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REVIEW ARTICLES
TURP syndrome - current concepts in the pathophysiology and management
H Krishna Moorthy, Shoba Philip
January-June 2001, 17(2):97-102
Trans Urethral Resection of Prostate (TURP) syndrome is one of the commonest and dreaded complications of urological endoscopic surgery. Even in the best of hands, the incidence of TURP syndrome is up to 20% and car­ries a significant mortality rate. This paper highlights the various pathophysiological mechanisms of TURP syndrome, steps to prevent/delay the onset of manifesta­tions and the treatment of established TURP syndrome.
  88,818 0 -
CASE REPORTS
Successful microsurgical penile replantation following self amputation in a schizophrenic patient
Saurabh Gyan, Sagar Sushma, Singhal Maneesh, Sagar Rajesh, MC Misra
July-September 2010, 26(3):434-437
DOI:10.4103/0970-1591.70589  PMID:21116370
Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common etiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis in an acute paranoid schizophrenic patient .The penis was successfully reattached using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.
  73,321 104 10
EVIDENCE BASED UROLOGY
Ureteroscopic lithotripsy - skip the stent and spare the patient
S Kumar
July-December 2005, 21(2):116-117
DOI:10.4103/0970-1591.19634  
  38,705 355 -
SYMPOSIUM
Traditional Asian folklore medicines in sexual health
Peter Lim Huat Chye
July-September 2006, 22(3):241-245
DOI:10.4103/0970-1591.27632  
Erectile dysfunction is one of the important health problems affecting man and his partner. Recently, many treatments have evolved for the treatment of erectile dysfunction or sexual health. Of the available treatments several are pharmacologically proven and tested medications. However, in Asia, there are significant users of unproven medications for sexual health. These medications are traditionally used by the folklore living in the countryside. These untested medications may have a profound effect on the body system and their interactions with other medications may be harmful. However, comprehensive accounts of such medications are unavailable. This paper descriptively highlights the common medications used for sexual health in Asia.
  31,006 861 7
REVIEW ARTICLE
Surgery for vaginal hydroceles: an update
N Ananthakrishnan, SP Pani
January-June 2005, 21(1):35-38
DOI:10.4103/0970-1591.19549  
In men, vaginal hydrocele is the most common morbidity due to Wuchereria bancrofti . Diagnosis is straightforward most of the time but when the swelling is not transilluminant, patients in whom the diagnosis is in doubt, children with hydroceles and those with co-morbid conditions should have ultrasonography to differentiate these swellings. Studies on the effect of medical treatment with diethylcarbamazine on the size of hydroceles are inconclusive. The only effective treatment for hydrocele is surgery as the minimally invasive therapy like aspiration and sclerotherapy are known to have high recurrence rates. Several surgical options are available for managing hydrocele but the recommended operation is hydrocelectomy, i.e. a subtotal excision of the parietal layer of the tunica vaginalis leaving a rim of approximately one-centimeter width around the testis and epididymis.
  28,842 508 -
ORIGINAL ARTICLES
Preputial reconstruction and tubularized incised plate urethroplasty in proximal hypospadias with ventral penile curvature
Amilal Bhat, Ajay Gandhi, Gajendra Saxena, Gautam Ram Choudhary
October-December 2010, 26(4):507-510
DOI:10.4103/0970-1591.74442  PMID:21369381
Aims : Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature. Materials and Methods : Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plication was added according to the severity of curvature. Feasibility of preputial reconstruction was assessed by applying 3 stay sutures-the first to fix the skin at the corona, the second at the junction of the inner and outer preputial skin for pulling up the skin over the glans, and the third stay on penile skin at the level of the corona for retracting the skin. Preputial reconstruction consisted of a standard 3 layered re-approximation of the margins of the dorsal hood. Results : Age of the patients varied from 10 months to 21 years with an average of 6 years and 4 months. Ventral curvature (mild 10, moderate 13, and severe 4 cases) was corrected by the mobilization of the urethral plate and spongiosum in 14 patients, 11 cases had mobilization of the proximal urethra in addition and 2 patients required single stitch dorsal plication with the above-mentioned steps. Two patients developed urethral fistula and 1 had preputial dehiscence. Conclusions : Preputioplasty with TIP is feasible in proximal hypospadias with curvature without increasing the complication rate. Postoperative phimosis can be prevented by on-table testing of the adequacy of preputial skin by 3 stay sutures.
