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   2019| October-December  | Volume 35 | Issue 4  
    Online since October 1, 2019

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Vesicovaginal fistula: Review and recent trends
Shanmugasundaram Rajaian, Murugavaithianathan Pragatheeswarane, Arabind Panda
October-December 2019, 35(4):250-258
DOI:10.4103/iju.IJU_147_19  PMID:31619862
Vesicovaginal fistula (VVF) is an abnormal communication between the bladder and the vagina. Prompt diagnosis and timely repair are essential for successful management of these cases. As the clinical scenario is variable, it is difficult to frame uniform guidelines for the management of VVF. Hence, the management protocol is dependent on the treating surgeon and the available resources. Conservative methods should be used in carefully selected patients. Delayed repair is better than the early repair of VVF. Transvaginal route for repair is preferred as it has low morbidity, higher success rates, and minimal complications. Anticholinergics should be used in the postoperative period for better chance of bladder healing. When facilities are available, all the patients may be referred to a tertiary care center where expertise and advanced resources are available. Trained surgeons adapting the new trends should refine the art of VVF repair.
  11,314 485 21
Techniques for fluoroscopy-guided percutaneous renal access: An analytical review
Gyanendra Ravindra Sharma, Bhojraj Luitel
October-December 2019, 35(4):259-266
DOI:10.4103/iju.IJU_149_19  PMID:31619863
Percutaneous renal access is a key step for a successful percutaneous nephrolithotomy. It involves the use of fluoroscopy, ultrasonography, or a combination of both. Over the years, various techniques have been proposed for fluoroscopy-guided access, and this article reviews the different techniques along with the anatomical principles for fluoroscopy-guided percutaneous renal access. A literature search was performed using “PubMed” for relevant literature describing the various techniques for fluoroscopy-guided percutaneous renal access. Each technique was analyzed in regard to how it describes selecting the skin site for puncture and determines the angle and depth of puncture. The advantages, limitations, and variations of these techniques were also studied. Each technique has its advantages and limitations. No study has compared all the techniques either in vivo or in vitro. Only a comparative study would establish the superiority of one technique over the other. Until this is done, endourologists should be well versed with the existing techniques.
  8,697 531 4
Urology in India: Numbers and practice
Apul Goel
October-December 2019, 35(4):245-247
DOI:10.4103/iju.IJU_246_19  PMID:31619860
  7,255 271 2
Intraperitoneal urinary bladder rupture diagnosed with ultrasound: An uncommon image
Mohan Lal, Anil Kumar, Surendra Singh
October-December 2019, 35(4):307-308
DOI:10.4103/iju.IJU_118_19  PMID:31619874
We present a case of intraperitoneal bladder rupture after fall. The patient presented with lower abdominal pain, difficulty to void urine, and mild hematuria. Catheterization revealed blood-tinged urine. Ultrasound showed a well-defined defect in the dome of bladder with flow of saline through the defect into the peritoneum, on flushing the Foley's catheter. On laparotomy, a 5 cm × 5 cm defect was found in the bladder dome that was repaired.
  4,207 152 4
Trends in the use of neoadjuvant chemotherapy for bladder cancer with nonurothelial variant histology: An analysis of the National Cancer Database
Campbell M Grant, Richard Amdur, Michael J Whalen
October-December 2019, 35(4):291-298
DOI:10.4103/iju.IJU_142_19  PMID:31619869
Introduction: The aim of this study is to evaluate the trends in the use of neoadjuvant chemotherapy (NAC) over time (2006–2014) for patients diagnosed with muscle-invasive bladder cancer (MIBC) with nonurothelial variant histology (NUVH) in the National Cancer Database. Materials and Methods: We queried the NCDB for patients with muscle-invasive (i.e. cT2-4N0-3M0/X) urothelial carcinoma (UC) of the bladder. We examined demographic, clinical, and pathologic features associated with NAC, also substratifying into pure UC and NUVH. Tests of association were performed using Chi-square/Fisher's exact test for categorical variables and t-tests, ANOVA, or Kruskal–Wallis test for continuous variables. Outcomes were examined with Cox proportional hazards and 90-day mortality with the Kaplan–Meier method. Results: Totally 22,320 patients met our inclusion criteria, of whom 22.6% received NAC. The proportion of NAC increased significantly over time in the neuroendocrine and urothelial cell categories with 57.1% and 34.1% of patients in 2014 receiving NAC vs. 44% and 10.6% in 2006. No other variant histology showed a significant increase across the time sampled. Patients receiving NAC were more likely to have downstaging to pT0 (13.4% vs. 2.7%), negative surgical margin (89.1% vs. 86%), and pN0 (63.2% vs. 60.5%) and were less likely to have 30-day (1.4% vs. 3%) or 90-day (5% vs. 8.3%) mortality. Rates of downstaging to pT0 after NAC were similar among histologies. Conclusion: Neoadjuvant chemotherapy utilization continues to slowly increase in patients with MIBC. Patients with variant histology lag behind in terms of receiving NAC but appear to derive as much benefit as patients with pure urothelial cell bladder cancer.
