Correlation between the preoperative serum prostate specific antigen, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy: An Indian experience.

Objectives: To correlate the preoperative serum prostate specific antigen (PSA), Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy (RARP) in Indian men with clinically localized cancer prostate. Materials and Methods: A prospective study analysis was done for 166 consecutive patients of prostate cancer who underwent RARP at our center from June 2006 to October 2009. Preoperative workup included serum PSA, biopsy Gleason score, and clinical staging. The preoperative parameters were correlated with final Gleason score, capsular penetration, seminal vesicle involvement, and lymph node status on final histopathology. Results: The mean age was 64 years (range: 50-76 years) with mean and median PSA of 17.98 ng/ml (range: 0.3-68.3 ng/ml) and 12.1 ng/ml, respectively. With increase in preoperative Gleason score, chance of organ confinement decreases (P=0.002) and capsular penetration increases (P=0.004) linearly. With increasing serum PSA, there is linear decrease in trend of organ-confined disease (P=0.03) and increased chances of seminal vesicle involvement (P=0.02). Patients with higher clinical stage have less probability of localized disease (P=0.007) and more chances of capsular penetration (P=0.04) and seminal vesicle involvement (P=0.004). Conclusion: Our data suggest that patients with higher preoperative serum PSA, Gleason score, and clinical stage have more chances of advanced pathological stage following RARP.

Primary tuberculosis of glans penis after intravesical Bacillus Calmette Guerin immunotherapy.

A 55-year-old male with carcinoma in situ of urinary bladder was treated with weekly intravesical injections of Bacillus Calmette Guerin (BCG) vaccine. Three days after the sixth injection, he developed low grade fever and multiple grouped punched out, 2-3 mm ulcers around meatus and corona glandis. In addition, multiple, firm, indurated, nontender papules and few deeper nodules were present on the proximal part of glans penis, along with bilateral enlarged, matted and nontender inguinal lymph nodes. There was no history suggestive of sexually transmitted diseases and high risk behavior. Chest X-ray was within normal limits, and Mantoux, Venereal Disease Research Laboratory (VDRL) and HIV antibody tests were negative. The biopsy from the penile ulcer revealed epithelioid cell granuloma with Langhans giant cells. Fine needle aspiration cytology from the lymph node also revealed epithelioid cell granuloma and acid fast bacilli on Ziehl Neelsen's stain. The tissue biopsy grew Mycobacterium tuberculosis. The BCG immunotherapy was stopped and patient was treated with four drug antitubercular therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide in standard daily doses along with pyridoxine. The edema resolved and the ulcers started healing within 2 weeks, and at 6 weeks after starting antitubercular therapy almost complete healing occurred. To the best of our knowledge, we describe the first case of an Indian patient with BCG induced primary tuberculosis of penis after immunotherapy for carcinoma urinary bladder and review the previously described cases to increase awareness of this condition in dermatologists and venereologists.

Renal tumors presentation: Changing trends over two decades.

Purpose: We have analyzed the changing trends in surgical treatment of renal tumors over the last 2 decades with regard to age incidence, presentation, incidental detection, and histopathology. Materials and Methods: Records of renal tumors were analyzed from January 1, 1988 to December 31, 2007. Data were split into 4 parts based on a 5-year time period, 1 for each cohort of patients: cohort 1 (1988-1992)-103 patients, cohort 2 (1993-1997)-161 patients, cohort 3 (1998-2002)-243 patients, and cohort 4 (2003-2007)-304 patients. A comparative study was performed with regard to age incidence, presentation, incidentallomas, histopathology, and management with statistical analysis. Results: Out of 811 renal tumors, 17.63% cases were benign and 82.37% were malignant. In the first cohort, 34.95% cases were detected in the seventh decade as compared with cohort 4 in which these were detected in the sixth (34.86%) and fifth decades (21.38%). Incidentallomas increased from 11 (10.67%) in cohort 1 to 84 (27.63%) in cohort 4 (P = 0.001). The cases of surgically treated tumors increased in number from 103 to 304 in cohort 4. Among the presenting features, incidence of weight loss, flank pain, and lump decreased while other clinical syndromes were constant. Only open radical nephrectomy was performed in the first 2 consecutive timeperiods. Laparoscopic radical nephrectomy was increasingly used in cohort 4 as compared with cohort 3 (121 vs 32, respectively). Similarly, open nephron sparing surgery (NSS) was increasingly used in cohort 4 as compared with cohort 3. Among the histopathologies, clear cell carcinoma was most common (73.35 %), but Fuhrman grading showed a trend toward more cases detected with grade 1 and 2 in cohort 4; 23.73% and 61.86%, respectively, as compared with 15.85% and 45.12% in cohort 1 (P = 0.001); more T1 tumors were detected (63.42% in cohort 4 as compared with 41.46% in cohort 1). Conclusions: A majority of renal tumors presented as symptomatic tumors. Recently, tumors are being detected at an early stage and grade; in the younger patients, with an increasing trend of laparoscopic and open NSS.

