Misinterpretation of the international prostate symptom score questionnaire by Indian patients.

INTRODUCTION: The international prostate symptom score (IPSS) is commonly used in the evaluation of the severity of symptoms of patients with prostatic enlargement. It is a self-administered questionnaire. It has not been validated in any Indian language and an English version is used which can be difficult to interpret by our patients who do not have English as their primary language. In this study, we evaluate the patient's ability to understand the IPSS by comparing the scores when the IPSS questionnaire was self-administered versus when it was administered using the assistance of a clinician. MATERIALS AND METHODS: Patients who presented with lower urinary tract symptoms suggestive of benign prostatic hyperplasia, who had passed at least twelfth grade of school and had a reasonable command over English were included in the study. They were allowed to self-administer the IPSS questionnaire following which a clinician, blinded to these scores, assisted the patient in filling the questionnaire. For each question, the score in both the questionnaires was noted and kappa agreement statistical test was used to assess the agreement between the two scores. RESULTS: A total of 87 patients were included in the study. It was found that none of the questions had a perfect agreement of scores in the self-administered and the assisted administration. CONCLUSION: Our results show that our patients misinterpret the IPSS questionnaire. This problem can lead to significant errors in interpretation of the symptom severity.

Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate.

INTRODUCTION AND OBJECTIVE: Transrectal ultrasound biopsy of prostate is a painful procedure. The introduction of the rectal probe is one of the major contributors to the pain associated with this procedure. Drugs that relax the anal sphincter should theoretically decrease this pain. This study was done to compare the efficacy and safety of two topical medications that relax the anal sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: 66 patients who were to undergo their first prostate biopsy were randomized to receive either 2 mL of 2 % topical diltiazem or 2 mL of 0.2 % topical nitroglycerine or placebo 20 minutes before prostate biopsy. All patients also received 15 mL of intrarectal lignocaine. A 10-point visual analogue score was used to record the pain immediately after the insertion of the probe, during biopsy and at the end of the procedure. RESULTS: The pain scores due to probe insertion, during biopsy and at the end of the procedure in patients who received topical diltiazem or nitroglycerine were significantly lower compared to the placebo group (p < 0.001). There were no significant differences in the pain scores between the patients receiving diltiazem compared to those receiving nitroglycerine. Higher incidence of headache and fall in blood pressure was noted in patients who received nitroglycerine compared to those receiving diltiazem. CONCLUSION: Topical diltiazem and nitroglycerine are equally effective in reducing the pain associated with transrectal prostatic biopsy. Diltiazem is safer compared to nitroglycerine.

Catheter-induced urethral erosion.

Indwelling bladder catheters are often placed when a patient requires voiding assistance. Long-term use of these catheters has been associated with significant morbidity This case presentation describes a complete erosion of the glans, urethra, and penile skin, up to the penoscrotal junction, as an outcome from long-term use of an indwelling bladder catheter. Appropriate nursing interventions can prevent this devastating health care outcome.

Evaluation of various nephrometric scoring system for nephrolithiasis to predict stone free status after percutaneous nephrolithotomy: A comparative study.

BACKGROUND: The CROES Nephrolithometry nomogram, S.T.O.N.E. Nephrolithometry Score and Guy's stone score were introduced for stratification of kidney stones disease on the basis of quantitative stone burden and its distribution. Till date there has been very limited data on head to head comparison of the existing scoring systems. Comparison and analyses among the scoring system helps in further refinement of these systems along with development of new more effective and broadly acceptable nomogram. OBJECTIVE: Predictability of the stone-free status (SFS) and post-operative complication after PCNL by various scoring systems (The CROES nomogram, S.T.O.N.E. nephrolithometry score and Guy's stone score). MATERIALS AND METHODS: Total 100 adult patients underwent PCNL after considering inclusion and exclusion criteria. All patients underwent Preoperative NCCT scan, investigations of blood (Hb%, PCV, bleeding and coagulation profile, urea, and creatinine), and urine (RE/ME and C/S), Postoperative X ray KUB/NCCT. RESULTS: ROC curves were developed for each scoring system to determine the accuracy to predict stone free status. We found CS had significantly higher AUC than other scoring systems [p-value for CS vs GSS = 0.0091 & CS vs SS = 0.000]. So CS has higher accuracy to predict stone free status. None of the scoring system had shown significantly higher AUC than other scoring system in predicting complication. CONCLUSION: CROES Nephrolithometry nomogram is most accurate to predict preoperative stone-free rate. All scoring systems can equally predict perioperative complications and other variables.

Urethral Catheter Induced Huge Anterior Urethral Diverticulum.

