Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database.

Introduction: There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods: For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results: In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions: This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE) Technique of Nerve-Sparing Robot-Assisted Radical Prostatectomy (RARP) in Indian Scenario: Technique, Feasibility, and Early Outcomes.

Potency and urinary continence are adversely affected post-prostatectomy. The primary objective is oncological safety by ensuring negative surgical margins (NSM) and best functional recovery through nerve preservation in appropriate patients. NeuroSAFE technique of intra-operative frozen-section (IFS) analysis was devised for comprehensive assessment of surgical margins adjacent to the neurovascular tissue surface of the prostate. We analyzed our initial experience with this technique. Five NS-RARPs were performed utilizing the NeuroSAFE technique between October 2021 and February 2022. Patient demographics, disease stage, operative console time, post-operative complications, final histopathology, biochemical recurrence (BCR), erectile function, and urinary continence were recorded. The mean age of patients was 59.2 ± 1.3 years. All had clinically organ-confined disease with ISUP grade ≤ 3. The mean operative time of NS-RARP with NeuroSAFE was 240 ± 21 min and average NeuroSAFE time was 45 ± 3.8 min. All patients had NSM on IFS. No patient had Clavien-Dindo grade > 1 complications. Margins were negative on final histopathology. No patient had BCR at 6 and 12 weeks. Three patients were able to have sexual intercourse and only one patient required single precaution pad at 12 weeks. NeuroSAFE is feasible and can ensure intra-operative oncological safety of the NS procedure. Moreover, it gives the opportunity to convert positive surgical margin to prognostically favorable NSM by secondary resection. Our initial experience which is the first in India is encouraging with favorable functional outcomes. Large prospective studies and longer follow-up are required specially to evaluate the oncological benefit.

Revolutionizing urology: the advancements and applications of robotic platforms.

Robot-assisted surgery is developing as an acme of minimally invasive surgery, given its utmost dominance over laparoscopic surgery. The objective was to review the status of robotic surgery in urological practice with its advantages and disadvantages in current scenario. We conducted a literature search using MEDLINE and identified 72 articles which were relevant to urology. Single-port and various multiport robotic platforms like Da Vinci, Versius, Hugo RAS, Revo-I, Senhance, Mantra, Avatera, Hinotori, and MicroSurge are described with pros and cons. With a surge in different medical surgical robots purging into the market and a race to become the next standard of care in robotic surgery, it is only a matter of time when robotic surgery becomes financially comparable to laparoscopic surgeries.

Corrigendum to "RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned" [Eur. Urol. Open Sci. 54 (2023) 33-42].

[This corrects the article DOI: 10.1016/j.euros.2023.05.007.].

Exploring the Ethical, Legal, and Social Implications of ChatGPT in Urology.

PURPOSE OF THE REVIEW: ChatGPT is programmed to generate responses based on pattern recognition. With this vast popularity and exponential growth, the question arises of moral issues, security and legitimacy. In this review article, we aim to analyze the ethical and legal implications of using ChatGPT in Urology and explore potential solutions addressing these concerns. RECENT FINDINGS: There are many potential applications of ChatGPT in urology, and the extent to which it might improve healthcare may cause a profound shift in the way we deliver our services to patients and the overall healthcare system. This encompasses diagnosis and treatment planning, clinical workflow, patient education, augmenting consultations, and urological research. The ethical and legal considerations include patient autonomy and informed consent, privacy and confidentiality, bias and fairness, human oversight and accountability, trust and transparency, liability and malpractice, intellectual property rights, and regulatory framework. The application of ChatGPT in urology has shown great potential to improve patient care and assist urologists in various aspects of clinical practice, research, and education. Complying with data security and privacy regulations, and ensuring human oversight and accountability are some potential solutions to these legal and ethical concerns. Overall, the benefits and risks of using ChatGPT in urology must be weighed carefully, and a cautious approach must be taken to ensure that its use aligns with human values and advances patient care ethically and responsibly.

Assessment of functional outcome following Duhamel retro-rectal pull-through surgery for Hirschsprung's disease: a follow-up study

Context: Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design: This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results: Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a "good" score of eighteen and above. Nineteen children had a "fair" score of 13-17. Five children had a "poor" score of less than thirteen, and among them, two had a "very poor" score of less than nine. The mean BFS was 13.72. Conclusions: Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence. (AU)

Whole-exome sequencing of Indian prostate cancer reveals a novel therapeutic target: POLQ.