  3,880 243 1
Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture
Prasant Nayak, Swarnendu Mandal, Manoj Das
October-December 2019, 35(4):273-277
DOI:10.4103/iju.IJU_57_19  PMID:31619865
Introduction: The aim of the study is to present our initial experience with ventral-inlay buccal mucosal graft urethroplasty (VI-BMGU) in female urethral stricture disease (USD). Methods: Between May 2016 and June 2018, 12 women with USD underwent VI-BMGU. All women were evaluated preoperatively with the American Urological Association (AUA) symptom score, uroflowmetry, calibration with a 12 Fr catheter, and ultrasonography with postvoid residual (PVR) urine measurement. Intraoperative confirmation of stricture was done with a 6 Fr cystoscope. Postoperatively, the women were followed at 3, 6, and 12 months after surgery with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Qmax) <12 ml/s, and failure to calibrate with 18 Fr catheters were considered as indicative of recurrence of the disease. Results: The mean age of the patients was 41 years. The mean follow-up period was 18 months. All women voided successfully after catheter removal. There was an improvement in AUA symptom score and Qmaxand a reduction in PVR at 3, 6, and 12 months. One woman had recurrence of stricture at 6 months and was treated by urethral dilatation followed by the institution of a self-dilatation regimen. The success rate was 92% in our case series. Conclusions: VI-BMGU is a simple and safe method of urethroplasty in women. Studies with a larger sample size and a longer follow-up are required to document the long-term success of this procedure.
  3,536 254 14
Dorsal onlay graft urethroplasty for female urethral stricture improves sexual function: Short-term results of a prospective study using vaginal graft
T Manasa, Nikhil Khattar, Mahesh Tripathi, Anuj Varshney, Hemant Goel, Rajeev Sood
October-December 2019, 35(4):267-272
DOI:10.4103/iju.IJU_134_19  PMID:31619864
Introduction: Both dorsal and ventral approaches are acceptable options for the surgical reconstruction of female urethral strictures (FUS), but damage to the sphincter and the clitoral nerves resulting in sexual dysfunction is the chief argument against the dorsal approach. Most of the reported case series are retrospective and none has evaluated sexual functions. This study prospectively evaluates the early sexual and functional results after dorsal onlay vaginal graft urethroplasty (DVGU) for FUS. Materials and Methods: All women with a history of obstructive voiding symptoms and previous urethral dilatation were evaluated with urodynamic study, voiding cystourethrography, and cystoscopy for the presence of FUS, which was defined as visual demonstration of anatomical narrowing on urethro-cystoscopy. DVGU was offered as a definitive management for all those identified with FUS. Surgical outcomes were assessed at 3 and 6 months with the International Prostate Symptom Score (IPSS), uroflowmetry, and postvoid residual (PVR) estimation. For sexually active females, sexual function was assessed using the Female Sexual Function Inventory (FSFI) score both preoperatively and at 3 months following surgery. Results: Seventy-one women were evaluated. FUS was identified in 29 women (flimsy in 12 and dense in 17). Thirteen women with dense strictures underwent DVGU. The mean improvement in the IPSS score, Qmax, and PVR was 12.6, 16.64 ml/s, and 103.08 ml at 3 months, respectively. The FSFI score improved with a mean of 6.42 points after urethroplasty. None of the patients developed incontinence. There were three failures after a mean follow-up of 8.5 months. Conclusion: The early functional results after DVGU are good without any negative impact on the continence or the sexual functions.
