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   2009| January-March  | Volume 25 | Issue 1  
    Online since February 18, 2009

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Percutaneous nephrolithotomy: Current concepts
Fabio C Vicentini, Cristiano Mendes Gomes, Alexandre Danilovic, Elias A Chedid Neto, Eduardo Mazzucchi, Miguel Srougi
January-March 2009, 25(1):4-10
DOI:10.4103/0970-1591.44281  PMID:19468422
Percutaneous nephrolithotomy (PNL) is the procedure of choice for large renal stones. Since its introduction in 1976, many aspects of the operative technique and the endoscopic equipments have had constant evolution, increasing the success rates of the procedure. We performed a literature search using Entrez Pubmed from January 2000 to July 2007 concerning PNL and many aspects related to all steps of the procedure. We could verify that PNL in supine position has been proved as an acceptable option, but more worldwide experience is necessary. Urologists must be trained to gain their own renal tract access. Minipercutaneous PNL still needs equipments improvements for better results. Tubeless PNL is increasing in popularity and different tract sealants have been studied. Medical prevention is proved to be effective against stone recurrence and should be always used after PNL. Although the evolution of the technique in the last 20 years, urologists must continue to improve their skills and develop new technologies to offer to the patients more and more a safe and effective option to treat large renal stones.
  8,417 929 13
Gangrene of the penis in a diabetic male with multiple amputations and follow up
P Vijayan
January-March 2009, 25(1):123-125
DOI:10.4103/0970-1591.45550  PMID:19468442
A 60-year-old insulin dependent, diabetic male with severe atherosclerosis requiring multiple amputations in the extremities in the past, with normal renal function presented with gangrene of glans penis. He was initially treated with debridement but as the gangrene progressed, partial penile amputation was performed. He showed no further progress of the disease and had no voiding difficulties even after 4 years of follow up.
  8,835 253 7
Feminizing genital reconstruction in congenital adrenal hyperplasia
Jeffrey A Leslie, Mark Patrick Cain, Richard Carlos Rink
January-March 2009, 25(1):17-26
DOI:10.4103/0970-1591.45532  PMID:19468424
The past several decades have seen multiple advances in the surgical reconstruction for girls born with Disorders of Sexual Differentiation. This surgery can be technically very demanding, and must be individualized for each patient, as the degree of virilization and level of confluence of the vagina and urogenital sinus will dictate the surgical approach. In this manuscript we present our approach and experience in the surgical options for girls born with Congenital Adrenal Hyperplasia, with special attention regarding clitoroplasty, urogenital mobilization, and vaginoplasty.
  8,064 530 8
Epidemiology of hospital acquired urinary tract infections in a medical college hospital in Goa
Umesh S Kamat, Agnelo Fereirra, Dilip Amonkar, Dilip D Motghare, Manoj S Kulkarni
January-March 2009, 25(1):76-80
DOI:10.4103/0970-1591.45542  PMID:19468434
Background: Hospital Acquired Urinary Tract Infection (HAUTI) is the commonest among the nosocomial infections, and hospital specific data concerning its magnitude and attributes is essential to its effective control. Materials and Methods: Prospective study was undertaken among 498 in-patients at the medical college hospital in Goa, employing the clinico-bacteriologic criteria of CDC, Atlanta, in the representative medicine and surgery wards. Antimicrobial sensitivity was tested using the Kirby-Bauer disc diffusion method. Statistical Analysis: Statistical significance of association was tested using the chi-square test and the unpaired t-test at 5% level of significance, while the strength of association was expressed as the Odd's ratio with 95% confidence interval calculated by Wolff's method. Results: While the overall infection rate was 8.03/100 admissions, 33.6% of the catheterized patients developed HAUTI. Effect of gender was found to remain restricted to the development of HAUTI among females at an earlier age and earlier in time series compared to males, but no overall difference in incidence in the two sexes. The factors significantly associated with HAUTI included: duration of hospitalization, per urethral catheterization and the duration of catheterization. E. coli, Pseudomonas, Kebsiella, and Candida accounted for over 90% of the isolates, and 73.5% of these were resistant to all the antibiotics for which sensitivity was tested. The remaining isolates demonstrated sensitivity to amikacin and/or cefoperazone-sulbactam. Conclusion: High infection rate coupled with widespread isolation polyantimicrobial resistant nosocomial pathogens emphasizes the importance of meticulous surveillance of nosocomial infections in the hospital, with due attention to antibiotic prescription practices.
