The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia: A prospective cohort study.

OBJECTIVE/BACKGROUND: Benign prostatic hyperplasia (BPH) is increasing substantial burden on health care systems. Men with high body mass index (BMI) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH. METHOD: The study included 560 patients (50-80 years) with BPH. Weight and height measured to calculate BMI. TRUS was used to measure PV. Patient demographics such as IPSS score and prostate specific antigen (PSA) were also noted. RESULTS: Patients in the study had a mean age of 65.3 ± 9.45 years and the mean BMI was 23.97 ± 4.89 kg/m2. The mean PV of each BMI group were 37.45 ± 0.81, 57.89 ± 1.52 and 77.94 ± 2.17 (ml) for normal, overweight and obese groups, respectively, and the average PV score was 57.76 ± 1.50 ml. The mean PSA score was 3.26 ± 0.94 (ng/dl) with a range of 0.6-10.4. There was significant correlation between BMI and PV (p = 0.001) as well as between BMI with PSA and IPSS (p = 0.02, 0.001, respectively). CONCLUSION: The results showing strong correlation between BMI and PV also BMI with PSA and IPSS. Therefore reducing weight may lead to a lower prostate volume in the elderly stage, making LUTS less noticeable and improving quality of life.

Prevalence of LUTS in young female population attending tertiary care centre.

OBJECTIVE: To obtain the prevalence of lower urinary tract symptoms (LUTS) in young female population in tertiary care centre. METHOD: We conducted a descriptive and analytic study with ques tionnaire based data collection. All subjects were interviewed using conventional method and International Consultation on Incontinence Questionnaire (ICIQ) Female LUTS form in the urology outpatient department, SMS medical college and hospital, Jaipur (India). RESULT: Total 1278 patients enrolled in study. Using the well-structured questionnaire using ICIQ-FLUTS form, the prevalence of LUTS was 78.01% while conventional method having only 35.8%. This result revealed that LUTS is a common condition among young Indian female population with vaginal delivery as the common risk factor. CONCLUSION: Screening for LUTS using a structured questionnaire identified a significantly higher prevalence of LUTS than the conventional method. The ICIQ-FLUTS form is a robust questionnaire that can be recommended for use in epidemiological research as well as routine clinical practice.

Effects of administration of local aminophylline on patients undergoing ureteroscopic lithotripsy.

INTRODUCTION: The presence of ureteral stones can cause pain, infections of urinary tract and hydronephrosis, resulting in the loss of renal function. For two decades, Ureteroscopy and laser stone fragmentation (URSL) attained a big rise and is the first line management for large ureteric stones and renal stones up to 2 cm. The present study was conducted to assess the success rate of ureteroscopic lithotripsy in treatment of ureteric calculus after local administration of aminophylline. MATERIALS AND METHODS: 100 patients having ureteric calculi <20 mm in size, aged 20-60 years were included in the study and randomly divided into Group A (n = 50) with administration of local aminophylline and Group B (n = 50) with administration of saline infusion. Ureteroscopy was performed after 5 min of administration of the solution. URSL was done using pneumatic lithoclast and/or laser. Various parameters like duration of procedure, ease of ureteral access, requirement of DJ Stent and need of further operative interventions were compared between case and control groups. The data was collected and then subjected to statistical analysis using IBM SPSS 20.0 version at significance level of p < 0.05. RESULTS: The mean age of study subjects having ureteral stones was found to be between 31 and 40 years of age with males being more affected. We observed less mean duration of surgery, higher success rate, easy ureteral access (p-value < 0.05) with aminophylline use than control group. The need of ureteral stent and Auxiliary procedures was significantly higher in the control than in the case group (38%). CONCLUSION: The use of aminophylline has been found to be highly useful and effective in reducing the need of stents and secondary surgery, decreased pain, and increased success rate. Thus, the use of aminophylline is recommended during URSL procedure for the successful management of ureteral calculi.

The effect of no oral antibiotic versus 7 days oral antibiotic during discharge in double J stented patients on stent related urinary tract infection: A randomized study.

