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   2010| April-June  | Volume 26 | Issue 2  
    Online since July 12, 2010

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Hemorrhagic cystitis: A challenge to the urologist
R Manikandan, Santosh Kumar, Lalgudi N Dorairajan
April-June 2010, 26(2):159-166
DOI:10.4103/0970-1591.65380  PMID:20877590
Severe hemorrhagic cystitis often arises from anticancer chemotherapy or radiotherapy for pelvic malignancies. Infectious etiologies are less common causes except in immunocompromised hosts. These cases can be challenging problems for the urologist and a source of substantial morbidity and sometimes mortality for the patients. A variety of modalities of treatment have been described for the management of hemorrhagic cystitis but there is none that is uniformly effective. Some progress has been made in the understanding and management of viral hemorrhagic cystitis. This article reviews the common causes of severe hemorrhagic cystitis and the currently available management options.
  12,797 698 17
Etiology and management of urinary retention in women
Amit Mevcha, Marcus J Drake
April-June 2010, 26(2):230-235
DOI:10.4103/0970-1591.65396  PMID:20877602
Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional; labeling symptoms as having a "psychogenic basis" should be avoided. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes. Investigations should be focused on identifying the underlying etiology and any reversible factor. A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis. Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control. Fowler's syndrome is a specific group diagnosed on urethral sphincter electromyogram, representing a very challenging clinical scenario.
  11,642 400 7
Management of male urinary incontinence
Katie C Moore, Malcolm G Lucas
April-June 2010, 26(2):236-244
DOI:10.4103/0970-1591.65398  PMID:20877603
The majority of male urinary incontinence seen is secondary to sphincter weakness following prostatic surgery. As there is a rising elderly population and increasing numbers of surgical interventions for prostate cancer, incidence of male incontinence is increasing. Hence, management of male incontinence has become a subject of increased interest for urologists. Various non-surgical and surgical approaches have been suggested for this devastating condition. Non-invasive therapies are suggested for early postoperative and mild incontinence. For surgical treatment the artificial urinary sphincter is still labeled the gold standard despite the introduction of several more minimally invasive treatments. However, as yet there is no consensus on the optimal timing and best modality for managing these men. Well designed, centrally funded clinical trials are required to establish which treatment modality to offer and when in the broad spectrum of male incontinence. This review focuses mainly on the management of post-prostatectomy incontinence since the management of other types varies little from the modalities of treatment in women.
  6,843 361 1
Medical management of overactive bladder
Sarvpreet S Ubee, Ramaswamy Manikandan, Gurpreet Singh
April-June 2010, 26(2):270-278
DOI:10.4103/0970-1591.65403  PMID:20877608
Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO) intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat.
  6,434 455 5
Role of surgery in advanced/metastatic renal cell carcinoma
Suresh Bhat
April-June 2010, 26(2):167-176
DOI:10.4103/0970-1591.65381  PMID:20877591
Metastatic renal cell cancer (RCC) is a malignant disease without curative treatment. These patients are usually symptomatic and desperate for effective palliative treatment. Radiotherapy, chemotherapy, and hormonal therapy are not effective in these patients. A multimodal approach consisting of cytoreductive nephrectomy, systemic therapy (which includes cytokines or targeted molecules), and metastasectomy have been shown to be useful in prolonging the survival and improving the quality of life in a select group of patients with metastatic renal cancer. Patients with oligometastatic disease, good performance status, and delayed presentation of the secondaries have better results following this integrated approach. Although there is some controversy regarding the order in which nephrectomy and systemic therapy are to be instituted, well-controlled studies like the South West Oncology Group and European organization research and treatment of cancer have shown that upfront nephrectomy gives better survival compared to neoadjuvant systemic therapy followed by nephrectomy. This order is the standard presently. Of late, with better understanding of the genetic basis and the biology of the various subtypes of renal cell carcinoma, targeted molecular therapies have emerged as an equally effective alternative therapy to cytokines. Recent reports have proven that targeted therapy is more effective with comparable side effects. Metastasectomy in a subgroup of patients improves survival and quality of life specifically in those with lung secondaries and painful bone metastases.