  28,462 133 3
SYMPOSIUM
Peyronie's disease and erectile dysfunction: Current understanding and future direction
Laurence A Levine
July-September 2006, 22(3):246-250
DOI:10.4103/0970-1591.27633  
Peyronie's disease is a physically and psychologically devastating disorder affecting close to 10% of adult men. It is currently believed to be a form of wound healing disorder where there is excessive scar formation in response to a triggering process, most commonly following trauma to the erect penis. In this circumstance, the plaque which is an inelastic scar of the tunica albuginea develops which causes a variety of penile deformities including curvature, indentation, loss of girth and shortening. Frequently pain will accompany erection or direct palpation of the plaque in the early, active phase of this disease, but pain does tend to resolve over time but the deformities tend to remain. In up to 90% of patients there is associated diminished erectile capacity. Fifty percent of the time, men note evidence of erectile dysfunction prior to developing the Peyronie's disease. A variety of factors may contribute to erectile dysfunction in this patient population. Most commonly there is an underlying vascular insufficiency, which may be due to the same processes that result in accelerated atherosclerosis including diabetes, hypertension, smoking, and dyslipidemia. There may also be a substantial psychogenic effect, as we know that the majority of men with Peyronie's disease are significantly psychologically distressed by the changes to their penis. Lastly, there has been some suggestion that the abnormal geometry of the penis may contribute to a reduction of intracavernosal pressure resulting in diminished rigidity. This article briefly reviews what is currently understood about the etiology and presentation of the patient with Peyronie's disease and tries to clarify several of the widely held misconceptions. In addition, there are recommendations for evaluation and a more detailed discussion of the erectile dysfunction associated with Peyronie's disease, as well as appropriate treatment options.
  26,731 362 1
REVIEW ARTICLE
Medical treatment of filariasis and chyluria
MS Ansari
January-June 2005, 21(1):24-26
DOI:10.4103/0970-1591.19546  
The medical treatment of filariasis and chyluria is based on dietary modification, i.e. a diet excluding fat, supplemented by medium chain triglycerides (MCT) and high protein content. Drug therapy include administration of antifilarial drugs like diethylcarbamizine (DEC), ivermectin and albendazole. Annual mass drug administration of DEC combined with albendazole is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in endemic areas. DEC-medicated salt has been effectively used in various filarial endemic countries and as well as in certain parts of India. Vector control is a useful means in addition to chemotherapy in control of lymphatic filariasis.
  26,437 645 1
SYMPOSIUM
The potential advantages of transplanting organs from pig to man: A transplant Surgeon's view
Carl G Groth
July-September 2007, 23(3):305-310
DOI:10.4103/0970-1591.33729  PMID:19718335
Once pig organs can be transplanted into humans, transplantation will move into a new era. There will be unlimited access to undamaged organs and cells for transplantation and, eventually, donation from deceased or live human beings will become obsolete. Furthermore, it will be possible to alleviate graft rejection, at least in part, by genetic modification of the source animal. Currently, there are three major obstacles to performing transplantations from pig to man: 1) a powerful immune barrier, 2) a potential risk of transmitting microorganisms, particularly endogenous retrovirus and 3) ethical issues related to the future recipients and to society at large. This article will first discuss ongoing work with regards to overcoming the current obstacles. Then, the many potential advantages of using pig organs will be listed. Next, the criteria for selecting the first patients for transplantation with pig organs, will be briefly discussed. Finally, some promising observations made in the context of early attempts at transplanting porcine cells to patients, will be mentioned.
