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   2003| January-June  | Volume 19 | Issue 2  
    Online since November 28, 2007

 
 
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CASE REPORTS
Rhinosporidiosis in male urethra
Dilip Kumar Pal, Biswanath Mukherjee, Ganesh Chandra Hati, Monoj Kumar Chowdhry
January-June 2003, 19(2):162-163
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RESEARCH ARTICLES
Buccal mucosal dorsal substitution urethroplasty in recurrent anterior urethral stricture
Shailesh A Shah, Prakash Ranka, Rajesh Choudhary, Manish Dhawan, Manish Vishnagara
January-June 2003, 19(2):152-156
Objective: To evaluate the durability of dorsal free graft aurethroplasty using buccal mucosa in adult recurrent bul­bar and pendulous urethral strictures. Patients and Methods: We treated 40 patients with re­current bulbar and penile urethral strictures during a pe­riod of 4 years. Mean age was 40 years. All patients underwent single stage urethral reconstruction using non­tubularized dorsal onlay buccal mucosa graft. The length of stricture dealt with was in the range of 2.5 cm to 12 cm. Follow-up was done at 3 weeks, 3 months, 6 months and then yearhv by uroflowmetry and if required by retrograde urethrogram. Results: Outcome was favourable in 38 patients (95%). 1 patient (2.5%) required VIU. I patient (2.5%) died due to pulmonary embolism in immediate postoperative pe­riod. Conclusions: Buccal mucosa is easy to harvest. It has thin and well- vascularized lamina propria with efficient imbibitions. Free graft placed dorsally over the tunica gains the mechanical support of the corpora and obviates urethrocele or diverticula formation. The technique offers the advantages of a fixed well-vascu larized surface with improved graft neo-vasculari-ation, reduced graft shrink­age, and optimum durability of graft.
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Role of fine needle aspiration cytology (FNAC) of testes in male infertility
Abraham Kurien, Kim Mammen, Sunitha Jacob
January-June 2003, 19(2):140-144
Fine needle aspiration of the testis, which is minimally traumatic, has questioned the need of a more invasive open biopsy in the evaluation of male infertility. This study aims to evaluate the efficacy of fine needle aspiration cytology (FNAC) as compared to open testicular biopsy in the evalu­ation of male infertility by correlating diagnoses from tes­tis FNA cytology with biopsy histology. We have also studied the necessity of bilateral or unilateral FNACs in the workup of the infertile man. This study was a prospec­tive study of 57 infertile men in whom bilateral testicular fine needle aspiration as well as testicular biopsy was done. The correlation between the 2 methods was 91.9%. Dis­crepancies between cytology and histology were mainly the result of insufficient smears. These data also suggest that bilateral FNACs and biopsies can be restricted to patients in whom there is appreciable difference in tes­ticular size or consistency.
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Total PSA and free PSA in patients with severe liver dysfunction
Rama Devi Mittal, Mahendra Kumar Singh, Charles Selvaraju, Gourdas Choudhuri
January-June 2003, 19(2):117-119
Objectives: To evaluate the effect of liver diseases in patients, on serum free prostate specific antigen (JPSA) levels, total prostate specific antigen (tPSA) levels and fPSA/tPSA ratios. Methods: Serum concentrations of total and free as well as JPSA/tPSA were determined in 20 men with histologi­cally confirmed liver cirrhosis, 15 men with chronic hepa­titis and 20 healthy men. Results: The serum levels of total PSA in liver cirrhosis as well as in chronic hepatitis were significantly lower than those observed in control. Free PSA remained unchanged. Conclusions: Our study suggests that despite severe liver dysfunction the tPSA, fPSA as well as the ratio of fPSA/ tPSA were not elevated as it was hypothesized that liver impairment might affect the PSA levels, as liver is a site for PSA metabolism.
