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   2011| January-March  | Volume 27 | Issue 1  
    Online since March 29, 2011

 
 
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SYMPOSIUM
Semen analysis and sperm function tests: How much to test?
SS Vasan
January-March 2011, 27(1):41-48
DOI:10.4103/0970-1591.78424  PMID:21716889
Semen analysis as an integral part of infertility investigations is taken as a surrogate measure for male fecundity in clinical andrology, male fertility, and pregnancy risk assessments. Clearly, laboratory seminology is still very much in its infancy. In as much as the creation of a conventional semen profile will always represent the foundations of male fertility evaluation, the 5th edition of the World Health Organization (WHO) manual is a definitive statement on how such assessments should be carried out and how the quality should be controlled. A major advance in this new edition of the WHO manual, resolving the most salient critique of previous editions, is the development of the first well-defined reference ranges for semen analysis based on the analysis of over 1900 recent fathers. The methodology used in the assessment of the usual variables in semen analysis is described, as are many of the less common, but very valuable, sperm function tests. Sperm function testing is used to determine if the sperm have the biologic capacity to perform the tasks necessary to reach and fertilize ova and ultimately result in live births. A variety of tests are available to evaluate different aspects of these functions. To accurately use these functional assays, the clinician must understand what the tests measure, what the indications are for the assays, and how to interpret the results to direct further testing or patient management.
  25,671 572 1
Genetic and epigenetic factors: Role in male infertility
MB Shamsi, K Kumar, R Dada
January-March 2011, 27(1):110-120
DOI:10.4103/0970-1591.78436  PMID:21716934
Genetic factors contribute upto 15%-30% cases of male infertility. Formation of spermatozoa occurs in a sequential manner with mitotic, meiotic, and postmeiotic differentiation phases each of which is controlled by an intricate genetic program. Genes control a variety of physiologic processes, such as hypothalamus-pituitary-gonadal axis, germ cell development, and differentiation. In the era of assisted reproduction technology, it is important to understand the genetic basis of infertility to provide maximum adapted therapeutics and counseling to the couple.
  12,077 361 6
Oxidative stress and antioxidants for idiopathic oligoasthenoteratospermia: Is it justified?
Ashok Agarwal, Lucky H Sekhon
January-March 2011, 27(1):74-85
DOI:10.4103/0970-1591.78437  PMID:21716893
Oxidative stress contributes to defective spermatogenesis and the poor quality of sperm associated with idiopathic male factor infertility. The aim of this study was to review the current literature on the effects of various types of antioxidant supplements in patients to improve fertilization and pregnancy rates in subfertile males with idiopathic oligoasthenoteratozoospermia (iOAT). Review of recent publications through PubMed and the Cochrane database. Oxidative stress is implicated in impaired spermatogenesis leading to the poor semen parameters and increased DNA damage and apoptosis in iOAT. Strategies to modulate the level of oxidative stress within the male reproductive tract include the use of oral antioxidant compounds to reinforce the body's defence against oxidative damage. In our evaluation, carnitines were considered the most established pharmacotherapeutic agent to treat iOAT, as evidence and data concerning carnitine supplementation have been shown to be most consistent and relevant to the population of interest. Other therapies, such as combined vitamin E and C therapy, are still considered controversial as vitamin C can act as a pro-oxidant in certain instances and the results of randomized controlled trials have failed to show significant benefit to sperm parameters and pregnancy rates. There is a need for further investigation with randomized controlled studies to confirm the efficacy and safety of antioxidant supplementation in the medical treatment of idiopathic male infertility as well as the need to determine the dosage required to improve semen parameters, fertilization rates and pregnancy outcomes in iOAT.
