ABSTRACT
Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. A patient underwent ileal ureteral substitution using a reconfigured ileal segment of Yang-Monti principle in our clinical centre. Authors report a case of a 41year old male involved in a homicidal stab injury with isolated renal pelvis injury underwent Thompson’s renal capsular flap repair. After 6 weeks, double J (DJ) stent was removed and following that patient developed urinoma. Percutaneous drain was placed to drain urinoma on emergency basis and again 6 Fr DJ stent was inserted but patient had recurrent fever and chills. On CECT evaluation authors noticed that DJ stent was outside the upper urinary tract. And then patient was re-explored where authors found 6 cm stricture of the proximal left ureter. A reconfigured small bowel tube was interposed between inferior calyx and proximal ureteral stumps. This technique offers certain distinct advantages. A short ileal segment is included with the consequent absence of metabolic complications. Yang-Monti Principle is a safer and efficient technique for clinical partial and complete ureteral defects with sustained, good, long-term results. Yang-Monti reconfigured tube seems to be promoted an equally efficient urine transport mechanism that persists unaltered for long periods if patients and potential risks could be well prepared.
ABSTRACT
Background: Urethral stricture is a relatively common disease. The choice of surgery is based on the stricture location, length of the stricture and etiology. Buccal mucosal graft (BMG) urethroplasty with Asopa and Kulkarni techniques, revolutionized the approach to anterior urethral stricture repair. Objective of the study was to compare both the dorsal onlay BMG urethroplasty technique of Kulkarni and the dorsal inlay BMG urethroplasty technique of Asopa for the management of long anterior urethral stricture. Methods: From January 2015 to October 2019, a total of 90 patients with long anterior urethral strictures were randomized into two groups. Group A (42 patients) managed by Kulkarni technique. Group B (48 patients) managed by Asopa technique. BMG urethroplasty was considered successful if no further procedure required postoperatively with maximum flow rate >15 ml/s during the follow-up period.Results: The success rate in group A and B were 80.9% and 87.5%, respectively. The mean operative time was significantly longer in group A (175±22.6 min) than in group B (102±18.14 min, p-value <0.001). The average blood loss was significantly higher in group A (154±15.65 ml) than in group B (112.76±12.62 ml, p-value <0.012).Conclusions: The dorsal onlay technique of Kulkarni and the dorsal inlay technique of Asopa buccal mucosal graft urethroplasty are reliable and satisfactory procedures with good success rates and minimum complications.
ABSTRACT
Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p<0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture.
ABSTRACT
Background: Although clear cell renal cell carcinoma (ccRCC) is the most common histological variety of malignant renal tumor, histological variants are often encountered in clinical practice which behaves differently. Paucity of such tumors makes them a subject of interest worldwide. As per European Association of Urology, since ccRCC is a non-designation, they included all non-clear cell RCC under one nomenclature as rare kidney cancer (RKC). The objective of our study is to determine influence of inflammatory markers on the prognosis of RKC.Methods: Data from cancer registry was retrieved and all rare kidney cancer patient’s data were analysed particularly the markers of inflammation like neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory immune index (SIII) and C reactive protein (CRP) to albumin ratio and their probable influence on cancer free survival (CFS), progression free survival (PFS) and overall survival (OS).Results: Data of 33 cases of rare kidney cancers were included in this study. The follow up duration ranges from 6.8 months to 38.6 months. In the univariate analysis, NLR had a significant influence on CFS, PFS and OS (cutoff value-3.2, 95% confidence interval [CI], CFS: p<0.05; PFS: p=0.05; OS: p<0.05), PLR in respect to CFS (cutoff value-67.5, 95% CI, p<0.05) and SIII had a significant impact on CFS and OS (cutoff value-8.67, 95% CI, 11.10-19.57, CFS: p<0.05; OS: p<0.05).Conclusions: Inflammation markers such as NLR, PLR, SII Index and CRP or albumin ratio could be independent predictors of clinical outcome and prognostics factors in rare kidney cancers. However, this needs to be validated by multicentre randomised studies.
ABSTRACT
Background: Duplex kidneys are common developmental renal anomaly with an incidence of 1% in healthy adult population.Adult individuals may present as non-functional moiety, calculus disease or an incidental finding. Duplex kidney is defined as a renal unit comprised of two pelvicalyceal systems. Based on the degree of fusion, it can present as bifid renal pelvis, partial ureteric duplication (Y-shaped ureter), incomplete ureteric duplication with ureters joining near or in bladder wall (V-shaped ureter) and complete ureteric duplication with separate ureteric orifices. The purpose of this study is to retrospectively review the various duplex kidney anomalies and associated pathology.Methods: This is a retrospective study, performed at Department of Urology, Gauhati Medical College Hospital, a tertiary centre, from September, 2018 to August, 2019. Preoperative imaging, plain intravenous urography or computed tomography intravenous urography was done.Results: 29 patients were diagnosed with variants of duplex kidney anomaly. It includes right side, left side and bilateral anomalies. Among all the patients 4 had incidental findings. 16 patients had associated renal or ureteral calculus. 5 patients had associated ureteropelvic junction obstruction while 1 patient had ureterovesical junction stricture. We found single patient in each group of duplex kidney anomaly associated with non-functional moiety with renal cell carcinoma, ureterocele with urothelial malignancy and horseshoe kidney with ureteropelvic junction obstruction respectively.Conclusions: Duplex kidney anomaly in most individuals is of no clinical significance. High index of suspicion along with good quality imaging can accurately detect specific anomaly and associated condition.
ABSTRACT
Background: There is a dearth of reliable blood and urine markers for transitional cell carcinoma of urinary bladder. CA 19-9 is a well-known marker for gastrointestinal malignancies and is being investigated for other malignancies including carcinoma bladder. In this prospective study, we evaluated the role of serum CA 19-9 as a tumor marker and correlated its level with tumor grade and stage.Methods: One hundred and fifteen patients with transitional cell carcinoma of urinary bladder and 69 healthy volunteers, as controls were included in the study. Preoperative blood sample was analysed for level of CA 19-9 using ELISA kit (normal - 0 U/ml to 37U/ml) and were correlated with grade and TNM stage of tumor.Results: The range of the control group is 2-38U/ml (mean: 17.67±9.68U/ml); TCC group is 1-94U/ml (mean: 37.12±31.52U/ml) (p=0.304). When CA 19-9 level >37IU/ml was taken as cut-off for a positive test, sensitivity of detecting T3 disease, T4 disease, MIBC, presence of node and high grade tumour were 80%, 75%, 70.3%, 78% and 57.8% respectively. However, there was a statistically significant increase in levels of CA19-9 in relation to higher grade (<0.001), presence of muscle invasion (<0.001), T stage (<0.001) and N stage (<0.001).Conclusions: Serum CA19-9 is almost invariably raised in patients with high grade and invasive disease. Thus, it has a place as a prognostic marker rather than as a diagnostic tool due to its low sensitivity for TCC bladder.