Drain fluid creatinine-to-serum creatinine ratio as an initial test to detect urine leakage following cystectomy: A retrospective study.

INTRODUCTION: Urine leak following radical cystectomy is a known complication. Among the various methods to diagnose this, assessment of drain fluid creatinine is a relatively easy procedure. We aimed to ascertain the validity of the drain fluid creatinine-to-serum creatinine ratio (DCSCR) as an initial indicator of urinary leak in patients undergoing radical cystectomy. METHODS: We retrospectively identified consecutive patients with documentation of drain fluid creatinine in the postoperative period following cystectomy and urinary diversion at our institution between January 2009 and December 2018. All continent diversions and any patient with a DCSCR >1.5:1 underwent contrast study postoperatively. A diagnosis of urine leak was made following confirmatory imaging. Receiver operative characteristic curves were created, and Youden's index was used to determine the strength and clinical utility of DCSCR as a diagnostic test. RESULTS: Two hundred forty-four of the 340 patients included in the study underwent cystectomy with conduit and 81 underwent neobladder creation. Sixteen out of 340 (4.7%) patients had radiologically confirmed urinary leak. DCSCR was elevated in all ureteric anastomotic leaks and in 1 out of the 7 neobladder-urethral anastomotic (NUA) leaks. The sensitivity and specificity of DCSCR to predict all urinary leaks were 68.8% and 80.9% at 1.12 (area under the curve [AUC] = 0.838), whereas at a value of 1.18 (AUC = 0.876) and with the exclusion of NUA leaks, the sensitivity was 77.8% and specificity was 87.6%. CONCLUSIONS: DCSCR is a good preliminary test for identifying patients who need prompt confirmatory testing for localizing urinary leaks. A drain creatinine level just 18% higher than the serum creatinine level can signify a urine leak. This is different from general assumptions of a higher DCSCR.

Relevance of semen polymerase chain reaction positive for tuberculosis in asymptomatic men undergoing infertility evaluation.

OBJECTIVE: Male partners of infertile women with genital tuberculosis (TB) are often screened for genital TB. We aimed to evaluate the clinical significance of a positive screening semen polymerase chain reaction (PCR) for Mycobacterium tuberculosis test (TB-PCR) in asymptomatic men undergoing infertility evaluation and determine the need for a detailed investigation and treatment for TB. MATERIALS AND METHODS: Between March 2012 and January 2013, male partners of 15 infertile women with a diagnosis of genitourinary TB (GUTB) as the cause of infertility, tested positive either on semen PCR for TB (13 cases), or Mycobacterium Growth Indicator Tube-960 test (2 cases). These asymptomatic men underwent infertility evaluation along with evaluation for GUTB. Diagnosis of GUTB was based on standard clinical criteria, which included a high index of suspicion along with clinical, laboratory, and/or radiological evidence of GUTB. Men who had no clinical evidence of GUTB were followed up with clinical evaluation, semen analysis, and repeat semen PCR for TB after 6 months. RESULTS: Fourteen subjects consented for inclusion in the study. One had a history of pulmonary TB 20 years earlier. Another patient was found to have mediastinal lymphadenopathy (tubercular). All except one had a normal semen analysis. None of the patients met the standard clinical criteria for GUTB diagnosis. 8 patients followed up at 6 months with repeat semen analysis, which was similar to the baseline values and no clinical evidence of TB. INTERPRETATION AND CONCLUSIONS: Asymptomatic men with positive screening semen PCR for TB do not have clinical evidence of TB. Male partners of women with infertility and GUTB should not be screened if they have no symptoms.

An unusual cause of urinary retention in a young female: a case report.

Inflammatory myofibroblastic tumors are commonly seen in young adults and adolescents and commonly present with painless hematuria. We report a case of a 38-year-old woman who presented to us with urinary retention due to a prolapsing tumor mass from the urethra, which was discovered to be an inflammatory myofibroblastic tumor arising from the bladder base and involving the bladder neck. The patient underwent a successful transurethral resection of the tumor and at 6-month follow-up was continent and symptom-free.

Characterization of thymic masses using (18)F-FDG PET-CT.

BACKGROUND: The resectability and survival may be improved in thymoma and thymic carcinoma with multimodality therapy. Various diagnostic imaging modalities are required for accurate diagnosis and preoperative staging of thymic masses. The present prospective study was planned to evaluate if Fluorodeoxyglucose (FDG) PET-CT can help differentiate various thymic lesions noted on conventional imaging modalities. METHODS: A prospective study was undertaken in 23 patients who had shown either an anterior mediastinal mass consistent with thymic origin or suspicious for a thymic mass on contrast-enhanced computed tomography scan. All patients underwent whole body FDG PET-CT after intravenous injection of 370 MBq of FDG. The interpretation of PET-CT images was based on the following criteria: FDG uptake (present or absent), SUVmax, pattern of uptake, invasion to surrounding structures, presence of metastasis and necrosis. The results of PET-CT were correlated with the final histopathology following surgery. Statistical analysis was performed with SPSS 11.5 for Windows software. The mean SUVmax of the 3 groups of pathology was compared using the Kruskal-Wallis Test. RESULTS: Thymic hyperplasia had an enlarged thymus with mean SUVmax of 1.1. Low risk thymoma had large tumors and their mean SUVmax was 3. High risk thymoma had small tumors with mean SUVmax of 2.1. As a group, thymoma had mean SUVmax value of 2.3. All thymic carcinomas were large, and their mean SUVmax was 7. The difference between the mean SUVmax for thymic hyperplasia, thymoma and thymic carcinoma was statistically significant. The difference between the SUVmax of high risk and low risk thymoma was not significant. CONCLUSION: (18)F-FDG PET-CT can help characterize various thymic lesions noted on conventional imaging modalities. However, larger prospective studies are further required to substantiate these findings.

An unusual presentation of biloma five years following cholecystectomy: a case report.

A 34-year-old female presented with right hypochondrial pain of 6 months following an uneventful open cholecystectomy about 5 years ago. A firm intra abdominal lump was felt in the right hypochondrium. Ultrasonography and computed tomography of the abdomen showed a large cystic lesion in relation to the porta hepatis. On exploration, a large cystic mass was found in relation to the undersurface of liver, adherent to the colon and duodenum. The cyst was excised leaving a cuff of cyst wall, densely adherent to the duodenum. A small opening with bile trickling through it was noted in the region of the confluence of hepatic ducts. Choledochotomy was done and T-tube placed. The bilious output from the sub-hepatic drain gradually decreased and the repeat T-tube cholangiogram on 14th day following surgery was normal. The patient, at one year of follow-up is asymptomatic with normal liver function tests.