  6,751 506 6
Venous thromboembolism: A problem in the Indian/Asian population?
Sunil Agarwal, Arvind Dhas Lee, Ravish Sanghi Raju, Edwin Stephen
January-March 2009, 25(1):11-16
DOI:10.4103/0970-1591.45531  PMID:19468423
Venous thromboembolism (VTE) is a common and potentially life threatening condition. It continues to be under diagnosed and undertreated. Awareness among Indians regarding this potentially life-threatening disease is low. Contrary to earlier belief, the incidence of VTE in Asia and India is comparable to that in Western countries. The risk of VTE is especially high in hospitalized patients, in a majority of whom it is clinically silent. It is one of the commonest causes of unplanned readmission and preventable death. In the United States, it is responsible for more deaths than accidents. Thromboprophylaxis is highly effective in reducing the incidence of VTE without any increase in clinically significant bleeding. It is worth emphasizing that prevention of VTE is much easier and cheaper than its treatment.
  6,610 522 8
Endoscopic treatment of vesicoureteral reflux: Current status
Goran Lackgren
January-March 2009, 25(1):34-39
DOI:10.4103/0970-1591.45534  PMID:19468426
Vesicoureteral reflux (VUR) affects around 1% of all children. It carries an increased risk of febrile urinary tract infections (UTIs) and is associated with impaired renal function. Endoscopic treatment with NASHA/Dx gel (dextranomer microspheres in a stabilized hyaluronic acid-based gel of nonanimal origin) is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: ~90% in several studies. It has also been shown to be effective in a variety of 'complicated' cases. Endoscopic treatment is therefore considered preferable to open surgery and long-term antibiotic prophylaxis. Nontreatment of VUR is being discussed as an alternative option, whereby children are treated with antibiotics only when UTIs occur. Considering all the available evidence, however, active intervention with endoscopic treatment remains preferable. A new approach to managing VUR may nevertheless be considered, with treatment decisions based not only on the grade of reflux, but also factors such as age, sex, renal scarring, and bladder dysfunction. Open surgery would be reserved for use only in the ~10% of children not responding to endoscopic treatment, and patients with refluxing primary megaureter.
  6,380 490 2
Detection and treatment of transplant renal artery stenosis
Sriram Krishnamoorthy, Ganesh Gopalakrishnan, Nitin Sudhakar Kekre, Ninan Chacko, Shyam Keshava, George John
January-March 2009, 25(1):56-61
DOI:10.4103/0970-1591.45538  PMID:19468430
Purpose: To assess the effects of transplant renal artery stenosis (TRAS) on blood pressure, renal function, and graft survival. To assess the usefulness of Doppler in predicting the clinical significance of TRAS and also to identify the predictive factors in Doppler that correlated with clinical features of TRAS. Materials and Methods: A prospective study was done on consecutive renal allograft recipients at Christian Medical College, over a period of 66 months from January 2002. All recipients underwent Doppler ultrasound (DUS) evaluation on the fifth post-operative day. Subsequent evaluation was done if the patients had any clinical or biochemical suspicion of TRAS. Angiogram was done in case of a high index of suspicion of significant stenosis or before angioplasty and stenting. The clinical and radiological outcomes of the patients with symptomatic or asymptomatic TRAS were analyzed. Results: Five hundred and forty three consecutive renal allograft recipients were analyzed, of whom, 43 were found to have TRAS. Nine recipients (21%) were detected to have TRAS on first evaluation. All had a high peak systolic velocities (PSV) recorded while 25 of them had other associated features. Patients with only high PSV required no further intervention and were followed up. They had a pretransplant mean arterial pressure (MAP) of 107.83 mmHg (SD = 13.32), ranging from 90 to 133 mm Hg and a posttransplant MAP of 106.56 mmHg (SD =16.51), ranging from 83 to 150 mm Hg. Their mean nadir serum creatinine was 1.16 mg% (SD = 0.24), at detection was 1.6 mg% (SD = 1.84) and at 6 months follow-up was 1.26 mg% (SD=0.52). Of the remaining 25 patients with other associated Doppler abnormalities, 11 required further intervention in the form of re-exploration in 2, angioplasty in 3 and stenting in 6 patients. One patient in the group of patients intervened, expired in the immediate post-operative period due to overwhelming urosepsis and consumption coagulopathy. The mean creatinine clearance (Cockroft-Gault method) in this group of remaining 10 patients, before and after intervention was 44.75 ml/min (SD=17.85) and 68.96 ml/min (SD = 10.56), respectively, with a mean increase by 24.21 ml/min (P=0.000). The mean arterial pressure before and after intervention in this group were 132.80 mm Hg (SD = 13.22) and 102 mm Hg (SD = 10.55), with a decline in the MAP by 30.80 mmHg (P=0.017). The haemoglobin levels also increased from 11.72 (SD=2.13) to 12.48 gm% (SD = 1.75), with a mean increase by 0.76 gm% (P=0.05). Conclusions: Patients with isolated high PSV do not have a significant alteration of blood pressure or allograft function and required no intervention. Although high PSV with associated Doppler anomalies are more suggestive of significant TRAS, the decision regarding surgical intervention is largely based on clinical assessment.
