Assessing safety and feasibility of monopolar transurethral resection of the prostate without post-operative catheter traction: A randomized controlled trial.

INTRODUCTION: Traction on the per-urethral catheter is commonly employed after monopolar transurethral resection of the prostate (mTURP) to reduce bleeding. However, its efficacy and impact on postoperative pain remain uncertain. Further, there is limited evidence to suggest any benefit regarding post-operative blood loss. MATERIALS AND METHODS: In a randomized controlled trial, 62 patients undergoing mTURP were assigned to either a traction (n = 30) or non-traction (n = 32) group. Blood loss, postoperative pain, and analgesic requirements were assessed between January 2022 and April 2023. {(IHEC-PGR/2021/DM/M.Ch/Jan/02), CTRI Registration: CTRI/2022/01/039199.}. RESULTS: No significant differences were observed between the traction and non-traction groups regarding postoperative blood loss (p-value- 0.632), fall in hemoglobin (p-value- 0.719) and hematocrit (p-value- 0.937) levels, and length of postoperative hospital stay (p-value- 0.797). However, the traction group reported significantly higher postoperative pain scores (p-value < 0.001) and increased analgesic requirements (p-value < 0.001). CONCLUSION: The study suggests that 12-hours catheter traction after mTURP does not reduce blood loss and is associated with increased postoperative pain.

Comparison between pre-emptive oral tramadol and tapentadol for attenuation of catheter-related bladder discomfort and surgical stress response in patients undergoing transurethral resection of prostate: A prospective, randomised, double-blind trial.

BACKGROUND AND AIMS: Surgical interventions involving urinary catheterisation often lead to catheter-related bladder discomfort (CRBD). With a very high incidence rate of 47%-90%, CRBD often leads to a distressing and painful recovery after surgery. Although many opioids have been used for the treatment of CRBD, the search for the best is still going on. This study investigated the efficacy and tolerability of oral tapentadol and tramadol on postoperative CRBD. METHODS: This was a prospective, randomised double-blind study. 100 patients, undergoing transurethral resection of the prostate were randomly assigned into two groups to receive tramadol 100 mg (Group A) or tapentadol 50 mg (Group B) orally 1 h before surgery. CRBD was evaluated on a 4-point severity scale in the post-operative area at 0, 0.5, 1, 2, 3, 4, 5 and 6 h. Pain and adverse effects were assessed postoperatively. Serum cortisol levels before and after the procedure were noted. Statistical analysis was done with the analysis of variance, t test. RESULTS: Postoperative CRBD, 2 h after surgery was significantly reduced in group B than group A (P = 0.012). Cortisol levels, postoperatively were significantly lower in Group B (113 ± 65.45) (P = 0.001) than group A (162.64 ± 118.84 ng/dL). Dry mouth was seen in four, nausea in eight and sedation in six patients in group A while none in group B. 14 patients in Group A and one patient in Group B needed intravenous paracetamol (P = 0.000). CONCLUSIONS: Premedication with tapentadol was more effective in reducing CRBD and pain postoperatively. The surgical stress response and side effects were significantly reduced with tapentadol.

Bladder Preservation with Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiation for the Treatment of Muscle-invasive Carcinoma of the Bladder: A Single-Center Experience.

Purpose The purpose of the study was to evaluate the short-term response and acute toxicities in muscle-invasive carcinoma urinary bladder treated with neoadjuvant chemotherapy followed by concurrent chemoradiation. Materials and Methods Thirty patients with muscle-invasive bladder cancer were treated with three cycles of neoadjuvant chemotherapy every 3 weeks. Response assessment was done after 4 weeks with repeat cystoscopy and imaging. Responders were treated with concurrent chemoradiation 60 Gy/30# at 2 Gy/# along with weekly injection cisplatin 35 mg/m 2 . Response assessment was done by new response evaluation criteria in solid tumors (version 1.1). Treatment-related acute toxicities were scored using common terminology criteria for adverse events version 4.0. Results Of the 30 patients, 25 patients responded to neoadjuvant chemotherapy with complete response in 17 patients (56.67%) and partial response in eight patients (26.66%). Five patients (16.66%) showed poor response and were advised radical cystectomy, of which four underwent radical cystectomy and one patient opted for concurrent chemoradiation. Of 26 patients who completed chemoradiation, complete response was seen in 21 patients (80.76%) and partial response was seen in four patients (15.38%). Only one patient developed progression of disease in the form of lung metastasis. All the patients with residual disease were advised to undergo salvage cystectomy. Among the patients receiving chemoradiation, grade 2 cystitis and diarrhea was seen in 10 patients (38.46%) and four patients (15.38%), respectively. Only one patient developed grade 3 diarrhea. Conclusion Bladder preservation treatment is an effective, safe, and convenient option for patients presenting with muscle-invasive carcinoma bladder. Neoadjuvant chemotherapy followed by chemoradiation was well-tolerated with an acceptable rate of complications.

A Rare Case of Renal Pelvic Hydatid Cyst Masquerading as Renal Calculi.

Background: Hydatid disease of urinary tract is most common in the kidney. In kidney, hydatid cysts are most commonly found in the renal parenchyma. Isolated hydatid cysts in the renal pelvis are extremely rare with only three cases reported in the literature. Case Presentation: We present a case of isolated hydatid cysts in the renal pelvis masquerading as renal pelvic calculi, which were diagnosed during surgery and confirmed on histopathology. Conclusion: Hydatid cysts can masquerade as renal calculi. Preoperative modalities may miss the correct diagnosis. Histopathology in suspected cases can confirm the diagnosis so that proper chemotherapy can be offered to patient to avoid recurrence.

Extragonadal germ cell tumour.

We report a rare case of extragonadal germ cell tumour in a 55-year-old man. He presented with a painless mass in right inguinal region, a few days after hernioplasty for right direct inguinal hernia, which caused diagnostic difficulties and treatment problems.

Postoperative infectious morbidities of cesarean delivery in human immunodeficiency virus-infected women.

OBJECTIVE: To compare the infectious complication rates from cesarean delivery of human immunodeficiency virus (HIV)-infected women and HIV-negative women. MATERIALS AND METHODS: A retrospective analysis was performed on data derived from HIV-infected women and HIV-negative women, who underwent cesarean delivery at two teaching hospitals. Main outcome measures were infectious postoperative morbidity. Descriptive, comparison analysis, and multiple logistic regression analysis were performed. RESULTS: One hundred and nineteen HIV-infected women and 264 HIV-negative women delivered by cesarean section and were compared. The HIV-negative women were more likely than the HIV-infected women to deliver by emergent cesarean section (78.0% versus 51.3%, resp., P < .05), to labor prior to delivery (69.4% versus 48.3%, resp., P < .01), and to have ruptured membranes prior to delivery (63.5% versus 34.8%, resp., P < .05). In bivariate analysis, HIV-infected and HIV-negative women had similar rates of post-operative infectious complications (16.8% versus 19.7%, resp., P > .05). In a multivariate stepwise logistic analysis, emergent cesarean delivery and chorioamnionitis but not HIV infection were associated with increased rate of post-operative endometritis (odds ratio (OR) 4.10, 95% confidence interval (95% CI) 1.41-11.91, P < .01, and OR 3.02, 95% CI 1.13-8.03, P < .05, resp.). CONCLUSION: In our facilities, emergent cesarean delivery and chorioamnionitis but not HIV infection were identified as risk factors for post-operative endometritis.