  5,996 468 4
Vesicovaginal fistulae
Mary Garthwaite, Neil Harris
April-June 2010, 26(2):253-256
DOI:10.4103/0970-1591.65400  PMID:20877605
Vesicovaginal fistula (VVF) formation represents a condition with devastating consequences for the patient and continues to pose a significant challenge to the surgeon. Quick and accurate diagnosis, followed by timely repair is essential to the successful management of these cases. A thorough understanding of the pathophysiology and anatomy of the fistula, potential factors that may compromise healing and experience in the fundamental principles of fistula repair are the vital tools of the fistula surgeon. This review was undertaken to provide an overview of the key areas in VVF investigation and management.
  4,713 376 8
Prevalence and risk factors of monosymptomatic nocturnal enuresis in Turkish children
Secil Ozkan, Elif Durukan, Elvan Iseri, Serhat Gurocak, Isil Maral, M Ali Bumin
April-June 2010, 26(2):200-205
DOI:10.4103/0970-1591.65387  PMID:20877597
Objectives : To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. Methods : After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. Results : MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. Conclusions : The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.
  4,782 107 5
Managing the urinary tract in spinal cord injury
Simon C.W Harrison
April-June 2010, 26(2):245-252
DOI:10.4103/0970-1591.65399  PMID:20877604
This review sets out to provide an overview of the author's approach to the management of the urinary tract in the patient who has suffered from an injury to their spinal cord. Emphasis is given to the need to understand the fundamental pathophysiological patterns that are seen with injuries that involve the sacral segments of the cord (the conus) and those that spare the conus but interrupt communication between the sacral parasympathetic and somatic centers and the brain (supraconal lesions). The importance of patient participation in management decisions is highlighted by considering the different ways in which the urinary tract can be managed and how the clinician needs to try to meet patient expectations and requirements while establishing safe urological management. Finally, consideration is given to the importance of establishing an appropriate follow up regime and managing urinary tract complications effectively.
  4,548 335 2
The surgical management of the refractory overactive bladder
Nikhil Vasdev, Benjamin D Biles, Raveen Sandher, Tahseen S Hasan
April-June 2010, 26(2):263-269
DOI:10.4103/0970-1591.65402  PMID:20877607
The refractory overactive bladder is a clinically challenging entity to manage and affects millions of people worldwide. Current surgical treatment options include botulinum toxin type A, sacral neuromodulation, and bladder reconstruction surgery all of which require careful attention to the individual patients needs and circumstances. In our paper we present a detailed up-to-date review on all the above mentioned surgical techniques from current literature and briefly describe our units experience with sacral neuromodulation.
  4,484 295 5
Impact on sexual function after reconstructive surgery for anterior urethral stricture disease
Uday P Singh, Ruchir Maheshwari, Vikas Kumar, Aneesh Srivastava, Rakesh Kapoor
April-June 2010, 26(2):188-192
DOI:10.4103/0970-1591.65384  PMID:20877594
Objective : To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation. Materials and Methods : The study group consisted of 150 men with a median (range) age of 40 (18-73) years who underwent 168 urethral reconstructive procedures for anterior urethral stricture disease between October 2003 and May 2009. We evaluated sexual functioning using the O'Leary Brief Male Sexual Function Inventory before and after surgery. Results : The median follow-up was 33 months (range 4-72). There were no significant changes in sexual drive and erectile function scores postoperatively for men in the 20-29, 30-39, 40-49, 50-59 and 60-69 years age groups. Overall, there was a significant improvement in ejaculatory function scores after surgery. This improvement was most robust in men in the 20-29, 30-39 and 40-49 years age group. Conclusion : Overall, anterior urethral reconstruction appears no more likely to cause postoperative sexual dysfunction. Different types of urethroplasties, surgical complexity with long stricture excision and the use of buccal graft, preputial flap/tube did not influence outcome.
