Non-invasive evaluation of bladder outlet obstruction in benign prostatic hyperplasia: a clinical correlation study.

Objectives: To determine the utility of ultrasonography (US)-derived parameters (e.g. prostate volume [PV], bladder wall thickness [BWT], post-void residual urine volume [PVR], and intravesical prostatic protrusion [IPP]) and uroflowmetry for identifying bladder outlet obstruction (BOO) by correlating them with the results of pressure-flow urodynamic studies (UDS). Patients and methods: In all, 164 patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), from May 2016 to December 2018, were included in this study. All had International Prostate Symptoms Score (IPSS), Quality-of-Life (QOL) index, uroflowmetry (including maximum urinary flow rate [Qmax]) and PVR measured by transabdominal US. Pressure-flow UDS were performed on all men and BOO was defined by a BOO Index (BOOI) >40. Men with a Qmax of ≥12.0 mL/s were considered to have 'good' flow. Results: Amongst the 164 men, the mean (SD) age, PV, BWT and Qmax were 66.72 (9.88) years, 51.91 (13.24) mm, 5.07 (0.91) mm, and 8.46 (3.59) mL/s, respectively. In all, 91 (55.49%) patients had BOO with a BOOI >40 and nine (5.49%) had equivocal BOO with a BOOI of 20-40. The IPP was a statistically significant predictor (P < 0.001) of BOO compared with other variables in the initial evaluation. In patients with BOO confirmed by the pressure-flow UDS, IPP Grade III was associated with a higher BOOI than was Grade I and II (P < 0.001). Conclusion: BWT, PV and PVR in conjunction with IPP are good predictors of clinically significant BOO due to BPH. Abbreviations: AUC: area under the curve; BOOI: BOO Index; BPO, benign prostatic obstruction; BWT, bladder wall thickness; IPP: intravesical prostatic protrusion; Pdet: detrusor pressure; PV: prostate volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QOL: quality of life; ROC: receiver operating characteristic; (TA)US: (transabdominal) ultrasonography; UDS: urodynamic studies.

Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi.

PURPOSE: To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. MATERIALS AND METHODS: The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. RESULTS: There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. CONCLUSION: Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

ABSTRACT Purpose To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. Materials and Methods The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. Results There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. Conclusion Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

Penile injuries: A 10-year experience.

We report our 10-year experience with penile injuries. We retrospectively reviewed the records of 156 cases of male external genitalia injuries between May 2002 and December 2012. Of these, only 26 patients presented without urethral injuries and were included in this study. Patients were divided into 4 groups: Group 1 (n = 12) with patients with penile fractures injuries; Group 2 (n = 5) with patients with penile amputation injuries; Group 3 (n = 2) with patients with penile penetrating injuries; and Group 4 (n = 7) with patients with penile soft tissue injuries. Grading of injury was done using the American Association for the Surgery of Trauma (AAST)-Organ injury scale of penile injury. Penile injuries without urethral injuries are urological emergencies which require immediate attention.

Prevalence of dental anxiety and its relation to age and gender in coastal Andhra (Visakhapatnam) population, India.