We report a 22-year old gentleman who presented with postmicturition urinary dribbling for nearly 1 year along with urinary urgency and frequency. He had a history of brain tuberculosis 2 years back and was hospitalized for 4 months with a urethral catheter. Examination revealed a 3 cm cystic swelling in the penoscrotal junction. On pressing the sac, a gush of urine came out through the urethral meatus. A micturating cystourethrogram revealed a huge anterior urethral diverticulum. Cystoscopic assessment also confirmed the diagnosis and demonstrated transillumination. He subsequently underwent surgical excision of the diverticulum and is doing well on follow-up.

Primary Urethral Tuberculosis With Urethrocutaneous Fistula in Association With Balanitis Xerotica Obliterans.

We present an unusual case of isolated urethral tuberculosis. The patient had a history of urethral strictures and persistent discharge from two peno-scrotal fistulas which was confirmed on urethrogram. He was treated with antitubercular treatment and a two stage urethroplasty.

Spontaneous Ureterocutaneous Fistula Secondary to Obstructed Ureteric Stone.

We present a unique case of ureterocutaneous fistula secondary to an obstructed ureteric stone. A fistulagram confirmed a communication between right flank and the proximal ureter. Ureterocutanoues fistula in the absence of trauma, iatrogenic causes, granulomatous infection, or malignancy is highly unusual.

Short-term Alteration of Renal Function and Electrolytes after Percutaneous Nephrolithotomy.

PURPOSE: To analyse the changes in renal function and serum electrolytes in the early post-operative period ofpercutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A total of 110 patients with normal renal function, who underwent PCNL in our institutewere evaluated prospectively. Haemoglobin percentage, packed cell volume, blood urea nitrogen, serum creatinineand serum electrolytes, namely sodium, potassium, chloride and ionized calcium were measured on the day beforesurgery and after 72 hours of the procedure. Renal function was assessed by Cockcroft-Gault formula and estimatedglomerular filtration rate was calculated by modification of diet in renal disease formula. RESULTS: Serum creatinine increased significantly from a mean value of 0.89 ± 0.199 mg/dL to 0.96 ± 0.252 mg/dL(P = 0.0002) and both creatinine clearance and estimated glomerular filtration rate experienced a significant fall -from a median value (interquartile ranges) of 82.99 (72.37 to 96.88) mL/min to 75.38 (63.89 to 94.05) mL/min incase of creatinine clearance (P = 0.0004) and from a mean value of 95.18 ± 19.87 mL/min/1.73 m2 to 89.30 ± 23.14mL/min/1.73 m2 in case of estimated glomerular filtration rate (P = 0.003). Furthermore, there were significantdrops in both haemoglobin percentage and packed cell volume. There were no significant alterations in serum electrolytes- sodium and potassium (mmol/L) [Median (IQR)] changed from a pre-operative figure of 137.5 (134.0 to140.0) and 3.85 (3.60 to 4.10) to a post-operative value of 138 (135.0 to 140.0) and 3.85 (3.50 to 4.10) respectively. CONCLUSION: Even though there is no significant variation in serum electrolytes, PCNL causes significant reductionin renal function in the early post-operative period.

Evaluation of stone-free rate using Guy's Stone Score and assessment of complications using modified Clavien grading system for percutaneous nephro-lithotomy.

To prospectively evaluate the ability of Guy's Stone Score (GSS) in predicting stone clearance rate and complication rate (by modified Clavien grade) for renal stones treated by percutaneous nephrolithotomy (PNL). From January 2013 to June 2014, a total of 142 patients undergoing PNL were evaluated prospectively. Patients with co-morbidities like hypertension, diabetes, renal failure were excluded from the study. All patients were classified according to GSS based on the findings of pre-operative intravenous urography (IVU) and per-operative retrograde pyelography (RGP). All PNL procedures were done by standard technique in prone position and success was defined as no residual stone visible on X-ray KUB done on the third postoperative day. Complications were classified according to modified Clavien grading system. The initial stone clearance rate was 71.1% and overall final stone clearance rate was 90.14%. The complication rate according to Clavien grading system was 40.1%. The final stone clearance rates were 93.9, 85.71, 90.47, and 77.77% in GSS I, II, III, and IV, respectively (p<0.001, <0.05, <0.05 and >0.05, respectively). The Clavien complication rates were 23, 61, 52, and 77.7% in GSS I, II, III, and IV, respectively (p<0.001). The GSS is a simple and easily reproducible system to preoperatively predict stone-free rate and perioperative complication rate. It helps in better patient counseling preoperatively.

Analysis of urinary stone composition in Eastern India by X-ray diffraction crystallography.