  4,597 174 2
Urodynamic assessment of urinary incontinence
Sarah L Housley, Chris Harding, Robert Pickard
April-June 2010, 26(2):215-220
DOI:10.4103/0970-1591.65392  PMID:20877600
Context : Urodynamic evaluation in the assessment of women complaining of urinary incontinence remains controversial with recent UK National Institute of Health and Clinical Excellence guidance maintaining that it is unnecessary prior to surgery for women with a primarily stress leakage. Other experts contend it should be part of routine preoperative assessment since it establishes a diagnosis, allows more careful patient counseling and predicts surgical outcome. Objectives : To summarize current literature to define the evidence level on which these conflicting opinions are based. Materials and Methods : A systematic literature search was performed and retrieved publications summarized in a narrative evidence review using both original papers and previous reviews. Results : Five hundred and one primary research papers and 65 previous reviews were retrieved. The findings were summarized in a narrative comprising overview, description of methods of bladder and urethral pressure measurement, and a summary of the literature concerning four key questions. Conclusion : The level of evidence was low regarding answering each of the questions posed, preventing firm conclusions. Urodynamic findings do correlate with relevant symptoms and, to some extent, with symptom severity, giving reasonable diagnostic accuracy. There is no reliable evidence that preoperative urodynamic diagnosis improves outcome from surgery for stress incontinence although it is likely to facilitate preoperative discussion. Tests to differentiate sphincter deficiency and urethral hypermobility are not currently recommended due to poor validity and reproducibility. This along with the current use of mid-urethral tapes as the universal primary surgical procedure means differentiation is not a necessity. Preoperative diagnosis of detrusor overactivity does not appear to worsen surgical outcome in women with a primary symptom of stress leakage. Large, well-designed prospective studies are now underway to provide a definitive answer to these questions.
  4,224 351 4
The surgical treatment of female stress urinary incontinence
Christopher K Harding, AC Thorpe
April-June 2010, 26(2):257-262
DOI:10.4103/0970-1591.65401  PMID:20877606
Urinary incontinence is a common symptom experienced by significant numbers of adult women. Stress urinary incontinence (SUI) is the most frequently encountered type and affects around 50% of incontinent females. Many affected women do not consult their doctors about this troublesome symptom perhaps based on a belief that they cannot be helped. Recent years have seen the development of several new and popular techniques for the surgical treatment of this condition and many of the "gold standard" procedures for stress incontinence have been challenged. Currently, evidence in favor of the use of sub-urethral tapes especially tension-free vaginal tapes suggests that a new standard of low morbidity and high efficacy surgical treatment for SUI has been set. This review is intended to examine all of the surgical options for the treatment of SUI and provide health care professionals with an overview of the vast array of currently available procedures.
  3,943 331 1
Endoscopic management of upper tract transitional cell carcinoma
James A Forster, Victor Palit, Anthony J Browning, Chandra Shekhar Biyani
April-June 2010, 26(2):177-182
DOI:10.4103/0970-1591.65382  PMID:20877592
Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm of the upper urinary tract. The "gold standard" management of upper tract TCC is nephroureterectomy. Technological innovations, miniaturisations and increased availability of energy sources such as Holmium laser fibers have improved the armamentarium of endoscopic management of upper tract TCC. Endoscopic management of upper tract TCC includes the percutaneous (antegrade) and retrograde approaches. Modern flexible ureterorenoscopy allows retrograde approach to small (<1.5cm), low grade and non-invasive tumors, which is inaccessible to standard rigid ureteroscopes without breaching the urothelial barrier. In patients with large tumors or in whom retrograde access is difficult, the percutaneous approach to the renal pelvis, although more invasive, provides an alternative access and control. Both retrograde and percutaneous approaches allow instillation of various chemotherapeutic agents. Careful selection of patients is the key point in the successful endoscopic management of upper tract TCC. Patient selection is based on tumor size, grade and multifocality and other patient factors such as comorbidities, single kidney, post kidney transplant and patient choice. Both motivation and compliance of patients are needed for long-term successes. However, until large randomized trials with long term follow-up are available, endoscopic management of upper tract TCC should be reserved for only selected group of patients. This review summarizes the current techniques, indications, contraindications and outcomes of endoscopic management of UTTCC and the key published data.
  3,887 318 4
Isolated tuberculous orchitis: A mimicker of testicular malignancy
Joseph Paul, Sriram Krishnamoorthy, Marie Teresa, Santosh Kumar
April-June 2010, 26(2):284-286
DOI:10.4103/0970-1591.65404  PMID:20877610
Isolated tuberculous orchitis is a rare entity. The coexistence of tuberculosis of the testis with filarial worm infestation is even more rare. In this report, we present a case of tuberculous involvement of the testis, associated with filarial worm infestation in the spermatic cord that presented as a testicular tumor. A 55-year-old male presented with unilateral testicular swelling of four months duration. As the clinical evaluation was suggestive of testicular malignancy, he underwent a right high orchidectomy. The histopathology report revealed isolated tuberculous orchitis without epididymal involvement along with filarial infestation of the spermatic cord.
