A prospective longitudinal study to evaluate bone health, implication of FRAX tool and impact on quality of life (FACT-P) in advanced prostate cancer patients.

BACKGROUND: Androgen-deprivation therapy (ADT) as a treatment modality in advanced prostate cancer has deleterious effect on bone mineral density (BMD) and quality of life (QOL). Using FRAX (Fracture Risk Assessment) model, candidates at high risk of fractures can be predicted and appropriate treatment can be initiated at early step to prevent skeletal-related events. Objectives of the present study were to evaluate bone health, implication of FRAX tool in advanced prostate cancer and to see the impact of ADT and Bone-directed therapy (BDT) on FRAX and FACT-P QOL scores. MATERIAL & METHOD: We conducted a prospective longitudinal study of 83 localized and metastatic prostate cancer patients from March 2017 to Dec 2020. FRAX tool using BMD femoral neck (GE-Lunar) was used to compute the probability of 10-year Major osteoporotic fracture (MOF) and hip fracture risk %. Patients who received monthly Zolendronic acid with or without Vitamin-D/calcium supplementation were classified as BDT group. FRAX and FACT-P were measured at baseline and 12 months follow-up and compared between different therapeutic modalities to see the impact on clinical outcomes. RESULTS: Majority of patients had skeletal metastasis (78.3%) and high-grade disease at presentation. Secondary osteoporosis was the most commonly (82.05%) observed clinical risk factor (CRF) followed by smoking (19.23%). Hip fracture risk ≥3% accounted for larger proportion of patients than did MOF risk ≥20% (21.2% and 2.5%, respectively). Statistically significant reduction was observed in both MOF and hip fracture risk in BDT group, while worsening on ADT. ADT duration correlated positively with both MOF and hip fracture risk (R2=0.148, P<0.001 and R2=0.164, P<0.001, respectively). FRAX score accurately predict future fracture events in majority (80%) of high-risk patients. Statistically and clinically significant worsening in PWB, EWB, PCS, FACT-P Total, FACT-P TOI and FAPSI scores were observed in patients on ADT. Statistically and clinically significant improvement was noted in physical well-being in BDT group. However, other QOL domains and FACT-P total scores remained stable. CONCLUSIONS: ADT caused duration depended worsening of FRAX and FACT-P score in these patients while improvements of FRAX were seen on BDT. FRAX tool is advantageous in identifying the patients who require early intervention or therapy to decrease skeletal-related events.

Diagnostic Relevance of GATA 3 Expression in Urinary Bladder Carcinoma of Divergent Differentiation and Other Histological Variants.

GATA binding protein 3, a zinc finger transcription factor, has now been demonstrated as a valuable and sensitive marker for conventional urothelial carcinoma with sparse literature related to its expression in various histological variants. It is a prospective study where 74 consecutive cases of bladder carcinoma were included between August 2016 and January 2017 followed by immunohistochemistry to assess GATA 3 expression in conventional as well as different urothelial carcinoma (UC) variants. Overall, 57 of the 74 lesions (77%) demonstrated nuclear staining for GATA 3. GATA 3 expression significantly correlated with histological grade (P < 0.001) and muscle invasion (P = 0.005). Divergent differentiation was observed in 54% (40/74) of the total cases. The study included 12 different variants of urothelial carcinoma. All or majority of the cases of clear cell (6/6, 100%), glandular (6/8, 75%), and sarcomatoid (4/6, 66.7%) variants expressed GATA 3 in a moderate to strong fashion and belonged to group III or IV. Nested variant, small cell carcinoma, pure squamous cell carcinoma, and squamous component of urothelial carcinoma with squamous differentiation do not show any GATA 3 expression. GATA 3 was expressed more intensely as well as in greater number of tumor cells at lymph node metastatic tumor deposits as compared to the primary tumor. GATA 3 expression was not significantly associated with tumor stage or patients' clinical outcomes. GATA 3 is expressed in majority of variants of UC albeit with variable staining; however, situation is challenging in some variants known to be associated with poor prognosis like nested variant, small cell carcinoma, and squamous cell carcinoma where it is not expressed. Hence, the sensitivity of this determinant is diminished in these variants, which may affect the interpretation of GATA 3 stains at metastatic sites as well as their distinction from secondary bladder involvement, by tumors of non-urothelial origin.