  6,114 373 11
Minimally invasive surgical options for ureteropelvic junction obstruction: A significant step in the right direction
Stephanie J Symons, Victor Palit, Chandra Shekhar Biyani, Jon J Cartledge, Anthony J Browning, Adrian D Joyce
January-March 2009, 25(1):27-33
DOI:10.4103/0970-1591.45533  PMID:19468425
Open pyeloplasty is the gold standard treatment for adult ureteropelvic junction obstruction (UPJO) with published success rates consistently over 90%. In recent years, the management of UPJO has been revolutionized by the introduction of endoscopic procedures and laparoscopic techniques. We analyzed the long-term results of endoscopic and other minimal access approaches for the treatment of UPJO. Early results for endopyelotomy were promising but long-term results were not encouraging. Laparoscopic pyeloplasty technique is well defined and duplicates the surgical principles of conventional open pyeloplasty. With such a large variety of minimally invasive procedures for the treatment of UPJO available, the treatment choice for UPJO must be based on the success and morbidity of the procedures, the surgeon's experience, the cost of the treatment, and the patient's choice. We feel that with the technological advances in instrumentation coupled with a decrease in cost and improved training of urological surgeons, laparoscopic pyeloplasty may evolve to be the new "gold" standard for the treatment of UPJO.
  5,126 432 10
The penile cuff test: A clinically useful non-invasive urodynamic investigation to diagnose men with lower urinary tract symptoms
Christopher Harding, Wendy Robson, Michael Drinnan, Stuart McIntosh, Mustafa Sajeel, Clive Giffiths, Robert Pickard
January-March 2009, 25(1):116-121
DOI:10.4103/0970-1591.45549  PMID:19468441
Objectives: To summarize the development of a novel non-invasive test to categorize voiding dysfunction in men complaining of lower urinary tract symptoms (LUTS) - the penile cuff test. Methods: The test involves the controlled inflation of a penile cuff during micturition to interrupt voiding and hence estimate isovolumetric bladder pressure (p ves.isv ). The validity, reliability, and clinical usefulness of the test were determined in a number of studies in men with LUTS. Results: The penile cuff test can be successfully performed in over 90% of men with LUTS. The reading of cuff pressure at flow interruption (p ) gives a valid and reliable estimate of invasively-measured p ves.isv and when combined with the reading for maximum flow rate obtained during the test (Q max ) produces an accurate categorization of bladder outlet obstruction (BOO). Use of this categorization prior to treatment allows improved prediction of outcome from prostatectomy. Conclusion: The penile cuff test fulfils the criteria as a useful clinical measurement technique applicable to the diagnosis and treatment planning of men with LUTS.
  5,131 295 1
Laparoscopic ureterolithotomy for lower ureteric stones: Steps to make it a simple procedure
Anil Mandhani, Rakesh Kapoor
January-March 2009, 25(1):140-142
DOI:10.4103/0970-1591.45556  PMID:19468448
Despite advances in endoscopy and availability of holmium lithotripsy there are ureteric stones, which primarily need to be treated with laparoscopic ureterolithotomy. Literature is replete with the stone retrieval in upper ureteric stone but there are a very few reports on stones removal from ureter below the lower sacroiliac joint. Putting a double J stent before starting the procedure does not give any extra advantage; rather it takes away significant operating room time. This point of technique describes port placement strategy, proximal ureteral occlusion; stone localization, ureterotomy, stone retrieval and laparoscopic stenting are the important steps where one would like to be careful enough to complete the procedure successfully.
