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   2007| April-June  | Volume 23 | Issue 2  
 
 
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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.
  26,008 1,262 5
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.
  21,781 608 7
Pelvic organ prolapse and stress urinary incontinence: A review of etiological factors
Payal D Patel, Kaytan V Amrute, Gopal H Badlani
April-June 2007, 23(2):135-141
DOI:10.4103/0970-1591.32064  PMID:19675790
Although they may present with significant morbidity, pelvic organ prolapse and stress urinary incontinence are mainly afflictions that affect quality of life. To appropriately treat these entities, comprehension of the various theories of the 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.
  9,868 576 6
Vesicovaginal fistula: An update
Santosh Kumar, Nitin S Kekre, Ganesh Gopalakrishnan
April-June 2007, 23(2):187-191
DOI:10.4103/0970-1591.32073  PMID:19675799
Vesicovaginal fistula (VVF) has been a social and a surgical problem for centuries and remains a challenge to surgeons. Though advances have been made in the understanding of the etiology, diagnostic procedures and management of these fistulae, controversies still exist over the ideal approach and time to repair. This review was undertaken to look into the recent literature with regard to the timing and surgical approach to VVF repair. The literature search was done using the Medline database with keywords: vesicovaginal fistula, laparoscopy and robotic repair filtered for the last 5 years.
  9,520 724 14
CASE REPORT
Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis
Mayank Mohan Agarwal, Shrawan K Singh, Arup K Mandal
April-June 2007, 23(2):208-210
DOI:10.4103/0970-1591.32081  PMID:19675807
Penile gangrene associated with chronic renal failure is very uncommon. A 52-year-old man with diabetes mellitus, diffuse atherosclerosis, ischemic cardiomyopathy and end-stage renal disease presented with blackening of distal penis for 10 days. His general condition was poor and gangrene of prepuce and glans was noted. Doppler and magnetic-resonance angiography revealed bilateral internal iliac artery obstruction. He underwent trocar suprapubic cystostomy and was planned for partial penectomy. But he died of severe diabetic complications in the interim period. Penile gangrene is a manifestation of widespread vascular calcifications associated with end-stage renal disease and is a marker of poor prognosis.
  8,108 315 9
SYMPOSIUM
Meningomylocele: An update
R Kapoor, S Agrawal
April-June 2007, 23(2):181-186
DOI:10.4103/0970-1591.32072  PMID:19675798
Therapy-resistant overactivity of detrusor or small capacity and poor compliance, will usually need to be treated by bladder augmentation. Ileal or colonic patches are used frequently for augmenting the bladder, with either intestinal segment appearing to be equally useful. Stomach is rarely used because of the associated complications, but it is the only available intestinal segment for patients with impaired renal function. Concerns regarding long-term effects of associated metabolic acidosis, including abnormalities in linear growth and bone metabolism are misplaced. Ureterocystoplasty offers an attractive urothelium-preserving alternative, avoiding the metabolic complications, mucus production and cancer risk of heterotopic epithelium associated with enterocystoplasty. Though ideal for patients with dilated ureter and nonfunctioning kidney, in patients with functioning kidney it carries added risks associated with transuretero-ureterostomy, mainly obstruction. Ureteral dilatation in meningomyelocele patients is avoidable with proper follow-up and treatment. Therefore they rarely should be candidates for this operation. Alternative urothelium-preserving techniques, such as auto augmentation and seromuscular cystoplasty, have not proven to be as successful as standard augmentation with intestinal segment. Work is in progress on various bioengineering techniques to culture and combine bladder cells in tissue culture for regeneration. Early efforts are exciting, but preliminary.
