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OBJECTIVE: Histopathological changes in oral (buccal or lingual) mucosa after exposure to urine are still not completely understood. We evaluated these changes in free oral mucosal graft integrated in human urethra. MATERIAL AND METHODS: Total 19 patients with recurrent urethral stricture after oral mucosa urethroplasty (buccal 12 and lingual 7) were prospectively evaluated. Intraoperatively integrated buccal or lingual mucosal graft sample that was previously engrafted to urethra was completely excised along with healthy oral mucosa, and it was sample processed for histopathological evaluation by dedicated pathologist. Preoperative clinical data were properly collected from all the study participants. RESULTS: The mean age of the patients was 30 years, and the mean preoperative peak flow rate was 4.2 mL/s. Etiology of initial stricture was idiopathic in 13 (68.42%) patients and traumatic urethral catheterization in 6 (31.58%) patients. Mean interval from previous buccal mucosal urethroplasty to current urethroplasty was 21.9 months (range 12-46 months). On repeat urethroplasty, the mean stricture segment length was 59.2 (38-77) mm [60.08 (38-74.6) mm buccal, and 58.32 (39.6-77) mm lingual]. These integrated oral mucosal grafts maintained their histopathological characteristics in all patients except some kind of changes like submucosal fibrosis in seven (58.33%) cases of buccal and vacuolar degeneration in five (71.42%) cases of lingual mucosal urethroplasty. CONCLUSION: Histopathological characteristics of integrated oral (buccal and lingual) mucosal grafts were maintained even on exposure to urine except some changes like submucosal fibrosis and vacuolar degeneration. Impact of these changes require further research.
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Primary squamous cell carcinoma (SCC) of renal pelvis is a rare neoplasm. A 75-year old male presented with history of chronic dull aching pain in left flank region for last 10-years with history of left pyelolithotomy about 30-years back. After proper workup, large calculus with heterogeneous density mass detected in nonfunctioning left kidney. After radical nephrectomy, histopathological examination revealed squamous cell carcinoma of renal pelvis. SCC should be suspected in a patient with long history of renal calculous and associated mass in non functioning kidney.
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INTRODUCTION: We studied the learning curve for percutaneous nephrolithotomy of urology residents according to stone complexity. METHODS: The learning curve of 8 residents with no previous experience of solo percutaneous nephrolithotomy was studied. Stones were classified according to complexity using the Guy stone score. Competence was reviewed using 4 markers, namely operative time, fluoroscopic time, complication rate using the modified Clavien grading system and success rate. Analysis was done in 3-month cohorts to determine how and when competence and excellence were achieved during 1 year of training for various grades of stone. The results of resident surgeons were compared with those of experienced endourologist. RESULTS: Resident surgeons achieved a plateau in mean operative time and fluoroscopic time for grade I stones after 30 to 35 cases but not for more complex stones. Similarly complications were decreased significantly only in grade I stone cases. Resident surgeons also achieved an almost excellent success rate of 87% for grade I stones only. CONCLUSIONS: This study of the learning curve of residents suggests that competence and near excellence is reached after 30 to 35 cases for grade I stones. However the learning curve for complex stones (grades II to IV) is steeper and requires more experience.
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Primary neuroectodermal tumor (PNET) is a rare entity with high malignant potential. It usually affects the skeletal system and primary extraskeletal involvement is uncommon. Because of rarity of tumor in the penis, only a few cases have been reported. A 17-year-old male adolescent presented with painless penile swelling of 4 weeks' duration. Clinical examination revealed multiple, 1 cm hard nodules palpable on penile shaft. Open incisional biopsy of the penile nodule revealed an undifferentiated malignant round cell tumor and on immunohistochemistry a diagnosis of PNET was made. Metastatic workup was negative. Total penectomy and perineal urethrostomy was performed, and subsequently adjuvant chemotherapy was given.