  24,511 240 -
REVIEW ARTICLE
Premature ejaculation
Chris G McMahon
April-June 2007, 23(2):97-108
DOI:10.4103/0970-1591.32056  PMID:19675782
Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects.
  22,755 1,234 5
Pathophysiology of pelvic organ prolapse and stress urinary incontinence
Payal D Patel, Kaytan V Amrute, Gopal H Badlani
October-December 2006, 22(4):310-316
DOI:10.4103/0970-1591.29113  
Although they may present with significant morbidity, pelvic organ prolapse and stress urinary incontinence are mainly afflicitions that affect quality of life. To appropiately treat these entities, comprehension of the various theories of pathophysiology is paramount. Utilizing a Medline search, this article reviews recent data concerning intrinsic (i.e., genetics, postmenopausal status) and extrinsic factors (i.e., previous hysterectomy, childbirth) leading to organ prolapse or stress incontinence
  21,545 532 3
SYMPOSIUM
Functional penile reconstruction: What do we have as on today?
Hussein Ghanem, Rany Shamloul
July-September 2006, 22(3):255-259
DOI:10.4103/0970-1591.27635  
Penile reconstructive surgeries are performed mainly as radical treatment for conditions associated with congenital abnormalities of the urethra or penis, after penile trauma, penile cancer, short penis, corporal fibrosis and in cases of gender reassignment. In this article, we review the controversial penile augmentation topic, clarifying how most workers disagree with its scientific basis. We also highlight recent advances in surgical techniques in treatment of penile injuries and those employed for female-to-male sex reassignment procedures. We also propose a practical approach for evaluating and counseling patients complaining of a small sized penis.
  21,372 423 -
REVIEW ARTICLES
Chyluria - a clinical and diagnostic stepladder algorithm with review of literature
Igbal Singh, P Dargan, N Sharma
January-June 2004, 20(2):79-85
Objectives: Chyluria is an infrequently discussed urological problem and a rare urological manifestation of filariasis. Apart from few isolated case reports the lit­erature regarding the etiology, diagnostic approach and management of chyluria is grossly inadequate. We un­dertook the present study to review chyluria in its entirety so as to have a broader insight in to its etiopathogenesis and to suggest the clinician with a proposed stepladder protocol approach (algorithm) towards its management. Methods: We made a detailed systematic data search for the period covering the last 37 years on the "Pubmed" for published English literature using the key words 'chy­luria', `milky urine' and 'hematochyluria'. The signifi­cant findings and recent advances on chyluria were reviewed. Results: About 250 articles were found; these were analyzed, tabulated and reviewed for their clinical ap­proach and management of chyluria. Conclusions: Though generally a harmless condition in a majority, chyluria should not be ignored, instead all cases must be aggressively investigated to arrive at a cause. These should then be managed on the lines similar to as proposed in our 10-stepladder protocol.
  21,660 0 -
SYMPOSIUM
Complications of grafts used in female pelvic floor reconstruction: Mesh erosion and extrusion
Tanya M Nazemi, Kathleen C Kobashi
April-June 2007, 23(2):153-160
DOI:10.4103/0970-1591.32067  PMID:19675793
Introduction: Various grafts have been used in the treatment of urinary incontinence and pelvic prolapse. Autologous materials such as muscle and fascia were first utilized to provide additional anatomic support to the periurethral and pelvic tissues; however, attempts to minimize the invasiveness of the procedures have led to the use of synthetic materials. Complications such as infection and erosion or extrusion associated with these materials may be troublesome to manage. We review the literature and describe a brief overview of grafts used in pelvic floor reconstruction and focus on the management complications specifically related to synthetic materials. Materials and Methods: We performed a comprehensive review of the literature on grafts used in pelvic floor surgery using MEDLINE and resources cited in those peer-reviewed manuscripts. The results are presented. Results: Biologic materials provide adequate cure rates but have associated downfalls including potential complications from harvesting, variable tissue quality and cost. The use of synthetic materials as an alternative graft in pelvic floor repairs has become a popular option. Of all synthetic materials, the type I macroporous polypropylene meshes have demonstrated superiority in terms of efficacy and fewer complication rates due to their structure and composition. Erosion and extrusion of mesh are common and troublesome complications that may be managed conservatively with observation with or without local hormone therapy, with transvaginal debridement or with surgical exploration and total mesh excision, dependent upon the location of the mesh and the mesh type utilized. Conclusions: The ideal graft would provide structural integrity and durability with minimal adverse reaction by the host tissue. Biologic materials in general tend to have fewer associated complications, however, the risks of harvesting, variable integrity of allografts, availability and high cost has led to the development and use of synthetic grafts. Synthetic grafts have a tendency to cause higher rates of erosion and extrusion; however, these complications can be managed successfully.
