Indian Journal of Urology
EDITORIAL
Year
: 2020  |  Volume : 36  |  Issue : 2  |  Page : 79--80

What is inside?


Anil Mandhani 
 Department of Urology and Kidney Transplant, Medanta the Medicity, Gurugram, Haryana, India

Correspondence Address:
Anil Mandhani
Department of Urology and Kidney Transplant, Medanta the Medicity, Gurugram, Haryana
India




How to cite this article:
Mandhani A. What is inside?.Indian J Urol 2020;36:79-80


How to cite this URL:
Mandhani A. What is inside?. Indian J Urol [serial online] 2020 [cited 2020 Jun 3 ];36:79-80
Available from: http://www.indianjurol.com/text.asp?2020/36/2/79/281965


Full Text

In the present issue of the Indian Journal of Urology, Bansal et al. in a randomized controlled trial on enhanced recovery after surgery (ERAS) versus conventional surgical care protocol in 54 open radical cystectomy in Indian patients, have shown that the ERAS protocol led to the faster bowel recovery.[1] However, it did not show any significant difference in the complications rate and length of hospital stay, which is unlike the findings in published literature from the West. Despite that, some of the measures in postoperative care of radical cystectomy patients should be incorporated in clinical practice, i.e. avoiding mechanical bowel preparation, early removal of nasogastric tube, sham feeding and early obligatory ambulation.

It is interesting to read results of long-term follow-up of patients with penile fracture.[2] Although, the initial management of fracture penis is well established, the long-term outcome in 20 men highlights the way we repair the gash in the tunica albuginea. Authors have reported 70% regain of sexual function in such patients at the mean of 4.6 months. Of those sexually active patients, 20% developed penile nodule and 10% had penile curvature not precluding sexual intercourse at the median follow-up of 36 months. None of the patients had Peyronie's disease. One important point, authors have highlighted is to avoid the use of prolene suture and bury the knots to reduce the incidence of nodule formation over the corpora.

I am taking the liberty to add my view point to Uroscan by Sharma G et al. on yet another modification of the nephrometry score, Simplified PADUA REnal nephrometry system to predict the complications in partial nephrectomy.[3] Unfortunately, such scores invariably fail to analyze “nontechnical skills for surgeons.” Such factors are communication, leadership issue, situation awareness, decision-making, preparedness in operating room, mood of the surgeon, and quality of assistance, etc., These factors do influence the surgical outcomes. Moreover, in the present context, surgical approach, i.e. open, laparoscopic or robot assisted in itself is an important determinant of the outcome. One surgeon can do a better job with laparoscopy than robot assistance for removing a tumor with the same score.

The choice of treatment for lower urinary tract symptoms (LUTS) in men with benign prostate enlargement (BPE) is guided by the International Prostate Symptom Score. In India, self-administered questionnaire is not a common practice, due to the complexity of the form and lack of comprehending it. The authors have modified the initial assessment of symptoms by doing a pictorial assessment based on authors' own modified version of the Visual Prostate Symptom Score.[4] This modified version was easy to administer took less time to fill and correlated well with the standard IPSS. Therefore, it could be incorporated in the initial assessment of patients of BPE with LUTS.

Finding the best treatment for stricture urethra still remains a holy grail for urologists. Sharma et al. have done a meta-analysis on the choice of graft among the available two grafts, i.e. buccal mucosa and penile skin for substitution urethroplasty.[5] They conclude that buccal mucosa gives 10% better success rate than the penile skin for substitution urethroplasty. However, the follow-up difference was significant, i.e. 14.6 months, which is a long enough time for stricture to recur. Although the authors did consider stricture etiology, follow-up duration, duration of procedure, stricture length, location, type of urethroplasty, etc., in analyzing their data, but unless an individual patient data are taken for the analysis, synthesis of evidence may not be robust. Another problem of such analysis is that success is not defined uniformly across the studies. Success of stricture surgery may consider one urethral dilatation or one urethrotomy to be part of it. Hence, the best graft as a substitute for urethroplasty is yet to be explored.

A thought provoking point has been raised by Malik et al. on an audit of 72 patients of postchemotherapy retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell tumors, wherein authors state that 75% reduction in tumor size can predict the presence of necrosis with 100% specificity.[6] Hence, should we avoid doing RPLND in a patient, who has 3 cm size mass, remaining from the initial size of 13 cm? This answer needs further studies in prospective setting, taking into account all other determinants. As of now National Comprehensive Cancer Network guidelines recommend RPLND for residual retroperitoneal nodes ≥1 cm.

And Finally, we present a useful review article by Wang et al. on how to improve donor pool in deceased donor kidney transplantation program.[7] This should stimulate us to involve more and more centers to start deceased donor transplant program and have a better understanding about improving the outcomes of the kidneys taken from expanded criteria donor pool.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

References

1Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, et al. Randomized controlled trial to compare outcomes with and without the enhanced recovery after urgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95-100.
2Sharma AP, Narain TA, Devana SK, Tyagi S, Parmar KM, Bora GS, et al. Clinical spectrum, diagnosis, and sexual dysfunction after repair of fracture penis: Is no news good news?. Indian J Urol 2020;36:117-22.
3Sharma G. Simplified PADUA REnal ephrometry system: A refitted PADUA score. Indian J Urol 2020;36:146-7.
4Sanman KN, Shetty R, Adapala RR, Patil S, Laxman Prabhu GL, Venugopal P. Can new, improvised Visual Prostate Symptom Score replace the International Prostate Symptom Score? Indian perspective. Indian J Urol 2020;36:123-9.
5Sharma G, Sharma S, Parmar K. Buccal ucosa or penile skin for substitution urethroplasty: A systematic review and meta-analysis. Indian J Urol 2020;36:81-8.
6Malik K, Raja A, Radhakrishnan V, Kathiresan N. A retrospective analysis of patients undergoing postchemotherapy retroperitoneal lymph node dissection and metastasectomy in advanced nonseminomatous germ cell tumors. Indian J Urol 2020:36:112-6.
7Wang Z, Durai P, Tiong HY. Expanded criteria donors in deceased donor kidney transplantation – An Asian perspective. Indian J Urol 2020;36:89-94.