BACKGROUND: Dental fear, anxiety and phobia have consistently been reported as widespread problems that persist despite the technological advances that have made dentistry less painful and less uncomfortable. The aim of this study was to assess the prevalence of dental anxiety (DA) and its relation to age and sex among Coastal Andhra (Visakhapatnam) population. MATERIALS AND METHODS: A randomized controlled study was designed among 340 individuals at GITAM Dental College and Hospital, Visakhapatnam. The sample for the study consisted of 180 female and 160 male subjects between 15 and 65 years of age; all were supplied with two questionnaires (Corah DA scale [CDAS] and Clarke and Rustvold dental concerns assessment scale describing anxiety provoking stimuli. The Mann-Whitney U-test and the Kruskal-Wallis test were applied (significance level P < 0.05). The correlations between the two questionnaires were calculated using the Spearman's rank correlation coefficient. RESULTS: Two questionnaires were collected from all 340 individuals and the Indian translation of both instruments was found to be internally reliable with a Cronbach's alpha of 0.093. Overall prevalence of DA was high (77.4%) but severe (22.6%) anxiety (phobia) was low. Kruskal-Wallis test showed a significant relation between age and DA. The mean CDAS scores were high in 25-35 (11.08) and low in 55-65 (9.45) year age groups. Mann-Whitney U test showed significant relation between sex and DA. Mean CDAS score levels were significantly higher in females (10.88) than in males (9.96) (P < 0.0001). CONCLUSION: Patients anxious about dental procedures are often more difficult to treat. If Dentists become aware about the level of DA among their patients, they can anticipate patient's behavior and can be prepared to take behavioral/pharmacological measures to reduce anxiety levels.

Effect of potassium magnesium citrate and vitamin B-6 prophylaxis for recurrent and multiple calcium oxalate and phosphate urolithiasis.

PURPOSE: To study the effects of long-term treatment with potassium magnesium citrate and vitamin B-6 prophylaxis (Urikind-KM6; 1,100-mg potassium citrate, 375-mg magnesium citrate, and 20-mg pyridoxine hydrochloride/5 mL) every 8 hours over 3 years. MATERIALS AND METHODS: A total of 247 patients with recurrent idiopathic hypocitraturia with or without hyperuricosuria and randomized controls were studied prospectively for 3 years. The total patients were divided into three groups. Control group 1 consisted of 61 patients (24.7%) who had moderate to severe hypocitraturia with or without hyperuricosuria and were recurrent stone formers but discontinued prophylaxis because of drug intolerance within 1 month of therapy. Control group 2 constituted 53 patients (21.5%) who were first-time stone formers and who had mild hypocitraturia with or without hyperuricosuria and were not put on prophylactic therapy and were followed for 3.16±0.08 years. Control group 3 constituted 133 patients (54.8%) who were recurrent stone formers who had moderate to severe hypocitraturia with or without hyperuricosuria and were put on prophylaxis therapy and were followed for 3.16±0.08 years. All patients were followed up at 6-month intervals. RESULTS: Potassium magnesium citrate prophylaxis produced a sustained increase in 24-hour urinary citrate excretion from initially low values (221.79±13.39 mg/dL) to within normal to high limits (604.04±5.00 mg/dL) at the 6-month follow-up. Urinary pH rose significantly from 5.62±0.2 to 6.87±0.01 and was maintained at 6.87±0.01. The stone recurrence rate declined from 3.23±1.04 per patient per year to 0.35±0.47 per patient per year. CONCLUSIONS: Potassium magnesium citrate prophylaxis was effective in reducing the recurrence of calcium oxalate and phosphate urolithiasis.

Normal values of median nerve cross-sectional area obtained by ultrasound along its course in the arm with electrophysiological correlations, in 100 Asian subjects.

INTRODUCTION: The objective of this study is to obtain normative cross-sectional area (CSA) values for median nerve by ultrasound at predetermined sites and correlate them with electrophysiological variables in healthy Asian subjects. METHODS: The median nerve was examined ultrasonographically in 100 healthy volunteers, mean age 39 years (range, 18­75 years). CSA of the median nerve was measured at wrist, mid-forearm, mid-arm, and axilla. All subjects underwent simultaneous standardized nerve conduction studies. RESULTS: The mean median nerve CSAs ± SD at the distal wrist crease was 7.2 ± 1 mm2; mid-forearm 4.8 ± 0.9 mm2; mid-arm 6.1 ± 1 mm2; axilla 5.9 ± 0.9 mm2. The CSA at the wrist was the largest compared with other levels (P < 0.001), and it increased with advancing age (P < 0.002). CONCLUSIONS: These normative data show that median nerve CSA is not uniform along its length. There are differences between gender, and values increase with advancing age.