Comparison of safety and efficacy of silodosin, solifenacin, tadalafil and their combinations in the treatment of double-J stent- related lower urinary system symptoms: A prospective randomized trial.

OBJECTIVE: To evaluate the efficacy and safety of silodosin, solifenacin, tadalafil and their combinations in reducing double J (DJ) stent-related symptoms (SRS). MATERIAL AND METHODS: A total of 335 patients who underwent DJ stenting and develop SRS at 1st week were randomized into eight groups. Ureteral stent symptom questionnaire (USSQ) and Quality of life (QOL) scores were noted in each group: Group A-Silodosin (8 mg OD)+ Solifenacin (10 mg OD)+ Tadalafil (5 mg OD), B - Silodosin 8 mg OD, C - Solifenacin 10 mg OD, D- Tadalafil 5 mg OD, E- Silodosin (8 mg OD) + Solifenacin (10 mg OD), F- Silodosin (8 mg 0D)+ Tadalafil (5 mg OD), G- Solifenacin (10 mg OD)+ Tadalafil (5 mg OD) and H-placebo. Analgesic (diclofenac 50 mg) was given as per requirement. All groups received the drugs for 14 days and again USSQ, QOL score with analgesic requirement were noted in each group. RESULTS: USSQ score was similar in all groups at 1st week but all groups (Groups A-G) led to significant decrease in USSQ score at 3rd week as compared to Group H with less requirement of analgesic. However when we compared groups with each other we found that mean USSQ score and analgesic requirement was favoring Group E as compared to other groups. Quality of life score was also best in Group E (mean 1.5) (p<0.05). CONCLUSION: Combination therapy with silodosin and solifenacin (group E) was effective for relieving SRS with improved quality of life and less requirement of analgesic than any other groups and should be considered in patients who develop SRS.

Benign diaphragmatic neurilemmoma mimicking a left adrenal cyst.

Neurilemmomas are benign, slow growing, encapsulated nerve sheath tumor. These tumors arise from the schwann cells of neural crest. Neurilemmomas can manifest in various form according to site, extent and severity of involvement of organ. Diaphragmatic neurilemmomas are very unusual and even difficult to diagnose on preoperative imaging. We will report a case of 39 year old male, who presented with complaints of occasional left flank pain for one year and subsequently investigated, which showed left adrenal cyst with haemorrhagic fluid content. On the contrary, when surgical exploration of the lesion was done, it showed a cyst within the diaphragm, completely separated from left kidney and left adrenal with haemorrhagic content in situ. Histopathological examination of the lesion showed it to be a benign neurilemmoma with cystic degeneration. Post opearatively patient did well. We believe that this is the first case report, which is addressing such kind of initial manifestation of diaphragmatic neurilemmomas.

Prostatic Ductal Adenocarcinoma-A Rare Entity With Radiological Dilemma Demanding Endoscopic Biopsy.

This is a rare case of a prostatic ductal adenocarcinoma. A 75-year-old gentleman presented with complaints of lower urinary tract symptoms, constipation, and occasional hematuria. The clinical and radiological differentiations from other retroperitoneal soft cystic lesion were difficult, and fine needle aspiration cytology from the papillary solid components of the cyst was required to reach diagnosis. Transrectal ultrasound-guided biopsy was performed in view of the raised serum prostate-specific antigen (>100 ng/mL); however, the cyst was ruptured without yielding any tissue for biopsy. In such difficult situations, a cystourethroscopic view, biopsy of the cyst, and immunohistochemical analysis can help in diagnosing and confirming the prostatic ductal adenocarcinoma.