  3,955 155 2
Slings in iatrogenic male incontinence: Current status
Fabrizio Gallo, M Schenone, C Giberti
April-June 2010, 26(2):279-283
DOI:10.4103/0970-1591.65423  PMID:20877609
Objectives: The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence. Materials and Methods: MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated. Results: With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively. Conclusions: Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.
  3,760 179 7
Non-catheter simple noninvasive bladder draining method with no costs
MG Hocking
April-June 2010, 26(2):296-298
DOI:10.4103/0970-1591.65409  PMID:20877615
Objectives: To develop a simple, rapid (8 min) non-invasive non-catheter method for draining urine from the bladder, with no introduction of infection. This is of interest to men with incomplete or no bladder emptying, and also to those with a large diverticulum. There are no running costs. It could also be cautiously explored for use by neo-bladder patients and for use in various conditions of poor detrusor function. Materials and Methods: This method is based on postural drainage used in physiotherapy. A carefully graded application of pressure, kneeling, with torso horizontal, facing downwards, supported by a 12-inch square stool-top, gave passive low-pressure voiding. If the abdominal contents approximate to a non-elastic viscous fluid, such pressure is transmitted uniformly everywhere (isostatic) and so will be equal both outside and inside the bladder, and, both outside and inside the ureters connected to it. Even if this assumption is not made, calculations show that the pressure is normally less than would cause upper tract damage. Starting with a low force was important for avoiding any upper tract damage (ureter dilation, and possible refluxing back into the kidney). Initially, a partial pre-emptying by normal urination was done (if feasible). A final stage employed a simple plastic crescent shape. Website: . Results: Average residual bladder volumes were 43 mL. Conclusions: The method was tested for four years on one patient with low-pressure chronic retention and found successful: no complications, infections, or adverse effects.
  3,754 112 -
Biomaterials in urinary incontinence and treatment of their complications
Philippa Sangster, Roland Morley
April-June 2010, 26(2):221-229
DOI:10.4103/0970-1591.65394  PMID:20877601
Biomaterials integrate with the anatomy and provide support to the weakened area. They are generally synthetic, but natural substances are also used. These substances are being increasingly used in stress urinary incontinence. This article discusses the various biomaterials, minimally invasive techniques, and recent advances for the treatment of female stress urinary incontinence. In addition, their complications and subsequent management are explored.
  3,552 233 -
Correlation of percentage changes in platelet counts with recurrence rate following radical nephrectomy
A Patel, R Bhavan, B Somani, G Nabi
April-June 2010, 26(2):183-187
DOI:10.4103/0970-1591.65383  PMID:20877593
Objectives : To categorize and correlate percentage changes in platelets counts - an objective approach with recurrence rate following radical nephrectomy. Materials and Methods : All consecutive patients who had radical nephrectomy for localized renal tumor in the period from January 1997 to December 2005 have been included in this study. The data was collected retrospectively. The primary outcome of this study was over all and cancer- specific survival and its correlation with percentage change in platelet count from pre-surgical level. Change in platelets counts was categorized as less than or more than 0-10%, 10-20% and more than 20% from base line (pre-surgery). This was correlated with the follow-up recurrence and disease free survival. Survival distribution were estimated using Kaplan-Meier method, univariate and multivariate regression analyses were performed using Cox proportional hazards models to address the impact of different prognostic factors on survival. Results : Of the 237 patients treated with radical nephrectomy, pT1, pT2, pT3, and pT4 accounted for 116 (49%), 44 (18.5%), 68(28.7%), and nine (3.8%) cases respectively. The mean tumor size was 6.3 cm (Range: 4-17 cm; SD: 3). The pre-operative platelet count ranged from 82 to 1573 (Mean: 327.5; SD: 171.7). The overall follow-up time ranged from 1-102 months (Mean: 39 months; SD: 27months). There was significant correlation between the recurrence rate and increase in platelets count of more than 20% following radical nephrectomy (P value- 0.0001). Conclusions : Categorization of platelets changes following radical nephrectomy for localized renal cell carcinoma, in particular, a change in more than 20% can accurately predict recurrence and cancer specific survival following radical nephrectomy for localized renal cell carcinoma.