  5,005 345 2
Review of invasive urodynamics and progress towards non-invasive measurements in the assessment of bladder outlet obstruction
CJ Griffiths, RS Pickard
January-March 2009, 25(1):83-91
DOI:10.4103/0970-1591.45544  PMID:19468436
Objective: This article defines the need for objective measurements to help diagnose the cause of lower urinary tract symptoms (LUTS). It describes the conventional techniques available, mainly invasive, and then summarizes the emerging range of non-invasive measurement techniques. Methods: This is a narrative review derived form the clinical and scientific knowledge of the authors together with consideration of selected literature. Results: Consideration of measured bladder pressure urinary flow rate during voiding in an invasive pressure flow study is considered the gold standard for categorization of bladder outlet obstruction (BOO). The diagnosis is currently made by plotting the detrusor pressure at maximum flow (p detQmax ) and maximum flow rate (Q max ) on the nomogram approved by the International Continence Society. This plot will categorize the void as obstructed, equivocal or unobstructed. The invasive and relatively complex nature of this investigation has led to a number of inventive techniques to categorize BOO either by measuring bladder pressure non-invasively or by providing a proxy measure such as bladder weight. Conclusion: Non-invasive methods of diagnosing BOO show great promise and a few have reached the stage of being commercially available. Further studies are however needed to validate the measurement technique and assess their worth in the assessment of men with LUTS.
  4,877 457 3
Epstein-Barr virus positive B-cell lymphoproliferative disorder/polymorphous B-cell lymphoma of the urinary bladder: A case report with review of literature
Sandhya Sundaram, Kai Zhang
January-March 2009, 25(1):129-131
DOI:10.4103/0970-1591.45552  PMID:19468444
We report an unusual case of a localized Epstein-Barr virus (EBV)-positive B cell lymphoproliferative disorder (LPD)/polymorphous B cell lymphoma of the urinary bladder in a 67 years old female patient. She had no known predisposing immunodeficiencies and presented with recent onset of hematuria. The CT and cystoscopic examination revealed a localized 2.5 cm polypoid or plaque-like mucosal mass on the right posterior and lateral wall of the bladder. The biopsy sample showed a diffuse and densely polymorphous atypical lymphoid infiltrate admixed with numerous small lymphocytes, histiocytes and occasional plasma cells and neutrophils. The large atypical cells were CD20+, CD79a+, CD30+, CD43+ and they were strongly positive for EBV by in situ hybridization using anti-EBER-1 probe. Polymerase chain reaction (PCR) for immunoglobulin heavy chain gene rearrangement study showed a clonal gene rearrangement. The findings indicated EBV+LPD of the bladder. Primary lymphoma of bladder is rare and primary EBV+LPD of the bladder has not been previously described. Potential misdiagnosis of poorly differentiated urothelial carcinoma can occur and accurate diagnosis depends on comprehensive immunohistochemical and molecular workups.
  5,065 194 1
Tension-free vaginal tape versus lata fascia sling: The importance of transvulvar ultrasound in the assessment of relevant anatomical parameters in treatment of women with stress urinary incontinence
Frederico Teixeira Brandt, Felipe Lorenzato, Carla Daisy Costa Albuquerque, Agostinho de Sousa Machado, Amanda de Carvalho Poca, Raíssa Almeida Viana
January-March 2009, 25(1):62-67
DOI:10.4103/0970-1591.45539  PMID:19468431
Objective: To describe the relevance of transvulvar ultrasound in the assessment of anatomical differences induced by the lata fascia sling (LFS) and tension-free vaginal tape (TVT) procedures. Materials and Methods: Forty women with stress urinary incontinence (SUI), aged 30 to 60 years, have been treated with either LFS (20 patients) or TVT (20 patients). The transvulvar ultrasound of the urethrovesical junction (UVJ) and proximal urethra (PU) has been used as the main investigational tool both pre- and post-operatively. The studied parameters were the vertical (VUVJD) and horizontal (HUVJD) UVJ distances, the pubourethral distance (PUD) and the PU length. Results: The VUVJD did not vary significantly after the LFS surgery (P=0.10). The PUD became shorter (P=0.001) and the HUVJD became shorter only at rest (P=0.03) after the correction by LFS. The TVT procedure has led to shortening of the VUVJ displacement (P=0.0005) and of the PU length (P=0.02). Conclusions: The transvulvar ultrasound was of utmost importance in the demonstration that both the LFS and TVT surgical procedures elongate the PU, even though the LFS technique does it more efficiently. The LFS technique focus more on shortening the PUD and the TVT procedure focus more on the correction of the vertical UVJ displacement.