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Effect of urinary retention on the levels of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) in prostatic disease
R Chawla, Rebecca Abraham, U Arora, Kim Mammen
January-June 2003, 19(2):120-124
In recent years, prostate specific antigen (PSA) has es­tablished itself as the most useful marker for adenocarci­noma of the prostate and has almost replaced the total acid phosphatase and prostatic acid phosphatase (PAP) for screening, diagnosis and monitoring the prostate car­cinoma patients. The PSA levels also rise in benign hyper­plasia of prostate (BPH) but to a lesser extent and high values are usually diagnostic of malignant disease. The present investigation was conducted to study the relevance of PAP estimation with or without PSA in prostatic dis­ease particularly in the context of hospitalized patients with retention of urine. Levels of the 2 markers were esti­mated in 132 patients with prostatic disease and results correlated with histological findings. BPH was detected in 112 patients whereas 20 patients were diagnosed with adenocarcinoma (ADCA) of prostate. Majority of the pa­tients in our study were referred from private clinics and 66.1 % of BPH and 50% of ADCA patients presented with acute urinary retention. Mean PSA and PAP levels in ad­enocarcinoma group were significantly higher (292.7 and 117.35 ng/ml, respectively) than in BPH group (7.05 and 1.92 ng/ml, respectively). It was observed that PSA levels were raised in BPH patients with urinary retention as com­pared to those with no retention. There was, however, no significant change in PAP levels in these patients. There was a very good correlation between the values of tumor markers (correlation coefficient: 0.86) in all the patients. Therefore, PAP is still a very good tumor marker of prostatic disease with almost comparable efficiency to that of PSA in differentiating the malignant from the benign dis­ease. It appears to be particularly important in hospital­ized patients with acute urinary retention as catheterization appears to raise the levels of PSA but not those of PAP.
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CASE REPORTS
Primary amyloidosis of the urinary bladder: A case report
N Srinath, AS Sandhu, R Bharadwaj, R Sood, SK Gupta, AA Pradhan, P Madhusoodanan
January-June 2003, 19(2):157-159
A case of young woman with primary bladder amyloido­sis presenting with haematuria is reported. The diagnosis was confirmed by bladder biopsy. Secondary amyloido­sis was excluded after extensive search for underlying causes. This rare entity can usually be treated conserva­tively. Long-term follow-up is recommended.
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Actinomycosis of urinary bladder - a rare entity
Chaman Lal Gupta, Rahul Gupta
January-June 2003, 19(2):159-160
Actinomycosis is considered the most misdiagnosed dis­ease usually involving the cervico fascial region, thorax, abdomen and occasionally also the pelvis, usually in case of the females using intra-uterine devices. The involve­ment of the urinary tract is rare and primary actinomyco­sis of urinary bladder is still rarer. The disease is usually diagnosed by demonstration of the discharged sulphur granules. In our case this was not the usual presentation and the patient was first diagnosed as having appendicu­lar mass and then bladder malignancy. The excised mass demonstrated features suggestive of actinomycosis.
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Vesical endometriosis: A case report
Dilip Kumar Pal
January-June 2003, 19(2):160-161
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Anuria in advanced carcinoma of prostate: Role of methyl prednisolone - a case report
Vibhav Malviya, Gopi Kishore, Arif Hameed, US Dwivedi, PB Singh
January-June 2003, 19(2):162-162
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Second primary tumour following partial penectomy
J Niranjan, AK Mandal, Pooja Bakshi Sharma, Kim Vaiphei
January-June 2003, 19(2):164-165
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Penile metastasis from carcinoma of the rectum: A case report
Shivananda Prabhu, K Ramachandra Pai, Erel AI Diaz, CC Joshua, Sawan Ala, Manoj Bobby
January-June 2003, 19(2):165-166
Penile metastases are extremely uncommon. When they do occur the primary lesion is most often in one of the pelvic organs. Patient may present with a painful nodule, priapisfn and urinary obstruction. Treatment is usually pal­liative. Aggressive surgical approach may benefit care­fully selected patients who have no other clinical metastatic lesions.
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An intratesticular cavernous haemangi­oma mimicking a testicular malignancy
WAS de Silva, SAS Goonewardena
January-June 2003, 19(2):166-167
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Goldenhar syndrome and urogenital abnormalities
Mohan Marulaiah, Anindya Chattopadhyay, Vijaykumar , PLNG Rao
January-June 2003, 19(2):167-169
The Goldenhar syndrome (oculo-auriculo-vertebral syn­drome or 1st and 2nd branchial arch syndrome) is a com­plex of craniofacial anomalies. It has been associated with anomalies in other systems and with abnormalities of the urogenital system. We present a case of Goldenhar syn­drome with multiple renal anomalies and a urogenital si­nus, which has not been reported before.