Retención urinaria aguda en varones jóvenes y de mediana edad debida a cálculos en la uretra: experiencia de un solo centro del norte de India / Acute Urinary Retention in Young Adult and Middle-Aged Males Due to Calculi in the Urethra: A Single Centre Experience From North India

Objetivo: Presentar nuestra experiencia en el tratamiento de la retención urinaria aguda (RUA) en hombres jóvenes y de mediana edad, debido a piedra/s en la uretra en un centro de atención terciaria. Material y métodos: Entre julio de 2004 y abril de 2011, se trató a 102 pacientes varones jóvenes y de mediana edad (18-40 años) que presentaban RUA debido a un cálculo en la uretra en nuestro centro. El tratamiento inicial consistió en la cateterización uretral o cistostomía suprapúbica con trocar. El tratamiento definitivo se realizó inmediatamente o después de un par de días en función de la disponibilidad de la anestesia y/o quirófano. La piedra se fragmentó con litotrito mecánico, litotrito neumático u holmio: láser YAG. Resultados: Todos los pacientes quedaron totalmente libres de sus piedra/s siguiendo el procedimiento definitivo. En todos los casos se consiguió micción espontánea. La infección post-operatoria del tracto urinario se observó en 8 pacientes que habían recibido tratamiento endoscópico inmediato. Se observó hematuria leve durante aproximadamente 48 h en 6 pacientes que recibieron cistolitotricia suprapúbica. Conclusión: El tratamiento endoscópico es actualmente la elección para piedra/s en la uretra que puede/n causar RUA en varones jóvenes y de mediana edad (AU)

Objective: To present our experience of managing acute urinary retention (AUR) in young and middle-aged male due to stone/s in the urethra at a tertiary care centre. Material and methods: Between July 2004 to April 2011, 102 male patients, young and middle-aged (18-40 years), who suffered from AUR due to calculus in the urethra were managed at our center. Initial management consisted of urethral catheterization or suprapubic trocar cystostomy. Definitive management was performed immediately or after a couple of days depending upon the availability of anesthesia and/or operation theatre. Stone was fragmented by mechanical lithotrite, pneumatic lithotrite or holmium: YAG laser. Results: All the patients were completely free of their stone/s following the definitive procedure. Voiding trial was successful in all the cases. Postoperative urinary tract infection was observed in eight patients who had undergone immediate endoscopic management. Mild hematuria for approximately 48hours was noted in six patients who underwent suprapubic cystolithotripsy. Conclusion: Endoscopic management is currently the treatment of choice for stone/s in the urethra which may cause AUR in young and middle-aged male (AU)

[Acute urinary retention in young adult and middle-aged males due to calculi in the urethra: a single centre experience from North India]. / Retención urinaria aguda en varones jóvenes y de mediana edad debida a cálculos en la uretra: experiencia de un solo centro del norte de India.

OBJECTIVE: To present our experience of managing acute urinary retention (AUR) in young and middle-aged male due to stone/s in the urethra at a tertiary care centre. MATERIAL AND METHODS: Between July 2004 to April 2011, 102 male patients, young and middle-aged (18-40 years), who suffered from AUR due to calculus in the urethra were managed at our center. Initial management consisted of urethral catheterization or suprapubic trocar cystostomy. Definitive management was performed immediately or after a couple of days depending upon the availability of anesthesia and/or operation theatre. Stone was fragmented by mechanical lithotrite, pneumatic lithotrite or holmium:YAG laser. RESULTS: All the patients were completely free of their stone/s following the definitive procedure. Voiding trial was successful in all the cases. Postoperative urinary tract infection was observed in eight patients who had undergone immediate endoscopic management. Mild hematuria for approximately 48 hours was noted in six patients who underwent suprapubic cystolithotripsy. CONCLUSION: Endoscopic management is currently the treatment of choice for stone/s in the urethra which may cause AUR in young and middle-aged male.

A cross-sectional pilot study to determine the prevalence of testosterone deficiency syndrome in working population of Indian men.