PURPOSE: Prostate cancer is the second most common cancer diagnosed worldwide and the third most common cancer among men in India. This study's objective was to characterise the mutational landscape of Indian prostate cancer using whole-exome sequencing to identify population-specific polymorphisms. METHODS: Whole-exome sequencing was performed of 58 treatment-naive primary prostate tumors of Indian origin. Multiple computational and statistical analyses were used to profile the known common mutations, other deleterious mutations, driver genes, prognostic biomarkers, and gene signatures unique to each clinical parameter. Cox analysis was performed to validate survival-associated genes. McNemar test identified genes significant to recurrence and receiver-operating characteristic (ROC) analysis was conducted to determine its accuracy. OncodriveCLUSTL algorithm was used to deduce driver genes. The druggable target identified was modeled with its known inhibitor using Autodock. RESULTS: TP53 was the most commonly mutated gene in our cohort. Three novel deleterious variants unique to the Indian prostate cancer subtype were identified: POLQ, FTHL17, and OR8G1. COX regression analysis identified ACSM5, a mitochondrial gene responsible for survival. CYLC1 gene, which encodes for sperm head cytoskeletal protein, was identified as an unfavorable prognostic biomarker indicative of recurrence. The novel POLQ mutant, also identified as a driver gene, was evaluated as the druggable target in this study. POLQ, a DNA repair enzyme implicated in various cancer types, is overexpressed and is associated with a poor prognosis. The mutant POLQ was subjected to structural analysis and modeled with its known inhibitor novobiocin resulting in decreased binding efficiency necessitating the development of a better drug. CONCLUSION: In this pilot study, the molecular profiling using multiple computational and statistical analyses revealed distinct polymorphisms in the Indian prostate cancer cohort. The mutational signatures identified provide a valuable resource for prognostic stratification and targeted treatment strategies for Indian prostate cancer patients. The DNA repair enzyme, POLQ, was identified as the druggable target in this study.

Expert survey on management of prostate cancer in India: Real-world insights into practice patterns.

To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web-based survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ≥90% and ≥75% agreement, respectively. Sixty-two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high-level evidence.

Outcomes of Minimally Invasive Radical Prostatectomy-a Contemporary Review.

Prostatectomy has been widely accepted as a treatment option for prostate cancer and can be performed via an open, laparoscopic, and robotic approach. The outcomes following prostatectomy are primarily sub-grouped into oncological and functional outcomes. Oncological outcomes have been comparable in the above three surgical modalities. However, the robotic platform seems to have a better functional outcome compared to open prostatectomy. The data on the outcome of the laparoscopic approach is scarce and is not widely performed due to technical difficulty. With experience continence outcomes have reached a plateau in many robotic series, however, the potency outcome is the real Achilles tendon of this procedure. Many factors influence potency outcomes but the amount and quality of nerve-sparing is one factor that is under a surgeon's control and it improves with experience.

Multi class disorder detection of magnetic resonance brain images using composite features and neural network.

Brain disorder recognition has becoming a promising area of study. In reality, some disorders share similar features and signs, making the task of diagnosis and treatment challenging. This paper presents a rigorous and robust computer aided diagnosis system for the detection of multiple brain abnormalities which can assist physicians in the diagnosis and treatment of brain diseases. In this system, we used energy of wavelet sub bands, textural features of gray level co-occurrence matrix and intensity feature of MR brain images. These features are ranked using Wilcoxon test. The composite features are classified using back propagation neural network. Bayesian regulation is adopted to find the optimal weights of neural network. The experimentation is carried out on datasets DS-90 and DS-310 of Harvard Medical School. To enhance the generalization capability of the network, fivefold stratified cross validation technique is used. The proposed system yields multi class disease classification accuracy of 100% in differentiating 90 MR brain images into 18 classes and 97.81% in differentiating 310 MR brain images into 6 classes. The experimental results reveal that the composite features along with BPNN classifier create a competent and reliable system for the identification of multiple brain disorders which can be used in clinical applications. The Wilcoxon test outcome demonstrates that standard deviation feature along with energies of approximate and vertical sub bands of level 7 contribute the most in achieving enhanced multi class classification performance results.