OBJECTIVE: To evaluate effects of 7 days oral antibiotic prophylaxis versus no antibiotics in the patients with DJ stents after 3 days iv antibiotic on discharge with respect to urinary tract infection and stent related symptoms. MATERIAL AND METHODS: A prospective randomized study in 90 patients being stented post PCNL/URSL. Group A: no oral antibiotics was given at the time of discharge, Group B: 7 days of oral antibiotic was given at the time of discharge. Patients were followed up and outcomes were assessed in the form of lower urinary symptoms (LUTS), urine culture and sensitivity at 1 and 3 weeks and DJ stent culture and sensitivity on removal at 3 weeks. RESULTS: There was no significant difference in age, gender, type of surgery (PCNL/URSL), duration of DJ stent between the two groups. Patients in group A and Group B have comparable UTI and stent related symptoms at 1 and 3 weeks respectively (p = 0.95 and p = 0.916 respectively). Similarly, there were no marked difference in urine culture at 1 and 3 weeks, respectively between two groups (p = 0.71 and p = 0.63, respectively). Overall there were no significant differences in Urinary symptoms, urine culture/sensitivity at 1 and 3 weeks and also DJ stent culture and sensitivity on removal at 3 weeks between the two groups. CONCLUSION: The incidence of UTI and stent related symptoms are same in both the groups. Therefore, prescribing oral antibiotics on discharge in selected patient with DJ stent has no added benefit and should be avoided.

Surgical interventions in female urethral strictures: a comprehensive literature review.

INTRODUCTION AND HYPOTHESIS: Female urethral stricture (FUS) is an uncommon entity. Although there is no clinical consensus on the best modality of treatment, several studies have been published describing different techniques of FUS management. We carried out a literature review of the different surgical techniques used in the management of FUS and their results. METHODS: We performed a systematic search of the PubMed and EMBASE databases and several cross-references. We grouped the data available from the studies into four general treatment categories. RESULTS: We reported 35 studies (488 patients) with outcome measures; 53.48% of cases were presumably idiopathic in origin. A history of prior intervention was described in 91.29% of cases. As a surgical intervention, urethral dilatation (UD) had the lowest success rate of only 41.25%. In contrast, local flaps performed better (92.54% success rate) than local or oral grafts (87.30% and 89.94%, respectively). Only 9.43% of patients experienced mild to moderate post-surgery de novo incontinence; most of them recovered with pelvic floor exercises. CONCLUSION: In practice, UD is tried first for FUS, at least once, before urethroplasty. In case of failure or short recurrence following UD, urethroplasty should not be delayed. In experienced hands, urethroplasty has a better outcome.

Efficacy of tranexamic acid in decreasing primary hemorrhage in transurethral resection of the prostate: A novel combination of intravenous and topical approach.

BACKGROUND: Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic enlargement; however, hemorrhage still remains one of the major complications. OBJECTIVE: The primary aim of this study was to evaluate the effect of tranexamic acid (TXA) in reducing intraoperative blood loss and need for blood transfusion. Secondary parameters compared were operating time, volume of irrigation fluid used, and reduction in hemoglobin concentration. SUBJECTS AND METHODS: A total of 70 eligible patients undergoing TURP were randomized based on computer generated table into two groups. The study group (1) received IV TXA 500 mg after induction of anesthesia and 500 mg in each irrigation fluid bottle (dual mode) and the control group (2) received none. RESULTS: The mean age (68.20 vs. 66.5 years), prostate size (57 vs. 51 g), and preoperative hemoglobin (13.3 vs. 13.5 g/dl) were similar between the groups. Intraoperative blood loss in the TXA group was found to be significantly reduced (174.60 ± 125.38 ml vs. 232.47 ± 116.8; P = 0.04). Blood transfusion was required in 2.8% of cases as compared to 14.2% in controls. Operating time, volume of irrigation fluid, and postoperative reduction of hemoglobin were not significant between the groups. No complications were observed in both groups. CONCLUSION: In this study, we observed that TXA, when used as a combination of Intravenous and topical route, effectively reduced intra-operative blood loss and the need for transfusion.