  7,578 600 -
Refractory overactive bladder: Beyond oral anticholinergic therapy
Ronald W Glinski, Steven Siegel
April-June 2007, 23(2):166-173
DOI:10.4103/0970-1591.32069  PMID:19675795
Objectives: In this review, we discuss the treatment of refractory overactive bladder (OAB) that has not adequately responded to medication therapy and we propose an appropriate care pathway to the treatment of OAB. We also attempt to address the cost of OAB treatments. Materials and Methods: A selective expert review of the current literature on the subject of refractory OAB using MEDLINE was performed and the data is summarized. We also review our experience in treating refractory OAB. The role and outcomes of various treatment options for refractory OAB are discussed and combined therapy with oral anticholinergics is explored. Emerging remedies including intravesical botulinum toxin injection and pudendal neuromodulation are also reviewed, along with conventional surgical options. Results: In general behavioral therapy, pelvic floor electrical stimulation, magnetic therapy and posterior tibial nerve stimulation (PTNS), have shown symptom decreases in 50-80% of patients with OAB. Depending on the study, combination therapy with oral anticholinergics seems to improve efficacy of behavioral therapy and PTNS in approximately 10-30%. In multicenter, long-term randomized controlled trials, sacral neuromodulation has been shown to improve symptoms of OAB and OAB incontinence in up to 80% of the patients treated. Studies involving emerging therapies such as pudendal serve stimulation suggest that there may be a 15-20% increase in efficacy over sacral neuromodulation, but long-term studies are not yet available. Another emerging therapy, botulinum toxin, is also showing similar success in reducing OAB symptoms in 80-90% of patients. Surgical approaches, such as bladder augmentation, are a last resort in the treatment of OAB and are rarely used at this point unless upper tract damage is a concern and all other treatment options have been exhausted. Conclusion: The vast majority of OAB patients can be managed successfully by behavioral options with or without anticholinergic medications. When those fail, neuromodulation or intravesical botulinum toxin therapies are successful alternatives for most of the remaining group. We encourage practitioners responsible for the care of OAB patients to gain experience with these options. More research is needed to assess the cost-effectiveness of various OAB treatments
  6,989 538 7
Male incontinence: Pathophysiology and management
Ajay K Singla
April-June 2007, 23(2):174-179
DOI:10.4103/0970-1591.32070  PMID:19675796
Post-prostatectomy incontinence in men is a devastating condition. It impacts the quality of life profoundly. Various types of male sling procedures have been introduced over the years. Bone anchored male sling appears to be effective and safe in intermediate term follow up. It certainly more effective than collagen implant and may provide alternative treatment option in patient with mild to moderate incontinence. In short term, other novel procedures seem to be promising. In spite of new technology, artificial urinary sphincter continues to provide high patient satisfaction and cure rates.
  6,923 581 1
Surgery for stress urinary incontinence in women: A 2006 review
Bertil FM Blok, Jacques Corcos
April-June 2007, 23(2):148-152
DOI:10.4103/0970-1591.32066  PMID:19675792
The surgical treatment of female stress urinary incontinence is a rapidly changing field. This review discusses recent advances in various injectables, minimally invasive techniques and open procedures. It particularly evaluates data from long-term outcome studies and describes peri- and postoperative complications from several procedures, such as bulking agents, tension-free vaginal tape and its modifications (TOT, TVT-O) as well as open and laparoscopic colposuspension.
  6,502 563 2
ORIGINAL ARTICLE
Erectile dysfunction among hypertensive men in a rapidly developing country
Abdulbari Bener, Abdullah Al-Ansari, Mustafa Afifi, Prasad V Krishna
April-June 2007, 23(2):109-113
DOI:10.4103/0970-1591.32057  PMID:19675783
Background: Previous studies have supported the association between hypertension and erectile dysfunction (ED). In addition, a significant correlation between hypertension in men and ED has been well established. Objectives: The aim of this study was to investigate the prevalence of ED, its severity and other sexual function domains in hypertensive patients in Qatar. Design and Setting: Cross-sectional study conducted between January and December 2006 at the Hamad General Hospital. Subjects: Qatari and nonQatari nationals 25 to 75 years of age were approached to participate in this study, 642 (75.5%) gave their consent. Materials and Methods: Qatari and nonQatari men aged 25 to 75 years who gave consent were interviewed face-to-face. Sexual function was evaluated with the International index of erectile function. Results: A total of 642 (75.5%) men responded, mean age of subjects was 57.1 11.9 years. The prevalence of ED in hypertensive patients was 58.3%. 21.2% of hypertensive men reported severe ED, 20.7% moderate ED and 16.4% mild ED. The comorbidities and risk factors were significantly more prominent in ED patients than in those with normal ED for hypercholesterolemia ( P =0.009), diabetes ( P =0.022) for hypertriglyceridemia ( P =0.033) and myocardial ischemia ( P =0.042). Conclusions: Our results have shown a greater prevalence of ED in the hypertensive men in the population of Qatar. The presence of another risk factor in addition to elevated blood pressure can increase the likelihood of ED.