  20,929 603 7
ORIGINAL ARTICLES
Penile growth in response to hormone treatment in children with micropenis
Rajendra B Nerli, Ajay Kumar Guntaka, Pravin B Patne, Murigendra B Hiremath
October-December 2013, 29(4):288-291
DOI:10.4103/0970-1591.120107  PMID:24235789
Introduction: Micropenis is defined as a stretched penile length 2.5 standard deviations less than the mean for age without the presence of any other penile anomalies, such as hypospadias. The term refers to a specific disorder that has a known set of causative factors and defined treatment modalities. The purpose of this study was to determine the effect of hormonal therapy on the gonadal response and penile growth in children who presented with micropenis. Materials and Methods: Children (<18 years) who met the criteria for micropenis were included in this study. Children more than 11 years old were treated using a standard protocol of 1,500 to 2,000 IU human chorionic gonadotrophin administrated intramuscularly, once per week, for 6 weeks. Children less than 11 years old were treated with parenteral testosterone enanthate 25 mg once a month for 3 months. Response was evaluated in terms of change in testosterone levels and size of penis. Results: Serum testosterone levels at baseline and after 8 weeks of hormonal treatment were <20 and 449.4 ng/mL, respectively (P < 0.0001) in all children more than 11 years old. Stretched penile length after hormonal treatment increased from 15.54 to 37.18 mm in children less than 11 years old and from 26.42 to 64.28 mm in children more than 11 years old (P < 0.001). Conclusions: Management of isolated micropenis revolves around testosterone (direct administration or encouraging the patient's body to make its own), and results with respect to increase in penile length are promising.
  21,190 117 1
ORIGINAL ARTICLE
A comparative study of fixed dose of Tamsulosin with finasteride vs Tamsulosin with dutasteride in the management of benign prostatic hyperplasia
NK Mohanty, Uday Pratap Singh, Nitin K Sharma, RP Arora, Vindu Amitabh
April-June 2006, 22(2):130-134
DOI:10.4103/0970-1591.26567  
OBJECTIVE: The aim of this study was to compare the efficacy, safety and tolerability of Dutasteride vs Finasteride in a fixed dose combination, with a uro-selective a-blocker Tamsulosin, in the management of symptomatic BPH associated with LUTS. MATERIALS AND METHODS: 105 males between 40-80 years, clinically diagnosed as Benign prostatic hyperplasia (BPH) having a baseline evaluation of their IPSS, UFR, PSA, LFT, KFT, sex health, ultrasound of prostate and PVUV, were randomized to receive a fixed dose combination therapy of Tamsulosin (0.4 mg) with Finasteride (5 mg), vs Tamsulosin (0.4 mg) with Dutasteride (0.5 mg), daily for six consecutive months. Follow- up at the end of the 2nd, 4th, 8th, 12th and 24th week was done with IPSS, UFR, PSA, ultrasound of Prostate, PVUV and sex health. RESULTS: There were five dropouts, three from the Finasteride arm and two from Dutasteride arm, leaving a total of 100 patients for the final evaluation. Patients in both the groups showed improvement in their symptoms score and urine flow rate from the baseline, but those with the Dutasteride combination not only showed much better improvement in their symptoms score and urine flow, but were also relieved of their obstructive symptoms earlier (10-14 days) than seen in the Finasteride group (24-35 days). None of the patients had acute retention of urine (AUR) during the trial. The post void urine volume was decreased more in the Dutasteride group, than in patients with Finasteride. Sexual dysfunction incidence was same in both the groups. Approximately 50% reduction in the PSA level was seen in both the groups, while LFT did not show significant difference from the baseline, in either group. Both the drugs were well tolerated, with the patient's good compliance and with no drop-out due to adverse effects. CONCLUSION : A combination of a-adrenergic blocker and 5-ARI is the best therapeutic option for medical management of BPH as it is safe, effective and well tolerated. A combination of Tamsulosin with Dutasteride results in early symptomatic relief and low PVUV, than seen with the Tamsulosin with Finasteride combination.