Novel predictive risk factor for Erectile Dysfunction: Serum folic acid.

The purpose of this study was to compare the serum Folic Acid (FA) levels in patients with Erectile Dysfunction (ED) and healthy controls and whether levels vary with its severity. The study was carried out on 77 sexually active individuals, out of which 41 complained of ED and 36 were apparently normal. Patients were excluded if they had any diseases known to cause ED. The severity was further categorised based on IIEF-5 scores. Blood serum levels of testosterone, lipid profile, random blood sugar, liver function test, renal function test and FA levels were obtained in each patient. Independent-samples t test of significance was used when comparing between two means. Pearson's correlation coefficient (r) test was used for correlating data. All clinical and biochemical parameters except FA were comparable in both the groups. FA levels were significantly decreased in ED group (5.29 vs. 10.8; p value = .004). Smoking habits were comparable between the groups, and FA levels did not vary among smokers and nonsmokers (p value = .46). Serum FA levels significantly declined with increasing severity of ED (8.28 vs. 5.56 vs. 4.37 vs. 3.5; p value < .001). Thus, decreased FA might possibly be one of the novel risk factors for ED.

Renal sinus angiomyolipoma: A rare case.

Angiomyolipoma (AML) consists of <10% of all renal tumors and is the most common benign mesenchymal neoplasm of the kidney. It arises from the renal cortex and extends toward perirenal fat. Fat-poor AML as well as those arising from rare locations may pose diagnostic difficulties. In our case, we report a rare presentation of this tumor arising from the renal sinus extending toward the pelvis thereby leading to an alternative diagnosis of transitional cell carcinoma of renal pelvis.

STONE score versus Guy's Stone Score - prospective comparative evaluation for success rate and complications in percutaneous nephrolithotomy.

PURPOSE: The aim of the current study was to compare Guy's score and STONE score in predicting the success and complication rate of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A total of 445 patients were included in the study between July 2015 and December 2016. The patients were given STONE score and Guy's Stone Score (GSS) grades based on CT scan done preoperatively and intra- and post-operative complications were graded using the modified Clavien grading system. The PCNL were done by a standard technique in prone positions. RESULTS: The success rate in our study was 86.29% and both the GSS and STONE score were significantly associated with a success rate of the procedure. Both the scoring systems correlated with operative time and postoperative hospital stay. Of the total cases, 102 patients (22.92%) experienced complications. A correlation between STONE score stratified into low, moderate, and high nephrolithometry score risk groups (low scores 4-5, moderate scores 6-8, high scores 9-13), and complication was also found (P = 0.04) but not between the GSS and complication rate (P = 0.054). CONCLUSION: Both GSS and STONE scores are equally effective in predicting success rate of the procedure.

Xanthogranulomatous pyelonephritis presenting as a type IV renal cyst.

A 20-year-old woman presented to our outpatient clinic with a 5-week history of recurrent right lumbar back pain. Contrast-enhanced computed tomography scan showed a Bosniak class IV renal cyst. She was treated with radical nephrectomy. Histopathology revealed xanthogranulomatous pyelonephritis.

Single-stage Female Epispadias Repair by Combined Infrasymphyseal Bladder Neck Plication and Urethrogenitoplasty: A Novel Technique.

OBJECTIVE: To evaluate the role of infrasymphyseal bladder neck plication and suspension from the pubic bone along with urethrogenitoplasty as a single-stage procedure for treating isolated cases of female epispadias. MATERIALS AND METHODS: Six patients with female epispadias having grade 3 urinary incontinence were treated through bladder neck plication and suspension from the pubic bone along with urethrogenitoplasty from December 2013 to March 2016. RESULTS: Of the 6 patients with a mean age of 5.91 years (3-10 years) and a mean postoperative follow-up of 13.17 months (4-29 months), 5 patients stopped wearing diapers and were fully continent with a dry period of more than 3 hours from the first week of catheter removal. One patient experienced urine leakage while playing or crying in the initial postoperative period. However, this patient became continent with a dry period of more than 3 hours after 4 months of follow-up. All patients had an excellent cosmetic outcome without any considerable postoperative complications. All patients were voiding well without significant postvoid residual urine. CONCLUSION: The present technique is simple, safe, and effective for achieving urinary continence in patients with female epispadias.