  11,152 401 19
Management options of varicoceles
Peter Chan
January-March 2011, 27(1):65-73
DOI:10.4103/0970-1591.78431  PMID:21716892
Varicocele is one of the most common causes of male infertility. Treatment options for varicoceles includes open varicocelectomy performed at various anatomical levels. Laparoscopic varicocelectomy has been established to be a safe and effective treatment for varicoceles. Robotic surgery has been introduced recently as an alternative surgical option for varicocelectomy. Microsurgical varicocelectomy has gained increasing popularity among experts in male reproductive medicine as the treatment of choice for varicocele because of its superior surgical outcomes. There is a growing volume of literature in the recent years on minimal invasive varicocele treatment with percutaneous retrograde and anterograde venous embolization/sclerotherapy. In this review, we will discuss the advantages and limitations associated with each treatment modality for varicoceles. Employment of these advanced techniques of varicocelectomy can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and, in a substantial number of men, increase semen quality and the likelihood of pregnancy.
  9,398 399 5
Guideline-based management of male infertility: Why do we need it?
Landon W Trost, Ajay Nehra
January-March 2011, 27(1):49-57
DOI:10.4103/0970-1591.78426  PMID:21716890
The current clinical guidelines for the management of infertility as presented by the American Urologic Association and European Association of Urology represent consensus opinions for the management of male-factor infertility. The goal of the present study is to define the currently available guidelines for male-factor infertility, provide a rationale for why guidelines should be implemented, and review concerns and shortcomings towards their incorporation into clinical practice. Successfully integrating guidelines into clinical practice offers the potential benefit of creating a standardized, efficient, and cost-effective algorithm for the evaluation of infertility and facilitates future research. Despite their availability and ease of use, many clinicians fail to adopt clinical guidelines for numerous reasons including decreased awareness of available guidelines, insufficient time, lack of interest, and personal financial considerations. The current guidelines are limited by the inability to generalize recommendations to a heterogeneous patient sample, the lack of interdisciplinary adoption of guidelines, and the need for additional emphasis on prevention and lifestyle modifications. Future direction for the current guidelines will likely incorporate a multidisciplinary approach with increasing utilization of genetic analysis and novel treatment strategies. As the field of infertility continues to expand, the utility of guidelines combined with physician clinical judgment will remain prominent in the treatment of male-factor infertility.
  8,782 505 1
ORIGINAL ARTICLES
Extra-anatomical complications of antegrade double-J insertion
AR Rao, A Alleemudder, G Mukerji, V Mishra, H Motiwala, M Charig, O. M. A. Karim
January-March 2011, 27(1):19-24
DOI:10.4103/0970-1591.78408  PMID:21716883
Introduction: Insertion of a double-J (JJ) stent is a common procedure often carried out in the retrograde route by the urologists and the antegrade route by the radiologists. Reported complications include stent migration, encrustation, and fracture. Extra-anatomic placement of an antegrade JJ stent is a rare but infrequently recognized complication. Materials and Methods: We performed a retrospective audit of 165 antegrade JJ stent insertions performed over three consecutive years by a single interventional radiologist. All renal units were hydronephrotic at the time of nephrostomy. All procedures were performed under local anaesthetic with antibiotic prophylaxis. Results: Antegrade stent insertion was carried out simultaneously at the time of nephrostomy in 55 of the 165 cases (33%). The remainder were inserted at a mean of 2 weeks following decompression. In five (3%) patients, who had delayed antegrade stenting following nephrostomy, the procedure was complicated by silent ureteric perforation and an extra-anatomic placement of the stent. These complications had delayed manifestations, which included two retroperitoneal abscesses, a pelvic urinoma, a case each of ureterorectal fistula, and ureterovaginal fistula. Risk factors for ureteric perforation include previous pelvic malignancy, pelvic surgery, pelvic radiation, and a history of ureteric manipulation. Conclusion: Antegrade ureteric JJ stenting is a procedure not without complications. Extra-anatomic placement of the antegrade stent is a hitherto the infrequently reported complication but needs a high index of suspicion to be diagnosed. Risk factors for ureteric perforation at the time of stent insertion have to be considered to prevent this potential complication.