  20,441 601 -
REVIEW ARTICLES
Prevention and treatment of urinary tract infection with probiotics: Review and research perspective
D Borchert, L Sheridan, A Papatsoris, Z Faruquz, JM Barua, I Junaid, Y Pati, F Chinegwundoh, N Buchholz
April-June 2008, 24(2):139-144
DOI:10.4103/0970-1591.40604  PMID:19468386
The spiralling costs of antibiotic therapy, the appearance of multiresistant bacteria and more importantly for patients and clinicians, unsatisfactory therapeutic options in recurrent urinary tract infection (RUTI) calls for alternative and advanced medical solutions. So far no sufficient means to successfully prevent painful and disabling RUTI has been found. Even though long-term oral antibiotic treatment has been used with some success as a therapeutic option, this is no longer secure due to the development of bacterial resistance. One promising alternative is the use of live microorganisms (probiotics) to prevent and treat recurrent complicated and uncomplicated urinary tract infection (UTI). The human normal bacterial flora is increasingly recognised as an important defence to infection. Since the advent of antibiotic treatment five decades ago, a linear relation between antibiotic use and reduction in pathogenic bacteria has become established as medical conventional wisdom. But with the use of antibiotics the beneficial bacterial flora hosted by the human body is destroyed and pathogenic bacteria are selectively enabled to overgrow internal and external surfaces. The benign bacterial flora is crucial for body function and oervgrowth with pathogenic microorganisms leads to illness. Thus the concept of supporting the human body's normal flora with live microorganisms conferring a beneficial health effect is an important medical strategy.
  19,810 1,066 8
SYMPOSIUM
Semen analysis and sperm function tests: How much to test?
SS Vasan
January-March 2011, 27(1):41-48
DOI:10.4103/0970-1591.78424  PMID:21716889
Semen analysis as an integral part of infertility investigations is taken as a surrogate measure for male fecundity in clinical andrology, male fertility, and pregnancy risk assessments. Clearly, laboratory seminology is still very much in its infancy. In as much as the creation of a conventional semen profile will always represent the foundations of male fertility evaluation, the 5th edition of the World Health Organization (WHO) manual is a definitive statement on how such assessments should be carried out and how the quality should be controlled. A major advance in this new edition of the WHO manual, resolving the most salient critique of previous editions, is the development of the first well-defined reference ranges for semen analysis based on the analysis of over 1900 recent fathers. The methodology used in the assessment of the usual variables in semen analysis is described, as are many of the less common, but very valuable, sperm function tests. Sperm function testing is used to determine if the sperm have the biologic capacity to perform the tasks necessary to reach and fertilize ova and ultimately result in live births. A variety of tests are available to evaluate different aspects of these functions. To accurately use these functional assays, the clinician must understand what the tests measure, what the indications are for the assays, and how to interpret the results to direct further testing or patient management.