  4,991 203 2
Closure versus nonclosure of buccal mucosal graft harvest site: A prospective randomized study on post operative morbidity
K Muruganandam, Deepak Dubey, Anil Kumar Gulia, Anil Mandhani, Aneesh Srivastava, Rakesh Kapoor, Anant Kumar
January-March 2009, 25(1):72-75
DOI:10.4103/0970-1591.45541  PMID:19468433
Objective: To prospectively compare the postoperative morbidity of closure versus non closure of the buccal mucosal graft (BMG) harvest site. Methods: Patients who underwent BMG harvest for urethroplasty were randomized into 2 groups; in group 1 donor site was closed and in group 2 it was left open. Self made questionnaires were used to assess post-operative pain, limitation to mouth opening, loss of sensation at graft site. The time to resumption of liquid and solid diet were also noted. Results: Fifty patients were studied, 25 in each group from July 2003 to July 2005. BMG was harvested from single cheek in most of the patients. Mean post operative pain score was 4.20 and 3.08 at day 1 in group 1 and group 2, respectively (P < 0.05). Return to oral intake in terms of liquid and solid diet was comparable between the groups. Difficulty with mouth opening was maximal during the first week with no difference among the two groups. Two patients in group 1 and one in group 2 had persistent peri-oral numbness at 6 months. None of the patients in both the groups had changes in salivation or retention cysts. Conclusion: Pain appears to be worse in the immediate post operative period with suturing of the harvest site. There is no difference in long term morbidity whether the graft site is closed or left open. It may be best to leave buccal mucosa harvest sites unsutured.
  4,864 243 8
Rapid onset renal deterioration in an adult with silent ureteropelvic junction obstruction
Nicholas J Hellenthal, Sasha A Thomas, Roger K Low
January-March 2009, 25(1):132-133
DOI:10.4103/0970-1591.45553  PMID:19468445
We report a case of a rapid renal deterioration due to ureteropelvic junction obstruction (UPJO) in an asymptomatic woman with prior normal diuretic renography. This case illustrates "silent" renal obstruction and the inability of diuretic renography in detecting significant renal obstruction. This case may favor close surveillance of any adult patient with potential UPJO, especially those with underlying renal disease or solitary kidney.
  4,685 194 1
Use of Doppler ultrasound for non-invasive urodynamic diagnosis
Hideo Ozawa, Toyohiko Watanabe, Katsutoshi Uematsu, Katsumi Sasaki, Miyabi Inoue, Hiromi Kumon
January-March 2009, 25(1):110-115
DOI:10.4103/0970-1591.45548  PMID:19468440
Objectives: A totally non-invasive transperineal urodynamic technique using Doppler ultrasonography has been developed. Methods: Since normal urine does not have blood cells, urine was thought not to produce the Doppler effects. However, basic studies confirmed that the decrease of pressure at high velocity (Bernouilli effect) caused dissolved gas to form microbubbles, which are detected by Doppler ultrasonography. Subjects sat and the probe was advanced via remote control to achieve gentle contact with the perineal skin. The digital uroflow data signals and the color Doppler ultrasound video images were processed on a personal computer. The flow-velocity curves from two sites; the distal prostatic urethra just above the external sphincter (V1) and the sphincteric urethra (V2) were plotted against time. The parameters of both the pressure-flow studies and the Doppler ultrasound urodynamic studies were compared in men who had various degrees of obstruction. Results: Functional cross-sectional area at prostatic urethra (A1), calculated by Q max /V1, was lower in the group of bladder outlet obstruction (BOO) vs. control group. Velocity ratio (VR), which was calculated by V1/V2, was the parameter having the best correlation with BOO index, though A1 had a similar correlation. This method is viable to diagnose the degree of BOO. Conclusions: The development of non-invasive Doppler ultrasound videourodynamics (Doppler UDS) will dramatically expand the information on voiding function.