  3,596 127 2
Primary urethral realignment should be the preferred option for the initial management of posterior urethral injuries
RP Shrinivas, Deepak Dubey
April-June 2010, 26(2):310-313
DOI:10.4103/0970-1591.65416  PMID:20877620
The initial management of posterior urethral injuries is controversial. Options of management include immediate surgical realignment, early realignment using minimally invasive techniques or simple suprapubic catheter (SPC) placement followed by delayed urethroplasty. The latter method has been preferred by most urologists but the last couple of decades have seen increasing reports of early urethral realignment which have provided better if not similar results as SPC placement. In this article a detailed analysis of studies involving primary realignment has been presented to reinforce the argument in favor of this approach.
  3,404 166 2
Hormone refractory carcinoma prostate with peritoneal metastases and malignant ascites without skeletal involvement: A case report and review of literature
Samuel P Benedict, Manish Ahuja, Kim J Mammen
April-June 2010, 26(2):287-288
DOI:10.4103/0970-1591.65405  PMID:20877611
Peritoneal carcinomatosis is rare in prostate cancer especially in the absence of skeletal or other visceral metastases. We report a case of hormone refractory adenocarcinoma prostate presenting with only peritoneal metastases and massive malignant ascites. Palliation with docetaxel based cytotoxic chemotherapy resulted in clinical improvement of refractory ascites decreasing respiratory embarrassment and thereby improving the quality of life.
  3,205 91 1
Cost benefits of intraoperative cell salvage in radical cystectomy
Sarvpreet S Ubee, Ramaswamy Manikandan, Adinarayana R Gudimetla, Gurpreet Singh
April-June 2010, 26(2):196-199
DOI:10.4103/0970-1591.65386  PMID:20877596
Objective : We have looked into the clinical and financial benefits of using intra-operative cell salvage (ICS) as a method to reduce the amount of autologous blood transfusion (ABT) requirement for our radical cystectomy (RC) patients. Materials and Methods : Fifteen consecutive patients undergoing radical cystectomy received cell salvaged blood (ICS), while 15 did not (NCS). The cost of using the cell saver, number of homologous transfusions, survival, and recurrences were recorded and compared using paired t-test and chi-square test between the two groups. A Dideco Electa; (Sorin Group, Electa, Italy) cell saver machine was used for all the patients in the ICS group and leukocyte filters were used on the salvaged blood before the autologous transfusion. Results : The mean age was 63 years (53-72 years), 66 years (46-79 years) in ICS and NCS groups, respectively (P = 0.368). All 15 (100%) patients in the NCS group required an allogenic transfusion compared to 9/15 (60%) in the ICS group (P = 0.08). There was a significant reduction in the mean volume of allogenic blood transfused with the use of cell saver. Median follow-up was 23 and 21 months in the ICS and NCS group with 10 and 4 patients alive at last follow-up, respectively. There was a saving of 355 pounds per patient in the ICS group compared to the NCS group. Conclusion : Our initial study shows that cell savage is feasible and safe in patients undergoing radical cystectomy. It does not adversely affect the medium term outcome of patients undergoing RC and is also cost effective.
  3,166 78 2
Is intravenous urogram no longer an imaging of choice for percutaneous nephrolithotomy?
Pallavi Aga, Rajesh Bansal
April-June 2010, 26(2):303-304
DOI:10.4103/0970-1591.65413  PMID:20877618
  2,963 131 2
'Egg shell' in bladder: A calculus around neglected Foley balloon catheter
Dharamveer Singh, Pawan Vasudeva, Apul Goel
April-June 2010, 26(2):299-300
DOI:10.4103/0970-1591.65410  PMID:20877616
Suprapubic catheterization of the bladder is used as a short- or long-term alternative to urethral catheterization. As with any indwelling urinary catheter, proper care is vitally important to minimize complications.
  2,948 103 2
Does rejection have a role in lymphocele formation post renal transplantation? A single centre experience
Muthu Veeramani, Sashikant Mishra, Abraham Kurien, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai
April-June 2010, 26(2):193-195
DOI:10.4103/0970-1591.65385  PMID:20877595
Aim : To assess the relation of acute rejection with respect to lymphocele incidence and determine the effect of lymphocele with graft survival. Methods : The paper is a singlecenter retrospective data review of renal transplant recipients from 1980 to 2007. A total of 1700 patients received kidneys from live donation, and 9 patients received from cadaver donor. The standard transplant technique was performed in all. Lymphocele incidence, demography, relation to rejection episodes, type of immunosuppression, and management options were studied. Univariate analysis was performed to assess the role of rejection to lymphocele formation. Results : 47 (35 males and 12 females) patients had symptomatic lymphocele in the post-transplant period. 51% of the lymphocele patients had history of rejection as compared to overall rejection rate of 20% (P = 0.009). 4 (7.2%) had at least 1 rejection and 19 (40.4%) had more than one rejection episodes. All 47 patients required aspiration. Of the 14 patients who did not settle with a maximum of two aspirations underwent marsupilization (5 open and 9 laparoscopic). 1, 5, and 10 year graft survival of overall transplant recipient and post-transplant lymphocele patients was 86.54%, 82.41% and 76.36% vs. 86.44%, 81.2% and 68.14%, respectively. Conclusion : Acute rejection episodes were associated with statistically increased risk of lymphocele. There was no adverse outcome of graft with lymphocele formation after rejection episodes with respect to the overall graft survival.