BACKGROUND: Stones in the urinary system are common in our country. This study was done to assess the composition of the urinary stones in eastern part of India. MATERIALS AND METHODS: A prospective study was done over a period of thirty months. A total of 90 stones were analyzed in this time period by using X-ray diffraction crystallography. RESULTS: Of the 90 stones analyzed, 77 were renal stones, 12 were ureteric stones and one was a bladder stone. Six stones (all renal) did not have properties to be represented by X-ray diffraction crystallography. The overall prevalence of the oxalate containing stones was 85.7% with calcium oxalate monohydrate (COM) being the major constituent. Calcium oxalate dihydrate (COD) was the next most common constituent. Struvite stones constituted 9.5% of the stones analyzed. Pure calcium phosphate stones were found in 4.7% of the cases. CONCLUSION: Our study reveals that the stone composition in the eastern part of India is different from that in other parts of the country. We have a comparatively lower prevalence of oxalate stones while a higher prevalence of phosphate and struvite stones.

Management of an iatrogenic injury in a crossed ectopic kidney without fusion.

Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision.

Transobturator taping for the treatment of incontinence after neobladder reconstruction.

Incontinence in the patients with neobladder is a distressing condition. Although conservative management may be helpful in some, a significant number of patients require some form of surgical intervention. Any surgical intervention, especially from the abdominal route can be significantly morbid in these patients because of extensive surgery done previously. There is a need for a technique that can take care of the postoperative incontinence without subjecting the patient to significant surgical risk. Artificial sphincters have been used in male patients but their use in female patients can be technically difficult. There are limited options available for women like transurethral bulking agents and pubovaginal slings. These procedures do not have very good results and female patients often end up with a cutaneous stoma. We, in this report, describe a female patient with incontinence after orthotopic neobladder reconstruction that could be successfully treated with transobturator taping.

Bilateral single ectopic ureters draining into a grossly dilated vagina in an adolescent female.

A 16-year-old female presented with dribbling of urine along with voluntary voiding since birth. Renal imaging revealed hydroureteronephrosis on the right side; the uterus and ovary were normal. A radionuclide scan showed a left nonfunctional kidney. On cystovaginoscopy, the urethra was shown to be normal and the urinary bladder was tubular with small capacity and an absent trigone. Although the vagina was capacious, no ureteric orifices were found. Computed tomography corroborated the diagnosis of bilateral, single ectopic ureters draining into a grossly dilated vagina. This case is unique because it is a bilateral single-system ureteral ectopia in a completely differentiated female genital tract that presented late in adolescence. To the best of our knowledge, this is the second such ureteral abnormality reported in the literature so far. The patient underwent ileocystoplasty with right ureteric reimplantation and nephroureterectomy for the left nonfunctional kidney, which histopathology showed to be tuberculosis. The patient is continent with cystometric capacity of more than 300 mL.

Occult mucin secreting adenocarcinoma of gall bladder with metastasis to urinary bladder.

Mucin secreting adenocarcinoma of the gall bladder is rare. Although it has propensity to metastasise, urinary metastasis is extremely unusual. We report a case with mucin secreting adenocarcinoma of the gall bladder with metastasis to the urinary bladder. To the best of our knowledge, this is the first case of its kind in the literature.

Successful management of urethro-ileal pouch fistula by cynoacrylate glue instillation.

Uro-enteric fistulae are difficult clinical conditions that have a significant bearing on the patient's quality of life. Surgical correction, though challenging, is the usual mode of treatment offered to these patients. We describe a case of urethro-ileal pouch fistula which could be managed successfully without surgery with the help of cynoacrylate glue instillation.

Isolated congenital urethrocutaneous fistula of the anterior urethra.

Isolated congenital urethrocutaneous fistula of the anterior urethra is an extremely rare anomaly in which, along with a normal urethra and meatus, a fistula is present. These cases usually present in the pediatric age group. To date, only one such case has been described in the adult population. We describe one such case in an adult and discuss the management of this uncommon anomaly.

Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate

INTRODUCTION AND OBJECTIVE: Transrectal ultrasound biopsy of prostate is a painful procedure. The introduction of the rectal probe is one of the major contributors to the pain associated with this procedure. Drugs that relax the anal sphincter should theoretically decrease this pain. This study was done to compare the efficacy and safety of two topical medications that relax the anal sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: 66 patients who were to undergo their first prostate biopsy were randomized to receive either 2 mL of 2% topical diltiazem or 2 mL of 0.2% topical nitroglycerine or placebo 20 minutes before prostate biopsy. All patients also received 15 mL of intrarectal lignocaine. A 10-point visual analogue score was used to record the pain immediately after the insertion of the probe, during biopsy and at the end of the procedure. RESULTS: The pain scores due to probe insertion, during biopsy and at the end of the procedure in patients who received topical diltiazem or nitroglycerine were significantly lower compared to the placebo group (p < 0.001). There were no significant differences in the pain scores between the patients receiving diltiazem compared to those receiving nitroglycerine. Higher incidence of headache and fall in blood pressure was noted in patients who received nitroglycerine compared to those receiving diltiazem. CONCLUSION:Topical diltiazem and nitroglycerine are equally effective in reducing the pain associated with transrectal prostatic biopsy. Diltiazem is safer compared to nitroglycerine.