  7,479 129 -
SYMPOSIUM
In vitro fertilization/intracytoplasmic sperm injection for male infertility
Rubina Merchant, Goral Gandhi, Gautam N Allahbadia
January-March 2011, 27(1):121-132
DOI:10.4103/0970-1591.78430  PMID:21716935
Progress in the field of assisted reproduction, and particularly micromanipulation, now heralds a new era in the management of severe male factor infertility, not amenable to medical or surgical correction. By overcoming natural barriers to conception, in vitro fertilization and embryo transfer (IVF-ET), subzonal sperm insemination, partial zona dissection, and intracytoplasmatic injection of sperm (ICSI) now offer couples considered irreversibly infertile, the option of parenting a genetically related child. However, unlike IVF, which necessitates an optimal sperm number and function to successfully complete the sequence of events leading to fertilization, micromanipulation techniques, such as ICSI, involving the direct injection of a spermatozoon into the oocyte, obviate all these requirements and may be used to alleviate severe male factor infertility due to the lack of sperm in the ejaculate due to severely impaired spermatogenesis (non-obstructive azoospermia) or non-reconstructable reproductive tract obstruction (obstructive azoospermia). ICSI may be performed with fresh or cryopreserved ejaculate sperm where available, microsurgically extracted epididymal or testicular sperm with satisfactory fertilization, clinical pregnancy, and ongoing pregnancy rates. However, despite a lack of consensus regarding the genetic implications of ICSI or the application and efficacy of preimplantation genetic diagnosis prior to assisted reproductive technology (ART), the widespread use of ICSI, increasing evidence of the involvement of genetic factors in male infertility and the potential risk of transmission of genetic disorders to the offspring, generate major concerns with regard to the safety of the technique, necessitating a thorough genetic evaluation of the couple, classification of infertility and adequate counseling of the implications and associated risks prior to embarking on the procedure. The objective of this review is to highlight the indications, advantages, limitations, outcomes, implications and safety of using IVF/ICSI for male factor infertility to enable a more judicious use of these techniques and maximize their potential benefits while minimizing foreseen complications.
  7,238 359 2
Varicocele-induced infertility: Newer insights into its pathophysiology
Michael L Eisenberg, Larry I Lipshultz
January-March 2011, 27(1):58-64
DOI:10.4103/0970-1591.78428  PMID:21716891
The association between varicoceles and male infertility has been known since the 1950s; however, the pathophysiology of the process remains uncertain. The primary proposed hypotheses involve hyperthermia, venous pressure, testicular blood flow, hormonal imbalance, toxic substances, and reactive oxygen species. It is difficult to identify a single or dominant factor, and it is likely that many of these factors contribute to the infertile phenotype seen in clinical practice. Moreover, patient lifestyle and genetic factors likely affect patient susceptibilities to the varicocele insult. While the current studies have weaknesses, they provide building blocks for futures studies into the pathophysiology of the varicocele.
  6,213 361 20
ORIGINAL ARTICLES
Comparison of three different endoscopic techniques in management of bladder calculi
Kamal Jeet Singh, Jaspreet Kaur
January-March 2011, 27(1):10-13
DOI:10.4103/0970-1591.78402  PMID:21716932
Introduction: We present our experience of comparison of endoscopic treatment of vesical calculus in bladder stone. Materials and Methods: This study included 67 patients of bladder stone treated in this hospital from between June 2006 to December 2009 who were randomly assigned in three groups-group 1 (transurethral removal using a nephroscope), group 2 (transurethral removal using a cystoscope), and group 3 (percutaneous removal using a nephroscope). Results: Statistical significant difference was observed in operating time-group 1 (32.1+ 8.5 mins), group 2 (69.2 +16.3), and group 3 (46 + 7.3). Statistically significant difference was also observed in the postoperative stay of the patient, which was highest for the group 3 patients. Complete clearance was achieved in all the patients. Group 1 had maximum number of urethral entries as compared to other two groups in consideration. Conclusions: Transurethral stone removal using a nephroscope is safe and efficacious method of stone removal without increasing the morbidity of the patients.
