BACKGROUND End-stage renal disease (ESRD) is associated with a multitude of physical, psychological, and social health challenges, including a profound impact on sexual and reproductive health. Among males with ESRD, erectile dysfunction (ED) is highly prevalent due to factors such as underlying comorbidities, including diabetes and hypertension, and the physiological effects of long-term dialysis. Kidney transplantation (KTx) has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance. However, the evidence surrounding the effectiveness of KTx in improving sexual function, specifically erectile function (EF), remains inconclusive. This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction (SexDys), particularly ED, in male ESRD patients. AIM To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD, assessed using the international index of EF (IIEF), to survey the prevalence of SexDys in this population, and to assess the correlation between various factors and SexDys through regression analysis. METHODS A systematic search of PubMed, EMBASE, Cochrane Library, Scopus, ClinicalTrials.gov, and Google Scholar was conducted, following the PRISMA 2020 guidelines. Prospective and retrospective cohort studies, as well as cross-sectional studies assessing EF pre- and post-transplantation, were included. These studies used validated tools such as the IIEF to measure EF. Meta-analyses were performed using a random-effects model to estimate standardized mean differences (SMD) and hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I ² statistic, and publication bias was evaluated with a funnel plot and the Egger’s test. RESULTS A total of 2419 studies were identified, with 362 abstracts screened and 193 full-text articles reviewed. Ultimately, 11 studies were included for qualitative analysis and 7 for quantitative synthesis. The random effects model for SMD yielded a combined estimate of 0.43 (95%CI: -0.20-1.07), indicating a small but non-significant improvement in EF post-transplantation. The heterogeneity across studies was substantial (I ² = 90%), reflecting significant variability in outcomes. Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors. Despite this trend, the overall result for changes in EF was not statistically significant (P = 0.15). Additionally, the combined HR from the meta-analysis was 2.87 (95%CI: 1.76-4.69), suggesting that KTx significantly increases the likelihood of improved EF, though variability between studies persisted (I ² = 63%). CONCLUSION While KTx offers some promise for improving EF in male ESRD patients, the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results. Despite this, individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups, particularly living-donor recipients. Future research should focus on larger, well-designed cohort studies with standardized outcome measures to provide more definitive conclusions. Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life. However, adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.

Introduction: Patients with urinary stone disease may present with CKD. The incidence of developing end stage renal disease (ESRD) in patients with renal calculi is 0.2%-3.2%. In the present study we aim to discuss outcomes of PCNL in CKD patients. Materials and Methods: This was a prospective observational study done, from January 2023 to March 2024. Data of 96 CKD patients with renal stones who underwent standard PCNL were recorded. Patients were followed up with urinalysis, serum creatinine and ultrasound KUB. Preoperative eGFR were compared with eGFR 36 months follow up. Patients were divided into two groups. Group 1- improved and group 2- stable or worsened disease since the final follow up visit. Observations and Results: After PCNL renal function improvement was seen in 52 (54%) patients that is, Group I & in 44 (46%) patients it was stable or declined that is, Group II. In Group I, mean preoperative eGFR was 41.13 +/- 14.23 ml/min/m2 which improved to 46.91 +/- 12.14. In Group II mean preoperative eGFR was 37.14 +/- 12.32 which declined to 33.17 +/- 12.57. The statistically significant factor decreasing the efficacy of PCNL in CKD patients were presence of co morbidities (Hypertension, DM; p = 0.007), staghorn stones (p = 0.001), history of previous renal surgery (p = 0.001), operation time > 100 min (p < 0.0001), post PCNL stone free status(p < 0.0001), and Complications(p = 0.03). After 6 months follow up 8 patients in Group I shifted from CKD stage 4 to CKD stage 3 and four patients in group II shifted from CKD stage 3 to CKD stage 4. Conclusion: Factors like presence of comorbidities, staghorn calculus, previous surgery operative time and post operative complications affects improvement of renal function in CKD patients after stone clearance.

Introduction: Consent-taking for surgery evolved from a historical paternalistic approach to informed consent in the mid-20th century. Modern healthcare models prioritize patient-centric care, and the use of multimedia tools may overcome challenges such as language barriers and complex medical surgical steps. This study evaluates the impact of an educational video on patient satisfaction for those undergoing percutaneous nephrolithotomy (PCNL), a procedure where explaining complexities verbally can be challenging. Materials and Methods: A randomized control trial was conducted at a tertiary care center in India from July 2022 to April 2024. A total of 232 adult patients scheduled for PCNL were randomly assigned to a study group (Group A) or a control group (Group B). Group A viewed an educational video about PCNL, while Group B provided standard written consent. The video, presented in patients’ native languages, covered procedural details, potential outcomes, and post-operative care. Patient satisfaction was assessed using a 10-question questionnaire at discharge, with scores ranging from one (poor) to five (best). Statistical analysis was performed using SPSS software to compare outcomes between the two groups. Results: The study found that Group A exhibited significantly higher satisfaction compared to Group B across all domains. Group A demonstrated a better understanding of the procedure, improved knowledge of post-operative care, reduced anxiety, and a greater awareness of potential complications. Specifically, the mean satisfaction scores for Group A were higher in understanding the procedure (13.15 vs. 10.00), post-operative care (8.46 vs. 6.84), and overall anxiety (8.65 vs. 6.96). The video also improved patients’ comprehension regarding potential complications and the need for further procedures. Complication rates and hospital stay durations were similar between both groups. Discussion: The educational video significantly enhanced patient satisfaction and the understanding of PCNL. This multimedia approach provided a consistent, clear explanation of the procedure, which improved patient comprehension and reduced anxiety, irrespective of literacy levels. These findings support the integration of video-assisted consent in pre-operative education to enhance patient engagement and satisfaction. Conclusions: The use of an educational video for consent in PCNL improves patient understanding and satisfaction. This method effectively complements traditional consent processes, providing a valuable tool for patient education in complex procedures.