  19,325 480 1
CASE REPORTS
Thrombosis of the dorsal vein of the penis (Mondor's Disease): A case report and review of the literature
Syed Sajjad Nazir, Muneer Khan
July-September 2010, 26(3):431-433
DOI:10.4103/0970-1591.70588  PMID:21116369
Superficial thrombophlebitis of the dorsal vein of the penis (penile Mondor's Disease) is an important clinical diagnosis that every family practitioner should be able to recognize. Dorsal vein thrombosis is a rare disease with pain and induration of the dorsal part of the penis. The possible causes comprise traumatism, neoplasms, excessive sexual activity, or abstinence. The differential diagnosis must be established with Sclerotizing lymphangitis and peyronies disease and doppler ultrasound is the imaging diagnostic technique of choice. Proper diagnosis and consequent reassurance can help to dissipate the anxiety typically experienced by the patients with this disease. We describe the symptoms, diagnosis, and treatment of the superficial thrombophlebitis of the dorsal vein of the penis.
  19,488 66 3
ORIGINAL ARTICLE
Does estimation of prostate volume by abdominal ultrasonography vary with bladder volume: A prospective study with transrectal ultrasonography as a reference
Shivadeo S Bapat, Satyajeet S Purnapatre, Ketan V Pai, Pushkaraj Yadav, Abhijit Padhye, YG Bodhe
October-December 2006, 22(4):322-325
DOI:10.4103/0970-1591.29114  
Objectives: Ultrasonography (USG) is the commonest modality for ascertaining prostate volume. Urologists commonly encounter a discrepancy between prostate volume on USG and actual volume of prostate, whereas transrectal ultrasonography (TRUS) gives near correct prostate volume. We undertook a prospective study to compare the relationship between changing bladder volumes to the volume of prostate. Materials and Methods: After approval of the Institutional Ethics Committee and informed consent, 25 patients (age group: 52-78 years) with lower urinary tract symptoms were assessed for prostate volume by USG at different bladder volumes and final comparison was done with TRUS in one setting. Each USG and TRUS was done by one urology resident under the guidance of one qualified radiologist with experience of over 15 years in this field. Equipment used was SIEMENS SONNOLINE ADARA with 3.5 MHz probe for USG and 7.5 MHz Endo p-2 (biplaner) probe for TRUS. First, patients were asked to empty their bladder and post void residual urine was measured along with prostate volume. Patients were given oral fluids and USG was repeated serially at three intervals with bladder volume of 100-200 ml, 200-300 ml and > 300 ml. Finally uroflowmetry was carried out followed by TRUS. Results were recorded in a tabulated form on 'Excel spread sheet'. Results: 1. Measurement of prostate volume increases with increase in bladder volume. 2. Calculated prostate volume at minimal bladder capacity (100-200 ml) was found to be the closest to the volume calculated by TRUS. Conclusion: Minimal bladder volume (100-200 ml) is essential for near correct estimation of prostate volume by USG. With increasing bladder volume, the volume of prostate increases disproportionate to its actual volume.
  18,635 265 1
CASE REPORT
A costly sting! Preputial gangrene following a wasp sting
Vishwanath S Hanchanale, Amrith R Rao, Hanif G Motiwala
October-December 2006, 22(4):370-371
DOI:10.4103/0970-1591.29129  
Penile injuries due to bites and stings are under-reported. The extent of injury depends not only on the initial trauma but also on the secondary injuries due to toxins and bacterial infections transmitted by the bite. Wasp bites are on the increase worldwide as humans encroach on their habitat. We report a case of wasp bite to the preputial skin of the penis leading to severe phimosis, difficulty in micturition and localized gangrene requiring emergency circumcision. Analysis of such cases can provide important information on the determinants of severe morbidity that may then be used in injury prevention.
  18,275 198 -
REVIEW ARTICLE
Epidemiology of lymphatic filariasis with special reference to urogenital-manifestations
SP Pani, V Kumaraswami, LK Das
January-June 2005, 21(1):44-49
DOI:10.4103/0970-1591.19551  
Lymphatic filariasis (LF) is currently endemic in as many as 80 countries round the globe, particularly in the tropics and sub-tropics. Wuchereria bancrofti as a causative organism accounts for over 90% of the global burden. India contributes about 40% of the total global burden and accounts for about 50% of the people at the risk of infection. In India, states like Andhra Pradesh, Bihar, Gujarat, Kerala, Maharastra, Orissa, Tamil Nadu, Utter Pradesh and West Bengal contribute to about 95% of total burden. W. bancrofti is the predominant species accounting for about 98% of the national burden, widely distributed in 17 states and six union territories. Diethylcarbamazine (DEC) is an effective drug acting on the parasite (without report of resistance in past five decades) and mass annual single dose community drug administration with selective vector control could result in effective elimination of infection by interruption of transmission. The WHO has called for targeting filariasis elimination by 2020. India is the largest LF endemic country and has targeted the elimination of LF by 2015.