AIM: To determine the prevalence of testosterone deficiency syndrome (TDS) in healthy Indian men employed in a hospital aged above 40 years. MATERIALS AND METHODS: A general medical health check-up camp was organized for all male employees above 40 years age working in surgical departments. After clinical history and systemic inquiry, subjects were requested to fill the St. Louis University's ADAM Questionnaire based on which the total and free-serum testosterone estimation was then done. RESULTS: One hundred fifty seven healthy volunteers enrolled for the study (mean age 53.1 years; range 40-60). The androgen decline in the aging male (ADAM) Questionnaire detected 106 men (67.5%) to be symptomatic for TDS. Serum testosterone estimation in these subjects revealed 41/106 to have low free-serum testosterone levels and 32/106 to have low total-serum testosterone. In 11 and 6 cases, respectively, the serum free- and total-testosterone levels were found to be low although the subjects were asymptomatic for TDS. CONCLUSIONS: The prevalence of symptomatic biochemical hypogonadism was 26.1%. The higher prevalence of symptoms alone of TDS was unusual. It could be because of the nature of the questionnaire. Free-serum testosterone may be a better single test to diagnose symptomatic hypogonadism than total-serum testosterone.

Implications of free radicals and antioxidant levels in carcinoma of the breast: a never-ending battle for survival.

BACKGROUND: Under normal circumstances, there is a steady balance between the production of oxygen derived free radicals and their destruction by the cellular antioxidant system inside the human body. However, any imbalance between the levels of these oxidants and antioxidants might cause DNA damage and may lead to cancer development. The aim of this study was to evaluate the level of antioxidants and free radicals in blood and tissue of cancer patients and compare these levels at different TNM stages to derive the possible role of free radicals and antioxidant enzymes in the etiology of breast cancer. MATERIALS AND METHODS: This study includes 30 patients suffering from cancer breast and 20 patients as controls who had benign breast diseases. Circulating lipid peroxide (Malonyldialdehyde [MDA]) levels and activities of the defensive enzymes (Superoxide Dismutase [SOD] and Catalase [CAT]) were estimated in the blood and breast tissue of these patients. RESULTS: Increased levels of free radicals and low levels of antioxidants were observed in malignant tissue. An elevated lipid peroxide concentration was found in the tissue of all the cancer breast patients as evidenced by an increase in the mean MDA level seen with increasing TNM stage of carcinoma breast. Levels of antioxidants SOD and CAT were decreased in cancer patients. CONCLUSION: The results of our study suggest that free radical activity is enhanced in cancer breast patients while the antioxidant defense mechanism is weakened. This activity is enhanced with the increasing severity of cancer as depicted in different TNM stages of breast cancer.

Heterotopic bone formation in renal cell carcinoma: a diagnostic challenge.

Formation of bone in cases of renal cell carcinoma is a rare finding and only a couple of case reports from Japan and one from India are mentioned in the literature. Calcification inside renal mass has been reported earlier but the prognostic implications have not been clearly elucidated. We report a case which showed heterotopic bone formation (ossification) inside the renal mass and was managed by radical nephrectomy. The histopathology showed clear cell renal carcinoma with multiple centers of ossification in the region of calcification suggesting bone formation. In this case report we discuss bone morphogenetic proteins which have been implicated as a prognostic and causative factor, highlight the difficulties in distinguishing between calcification and bone formation on the basis of radiological investigations and mention the geographic implications of this rare phenomenon which has not been described earlier.

Harvesting buccal mucosa graft under local infiltration analgesia--mitigating need for general anesthesia.

For buccal mucosal graft urethroplasty, nasal or oral endotracheal intubation anesthesia is used for harvesting the graft from the oral cavity. A technique of graft harvesting under local anesthesia using 2% lidocaine solution with adrenaline (1:200,000) is described. This method requires a cooperative patient but saves the morbidity of general anesthesia.

Idiopathic chronic orchialgia - a frustrating issue for the clinician and the patient.

Chronic testicular pain represents a management dilemma to clinicians and remains a very frustrating clinical problem. In nearly 25% of patients there is no obvious cause for idiopathic chronic orchialgia. Chronic testicular pain may occur at any age but the majority of patients are in 20-30 years of age group. The desired goal of the treatment is to allow the patient return to routine activity without significant use of analgesics. There is very little published material, in urology, about the etiology and treatment of idiopathic chronic orchialgia but situation is not bleak since many treatment options do exist which can allow the patient enjoy life with mechanisms for coping with pain. A multidisciplinary team approach is required, so that the patient can benefit from the different treatment options available at present.