  6,228 410 7
Clinical evaluation of a simple uroflowmeter for categorization of maximum urinary flow rate
Simon Pridgeon, Christopher Harding, Douglas Newton, Robert Pickard
April-June 2007, 23(2):114-118
DOI:10.4103/0970-1591.32058  PMID:19675784
Objective: To evaluate the accuracy and diagnostic usefulness of a disposable flowmeter consisting of a plastic funnel with a spout divided into three chambers. Materials and Methods: Men with lower urinary tract symptoms (LUTS) voided sequentially into a standard flowmeter and the funnel device recording maximum flow rate (Q max ) and voided volume (V void ). The device was precalibrated such that filling of the bottom, middle and top chambers categorized maximum input flows as <10, 10-15 and > 15 ml s -1 respectively. Subjects who agreed to use the funnel device at home obtained readings of flow category and V void twice daily for seven days. Results: A single office reading in 46 men using the device showed good agreement with standard measurement of Q max for V void > 150 ml (Kappa = 0.68). All 14 men whose void reached the top chamber had standard Q max > 15 ml s -1 (PPV = 100%, NPV = 72%) whilst eight of 12 men whose void remained in the bottom chamber had standard Q max < 10 ml s -1 (PPV = 70%, NPV = 94%). During multiple home use by 14 men the device showed moderate repeatability (Kappa = 0.58) and correctly categorized Q max in comparison to standard measurement for 12 (87%) men. Conclusions: This study suggests that the device has sufficient accuracy and reliability for initial flow rate assessment in men with LUTS. The device can provide a single measurement or alternatively multiple home measurements to categorize men with Q max < 15 ml s -1 .
  5,856 377 5
CASE REPORT
An unusual case of urinary tract obstruction due to imperforate hymen in an 11-month-old infant
Sajni Khemchandani, Amit Devra, Sandeep Gupta
April-June 2007, 23(2):198-199
DOI:10.4103/0970-1591.32076  PMID:19675802
Variations in the anatomy of the hymen are common and imperforate hymen is an extreme manifestation. In spite of the recommendations for early inspection of the external genitalia, hymenal malformations escape diagnosis until the time of menarche. Rarely, female infants with imperforate hymen present with urologic complications. We would like to present an unusual case of urinary retention in an 11-month-old female infant due to imperforate hymen. This infant was successfully treated surgically.
  5,638 361 3
ORIGINAL ARTICLE
Role of non-contrast spiral computerized tomography in acute ureteric colic
S Feroze, Baldev Singh, T Gojwari, S Manjeet, Bashir Athar, Hussain Hamid
April-June 2007, 23(2):119-121
DOI:10.4103/0970-1591.32059  PMID:19675785
Aim: To evaluate the sensitivity and specificity of noncontrast helical computerized tomography (CT) in ureteric colic with comparative evaluation of KUB and ultrasonography (USG). Setting: Tertiary care university hospital. Materials and Methods: One hundred patients aged between 20 and 75 years referred from the emergency department as acute ureteric colic were evaluated with KUB and USG followed by noncontrast helical CT. Results: Noncontrast helical CT was 91% sensitive and 98% specific in detecting urolithiasis compared to a sensitivity of 20% and 30% for KUB and USG and specificity of 94% and 98% respectively. Conclusion: Noncontrast helical CT is a very sensitive and specific investigation for evaluation of acute flank pain due to urolithiasis, besides helping in the detection of nonrenal causes of pain.
  5,586 385 -
Age-specific prostate specific antigen and prostate specific antigen density values in a community-based Indian population
Arvind P Ganpule, Mahesh R Desai, T Manohar, Sharad Bapat
April-June 2007, 23(2):122-125
DOI:10.4103/0970-1591.32060  PMID:19675786
Introduction: We sought to determine the distribution of serum prostate specific antigen (PSA) levels in a community-based population in the state of Gujarat in India. Materials and Methods: Community screening of subjects residing in Kheda and Anand districts of Gujarat was done with digital rectal examination (DRE), uroflowmetry and transabdominal sonography and serum PSA. In three villages transrectal sonography was done in addition to transabdominal sonography. All patients with a PSA of more than 4 ng/ml and / or abnormal DRE were evaluated. Biopsy-proven prostatic malignancy was detected in 20 patients. Subjects who did not follow up and who had biopsy-proven malignancy were excluded from the analysis, 1899 subjects were analyzed. Results: One thousand seven hundred and eighty-seven (89.17%) had a PSA of <4 ngml, 180 (8.9%) had a PSA between 4-10 ng/ml, while 37 (1.8 %) had a PSA more than 10ng/ml. There was a statistically significant correlation between age and prostate volume (correlation coefficient 0.33) and between prostate volume and PSA (correlation coefficient 0.50). The age-specific PSA values derived as the 95th percentile value were as follows, 40-49 years (0-2.1), 50-59 years (0-3.4), 60-69 years (0-4.2) and more than 70 years (0-5.0). The 95th percentile value for PSAD was 0.19. Conclusion: Indians need to have separate PSA reference ranges. The age-specific PSA ranges for men in the present study population are on the lower side and the prostate specific antigen density on the higher side.