  5,880 258 7
SYMPOSIUM
Vasectomy and vasectomy reversal: An update
Ranjith Ramasamy, Peter N Schlegel
January-March 2011, 27(1):92-97
DOI:10.4103/0970-1591.78440  PMID:21716894
Vasectomy is an elective surgical sterilization procedure for men that is intended to obstruct or remove a portion of both vas deferens, thereby preventing sperm from moving from the testes to the ejaculatory ducts. Although intended for permanent sterilization, vasectomy can be reversed in most men seeking to restore their fertility due to a change in marital status or reproductive goals. The purpose of this document is to provided a synopsis of the latest techniques used in vasectomy and reversal.
  5,306 236 2
Surgical sperm retrieval: Techniques and their indications
Rupin Shah
January-March 2011, 27(1):102-109
DOI:10.4103/0970-1591.78439  PMID:21716933
Men with azoospermia can father a child through intra-cytoplasmic sperm injection if sperm can be retrieved from their epididymis or testis. Several percutaneous and open surgical procedures have been described to retrieve sperm. The various techniques and their merits are discussed in this review. In men with obstructive azoospermia, epididymal sperm can usually be retrieved by percutaneous epididymal sperm aspiration (PESA). If PESA fails then testicular sperm are obtained by needle aspiration biopsy (NAB). In men with non-obstructive azoospermia, there will be no sperm in the epididymis and testicular sperm retrieval is required. Percutaneous retrieval by NAB can be tried first. If that fails then testicular sperm extraction (TESE) from open microsurgical biopsies is performed using the single seminiferous tubule (SST) or the microdissection TESE techniques. The simplest, least invasive procedure should be tried first.
  4,544 380 4
ORIGINAL ARTICLES
Dual kidney transplantation from expanded criteria deceased donors: Initial experience from single center
Pranjal Modi, Jamal Rizvi, Bipinchandra Pal, Hargovind Trivedi, Veena Shah, Manisha Modi, Aruna Vanikar
January-March 2011, 27(1):30-33
DOI:10.4103/0970-1591.78415  PMID:21716886
Aim: To evaluate results of dual kidney transplantation from expanded criteria deceased donors. Materials and Methods: Between January 2000 and December 2009, 23 dual kidney transplantations were performed from expanded criteria deceased donors; 11 were from non-heart-beating donors and 12 from brain-dead heart-beating donors. All transplantations were performed in monolateral iliac fossa. Results: Two perioperative deaths occurred due to sepsis and multiorgan failure in non-heart-beating group, and one in brain dead group. One- and five-year graft and patient survival in recipients having organs from brain-death heart-beating group were 91.67%. In non-heart-beating group, 1- and 5-year graft survival was 65.45% and 81.82%, and 1- and 5-year patient survival was 43.64% and 61.36%, respectively. Conclusion: Dual kidney transplantation from expanded criteria brain dead donors has better graft and patient survival than from non-heart-beating donors.
  4,722 128 3
Zinc status of patients with benign prostatic hyperplasia and prostate carcinoma
Pamela Christudoss, R Selvakumar, Joseph J Fleming, Ganesh Gopalakrishnan
January-March 2011, 27(1):14-18
DOI:10.4103/0970-1591.78405  PMID:21716879
Objectives: The exact cause of benign prostatic hyperplasia (BPH) and prostatic carcinoma is unknown. Changes in the level of the trace element zinc (Zn) are known to be associated with the functioning of different organs (breast, colon, stomach, liver, kidney, prostate, and muscle). This study is aimed at estimating and comparing the zinc levels in the prostate tissue, plasma, and urine obtained from patients diagnosed with BPH or prostatic carcinoma. Materials and Methods: The prostate tissue zinc, plasma zinc, and urine zinc/creatinine ratio in BPH, prostate cancer, and normal subjects were measured by atomic absorption spectrophotometry. Results: In prostate carcinoma, the mean tissue zinc was decreased by 83% as compared to normal tissue and in BPH, there was a 61% decrease in mean tissue zinc as compared to normal tissues. Both these values were statistically significant. The plasma zinc in prostate cancer patients showed a 27% decrease (P < 0.01) as compared to controls and 18% decrease (P < 0.01) as compared to BPH. The urine zinc/creatinine (ratio) was significantly increased to 53% in prostate cancer patients, and a 20% significant increase was observed in BPH as compared to normal subjects. Conclusions: It is evident from this study that BPH or prostate carcinoma may be associated with a reduction in the levels of tissue zinc, plasma zinc, and an increase in urine zinc/creatinine.