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Leiomyoblastoma of the urethra
Dilip Kumar Pal
January-June 2003, 19(2):169-170
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RESEARCH ARTICLES
Limited additional lateral biopsies improve the diagnostic accuracy of transrectal ultrasound guided sextant prostate biopsy
KC Balaji, I Arnautovic, A Arnautovic, Durwood Neal
January-June 2003, 19(2):125-128
We prospectively evaluated the need for routine use of additional lateral biopsies at the time of standard sextant prostatic biopsy to reduce the false negative rates. A total of 23 consecutive patients underwent 24 TRUS guided prostatic biopsies resulting in 246 biopsy cores. Prostate cancer was diagnosed in 8/24 (33.3%) biopsies. Although the age and prostate volume did not significantly differ between patients with or without cancer (p>O. 05), the pre­biopsy PSA and PSAD were significantly higher in pa­tients diagnosed with prostate cancer (p<0.05). Of the 8 patients diagnosed with prostate cancer 2/8 (25%) had cancer in the biopsies lateral to but not in the standard sextant biopsy sites. The additional lateral biopsies im­proved the sensitivity and negative predictive value of TRUS guided biopsy by 33.3% and 13% respectively. In conclusion, in spite of the small sample size in this study, prostate cancer detection is increased by 25% because of additional lateral biopsies at time of standard sextant prostatic biopsy.
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Estramustine phosphate in the treatment of hormone escape prostatic carcinoma - a 3 year follow-up
Altaf H Syed, Mohd N Akhtar, C Shearing, PR Bollina, DN Tulloch
January-June 2003, 19(2):129-134
Objective: A recent literature review has shown rekin­dled interest in the use of estramustine phosphate (EMP) inpatients with advanced prostatic cancer. This led us to assess prostate specific antigen (PSA ) response and drug tolerability following EMP therapy inpatients with hor­mone refractory prostate cancer Patients and Methods: Twenty-five patients with a mean age of 73.5 years (range 49 to 85 years) received EMP for hormone insensitive prostate cancer from January 1996 onwards. They were received at 6 weeks initially followed by 3 monthly intervals to monitor further progression of disease. At each visit clinical examination and blood chem­istry (PSA, etc) was done and further investigations, i.e., bone scan, CT scan, etc. were requested if thought neces­sary. Results: According to the WHO score of pain 71 %found immediate symptomatic relief following EMP treatment but only 29% were pain free after one year PSA level showed a persistent decline of >50% of pre-treatment value in 16 patients (64%) at 6 weeks. However, at 1 year 22% had either a still declining PSA or had reached a stable nadir PSA level while the rest showed rising PSA suggesting in­sensitivity to EMP. Three out of 5 patients (excluding I patient with intolerance at 2 months) with >80% decrease in PSA at 6 weeks had longer period of progression free interval (1 year in 2 and 2 years in 1 patient). The treat­ment was generally well tolerated (72%) as only 7 patients had to discontinue EMP because of severe side ef­fects. Conclusions: EMP treatment in patients with hormone escaped prostatic cancer does produce immediate PSA response which is reflected simultaneously in pain improve­ment in the majority of cases but overall the benefit is shortlived. Patients who have >80% reduction in pre-treat­ment PSA value at 6 weeks may have longer period of pro­gressionfree intervals. However EMP was generally well tolerated.
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Early report of randomized double blind clinical trial of hormonal therapy of carcinoma of prostate (CAP) stage D2
Jagdeesh N Kulkarni, Roby Gupta
January-June 2003, 19(2):135-139
Objectives: We herein report our experience of double blind randomized clinical trial comparing combined an­drogen blockade vs monotherapy in stage D2 CaP. Patients and Methods: Through June 1999 and May 2001, 100 patients of stage D2 CaP were randomized into placebo (44) and flutamide (42) group after orchiectomy in double blind fashion using the strictest criteria. All men and histological proof of CaP with bone metastasis dem­onstrated on imaging: bone scan and skeletal survey. These patients were further substratified according to number o f bony metastases into high volume disease (HVD>5 sites) and low volume disease (LVD<5 sites). The follow-up was at 3 month intervals. Criteria for decoding were clinical or serological progression and serious adverse effects. Results: Of the 100 patients recruited in the trial, 48 had HVD and 52 LVD. Treatmentwise they were almost equally distributed in flutamide group and placebo group. In the follow-up ranging front 6 to 24 months, 30 out of 100 patients (30%) required decoding, reasons for decod­ing were progression of disease in 25 and serious adverse effects in remaining 5. These 25 patients were further analyzed according to treatment group, volume of metas­tasis pre -orchiectomy PSA and Gleason score. We observed that number of bony metastases had impact over the dura­tion of response to hormonal therapy. Discussion: We initiated this simple trial to address the issue of benefit of total androgen blockade over monotherapy in Indian population. In the initial analysis, we observed that treatment group did not make any impact over the response. While subset of prostate cancer with large number of bony metastases has higher propensity to convert into hormone refractory cancer Conclusions: Addition of flutamide did not provide ben­efit. We observed that large number of bony metastases had poor response to hormonal therapy, hence it requires large trial to substantiate this initial observation.