  3,289 232 14
Safety and outcome of percutaneous nephrolithotomy in patients with solitary kidney: A tertiary care center experience
Uday Pratap Singh, Sanjoy Kumar Sureka, Kumar Madhavan, Anubhav Raj, MS Ansari, Rakesh Kapoor, Aneesh Srivastava
October-December 2019, 35(4):287-290
DOI:10.4103/iju.IJU_48_19  PMID:31619868
Introduction: Percutaneous nephrolithotomy (PCNL) for stones in solitary kidney poses a significant challenge and potential threat for acute kidney injury or progression of chronic kidney disease (CKD). We present our experience of PCNL in solitary functioning kidney (SFK) to evaluate the safety, efficacy, and postoperative complications and highlight the differences between these outcomes with respect to the stage of CKD. Methods: We carried out a retrospective study of patients with SFK, who underwent PCNL at our center from April 2010 to March 2018. Patients who had a minimum of 6 months of follow-up were included. Patients were classified into CKD groups based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative. Group 1 included Stages 1, 2, and 3A and Group 2 included Stages 3B, 4, and 5. Postoperative complications and stone-free rate were recorded and graded according to the Clavien–Dindo classification and compared between the two groups. Results: We had a total of 128 patients (Group 1 – 84 and Group 2 – 44). Stone-free rate after the first PCNL was higher in Group 1 as compared to Group 2 (88.1% [n = 74] vs. 50% [n = 22],P= 0.02). Overall, 48 patients (37.5%) had postoperative complications, but most were minor. Clavien Grade 1 and 2 complications were seen in 34 patients (Group 1, n = 18 and Group 2, n = 16,P= 0.069), whereas Grade 3 and 4 complications were seen in 14 patients (Group 1, n = 2 and Group 2, n = 12,P < 0.001), respectively. Need for postoperative (number of sessions) dialysis was seen with increased frequency in patients with higher chronic kidney stages (Group 1 vs. Group 2; 6 vs. 22 sessions,P < 0.001). Conclusion: PCNL in SFK is safe, with satisfactory outcome, but patients with advanced CKD stage have higher risk of complications including need for dialysis and may require multiple sessions for complete stone clearance. Hence, they should be managed at high output tertiary centers.
  3,315 201 2
Diagnostic precision of sentinel lymph node biopsy in penile cancer
Jose Gustavo Ramos, David Camilo Jaramillo, David Sandoval, Laura Juliana Gallego, Carlos Riveros, Jonathan Armando Sierra, Isis Vargas, Byron Eduardo López De Mesa López, Linda Ibata, Rodolfo Varela
October-December 2019, 35(4):282-286
DOI:10.4103/iju.IJU_79_19  PMID:31619867
Introduction: Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for evaluation of nodal involvement in patients with penile cancer and nonpalpable lymph nodes. Nevertheless, SLNB is not used in a regular basis due to the lack of studies that adequately characterize the performance of this procedure. The purpose of this study was to evaluate the diagnostic performance of SLNB in patients with infiltrative penile carcinoma without palpable inguinal lymph nodes in a Colombian population. Materials and Methods: This is a retrospective observational study of 89 patients diagnosed with infiltrative penile squamous cell carcinoma with nonpalpable inguinal lymph nodes. These patients underwent partial or complete penectomy, along with SLNB, between 2008 and 2017. Those individuals with a positive SLNB underwent inguinal lymphadenectomy, while those with a negative SLNB were followed on a quarterly basis with a physical examination and imaging to assess relapse. Statistical analysis was done using the STATA 14 software. A contingency table was made to calculate sensitivity, specificity, positive predictive value, negative predictive value, and exactitude, each one with its own confidence interval (CI) of 95%. Results: There was an average follow-up of 31.4 months, and all 89 patients were evaluated; most primary tumors were T2 (55%), followed by T1 (37%), all of which were subclassified as T1b and T3 (8%). Tumours were most frequently located in the glans (43%). All patients were classified as cN0 and underwent SLNB. Sixty-one patients (69%) tested negative in the SLNB, four of whom (6%) presented with lymph node relapse. On the other hand, 28 patients (31%) tested positive in the SLNB and consequently underwent inguinal lymphadenectomy, seven of whom had negative lymph nodeinvolvement (25% false positives). According to the results, the sensitivity was 84% (95% CI, 65.3–93.6) and the specificity was 89% (95% CI, 79.4–94.7), with a false-negative rate of 6.5%. Conclusions: The SLNB using radiotracer can be a useful method for lymph node staging in patients with penile cancer and nonpalpable lymph nodes when performed in experienced centers.
  3,165 206 2
What's inside?
Apul Goel
October-December 2019, 35(4):248-249
DOI:10.4103/iju.IJU_276_19  PMID:31619861
  2,464 123 -
Complete situs inversus – is it a contraindication for organ donation?