  2,942 93 2
Lymphangioma circumscriptum of the scrotum following vasectomy
Dilip Kumar Pal, Manju Banerjee, Dhrubajyoti Moulik, Biplab Kumar Biswas, Manoj Kumar Choudhury
April-June 2010, 26(2):294-295
DOI:10.4103/0970-1591.65408  PMID:20877614
Lymphangioma circumscriptum is a congenital lymphatic hamartoma and rarely occurs in the male genital organs. Here we report a case of acquired lymphangioma circumscriptum of scrotum following vasectomy, which has not been reported till date. High clinical suspicion index is the clue to the clinician for diagnosis; histopathological confirmation and adequate surgical excision with deep lymphatic cisterns give the best result.
  2,946 87 2
Delayed repair is the ideal management for posterior urethral injuries- For the motion
S Joseph Philipraj
April-June 2010, 26(2):305-309
DOI:10.4103/0970-1591.65414  PMID:20877619
Posterior urethral injuries are seen in trauma cases with pelvic fracture. The time-tested and honored method of management is immediate supra-pubic diversion followed by delayed repair. Immediate alignment as a management option is not new. It was abandoned 30 years ago due to high incidence of incontinence and impotence. However, of late there is a tendency towards immediate management of these injuries with various endoscopic maneuvers. Unfortunately, there is little evidence supporting this. Even these evidences are of limited in number and of limited duration of follow-up.
  2,850 149 4
Can p53, Ki-67 and bcl-2 predict biochemical failure after radical prostatectomy?
B Baseskioglu, B Akdogan, DE Baydar, H Ozen
April-June 2010, 26(2):206-212
DOI:10.4103/0970-1591.65390  PMID:20877598
Background and Objective : To analyze p53, Ki-67 and bcl-2 expressions immunohistochemically and their predictive role in biochemical recurrence after radical prostatectomy. Materials and Methods : Seventy one patients who had undergone radical prostatectomy between 1992 and 2001 were randomly selected. Tissue microarrays were constructed from their radical prostatectomy specimens. They contained four cores from neoplastic and additional four cores from corresponding non-neoplastic regions. Gleason score ranged from 6-9, and pathological stage ranged from T2N0Mx to T3BN1. Staining for bcl-2 was scored visually taking percent negative, weak, moderate and strong positivity into consideration. Strong immunoreactivity was considered positive for p53. Ki-67 index was measured as the percentage of positive nuclei among tumor cells. Statistical analysis was performed to explore correlations between staining patterns and clinicopathological prognostic parameters. Results : The follow-up period extended from 13 to 112 months with a mean 60 (48 ± 23, 2) months. Of all, 38.02% had no evidence of disease, 52.1% were alive with disease and 9.8% were died during follow-up. The expression of p53, Ki-67 and bcl-2 in tumors were 39%, 76% and 5% respectively. While the secretory layer showed negative or weak bcl-2 staining in most cases, expression in basal cells was often stronger. Statistical analysis revealed differences in staining between normal and carcinoma for all three markers. There was no correlation between staining patterns and time to biochemical relapse. On the other hand, cases with higher Gleason sum showed the tendency for over expression of p53, Ki-67 and bcl-2 although the differences were not statistically different. Multivariate analysis revealed CMS group and seminal vesicle invasion as the independent predictors of PSA failure (log rank P = 0.0039 and P = 0.001, respectively). Conclusion : The proteins bcl-2, p53 and Ki-67 were expressed at a different rate in normal and neoplastic prostate tissue. Bcl-2 was mainly expressed by basal cells in normal glands. p53 and Ki-67 expression were increased in most prostate carcinomas. However, overall expression levels did not correlate with biochemical recurrence in this study.