  5,460 461 7
CASE REPORT
Failure of sonography to visualize a kidney affected by emphysematous pyelonephritis
Anis A Rauf, Almothana Shanaah, Amit Joshi, Subhash Popli, Mohammad Vaseemuddin, Todd S Ing
April-June 2007, 23(2):200-202
DOI:10.4103/0970-1591.32077  PMID:19675803
We describe a diabetic patient who presented with acute renal failure as a result of acute bilateral emphysematous pyelonephritis. Initially, both an abdominal X-ray examination and a renal sonogram were unremarkable. Two days later, however, the previously visualized right kidney could not be demonstrated again by a repeat renal sonogram. A computed tomogram and a repeat abdominal X-ray study confirmed the diagnosis of emphysematous pyelonephritis. To our knowledge this is one of the few described cases of emphysematous pyelonephritis distinguished by a sonogram's inability to visualize a kidney because of interference with imaging by the gas produced by the bacteria that are responsible for the pyelonephritic infection.
  5,389 318 1
ORIGINAL ARTICLE
Comparison of fluid absorption during transurethral resection of prostate and Holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration
Shivadeo Bapat, Salil Umranikar, Vikram Satav, Abhijeet Bapat, Arun Joshi, Gauri Ranade
April-June 2007, 23(2):126-129
DOI:10.4103/0970-1591.32061  PMID:19675787
Objective: We conducted a study to detect, quantify and compare irrigation fluid absorption in transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP), using BEC. Materials and Methods: The study included 50 patients of lower urinary tract symptoms, secondary to benign enlargement of prostate. The patients were nonrandomly allocated to undergo TURP and HoLEP. Twenty-six patients underwent TURP and the remaining 24 underwent HoLEP. Sterile water tagged with 1% ethanol w/v was used for irrigation. Absorption was detected and quantified every 10min by BEC levels. Data was analyzed using standard nomograms. Results: In HoLEP, 14/24 had no fluid absorption. The remaining 10/24 showed fluid absorption ranging from 95 ml to 300 ml. In TURP, all had fluid absorption ranging from 250-980 ml. Three TURP patients developed overt symptoms, while none did in the HoLEP group. Conclusions: Fluid absorption observed in our study in the HoLEP group was lower than in the TURP group.
  5,015 353 2
SYMPOSIUM
Use of urodynamics prior to surgery for urinary incontinence: How helpful is preoperative testing?
Gary E Lemack
April-June 2007, 23(2):142-147
DOI:10.4103/0970-1591.32065  PMID:19675791
It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence with urodynamic testing enhances presurgical counseling, more effectively models patients' expectations or improves postoperative outcome. Nonetheless, urodynamic testing is frequently utilized in the assessment of women with stress urinary incontinence and clearly accomplishes a number of goals when utilized for this purpose. For example, there are data to suggest that the risk of voiding dysfunction can be mitigated by utilizing data obtained from urodynamic testing to identify women more likely to void ineffectively after conventional stress incontinence procedures. Furthermore, it has been suggested though not proven, that patients with more severe forms of stress incontinence as identified by urodynamic testing, might be less likely to improve after surgery compared to others with more modest degrees of incontinence. Since urodynamic testing is invasive, costly and not always available, it is imperative that the usefulness of such testing be carefully explored and its utility appropriately defined. In this review, we discuss urodynamic techniques to assess stress urinary incontinence, particularly focusing on the ability of leak point pressure testing and urethral pressure profilometry to predict which patients would most likely benefit from surgery and which might be more likely to experience adverse events following surgery.
  4,601 484 4
What is the prevalence of overactive bladder symptoms in a lower socioeconomic female population? A suggestion for a study in India
Kaytan V Amrute, Brian Vanderbrink, Gopal H Badlani
April-June 2007, 23(2):192-194
DOI:10.4103/0970-1591.32074  PMID:19675800
Although it is suggested that in the United States overactive bladder affects one out of six individuals, this estimation may represent a subset of the population. Using a Pubmed literature search, many studies do not address those in a lower socioeconomic strata and the prevalence of overactive bladder may be higher. Overactive bladder symptoms may be under-reported in this population due to social stigma, lack of education or inaccessibility to medical care. This paper proposes to perform an epidemiological study incorporating validated incontinence questionnaires to assess the prevalence of overactive bladder symptoms among Indian women.