  4,430 166 9
Live related donors in India: Their quality of life using world health organization quality of life brief questionnaire
Sunil K Vemuru Reddy, Sandeep Guleria, Okidi Okechukwu, Rajesh Sagar, Dipankar Bhowmik, Sandeep Mahajan
January-March 2011, 27(1):25-29
DOI:10.4103/0970-1591.78411  PMID:21716885
Context: Organ selling is now legally banned in India. Numerous studies have documented that organ vendors have a poor quality of life (QOL) following kidney donation. Aims: This study was designed to assess the QOL of living related donors in India. Settings and Design: This study was a single-center prospective study. Materials and Methods: The QOL of 106 consecutive related kidney donors was compared before and 6 months after the donation using the World Health Organisation Quality of Life Brief Questionnaire. Statistical Analysis Used: STATA 9.0 (College Station, Texas) was used and a p value less than 0.05 was considered significant. Results: The response rate was 94.3% and the mean age was 43.2±11.95 years. Females constituted 73% of the population. Our study showed a significant improvement in the QOL among three of the four domains. The surgical technique (86- mini open donor nephrectomy, and 14 laparoscopic donor nephrectomy), education status, and marital status did not make any difference in the change in the QOL. Conclusions: Despite a number of our donors being unemployed and not being well educated, live related kidney donation improves the QOL of donors.
  4,454 105 2
CASE REPORTS
Primary malignancy of seminal vesicle: A rare entity
Rajaraman Ramamurthy, Saravanan Periasamy, Viswanathan Mettupalayam
January-March 2011, 27(1):137-139
DOI:10.4103/0970-1591.78417  PMID:21716878
We report a rare case of seminal vesicle malignancy (primitive neuro ectodermal tumor) in a 40-year-old male patient. He was treated with enbloc resection of the tumor and ureteric reimplantation. In view of the rarity of this entity, management of these tumors should be individualized.
  4,175 73 -
UROPATHOLOGY
A rare case of plasmacytoid urothelial carcinoma of bladder: Diagnostic dilemmas and clinical implications
Khaliqur Rahman, Santosh Menon, Asawari Patil, Ganesh Bakshi, Sangeeta Desai
January-March 2011, 27(1):144-146
DOI:10.4103/0970-1591.78409  PMID:21716882
Plasmacytoid urothelial carcinoma is an uncommon and aggressive variant of urothelial carcinoma associated with late presentation and poor prognosis. We discuss here the first reported case from India of a 54-year-old male who presented with hematuria. Cystoscopy showed edematous and ulcerated mucosa throughout the bladder. A transurethral biopsy revealed urothelial carcinoma with plasmacytoid appearance. He underwent a radial cystectomy which on histopathology showed plasmacytoid urothelial carcinoma of the bladder of high stage with involvement up to bladder serosa and adventitial walls of the ureter. The diagnostic dilemmas of this unusual variant of urothelial malignancy and its clinical impact are discussed.
  3,854 82 -
CASE REPORTS
Impacted calculus within a urethral stent: A rare cause of urinary retention
Shanmugasundaram Rajaian, Ganesh Gopalakrishnan, Santosh Kumar, Nitin S Kekre
January-March 2011, 27(1):133-134
DOI:10.4103/0970-1591.78423  PMID:21716876
An elderly male presented to the emergency department with acute urinary retention. He had poor flow of urine associated with serosanguinous discharge per urethra for 3 days duration. Earlier he underwent permanent metallic urethral stenting for post TURP bulbar urethral stricture. Plain X-ray of Pelvis showed an impacted calculus within the urethral stent in bulbar urethra. Urethrolitholapaxy was done with semirigid ureteroscope. Urethral stent was patent and well covered. Subsequently he had an uneventful recovery. We describe a unique case of acute urinary retention due to calculus impaction within a urethral stent.