  4,478 359 2
The use of ultrasound-estimated bladder weight in diagnosing bladder outlet obstruction and detrusor overactivity in men with lower urinary tract symptoms
Fadi Housami, Marcus Drake, Paul Abrams
January-March 2009, 25(1):105-109
DOI:10.4103/0970-1591.45547  PMID:19468439
Objectives: Measurement of bladder weight using ultrasound estimates of bladder wall thickness and bladder volume is an emerging clinical measurement technique that may have a role in the diagnosis of lower urinary tract dysfunction. We have reviewed available literature on this technique to assess current clinical status. Methods: A systematic literature search was carried out within PubMed and MedLine to identify relevant publications. These were then screened for relevance. Preliminary results from our clinical experiments using the technique are also included. Results: We identified 17 published papers concerning the technique which covered clinical studies relating ultrasound-estimated bladder wall thickness to urodynamic diagnosis in men, women, and children together with change in response to treatment of bladder outlet obstruction. The original manual technique has been challenged by a commercially available automated technique. Conclusion: Ultrasound-estimated bladder weight is a promising non-invasive technique for the categorization of storage and voiding disorders in both men and women. Further studies are needed to validate the technique and assess accuracy of diagnosis.
  4,483 329 4
The current role of telomerase in the diagnosis of bladder cancer
Sara Bravaccini, Valentina Casadio, Dino Amadori, Daniele Calistri, Rosella Silvestrini
January-March 2009, 25(1):40-46
DOI:10.4103/0970-1591.45535  PMID:19468427
Bladder cancer has an incidence of 15 cases per 100,000 persons in the global population and is the most common tumor of the urinary tract. Imaging techniques, cytoscopy, and cytology are either invasive or not sufficiently accurate to detect early stage tumors, and the need for new diagnostic markers still remains. Among the markers most recently proposed to improve diagnostic accuracy and especially sensitivity, increasing attention has been focused on the role of the ribonucleoprotein, telomerase. Relevant papers on the etiology, diagnosis, and evaluation of bladder cancer using telomerase in urine were searched for and considered. The PubMed search was performed using the text terms "bladder cancer", "diagnosis", and "telomerase". Previous studies have shown that the quantitative Telomerase Repeat Amplification Protocol (TRAP) assay performed in voided urine is an important non-invasive tool for the diagnosis of bladder tumors since it has very high sensitivity and specificity, even for early stage and low grade tumors. The main limitation of this test is the rate of false positive results due to the presence of inflammatory or non-tumor cells (i.e., epithelial cells from the lower genital tract), which express telomerase activity (TA). Consequently, an in situ analysis would seem to be important to identify the nature of telomerase-positive cells. Immunocytochemical detection of the hTERT subunit by a specific antibody seemed to open up the possibility to identify different cellular components of urine. However, the lack of a strict relationship between hTERT protein expression and telomerase activity has, to a certain extent, made this approach less relevant. In conclusion, telomerase activity in urine determined by TRAP seems to be marker of great potential, even more advantageous in cost/benefit terms when used in selected symptomatic patients or professionally high-risk subgroups.
  4,257 338 9
Development and application of the condom catheter method for non-invasive measurement of bladder pressure
R van Mastrigt, J.J.M Pel, J.W.N.C Huang Foen Chung, S de Zeeuw
January-March 2009, 25(1):99-104
DOI:10.4103/0970-1591.45546  PMID:19468438
Objectives: A non-invasive method to measure the bladder pressure in males using a condom catheter has been developed. The measurement technique, its validation and limitations, a diagnostic nomogram to non-invasively diagnose bladder outlet obstruction (BOO), and results of large-scale application are discussed. Methods: Modified incontinence condoms are attached to the penis. During voiding the flow of urine is mechanically interrupted. The subsequent maximum pressure in the condom reflects the isovolumetric bladder pressure. The method was validated in a group of 46 patients with lower urinary tract symptoms who were simultaneously studied invasively and non-invasively. Subsequently it was applied in a non-invasive epidemiological study in 1020 healthy males. Results: The reproducibility of the measured isovolumetric bladder pressure is comparable to that of conventional pressure-flow parameters. The measured pressure can be used to diagnose bladder outlet obstruction with a diagnostic accuracy (Area Under receiver operator characteristic curve) of 0.98, which compares most favorably with the area under the curve of 0.79 of Q max in the same population. During condom catheter measurements, both the involuntary interruption of voiding and the forced diuresis increase post-void residual volume. This increase does not affect the accuracy of the pressure measurements. Conclusions: We conclude that in males bladder pressure can successfully be measured non-invasively using the condom catheter method. By combining the measured volumetric bladder pressure with a separately measured free flow rate, BOO can non-invasively and accurately be diagnosed.