  4,648 353 1
Conservative management of voiding dysfunction
Anita Patel
April-June 2007, 23(2):161-165
DOI:10.4103/0970-1591.32068  PMID:19675794
This review article discusses the efficacy of various conservative therapies in the management of voiding dysfunction with special reference to urinary incontinence. The article emphasizes the fact that conservative therapies have limited side effects and they do not jeopardize future treatment options. Behaviour therapy, pelvic floor therapy and biofeedback; electrical and magnetic stimulation are discussed here individually. Though there is unanimous agreement that these therapies improve quality of life, complete cure is rare. All therapies work better in conjunction with each other rather than in isolation. The review also highlights the need for randomized controlled trials of better methodology.
  4,380 467 1
ORIGINAL ARTICLE
Clinical evaluation of efficacy and safety of cyclosporine (Imusporin) in renal transplant patients with stable graft function maintained on neoral or bioral
Mrigank S Jha, Aneesh Srivastava, Deepak Dubey, Amit Gupta, RK Sharma, Anant Kumar
April-June 2007, 23(2):130-132
DOI:10.4103/0970-1591.32062  PMID:19675788
Objective: Previous pharmacokinetic studies have demonstrated bioequivalence of Imusporin (microemulsion preparation of cyclosporine, Cipla) to the innovator product Neoral (Novartis, Switzerland). This study was done to evaluate the clinical efficacy and safety of Imusporin in patients who have already undergone renal transplant and have stable graft function maintained on cyclosporine preparation other than Imusporin. Materials and Methods: Twenty-two renal allograft recipients (mean age of 31.77 years, range 18-53 years), with stable graft function, previously on Neoral or Bioral were switched over to Imusporin after recording their relevant baseline clinical and biochemical parameters. These were repeated on 1, 4, 7, 15, 30 and 90 days after the start of therapy. Change in dosage required to maintain C2 levels at each visit were analyzed by paired sample t -test. Safety of the drug was assessed by the type and severity of adverse events developed during the therapy. Cost analysis was done assuming an average maintenance immunosuppression dose of 150 mg/day of cyclosporine. Results: Twenty-one patients completed the study. One patient was lost to follow-up. Mean C2 value before switchover was 894 208 ng/ml, which was not significantly different from the mean values of C2 after switchover therapy ( P >0.30). Change in dosage required to maintain C2 levels was not significantly different from the baseline dose of 2.34 mg/ kg body weight ( P >0.1). No patient developed graft rejection after switchover therapy at a median follow-up of 16 months (14-18 months). Mean baseline SCr was similar to SCr at day 90 (1.38 vs. 1.37 mg/dl, P =0.930). No severe adverse events were reported. Mild side-effects included headache (4), somnolence (2), dry mouth (5) and generalized fatigue (6). Use of Imusporin (Cipla, India) results in an annual savings of Rs. 19892 over Neoral (Novartis, Switzerland) and Rs. 2263 over Bioral (Panacea Biotech, India). Conclusions: Imusporin is clinically as safe and efficacious as other cyclosporine preparations available while significantly reducing the cost of treatment.
  4,469 364 2
CASE REPORT
Posterior urethral polyps and review of literature
Prashant Jain, Hemanshi Shah, Sandesh V Parelkar, SS Borwankar
April-June 2007, 23(2):206-207
DOI:10.4103/0970-1591.32080  PMID:19675806
Urethral polyp is a rare finding in young children. Fibroepithelial polyps of the urethra are usually diagnosed during the first decade of life. They present with obstruction, voiding dysfunction and hematuria. They can be associated with other congenital urinary tract anomalies. They are usually benign fibroepithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy.
  4,039 289 6
Paecilomyces pyelonephritis in a patient with urolithiasis
K Sriram, Mary S Mathews, Ganesh Gopalakrishnan
April-June 2007, 23(2):195-197
DOI:10.4103/0970-1591.32075  PMID:19675801
Fungal organisms are increasingly implicated in nosocomial urinary tract infections. Although Candida, Mucor and Aspergillus are the most commonly identified species, rare fungi are also occasionally observed to infect humans. Misidentification of the organism could result in treatment with an inappropriate antifungal agent, which could result in a florid fungal pyelonephritis. We report the occurrence of fungal pyelonephritis in a patient with stone disease secondary to Paecilomyces variotii . This case report emphasizes the need for an accurate identification of the organism and early and appropriate treatment.