Role of Urinary and Serum Carbohydrate Antigen 19-9 as a Biomarker in Diagnosis of Adult Giant Hydronephrosis.

INTRODUCTION: The most common cause of adult Giant Hydronephrosis (GH) is congenital Uretero-Pelvic Junction (UPJ) obstruction. Conventional imaging modalities, like Intravenous Urography (IVU) and Computed Tomography Urography (CTU) and radionuclide renal scan can be fallacious. Serum carbohydrate antigen 19-9 (CA19-9) is a useful tumour marker for gastrointestinal and pancreatic cancer. Only a few studies and case reports have shown raised serum levels due to benign hydronephrosis and GH. AIM: To investigate the prognostic role of urine and serum CA19-9 in the diagnosis and follow-up of adult GH due to UPJ obstruction. MATERIALS AND METHODS: The present hospital based observational study was conducted on 24 adult patients (Group 1) with unilateral GH due to UPJ obstruction. Twenty four healthy adults were included as control (Group 2). Serum and voided urine samples were collected to evaluate Carbohydrate Antigen (CA) 19-9 in each group. During surgery, urine from the affected pelvis was collected to determine CA19-9 level. Patients were followed up after surgery at 3 and 9 months with serum and voided urine samples for CA19-9 level. RESULTS: Preoperative Serum and voided urine CA19-9 were significantly greater in Group1 than in controls, which significantly correlated inversely with preoperative percentage renal function and glomerular filtration rate. Postoperative improvement in renal function significantly correlated inversely with serum and voided urine CA19-9 at 3 and 9 months. CONCLUSION: Voided urine CA19-9 can be a non-invasive clinical marker in adult GH due to UPJ obstruction. The clinical implications of these data for diagnosis and follow-up of these patients are significant. Our findings suggest, significant decrease in urinary Ca19-9 level during follow-up is predictive of excellent surgical outcome and resolution of renal damage.

Fertility Potential in Adult Hypospadias.

INTRODUCTION: Hypospadias is a congenital anomaly of the urogenital tract characterized by abnormal location of the external urethral meatus over ventral aspect of penis. The ideal time to correct primary hypospadias is when aged 6-12 months. However, in some developing countries, such as ours, this anomaly may be left untreated until adulthood. There are multiple risk factors responsible for development of this anomaly, out of which paternal sub fertility is one of them. As the child grows into adulthood, fertility status becomes an important issue, frequently raised by patients. AIM: To evaluate the fertility potential of adult hypospadiac patients and to rule out the effect of age of surgical correction over fertility potential. MATERIALS AND METHODS: Seventy three adult patients of hypospadias were prospectively evaluated, out of which 43 were operated during adulthood. All patients underwent measurement of penile length and circumference in both flaccid and erect positions along with testicular volume, serum LH, FSH and testosterone and semen analysis. A set of questionnaire was given to all the patients which included assessment of erectile function (IIEF-5), ejaculatory function, strength of libido and level of satisfaction after sexual intercourse. Results were compared with an age matched control group of 70 healthy person. RESULTS: Out of 73 patients with a mean age of 23.73 years, 14(19.17%) had proximal and rest 59(80.82%) had distal type of hypospadias. Mean penile length in both type of hypospadiac patients under both flaccid and erect conditions (7.92±1.33 and 9.62±1.31cm) were significantly shorter than those of control (10.78±0.94 and 13.15±1.15 cm) (p<0.001). In spite of short penile length, the level of satisfaction of all patients and their partner after penetrating intercourse were comparable to control (p>0.05). The strength of libido (p>0.05) was comparable with control in both type of hypospadiac patients; however IIEF-5 scores was poor in the proximal type of hypospadias. Semen volume (ml), sperm concentration (mill/ml), active sperm motility (%), and normal sperm morphology were comparable between distal hypospadiac group and control (p>0.05), however these parameters were poor in proximal type. The serum FSH and LH levels were significantly higher and serum testosterone level was significantly lower in hypospadiac patients than control (p <0.001). However, no difference in testicular size was found. The patients who were operated during childhood had shorter penile length compared to patients operated during adulthood. CONCLUSION: Fertility potential parameters in distal type of hypospadias were comparable with control. However the proximal type had poor erectile function and semen quality. Patients operated in either childhood or in adulthood, there was no significant difference in fertility potential.