  4,250 297 3
Role of maximum androgen blockade in advanced prostate cancer
Rajinikanth Ayyathurai, Rosely De Los Santos, Murugesan Manoharan
January-March 2009, 25(1):47-51
DOI:10.4103/0970-1591.45536  PMID:19468428
Androgen ablation is the mainstay treatment for advanced prostate cancer (PC). Researchers proposed that maximum androgen blockade (MAB) therapy with antiandrogen agent in combination with castration might result in a better outcome among patients with advanced PC. In the last two decades, numerous trials and pooled data analyses were conducted to optimize the role of MAB in the treatment of metastatic PC. Non-steroidal antiandrogens administered as part of MAB proved to have a small (3%) survival benefit, however, the magnitude of this difference is of questionable clinical significance. Available evidence suggests that MAB should not be routinely offered to patients with metastatic PC, however, it should remain a reasonable option when discussing management. The standard first line treatment should be a monotherapy, consisting of orchiectomy or LHRH agonist. MAB still has a role as a short-term therapy (2-4 weeks). The ongoing large sample population based prospective studies may add new dimensions in the use of MAB in treatment of the prostate cancer in future.
  4,111 366 -
Penile shaft sinus: A sequalae of circumcision in urethral duplication
Lukman O Abdur-Rahman, AbdulRasheed A Nasir, John O Agboola, James O Adeniran
January-March 2009, 25(1):134-136
DOI:10.4103/0970-1591.45554  PMID:19468446
Urethral duplication (UD) is rare congenital anomalies with varied presentation. Careful clinical evaluation of children by specialist would enhance diagnosis, adequate management and reduce occurrence of complication. We present a 12-year-old boy with chronic post circumcision ventral penile sinus that was successfully managed for urethral duplication.
  4,127 166 2
Primary adenocarcinoma of the seminal vesicle
M Tarjan, I Ottlecz, T Tot
January-March 2009, 25(1):143-145
DOI:10.4103/0970-1591.45557  PMID:19468449
Primary adenocarcinomas of the seminal vesicle (SVC) are very rare and poorly understood neoplasms with only somewhat more than 50 histologically confirmed cases reported in the literature. We demonstrate a case of SVC and discuss the problems related to diagnosis in this tumor.
  4,070 196 7
Intraparenchymatous adenomatoid tumor dependent on the rete testis: A case report and review of literature
A Jimenez Pacheco, JL Martínez Torres, F Valle Diaz de la Guardia, MA Arrabal Polo, A Zuluaga Gomez
January-March 2009, 25(1):126-128
DOI:10.4103/0970-1591.45551  PMID:19468443
The adenomatoid tumor is the most frequent paratesticular tumor. It is a benign tumor, which in women is mainly found in the uterus and the fallopian tubes, while in men it is most frequently found in the epididymis. These lesions may also affect the testicular albuginea, the spermatic cord and, in exceptional cases, the testicular parenchyma, of which there are only 4 published cases, the ejaculatory ducts, prostate, etc. The clinical signs and imaging studies are, on many occasions, difficult to differentiate from malign intratesticular solid tumor, which can result in unnecessary orchidectomies. We present a new case of intraparenchymatous adenomatoid tumor dependent on the rete testis.
  4,067 154 5
Professor A. Venugopal: Founder of Urology at Madras Medical College
C Chinnaswami
January-March 2009, 25(1):2-3
DOI:10.4103/0970-1591.45530  PMID:19468421
  3,885 310 -
Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute
Milind P Joshi, Heemanshi S Shah, Sandesh V Parelkar, Amit A Agrawal, Beejal Sanghvi
January-March 2009, 25(1):52-55
DOI:10.4103/0970-1591.45537  PMID:19468429
Aim: To determine diagnostic value of magnetic resonance urography in cases of duplex renal system. Method: Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery. Results: Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU. Conclusion: MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system.
  3,758 203 3
Prostatic fascia and recovery of sexual function after radical prostatectomy: Is it a "Veil of Aphrodite" or "Veil of mystery"!
