the patients with renal PNET but also to highlight its propensity to involve inferior vena cava (IVC) and also present a rare occurrence of Ewing's sarcoma (ES)/PNET of the renal pelvis. The clinical, operative, and histopathology records of four patients of renal PNET treated between January 2017 and December 2019 were reviewed and data analyzed concerning the available literature. Out of the four patients treated, two had level III and IV IVC thrombus, and one had dense desmoplastic adhesions with the IVC wall. One of the cases had a rare presentation of ES/PNET of the renal pelvis. All patients were managed surgically, while only one patient received adjuvant chemotherapy and following up with remission for the last 2 years and 4 months. On IHC, cluster of differentiation-99 (CD-99) was positive in all patients, and three were positive for Friend leukemia integration-1. PNET of the kidney is primarily an immunohistopathological diagnosis. This neoplasm has an increased propensity for the local invasion of surrounding structures. A multimodality approach with surgery, chemotherapy, and radiotherapy could offer better outcomes, although the prognosis of these tumors remains poor.

Effect of Ureteral Stent Length and Position of Stent Coil in Bladder on Stent-Related Symptoms and Quality of Life of Patients.

INTRODUCTION: Various standardized questionnaires can evaluate ureteral stent-related symptoms. The present study utilized a validated instrument, Ureteral Stent Symptoms Questionnaire (USSQ), to know the impact of the length of double J stent (DJS) in comparison to ureter length on patients and their quality of living. MATERIALS AND METHOD: This study is a prospective clinical study conducted in the Department of Urology at a tertiary care center in South India. Patients who underwent DJS after endoscopic ureteral lithotripsy were included in the study. On a computerized tomography scan, the ureteral to stent length ratio (USR) was calculated. USSQ scores at the time of DJS removal and two weeks thereafter were recorded. The distal coil of the stent in the bladder was recorded as grade 1 - not crossing the midline and grade 2 - crossing the midline. Different symptom scores were compared between both grades of bladder coil and for USR of all the patients. RESULT: A total of 157 patients were included in the study. Over 46 (29.3%) patients had grade-1 and 111 (70.7%) had grade-2 bladder coil. Totally 93 (59.23%) patients reported pain, while 64 (40.77%) patients had no pain. Grade-2 coil patients had more pain than grade 1 (P=0.01). There was a weak inverse relationship between the USR and urinary symptom (P=0.004), pain symptom (P=0.04), and quality of work (P=0.005). CONCLUSION: Stent length or position of the intravesical stent coil does not appear to affect the quality of life except for the pain. Hence, choosing stent length according to ureteral length seems to have a minimal role in decreasing stent-related morbidity.