Primary Squamous Cell Carcinoma of Kidney Associated With Large Calculus in Non-functioning Kidney: A Case Report.

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.

Comparison of sonoelastography with sonourethrography and retrograde urethrography in the evaluation of male anterior urethral strictures.

OBJECTIVE: Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. MATERIAL AND METHODS: Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. RESULTS: Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was non-significant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis. CONCLUSION: Sonoelastography estimates stricture site and length better in comparison with RUG and SUG. It estimates degree of spongiofibrosis which serves as an important prognostic factor for stricture recurrence more accurately than SUG.

Deterioration in the renal function and risk of microalbuminuria after radical, simple and donor nephrectomy: A long-term outcome.

OBJECTIVES: Evaluation of deterioration in renal function and risk of micro albuminuria after radical, simple and donor nephrectomy. MATERIALS AND METHODS: A total of 594 patients underwent nephrectomy (159 radical, 318 simple and 117 donors) from February 2009 to December 2012 in our institute. First 300 eligible patients were divided in 3 groups, each having equalled number of patients. Group 1 was consisted of patients who underwent radical, group 2 had simple and group 3 had donor nephrectomy. These patients were followed up to February 2015. Follow up of all the patients were done at first month following the surgery and then in every six months subsequently. The follow up included the measurement of serum creatinine and urinary micro albumin in a spot urine sample. CKD-EPI equation was used for calculation of e GFR. RESULTS: At the end of our study, 35 patients (41.6%) in group 1 and 8 patients (8.69%) in group 2 developed CKD stage 3. During the follow-up period, 41% patients in group 1, 13% in group 2 and 4% in group 3 developed MA. CONCLUSION: Nephron-sparing surgery should be the standard treatment of renal tumors, wherever possible. There should be a regular follow up of the patients after radical, simple and donor nephrectomy because of risk of CKD. Early consultation with nephrologists should be done by the patients who are suffering from MA after nephrectomy.

Pneumatic cystolithotripsy versus holmium:yag laser cystolithotripsy in the treatment of pediatric bladder stones: a prospective randomized study.

PURPOSE: Holmium:yttrium-aluminum-garnet (Ho:YAG) laser and Pneumatic cystolithotripsy (CL) are the most widely practiced transurethral procedures for treatment of pediatric bladder stones. The aim of our study was to compare the safety and efficacy of Ho:YAG laser CL and pneumatic CL in the treatment of pediatric bladder stones. METHODS: In this prospective randomized study from January 2012 to April 2015, 25 male children with bladder stones <3 cm were consecutively randomized into two treatment groups: group A (pneumatic CL) consisted of 13 patients and group B (Ho:YAG CL) consisted of 12 patients. Operative time, duration of stay and complications were recorded. Patients were followed up prospectively. RESULTS: The mean operative time was significantly lower in group B (25.6 vs. 31.6 min) for stones <1.5 cm (p = 0.040). However, for stones between 1.5 and 3 cm in size, the mean operating times were similar in both the groups (49.4 min in Ho:YAG vs. 44.6 min in pneumatic, p = 0.40). There was no difference in complication rates and hospital stay in both the groups. No major complications were seen in both the groups. CONCLUSIONS: We found that Ho:YAG CL was more effective than pneumatic CL for treating bladder stones smaller than 1.5 cm.

Prospective Evaluation of Learning Curve of Urology Residents for Percutaneous Nephrolithotomy.

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.