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Surgical management of ambiguous genitalia in infants and children: An SGPGI experience
Subodh Kumar Das, Anant Kumar, NK Arvind, S Phadke
January-June 2003, 19(2):145-151
Introduction: Assignment of a proper gender to a neonate born with ambiguous genitalia is a social emer­gency. Once a sex has been assigned the next critical step is performance, if needed, of a reconstructive procedure in a timely fashion. In an attempt to evaluate our experi­ence with this unique group of patients, we have retro­spectively reviewed the course of 31 children managed surgically at our institute between 1989 and 2000. Patients and Methods: This series consists of 16 geno­type females with congenital adrenal hyperplasia (CAH), 7 male pseudohermaphrodites, 5 children with mixed go­nadal dysgenesis (MGD), and 3 true hermaphrodites. All the 16 patients with CAH underwent vaginoplasty, and clitoral recession. Five of the male pseudohermaphrodites were raised as females. All of them underwent B/L gona­dectomy, and clitoral recession. Perineal vaginoplasty was done in 4 of these patients and I patient who was due for colo-vaginoplasty was lost to follow-up. 2 male pseudoher­maphrodites were raised as males. Both of them under­went B/L orchiopexy and hypospadias repair. Four of the 5 cases of MGD were given a female sex assignment and all 4 underwent gonadectomy due to high risk of gonado­blastoma. In the 5th patient a male gender assignment was given. There were 3 true hermaphrodites, 2 of whom were managed by clitoral recession and vaginoplasty. One pa­tient was diagnosed at the age of 15 years. This patient had been brought up as a male child and presented to us with the complaint of pain in the lower abdomen. Investigations revealed haematometra and haematocolpos and the patient had to undergo B/L salpingo-oophorectomy and hysterectomy. Results: The postoperative period in most of the pa­tients was uneventful except for 2 minor complications. The cosmetic results have been excellent. 2 patients were lost to follow-up. Follow-up in the rest of the patients ranged from 9 months to 6.3 years and all the patients were found well adjusted to the society as far as their gen­der assignment is concerned. However the functional re­sults are yet to be evaluated, as most of the patients have not yet achieved full sexual maturity. Conclusion: This retrospective review emphasizes the complexities of assessment and management of ambigu­ous genitalia in infants and children. It also confirms the data from other series that the vast majority of infants born with the 4 most common forms of ambiguous genitalia (CAH, MGD, male pseudohermaphroditism, and true hermaphroditism) may be raised as females as phallic in­adequacy usually makes it difficult to achieve a cosmeti­cally acceptable appearance. However the sex of rearing and parents' intentions and wishes should be taken into consideration in the reconstruction of genitalia of a child.
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Color doppler ultrasonography: Its role in detection and treatment outcome in infravesical obstruction
Saleem Wani, Arif Hamid, M Gopi Kishore, Vibhav Malviya, US Dwivedi, PB Singh
January-June 2003, 19(2):109-112
Bladder weight and detrusor blood perfusion increases significantly with infravesical obstruction (IVO) and re­lease of obstruction results in reduction of bladder weight and detrusor blood flow. 38 patients with IVO were sub­jected to color Doppler ultrasonography (CD U) to detect the blood flow in the hypertrophied detrusor muscle. Blood flow was detected in 84.5% (Fisher exact probability <0.001). After surgical relief of obstruction, blood flow remained positive in 21.05% patients at 3 months and 13.10% patients at 6 months, which was because of per­sistence of IVO. Color Doppler ultrasonography (CDU) is a simple and non-invasive tool which can help in diag­nosis and follow-up of infravesical obstruction.
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Doxazocin in management of benign prostatic hyperplasia
NK Mohanty, RP Arora, AK Jha, S Singh Pal
January-June 2003, 19(2):113-116
A total 220 patients with benign prostatic hyperplasia (BPH) but not having absolute indication for surgery were enrolled for 8 weeks single label study, using doxazocin (Doxacard) 4 mg daily for their features of prostatism, with a six month follow up. The study revealed an improve­ment of 90% in their symptoms at the end of the study with an increase of maximum flow rate (MFR) by 5-5.5 ml/sec and average flow rate (AFR) 2.5-3 ml/sec. Adverse effects were minimum and patient compliance was very good with good drug tolerability. Our study strongly supports the use of doxazocin as an alternative in the management of uncomplicated BPH with hypertension.
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REVIEW ARTICLE
Y chromosome microdeletion and male infertility
Akanchha Kesari, Aneesh Srivastava, Rama Devi Mittal
January-June 2003, 19(2):103-108
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