Psoas abscess-like metastasis from transitional cell carcinoma of urinary bladder.

We report a 70-year-old male who presented with gross painless total haematuria associated with persistent left hip pain of one month duration. Computerised tomography of abdomen revealed a mass on the right lateral wall of urinary and abscess like lesion in the left psoas. He underwent transurethral resection of bladder tumour and ultrasonographical guided tru-cut biopsy of psoas lesion. Histopathology confirmed transitional cell carcinoma with metastasis to left psoas muscle. The presentation highlights the clinical and radiological features along with review of literature of rare metastatic site from transitional cell carcinoma of urinary bladder.

Diagnosis and management of duodenal obstruction due to renal cell carcinoma.

Two cases of duodenal obstruction secondary to renal cell carcinoma are described. One case had delayed metastasis to duodenum four years after right radical nephrectomy and the second case had a large right renal cell carcinoma with duodenal involvement. The possibility of duodenal involvement or metastasis should be kept in mind in any patient presenting with upper gastrointestinal obstructive symptoms and with right sided renal tumour or radical nephrectomy in the past. Whenever suspected, radiography and if required endoscopic assessment should be supplemented to diagnose this condition. Extensive local disease or presence of concurrent metastasis usually rules out the possibility of cure. We describe the clinico-radiological features of this condition along with a review of the literature.

Synchronous Urolithiasis in Orthotopic and Left to Right Crossed Ectopic Kindneys.

Presented here is a case of 20 year old male with multiple calculi in orthotopic as well as in left to Ritht crossed ectopic kidney without fusion, causing obstructive uropathy, leading to progressive Reanal failure and uraema, thus posing a challenge in management. A fter pre-operative preparation With repeated haemodialysis, a complete clearance of stones form both kidneys was accomplilshed At one operation. The post-operative course was uneventful with considerable improvement and Stablization in renal functional status.

Concomitant renal oncocytoma and bladder tumour (a case report).

We report a case of concomitant renal oncocytoma and transitional cell carcinoma of urinary bladder. The presentation was intermittent hematuria, urine outflow obstructive symptoms, and mild chronic renal failure. Renal mass was an incidental finding. He was accordingly managed by transurethral resection of bladder tumour and radical nephrectomy and is tumour free upto one and half year of follow up.

Management of urinary tract calculi by extracorporeal shock wave lithotripsy.

From July 1989 to April 1993, Extracorporeal Shockwave Lithotripsy (ESWL) was performed on 642 patients, of which 21 were from the pediatric age group. All treatments were done on a second generation lithotriptor-Siemens Lithostar, which does not require any modification for positioning of children. Fragmentation was achieved in all the patients (100%). A complete stone free rate was achieved in 17/21 patients (80.9%). Three (14.3%) patients had insignificant residual fragments whereas 1 (4.8%) had a residual fragment approximately 4 mm in size. 5640 shocks were required on an average. We have used low energy shockwaves with good results. General anesthesia was required for lithotripsy in only one child. The average fluoro exposure time was 1.6 minutes. We conclude that ESWL is a safe and effective method for treating urinary tract calculi in children.

Vivax malaria causing priapism.

We report a 14 year old boy who had priapism induced by vivax malaria. The onset was latent and course was protracted, refractory to anti-malarial and conservative treatment, but satisfactory detumescence was achieved after surgical intervention.