  17,496 536 2
Varicocele and the urologist
Rajeev Kumar, Narmada P Gupta
April-June 2006, 22(2):98-104
DOI:10.4103/0970-1591.26561  
Varicoceles are variably considered the commonest 'correctable' cause of male infertility or the commonest 'over-reported' cause of infertility, depending on the individual viewpoint. This dichotomy has resulted from a lack of clear understanding of the effect of varicoceles on spermatogenesis and an absence of well-designed trials to evaluate the outcomes. This is coupled with surgery in unclear indications and sometimes by surgeons with limited surgical skills who assume that the surgery can cause no harm. A recent debate on 'Are we overdoing varicocelectomies' that was initiated by the Urological Society of India at its annual meeting in 2006 prompted us to review the recent developments in the fields of pathogenesis and surgical technique and the issue of 'overdoing' varicocelectomies. A review of recent literature on the subject was performed. There is an increasing body of evidence pointing towards the role of reactive oxygen species (ROS) and oxidative stress in the pathogenesis of varicocele related subfertility. This has been found in studies evaluating both direct and indirect markers of oxidative stress. Apoptosis and DNA fragmentation may be the end effectors of ROS induced damage. Other proposed etiologic factors are tissue hypoxia and hormonal imbalances. Among the various therapeutic options for varicoceles, microsurgical ligation has the best results with minimal complications. Loupe magnification may be an acceptable alternative in case of non availability of expertise with microsurgery or the microscope itself. The anatomical reasons for this and the studies on which this conclusion is based are reviewed. Finally, we discuss the problem of too many varicocele surgeries and its possible demerits. We also review the current guidelines and the need for proper case selection before surgery.
  16,694 401 1
SYMPOSIUM
Medical negligence liability under the consumer protection act: A review of judicial perspective
SV Joga Rao
July-September 2009, 25(3):361-371
DOI:10.4103/0970-1591.56205  PMID:19881133
It is important to know what constitutes medical negligence. A doctor owes certain duties to the patient who consults him for illness. A deficiency in this duty results in negligence. A basic knowledge of how medical negligence is adjudicated in the various judicial courts of India will help a doctor to practice his profession without undue worry about facing litigation for alleged medical negligence.
  16,430 512 1
Acute postoperative complications of hypospadias repair
Amilal Bhat, Arup Kumar Mandal
April-June 2008, 24(2):241-248
DOI:10.4103/0970-1591.40622  PMID:19468404
Purpose: Complications in hypospadias surgery are higher than other reconstructive procedures. The incidence of complications can be reduced if proper preventive measures are taken. The review aims to highlight incidences, causes, and preventive measures of acute complications of hypospadias repair. Materials and Methods: Literature reports were reviewed in Pubmed by giving the key word acute complications of hypospadias repair, wound infection, wound dehiscence, flap necrosis, edema, penile torsion, urethral fistula, bleeding and hematoma and urethral stents problems. Summaries of all articles were reviewed with full text of relevant article and results were analyzed. Results: Besides mentioning the complications of hypospadias repair in individual articles on the subject, we did not come across any separate article on this subject in the published English literature. Fistula is the commonest complication followed by edema and penile torsion. Conclusions: Most acute complications can be prevented with adherence to principles of plastic and microsurgery, meticulous preoperative planning, and judicious postoperative care. Deviation from these principles may lead to disaster and even failure of the repair. The aim in hypospadias surgery should be following these principles and bring down the complication rates <5% in distal hypospadias and <10% in proximal hypospadias.
  16,207 729 10
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