  3,619 97 2
REVIEW ARTICLE
Surgical management of upper tract urothelial carcinoma
Vincent G Bird, Prashanth Kanagarajah
January-March 2011, 27(1):2-9
DOI:10.4103/0970-1591.78400  PMID:21716884
Upper tract urothelial cell carcinoma accounts for 5% of all urothelial tumors. Compared to lower urinary tract tumors, upper tract urothelial carcinoma is diagnosed more frequently at advanced stages. Open radical nephroureterectomy remains the gold standard treatment option for upper tract tumors. However, with the advancement of minimally invasive techniques and the benefits of these procedures regarding perioperative morbidity, cosmesis, and earlier convalescence, these options have shown promise in managing the patients with upper tract urothelial carcinoma. Despite the perioperative advantages, concerns exist on the oncological safety after minimally invasive surgery. In this article, we provide a comprehensive overview of the surgical management of upper tract urothelial carcinoma.
  3,306 311 1
CASE REPORTS
Breast carcinoma metastasizing to the urinary bladder and retroperitoneum presenting as acute renal failure
Kamlesh G Shah, Pranjal R Modi, Jamal Rizvi
January-March 2011, 27(1):135-136
DOI:10.4103/0970-1591.78421  PMID:21716877
Breast carcinoma is the most common nondermatologic cancer diagnosis in women. Common metastatic sites include lymph nodes, lung, liver, and bone. Breast carcinoma metastatic to the bladder has been reported only sporadically. Most patients were symptomatic breast cancer with evidence of disseminated disease at the time of diagnosis. Metastasis usually occurred many years after diagnosis, and the prognosis was poor. We report a case of breast caricinoma metastasizing to the urinary bladder and retroperitoneum, which presented initially with acute renal failure. Patient was treated with bilateral per cuteneous nephrostomies and chemotherapy. Starting from this clinical case we review the available literature on this issue. Patients with breast cancer presenting with urinary symptoms should be examined for possible bladder metastasis.
  3,537 48 3
URORADIOLOGY
Giant unilateral hydrocele ''en-bisac'' with right hydronephrosis in an adult: A rare entity
Dharamveer Singh, Pallavi Aga, Apul Goel
January-March 2011, 27(1):142-143
DOI:10.4103/0970-1591.78413  PMID:21716881
Abdominoscrotal hydrocele consists of two large sacs; the abdominal and scrotal, both are connected via the inguinal canal. The diagnosis is made by clinical examination and can be confirmed with ultrasound scan. Surgical treatment is considered mandatory since spontaneous resolution is extremely rare. Herein, we report a case of giant unilateral hydrocele en-bisac who presented with spontaneous rupture of the sac.
  3,488 82 1
SYMPOSIUM
Techniques for microsurgical reconstruction of obstructive azoospermia
Joel L Marmar
January-March 2011, 27(1):86-91
DOI:10.4103/0970-1591.78438  PMID:21716572
About 10%-15% of infertile men present with azoospermia, and ductal obstruction is the cause in 40% of them. For about 25-30 years, microsurgical reconstruction was the only way to manage obstructive azoospermia, and several innovative techniques have been developed and implemented. Presently, assisted reproductive technologies (ART) are available for these men as an alternative to surgery. Clinicians who treat these men must be familiar with all of these options, and many of the ART techniques have been covered in other sections of this symposium. However, the present article focuses on vasovasostomies and vasoepididymostomies. The intent of this review is to critique these microsurgical procedures, and present some surgical "pearls" related to them.
  3,048 228 2
Surgery for azoospermia in the Indian patient: Why is it different?
Rajeev Kumar
January-March 2011, 27(1):98-101
DOI:10.4103/0970-1591.78441  PMID:21716895
Obstructive azoospermia is one of the few surgically correctable causes of male infertility. The outcomes of surgery in these patients are variable and often dependent upon the diagnosis and surgical expertise. We aimed to review the reported outcomes in Indian patients and evaluate potential reasons why these outcomes may be different from those reported from other regions. A search was performed on Medline/Pubmed using relevant keywords to identify publications from India on surgical management of azoospermia. The same search was repeated on Google and on the website of the Indian Journal of Urology. Personal emails were sent to prominent urologists performing surgery for azoospermia in India to obtain their opinions and reprints of their published articles. These were then reviewed. Very few articles were identified that pertained to the original search. A large majority of patients are diagnosed with idiopathic infertility. The outcomes of surgery where a clear diagnosis can be made are generally good and often comparable with the published literature. Infections are probably an under-diagnosed etiology. More research and publications are required to determine the etiology of obstructive azoospermia in the Indian men. These would help appropriate patient counseling and treatment.