Multi class disorder detection of magnetic resonance brain images using composite features and neural network

Brain disorder recognition has becoming a promising area of study. In reality, some disorders share similar features and signs, making the task of diagnosis and treatment challenging. This paper presents a rigorous and robust computer aided diagnosis system for the detection of multiple brain abnormalities which can assist physicians in the diagnosis and treatment of brain diseases. In this system, we used energy of wavelet sub bands, textural features of gray level co-occurrence matrix and intensity feature of MR brain images. These features are ranked using Wilcoxon test. The composite features are classifi ed using back propagation neural network. Bayesian regulation is adopted to fi nd the optimal weights of neural network. The experimentation is carried out on datasets DS-90 and DS-310 of Harvard Medical School. To enhance the generalization capability of the network, fi vefold stratifi ed cross validation technique is used. The proposed system yields multi class disease classifi cation accuracy of 100% in diff erentiating 90 MR brain images into 18 classes and 97.81% in diff erentiating 310 MR brain images into 6 classes. The experimental results reveal that the composite features along with BPNN classifi er create a competent and reliable system for the identifi cation of multiple brain disorders which can be used in clinical applications. The Wilcoxon test outcome demonstrates that standard deviation feature along with energies of approximate and vertical sub bands of level 7 contribute the most in achieving enhanced multi class classifi cation performance results.

Role of RPLND and Metastasectomy in the Management of Oligometastatic Renal Cell Carcinoma.

Although lymphadenectomy is currently accepted as most accurate and reliable staging procedure for lymph node metastases, its therapeutic benefit in renal cell carcinoma (RCC) still remains controversial. Although the new, targeted therapy paradigms have changed the treatment of patients with advanced RCC and offer prolonged survival, cure is extremely uncommon in the absence of surgical resections. In this paper, the current role of metastasectomy is reviewed. Review the available literature concerning the role of retroperitoneal lymph node dissection and metastasectomy in outcome of oligometastatic RCC. A PubMed search was conducted to identify original articles, review articles, and editorials addressing the role of retroperitoneal lymph node dissection and metastasectomy in outcome of oligometastatic RCC. Keywords included renal tumors, renal cell cancer, kidney cancer, lymphadenectomy, metastasectomy, and oligometastases. While there is no randomized study available, recent large observational studies have better defined the prognosis of patients with metastatic RCC with or without metastasectomy and RPLND. To date, the available evidence suggests that RPLND and metastasectomy may be beneficial when technically feasible in patients with locally advanced (unfavorable clinical and pathologic characteristics) and oligometastatic disease. A proportion of patients will achieve long-term survival with aggressive surgical resection.

Clinical Utility of Gallium-68 PSMA PET/CT Scan for Prostate Cancer.

BACKGROUND: Prostate cancer is biologically and clinically a heterogeneous disease that makes imaging evaluation challenging. One of the important challenges in this cancer is to detect recurrent disease. Biochemical response using Prostate Specific Antigen (PSA) and Imaging using several PET tracers have poor sensitivity and specificity. Therefore, we analyse the role of Ga68-PSMA (Prostate Specific Membrane Antigen) imaging in prostate cancer, which is a new PET tracer. METHODS: In this study, we evaluated PET scans of 262 patients with diagnosis of prostate cancer. These patients were scanned using Ga68-PSMA for either staging or response evaluation. RESULTS: 336 PSMA scans were performed. Ga68-PSMA scan resulted in the detection of extra-prostatic disease in 53.2% of cases when done at baseline before commencing any treatment. The sensitivity of Ga68-PSMA at baseline with histopathological diagnosis was 95% with 95% CI ranging from 86% to 98%. The positive predictive value was high at 98% with 95% CI ranging from 91% to 99%. In 26 (10%) patients who had surgical castration, Ga68-PSMA scan was able to detect disease progression / castration resistance in 100% of cases. The outcome of castration-resistant prostate cancer was compared with other cases where castration was not done. In those who did not undergo castration, there was a significantly better response by hormone therapy (p = 0.03) and radiotherapy (p = 0.01) on Ga68-PSMA. The sensitivity of Ga68-PSMA response with biochemical response was 66.7% with 95% CI ranging between 46 %- 82.7%. Ga68-PSMA response did not correlate with biochemical response. CONCLUSION: Ga68-PSMA has good sensitivity for diagnosis, staging, restaging, evaluation of therapy response and prognostication in prostate cancer.