  3,978 295 3
REVIEW ARTICLE
Application of evidence-based urology in improving quality of care
Arabind Panda, LN Dorairajan, Santosh Kumar
April-June 2007, 23(2):91-96
DOI:10.4103/0970-1591.32055  PMID:19675781
Evidence-based medicine requires use of the best available evidence for optimal patient care. Increasingly scarce resources and escalating demands on time have led to emphasis on effective treatment. Opinion is slowly yielding to high-quality existent evidence. It is important that urologists adapt to these changes for them to deliver optimum care to the patients. This article discusses the levels of evidence, the nature of desirable evidence, means of assessing quality of clinical trials and meta-analysis and finally the practice of evidence-based urology with special reference to bedside evidence-based urology.
  3,823 388 1
GUEST EDITORIAL
Recent updates in the management of urinary incontinence
Gopal H Badlani
April-June 2007, 23(2):133-134
DOI:10.4103/0970-1591.32063  PMID:19675789
  3,747 437 -
CASE REPORT
An unusual complication of silver nitrate therapy for chyluria
Jayesh V Dhabalia, Girish G Nelivigi, Manav Suryavanshi, Shal Kakkattil, Vikash Kumar Singh
April-June 2007, 23(2):203-204
DOI:10.4103/0970-1591.32078  PMID:19675804
Chyluria is a common disorder in the tropics. In our country it is most commonly managed by instillation of silver nitrate. We report a patient who developed severe perinephric hematoma due to pseudoaneurysm of renal artery following silver nitrate instillation. He was managed by angioembolisation followed by drainage of infected perinephric hematoma. We discuss various modalities of treatment of chyluria including complications of silver nitrate therapy.
  3,690 294 -
UROSCAN
T1 bladder cancer on restaging transurethral resection should be treated with immediate cystectomy
Gagan Gautam, Rajeev Kumar
April-June 2007, 23(2):218-218
PMID:19675813
  3,423 258 -
Role of simultaneous fine needle aspiration cytology of palpable inguinal lymph node and primary tumor biopsy in carcinoma of the penis
Nikhil Khattar, LN Dorairajan, Santosh Kumar
April-June 2007, 23(2):220-221
PMID:19675815
  3,259 278 -
LETTER TO EDITOR
Preservation of urethra devoid of corpus spongiosum in patients undergoing urethroplasty
Amilal Bhat
April-June 2007, 23(2):213-214
DOI:10.4103/0970-1591.32083  PMID:19675809
  3,064 274 -
EDITORIAL
Worshiping false Gods
Nitin S Kekre
April-June 2007, 23(2):89-90
DOI:10.4103/0970-1591.32054  PMID:19675780
  2,956 353 -
UROSCAN
Which one is better, Wallace or Bricker?
Naval Khurana, Aneesh Srivastava
April-June 2007, 23(2):216-217
PMID:19675811
  2,975 283 -
EVIDENCE BASED UROLOGY
Ureteral frozen section analysis during radical cystectomy: Do margins matter?
Rajiv Mukha, Santosh Kumar, Nitin S Kekre
April-June 2007, 23(2):211-212
DOI:10.4103/0970-1591.32082  PMID:19675808
  2,899 261 1
UROSCAN
Search for new α1a-adrenoceptor-selective antagonist for treating lower urinary tract symptoms associated with benign prostatic hyperplasia
Naval Khurana, Aneesh Srivastava
April-June 2007, 23(2):215-216
PMID:19675810
  2,753 352 -
Transurethral ethanol ablation for symptomatic benign prostatic hyperplasia
Gagan Gautam, Nitin Arora
April-June 2007, 23(2):219-220
PMID:19675814
  2,619 267 -
COMMENTARY
Male incontinence: Pathophysiology and management
Rob Pickard
April-June 2007, 23(2):179-180
DOI:10.4103/0970-1591.32071  PMID:19675797
  2,470 303 1
An unusual complication of silver nitrate therapy for chyluria
Anant Kumar
April-June 2007, 23(2):205-205
DOI:10.4103/0970-1591.32079  PMID:19675805
  2,362 266 2
UROSCAN
Are we along the path for laparoscopic partial nephrectomy?
Naval Khurana, Saurabh Agarwal, Aneesh Srivastava
April-June 2007, 23(2):217-217
PMID:19675812
  2,069 226 -
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