Primitive neuroectodermal tumor of the penile urethra.

Primitive neuroectodermal tumor (PNET)/Ewing's sarcoma tumors are a group of highly malignant tumors composed of small, round cells showing neuroectodermal differentiation that commonly affects soft tissue and bone. PNET involving the genitourinary system is rare and PNET of the penile urethra is rarer still. It exhibits a highly aggressive biological behavior with poor prognosis. We report a case of a 27-year-old male presenting with penile swelling and difficulty in passing urine. Examination revealed a firm penile urethral mass. Pathological and immunohistochemical results of the specimen obtained from urethroscopic biopsy followed by total penectomy confirmed the diagnosis of PNET of the urethra. He received combination chemotherapy: ifosfamide and etoposide (IE) + vincristine, Adriamycin, and cyclophosphamide (VAC). In conclusion, PNET has to be considered in the differential diagnosis of a penile urethral mass in young patients.

Safety of uro-oncology practice and robot-assisted surgery during the peak of COVID-19 pandemic: A report from India.

Aim: The pandemic by novel coronavirus disease 2019 (COVID-19) is the biggest threat to global health care. Routine care of cancer patients is affected the most. Our institute, situated in Mumbai, declared as the hotspot of COVID-19 in India, continued to cater to the needs of cancer patients. We did an observational study to review the experience of managing uro-oncology patients and who underwent either open, endoscopic, or robot-assisted surgery for urological malignancy. Materials and Methods: During the peak of COVID-19 pandemic from March 21, 2020, to June 21, 2020, all the uro-oncology cases managed in our tertiary care hospital were analyzed. Teleconsultation was started for follow-up patients. All patients requiring surgery underwent reverse transcription-polymerase chain reaction for COVID-19. Institutional protocol was formulated based on existing international guidelines for patient management. Adequate personal protection and hydroxychloroquine prophylaxis were provided to health-care professionals. Results: During the study period, 417 outpatient consultations were made. Forty-nine patients underwent surgery for different urological malignancies. Majority of the surgeries were robot-assisted surgeries (59.2%, 29 patients), followed by endoscopic procedures (28.5%, 14 patients) and few open procedures (10.2%, five patients). Most of our patients were elderly males (mean, 62.5 years). With a median follow-up of 55 days (interquartile range, 32-77), there was no report of COVID-19 infection in any patient or health-care provider. Conclusions: We can continue treating needy cancer patients with minimal risk by taking all precautions. Our initial experience of managing uro-oncology cases during this pandemic is encouraging. Robotic surgeries can be safely performed.

Peri-operative, Functional, Quality of Life, and Oncological Outcomes After Robot-Assisted Radical Cystectomy and Intra-corporeal Orthotopic Ileal Neobladder-Our Experience.

Robot-assisted radical cystectomy (RARC) and intracorporeal orthotopic neobladder (OINB) is technically a challenging surgery due to the involvement of prolonged console time and higher level of surgical skills. Therefore, standardizing technique and testament of good functional and oncological outcomes is required to increase its acceptance among surgeons. We report our experience of RARC with OINB and analyze the perioperative, functional, quality of life, and survival outcomes. Single surgeon experience of over 22 OINB after RARC is done, which includes 21 male and one female patients, was done retrospectively. Modified Karolinska Studer technique of neobladder creation was followed. Intraoperative findings, post-operative complications, and follow-up information were recorded for analysis. The patients' median age was 50.5 years (IQR, 41.25-55.50), and the median follow-up period was 45.5 months (IQR, 26.75-68). Median console time was 447.5 min (IQR, 347.5-500), blood loss was 225 ml (IQR, 200-250), and hospital stay was 12 days (IQR, 11-15). Most of the complications were Clavien-Dindo grades I and II. Longer surgery time and more complications were noted in the first 10 cases compared to the next 12 cases. Day and night-time urinary continence is 95% and 77% at 12 months, respectively. Two patients died of disease, and overall survival at 5 years was 84%. Our experience supports OINB as a feasible option after RCIC with acceptable complications, good functional and survival outcomes, with better quality of life. With experience, surgical morbidity and operative time decrease. This surgery should be undertaken after gaining experience with an intracorporeal ileal conduit and has a steep learning curve.

Carcinoma penis: How late can inguinal nodal metastases occur?

Inguinal nodal metastasis is the single most important prognostic factor for survival in a patient with carcinoma penis. In patients without inguinal lymph nodal metastasis at presentation, options include close surveillance or prophylactic inguinal lymph nodal dissection. The majority of patients on surveillance who develop inguinal nodal metastases do so within two to three years of treatment of the primary. Here we report a case who developed inguinal nodal metastasis 10 years after the treatment of primary. This raises questions about the natural history and biology of the disease, the optimum surveillance and whether a patient of carcinoma penis can ever be considered risk-free for metastasis.

Organ Preservation Surgery for Carcinoma Penis.

Carcinoma of the penis is not uncommon in India. A sizeable number of patients do not report to the doctors in fear of mutilation to the organ and hence subsequently end up with advanced disease. Many patients with T1 or T2 disease when carefully selected are amenable to organ-preserving penile procedures including surgery, topical therapy, laser, and radiation therapy. Identification of appropriate patients and institution of these treatments has been noted to produce oncologically comparable results to extirpative surgeries. In this article, we review the criteria to identify patients qualifying for organ-preserving treatments and also review outcomes with a variety of penile-preserving procedures.

Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis.

BACKGROUND: The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns. AIMS: This study compares practice patterns in utilization of PLND between Indian and United States (US) practices. SETTINGS AND DESIGN: We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database. SUBJECTS AND METHODS: Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk. RESULTS: Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends. CONCLUSIONS: Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.

Genitourinary cancers: Summary of Indian data.

Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice. The associated morbidity and mortality and the significant proportion of affected middle-age individuals have a major bearing on the death-adjusted life years compared to other malignancies. Genitourinary system tumors encompass a very broad spectrum with regard to age, location, histology, and clinical outcomes. Advances in diagnostic imaging, surgical techniques, radiotherapy equipment, and generation of newer chemotherapeutic and targeted agents over the past few years have helped improving treatment outcome. Several focused groups within India have been working on a range of topics related to genitourinary system tumors, and a significant body of work from India in the recent years is being increasingly recognized throughout the world. The present article summarizes the key published work related to the epidemiology of genitourinary system tumors in the Indian setting. A PubMed search was made for locating and selecting articles relevant to the topic.

Current update of management of clinical stage I non seminomatous germ cell tumors of testis.

The management of patients with testicular germ cell tumors (GCT) has evolved significantly over the past 30 years with cure rates approaching nearly 100% for low-stage disease and more than 80% for advanced disease. Controversy surrounds about ideal management of clinical stage I non seminomatous germ cell tumors (CS I NSGCT) of the testis due to multiple treatment options available with more or less equal efficacy. Nerve-sparing retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy with two cycles of bleomycin, etoposide, and cisplatin , or surveillance have all achieved long-term survival in nearly 100% of patients with clinical stage I NSGCT. Retroperitoneal lymph node dissection is still favoured as the therapy of choice for clinical stage I non-seminomatous germ cell tumors in many centres, but as risk factors for the primary tumor have become better understood, surveillance and risk-adapted therapy, including surveillance for low-risk patients and adjuvant chemotherapy for the high-risk group, is now being considered a therapeutic option. The objective of this study is to review current developments in the management of CS I NSGCT testis with emphasis on risk stratification and treatment recommendations.