Radical Prostatectomy for Locally Advanced Prostate Cancers-Review of Literature.

Twenty-five to thirty percent of patients with prostate cancer present with locally advanced disease. While risk stratification remains the same with high incidence of upstaging of disease on imaging and histopathological evaluation; there have been progressive refinements in surgical therapy. With availability of reasonably robust data, radical prostatectomy in men with locally advanced prostate cancers seems to effect improvement in both cancer specific and overall survival rates in comparison to the current standard of care of radiation with androgen deprivation therapy. Studies using radical prostatectomy as a part of multimodality approach have also shown promising results. There is an imminent need for well-designed prospective studies of benefits of radical prostatectomy over radiation and androgen deprivation as well as benefits of multimodality therapy over monotherapy. Surgery for patients with locally advanced prostate cancer is technically challenging. Surgical outcomes are comparable to those of organ-confined disease when performed in high-volume centers. Neoadjuvant therapies prior to radical prostatectomy might improve surgical outcomes, but whether they will translate into a better cancer specific and overall survival are yet to be ascertained.

VEIL Surgical Steps.

Inguinal lymphadenectomy remains the standard of care for metastatic nodal disease in cases of penile, urethral, vulval and vaginal cancers. Outcomes, including cure rates and overall and progression-free survivals, have progressively improved in these diseases with extending criteria to offer inguinal lymph node dissection for patients 'at-risk' for metastasis or loco-regional recurrence. Hence, despite declining incidence of advanced stages of these cancers, many patients will still need to undergo lymphadenectomy for optimal oncological outcomes. Inguinal node dissection is a morbid procedure with operative morbidity noted in almost two third of the patients. Video endoscopic inguinal lymphadenectomy (VEIL) was described and currently practiced with proven equivalent oncological outcomes. We describe our technique of VEIL using laparoscopic and robotic access as well as various new surgical strategies.

GnRH Antagonist: a New and an Effective Way of Treatment of Advanced Prostate Cancer.

Castration remains the mainstay of treatment in the management of metastatic prostate cancer. Medical castration plays an important role in a majority of these patients. Gonadotropin releasing hormone (GnRH) agonists have been commonly used hitherto to achieve medical castration. Arrival of GnRH antagonists have opened a new approach in the management of these patients with distinct drug-related and cancer-related benefits including prevention of microsurges and reduction in cardiovascular complications. This article elucidates the mechanism of action of GnRH antagonists along with its clinical advantages and demerits.

A Multi Directional Perfect Reconstruction Filter Bank Designed with 2-D Eigenfilter Approach: Application to Ultrasound Speckle Reduction.

B-Mode ultrasound images are degraded by inherent noise called Speckle, which creates a considerable impact on image quality. This noise reduces the accuracy of image analysis and interpretation. Therefore, reduction of speckle noise is an essential task which improves the accuracy of the clinical diagnostics. In this paper, a Multi-directional perfect-reconstruction (PR) filter bank is proposed based on 2-D eigenfilter approach. The proposed method used for the design of two-dimensional (2-D) two-channel linear-phase FIR perfect-reconstruction filter bank. In this method, the fan shaped, diamond shaped and checkerboard shaped filters are designed. The quadratic measure of the error function between the passband and stopband of the filter has been used an objective function. First, the low-pass analysis filter is designed and then the PR condition has been expressed as a set of linear constraints on the corresponding synthesis low-pass filter. Subsequently, the corresponding synthesis filter is designed using the eigenfilter design method with linear constraints. The newly designed 2-D filters are used in translation invariant pyramidal directional filter bank (TIPDFB) for reduction of speckle noise in ultrasound images. The proposed 2-D filters give better symmetry, regularity and frequency selectivity of the filters in comparison to existing design methods. The proposed method is validated on synthetic and real ultrasound data which ensures improvement in the quality of ultrasound images and efficiently suppresses the speckle noise compared to existing methods.

Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.