Ganesh Baliram Sonawane, Krishna H Moorthy, Biju S Pillai
October-December 2019, 35(4):303-304
DOI:10.4103/iju.IJU_82_19  PMID:31619872
Complete situs inversus, (SI), the total transposition of thoracic and abdominal organs, is rare and is considered a contraindication for organ donation. We report a patient of complete SI, who underwent donor nephrectomy. A 21-year-old male, without significant medical history, presented for voluntary living-unrelated renal donation and was found to have complete SI on evaluation and underwent right donor nephrectomy. The recipient is doing well on the follow-up. Meticulous surgical planning while selecting kidneys would enable renal donation even in cases of complete SI.
  2,416 88 2
Surgical correction of ectopic scrotum and penile torsion in a 5-year-old boy
Eiji Hisamatsu, Ryohei Shibata, Kaoru Yoshino
October-December 2019, 35(4):299-300
DOI:10.4103/iju.IJU_160_19  PMID:31619870
Ectopic scrotum is a rare condition, which is described as an anomalous position of one hemiscrotum along the inguinal canal. This anomaly is associated with other genitourinary anomalies. We report a 5-year-old boy with ectopic scrotum and penile torsion, who was successfully treated by simultaneous surgery.
  2,325 104 1
Frequency volume chart for the illiterate population: A simple solution
Pawan Vasudeva, Niraj Kumar, Helmut Madersbacher, Siddharth Yadav, Vishnu Prasad, Kumar Saurav
October-December 2019, 35(4):278-281
DOI:10.4103/iju.IJU_135_19  PMID:31619866
Introduction: We aimed to assess the feasibility of a novel method of recording frequency volume chart (FVC) in adult patients who are either illiterate or are unable to make the required written record. Materials and Methods: This prospective study included adult patients, in whom FVC was required as part of their urological evaluation, who were either illiterate or were not sufficiently literate to make the required written record. Three groups of people were involved in the study: (i) patient, (ii) nursing staff, and (iii) the investigator/coinvestigator. The investigator/coinvestigator briefed the patient and the nursing staff, separately, regarding their roles in detail. The patient-reported (investigator/coinvestigator interpreted) data were compared with the data recorded by the nursing staff to assess the feasibility of this novel method. Results: A total of 30 patients were included in the study, with a mean age of 45.1 years and male: female ratio of 2:1. The patient-reported (investigator/coinvestigator interpreted) data including 24-h urine production, daytime urine volume, nocturnal urine volume, daytime urinary frequency, nocturia, average voided volume, and maximum voided volume were similar to the data reported by the nursing staff, with no significant differences. All patients completed the FVC satisfactorily, except one patient who failed to report the night time voids. Conclusions: Our novel method of recording FVC is feasible, reliable, and clinically as informative/applicable as the written FVC in patients who are illiterate/insufficiently literate to make a written record of FVC.
  2,147 162 -
Accessory right hepatic artery originating from proximal and distal right renal artery in two subjects
Lal Darsan, Vaibhav Vishal, Felix Cardoza
October-December 2019, 35(4):305-306
DOI:10.4103/iju.IJU_86_19  PMID:31619873
The hepatic arteries are known for aberrant origins and course. The following two-case report discusses the unique origin of accessory right hepatic artery from proximal and distal right renal arteries, respectively, its clinical significance, and the importance of a preoperative angiogram in renal and liver surgeries involving vascular control.
  2,135 96 2
Transurethral resection of bladder tumor in a case of metastatic carcinoma prostate with penile prosthesis implant
Mihir Pandya, Jithin Lal, Ravikumar Karunakaran
October-December 2019, 35(4):301-302
DOI:10.4103/iju.IJU_144_19  PMID:31619871
Synchronous presentation of genitourinary tract malignancies is common, and more so for carcinoma prostate and carcinoma urinary bladder. Each of the carcinomas is treated as per their stage at presentation. Here, we report a case of metastatic carcinoma prostate with penile implant presenting with bladder lesion managed by transurethral resection of bladder tumor (TURBT) through perineal urethrostomy.
  1,735 89 2
Re: Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9
Gopal Sharma, Aditya Prakash Sharma
October-December 2019, 35(4):310-311
DOI:10.4103/iju.IJU_232_19  PMID:31619875
  1,695 92 -
Operative atlas of laparoscopic and robotic reconstructive urology
Rishi Nayyar
October-December 2019, 35(4):309-309
  1,547 95 -
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