Anil Mandhani
January-March 2009, 25(1):146-148
DOI:10.4103/0970-1591.45558  PMID:19468450
Sexual dysfunction is one of the most controversial aspects associated with radical prostatectomy. Since Walsh's description of neurovascular bundle there have been number of articles describing various modification to the technique of bilateral nerve sparing to augment the recovery of sexual function. There is a very thin line between performing an ideal nerve sparing and giving equally good oncological outcome in terms of negative surgical margin. ''Veil of Aphrodite'' nerve sparing technique was conceptualized by Menon et al. Lately other related terms have emerged in the literature e.g., ''high anterior release, ''curtain dissection,'' or ''incremental nerve sparing. Does veil technique of radical prostatectomy help improve recovery of sexual function? Do mere presence of nerves in veil account for potency? Are these nerve parasympathetic? This short review tries to find the answer of these questions in contemporary world literature.
  3,653 250 1
Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty
Pratipal Singh, Paresh Jain, Anand Dharaskar, Anil Mandhani, Deepak Dubey, Rakesh Kapoor, Anant Kumar, Aneesh Srivastava
January-March 2009, 25(1):68-71
DOI:10.4103/0970-1591.45540  PMID:19468432
Objective: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. Material and Methods: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. Results: Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR) was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05). Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05). No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion) and three had increased drain output for more than 3 days in laparoscopy group. Conclusion: Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients.
  3,423 255 1
Perineal sound recording for diagnosis of bladder outlet obstruction
Tim Idzenga, Johan J.M Pel, Ron van Mastrigt
January-March 2009, 25(1):92-98
DOI:10.4103/0970-1591.45545  PMID:19468437
Objectives: Elderly men are prone to developing lower urinary tract symptoms (LUTS) possibly caused by bladder outlet obstruction (BOO). The most frequently used method to diagnose this condition is an invasive and time-consuming pressure-flow study. We are developing a novel non-invasive method to diagnose BOO in men with LUTS based on perineal sound recording. Methods: A biophysical model urethra was made from polyvinyl alcohol (PVA) cryogel with viscoelastic properties comparable to those of the male pig urethra. To this model different degrees of obstruction were applied and sound was recorded at different positions downstream of the obstruction. In a study in 16 healthy male volunteers the variability and repeatability of perineal sound recording was tested. Results: In the model three parameters, derived from the frequency spectrum of the recorded sound (i.e., weighted average frequency, standard deviation and skewness) are uniquely related to the degree of obstruction (linear regression, P<0.001). The variability of perineal sound recording in healthy male volunteers was found to be smaller within volunteers than between volunteers (Kruskal-Wallis, P<0.001) and the repeatability was comparable to that of the maximum flow rate. Conclusions: We conclude that perineal sound recordings are significantly different between volunteers. In combination with the unique relations found in the model-experiments these results increase the probability that perineal sound recording can be used as a simple and cheap non-invasive method to diagnose BOO. Clinical testing of this method is therefore strongly indicated.
  3,096 268 1
Antibiotic prophylaxis in vesicoureteral reflux: A paradigm shift
JS Banerji, JC Singh
January-March 2009, 25(1):150-151
  3,047 308 -
Aggressive angiomyxoma of the spermatic cord: A rare entity
Ajay Malik, KJ Singh, Anurag Mehta
January-March 2009, 25(1):137-139
DOI:10.4103/0970-1591.45555  PMID:19468447
Aggressive angiomyxoma (AA) is an uncommon tumor occurring in females and is rarely reported in males with propensity to recur. Due to its presence in perineal and genital region, it has to be differentiated from other myxoid neoplasms. The tumor expresses estrogen and progesterone receptors, which may have a role to play in tumor therapy. Wide local excision remains the mainstay of the treatment. We present a case of AA excised from left spermatic cord.
  3,004 125 2
Bladder outlet obstruction and non-invasive urodynamics - The future?
Nitin S Kekre
January-March 2009, 25(1):1-1
DOI:10.4103/0970-1591.45529  PMID:19468420
  2,789 324 -
Can tomato juice be used for prophylaxis in recurrent stone formers?
Madhu S Agrawal, Sanjeet Kumar Singh
January-March 2009, 25(1):149-150
  2,802 286 -
Noninvasive methods of diagnosing bladder outlet obstruction
Robert Pickard, Clive Griffiths
January-March 2009, 25(1):81-82
DOI:10.4103/0970-1591.45543  PMID:19468435
  2,683 288 -
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