  3,007 255 -
SYMPOSIUM-EDITORIAL
Male infertility - Current concepts
Rajeev Kumar
January-March 2011, 27(1):39-40
DOI:10.4103/0970-1591.78419  PMID:21716888
  2,830 405 -
UROSCAN
Extracorporeal shock wave lithotripsy in impacted upper ureteral stones: Comparison between stented and non-stented technique
Vikash Kumar, Jayesh V Dhabalia
January-March 2011, 27(1):151-153
  2,716 97 -
EDITORIAL
Male infertility clinic - Is it useful?
Nitin S Kekre
January-March 2011, 27(1):1-1
DOI:10.4103/0970-1591.78399  PMID:21716931
  2,323 245 -
UROSCAN
Prostate cancer vaccine: A new paradigm for prostate cancer treatment
Amod Kumar Dwivedi, Vengetesh K Sengottayan, Apul Goel
January-March 2011, 27(1):148-149
  2,378 82 -
ORIGINAL ARTICLES
Is modified Raz technique of midurethral sling a reliable and cost-effective method of treating stress urinary incontinence?
Rakesh Kapoor, Ruchir Maheshwari, Deepa Kapoor, Uday P Singh, Rohit Upadhyay
January-March 2011, 27(1):34-38
DOI:10.4103/0970-1591.78418  PMID:21716887
Objectives: We report our experience of pure stress urinary incontinence (SUI) treated by midurethral synthetic sling placement by modified Raz technique. Materials and Methods: Fifty-three patients with pure SUI operated at our institute between June 2003 and December 2008 were included in this study. Midurethral sling tape, fashioned from commercially available large pore synthetic mesh, was placed using the modified Raz technique. The technique consisted of placing the tape within retropubic space using double-pronged needle, which is passed under finger control through the fascia and retropubic space. Outcomes were assessed on the basis of patient's interview in follow-up OPD. Results: Mean age was 57.68 (28-69) years. Forty-five (85%) patients were totally dry and eight (15%) socially dry at the end of the follow-up. Mean operative time was 46.5 + 11.3 minutes (35-80 minutes). None of the patients required blood transfusion or had bladder/bowel injury. Mean duration of hospital stay was 2.17 days (2-4 days). Mean duration of follow-up was 46.1 months (12-78 months). Conclusions: Modified Raz technique is safe and cost-effective for placing midurethral sling for genuine stress incontinence.
  2,354 93 3
CASE REPORTS
Mesonephric adenoma in remnant ureteric stump: A rare entity
Kamal Jeet Singh
January-March 2011, 27(1):140-141
DOI:10.4103/0970-1591.78414  PMID:21716880
Nephrogenic Adenomas have been reported though out the Urinary Tract from Renal Pelvis to the Urethra. We present one rare case of its occurrence in the remanant ureteral stump.
  2,256 57 2
UROSCAN
Equivocal ureteropelvic junction obstruction: Is there a role of therapuetic double J stent
Sumit Sharma, Ravimohan S Mavuduru, Mohan M Agarwal
January-March 2011, 27(1):150-151
  1,904 95 -
Reconstruction of ureteral defect lesion with vein graft and a biodegradable endoluminal stent: An innovative therapeutic approach
Rohit Kathpalia, Vengetesh K Sengottayan, Apul Goel
January-March 2011, 27(1):147-148
  1,508 59 -
Role of 5-alpha reductase inhibitors in the prevention of prostate cancer
Bhupendra P Singh, SN Sankhwar, Apul Goel
January-March 2011, 27(1):153-155
  1,309 83 -
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