  2,826 83 2
Renal cell carcinoma with melanin pigment
Jayaprakash Shetty, Chandrika , Prabhu Laxman
April-June 2010, 26(2):292-293
DOI:10.4103/0970-1591.65407  PMID:20877613
The incidence of renal cell carcinoma has been steadily increasing. There are several morphological types of renal cell carcinoma. Recognizing histologic patterns of renal cell carcinoma is important for correct diagnosis and subsequent medical care for the patient. Melanotic tumors in the kidney are very rare. Here, we present an unusual case of renal cell carcinoma with melanin pigment.
  2,834 73 6
Bladder wall thickness for the assessment of voiding dysfunction
Abhishek Jain, SN Sankhwar, Apul Goel
April-June 2010, 26(2):319-320
  2,752 110 -
Donor gonadal vein reconstruction for extension of the transected renal vessels in living renal transplantation
Muthu Veeramani, Vikas Jain, Arvind Ganpule, RB Sabnis, Mahesh R Desai
April-June 2010, 26(2):314-316
DOI:10.4103/0970-1591.65417  PMID:20877621
Introduction: Donor gonadal vein is a readily available vascular reconstruction material for vascular reconstruction, for difficult situations, in living related renal transplantation. Vein extension with the gonadal vein has been described as a simple and safe method to elongate renal vein especially in right living donor kidneys. We applied the donor gonadal vein for lacerated accessory renal artery and renal vein reconstruction. Materials and Methods: The donor gonadal vein was used to reconstruct the lacerated accessory renal artery in one patient. The donor gonadal vein was isolated, used as an interposition graft to bridge the gap between transected accessory renal artery and external iliac artery of the recipient. In another patient, gonadal vein was used to reconstruct short right renal vein, which got damaged during retrieval. Results: This technique resulted in a tension-free anastomosis. There were no procedure related complications. The ischemia time remained within acceptable limits and grafts showed excellent outcomes. Conclusions: The use of gonadal vein for renal vascular reconstruction seems to be an acceptable option during living related renal transplantation, lest the need arise, with no increased graft morbidity.
  2,681 96 3
Intra-operative cell salvage in radical cystectomy
Abhay Rane
April-June 2010, 26(2):158-158
DOI:10.4103/0970-1591.65379  PMID:20877589
  2,477 217 -
Partial siamese twin as potential organ donor
Rakesh Kapoor, Ruchir Maheshwari, Aneesh Srivastava, Raj K Sharma
April-June 2010, 26(2):289-291
DOI:10.4103/0970-1591.65406  PMID:20877612
During evaluation of a partial Siamese twin for removal of nonviable parasitic part in an 8-year-old male child, a fully functional kidney was found. The functional status of the extra kidney was found to be within acceptable limits for the purpose of transplant, which was subsequently done in a 24-year-old patient with end-stage renal disease. The recipient is healthy 19 months after the surgery. The possibility of using organs from a partial Siamese twin makes this a unique case report.
  2,493 69 -
Medical education: The need for uniform standards!
Nitin Kekre
April-June 2010, 26(2):157-157
DOI:10.4103/0970-1591.65378  PMID:20877588
  2,106 145 -
Adjuvant radiotherapy with hormonal management for locally advanced carcinoma prostate-do we have a case?
John S Banerji, Santosh Kumar
April-June 2010, 26(2):321-323
  2,076 77 -
Female and functional urology in 2010
Andrew Thorpe
April-June 2010, 26(2):213-214
DOI:10.4103/0970-1591.65391  PMID:20877599
  1,945 128 -
Minimally invasive radical prostatectomy: Perception vs. Reality
TJ Nirmal, NS Kekre
April-June 2010, 26(2):318-319
  1,975 90 -
Blue nevus of the prostate
Ranjini Kudva, Padmaraj Hegde
April-June 2010, 26(2):301-302
DOI:10.4103/0970-1591.65411  PMID:20877617
  1,933 72 4
The peer reviewers
Sourabh Aggarwal
April-June 2010, 26(2):317-317
DOI:10.4103/0970-1591.65418  PMID:20877622
  1,740 66 -
Tackling the prostate cancer: Moving in the right direction
Bhupendra P Singh, SN Sankhwar, A Jain
April-June 2010, 26(2):320-321
  1,600 98 -
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