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) I (MP48)1 May 2024MP48-14 OUTCOMES OF LAPAROSCOPIC PYELOPLASTY IN POORLY FUNCTIONING KIDNEYS: A TERTIARY CARE INSTITUTE's PERSPECTIVE Vikram Singh, Shashank Tripathi, Mahendra Singh, Kartik Sharma, Deepak Prakash Bhirud, Shivcharan Navriya, Rahul Jena, Gautam Ram Choudhary, and Arjun Singh Sandhu Vikram SinghVikram Singh , Shashank TripathiShashank Tripathi , Mahendra SinghMahendra Singh , Kartik SharmaKartik Sharma , Deepak Prakash BhirudDeepak Prakash Bhirud , Shivcharan NavriyaShivcharan Navriya , Rahul JenaRahul Jena , Gautam Ram ChoudharyGautam Ram Choudhary , and Arjun Singh SandhuArjun Singh Sandhu View All Author Informationhttps://doi.org/10.1097/01.JU.0001009512.15743.d7.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Laparoscopic pyeloplasty is a well-established surgical procedure for the management of ureteropelvic junction obstruction. However, its effectiveness in cases of poorly functioning kidneys remains a subject of debate. This study aimed to compare the outcomes of laparoscopic pyeloplasty in poorly functioning kidneys with renal function ranging from 15% to 30%. METHODS: We retrospectively analysed a cohort of patients who underwent laparoscopic pyeloplasty between January 2019 and July 2023. Only those patients were included who had preoperative differential renal function between 15% to 30%. Patients were divided into two groups based on preoperative renal function: Group A (15% to 20%) and Group B (20% to 30%). Surgical success, defined as improvement in differential renal function, improvement in Effective renal plasma flow (ERPF) and symptom improvement was the primary outcome measure. Secondary outcomes included operative time, postoperative complications, and length of hospital stay. RESULTS: A total of 121 patients were included in the study, with 51 in Group A and 70 in Group B. There was no statistically significant difference in surgical success between the two groups (p=0.49). Both groups showed significant improvement in symptoms (VAS SCORE) postoperatively. Postoperative complications (p=0.590), duration of surgery (p=0.260) and length of hospital stay (p=0.169) were similar between the two groups. Furthermore, there was a significant increase in the postoperative ERPF (Group A; p value=0.001, Group B; p value=0.001) and differential renal function as compared to the preoperative values within the same group (Group A; p value=0.001, Group B; p value=0.001). The analysis revealed that there was a significant improvement in curve types before and after the surgical procedure within Group A and group B, as determined by the Wilcoxon Signed Ranks Test.(Group A; p value=0.025, Group B; p value=0.005). CONCLUSIONS: Laparoscopic pyeloplasty is an effective and safe surgical option for patients with poorly functioning kidneys, yielding outcomes similar to those with good renal function. This study provides evidence to support the use of laparoscopic pyeloplasty as a treatment modality for UPJ obstruction in this patient population. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e778 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Vikram Singh More articles by this author Shashank Tripathi More articles by this author Mahendra Singh More articles by this author Kartik Sharma More articles by this author Deepak Prakash Bhirud More articles by this author Shivcharan Navriya More articles by this author Rahul Jena More articles by this author Gautam Ram Choudhary More articles by this author Arjun Singh Sandhu More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:Laparoscopic simple nephrectomy (LSNx) is among the gold standard options for management of selected poorly functioning and most non-functioning kidneys (PFK/NFKs). Our objective was to audit our patients who had undergone LSNx for benign causes and assess their perioperative outcomes and analyse the factors correlating with these outcomes. MATERIALS AND METHODS:We reviewed our prospectively collected data of patients with PFK/NFKs due to benign causes who underwent a LSNx on a three-dimensional (3D) system via a transperitoneal approach between January 2017 and June 2023. Details on clinical profile, radiological findings and peri-operative details were recorded and analysed. RESULTS:A total of 302 patients underwent LSNx in the study duration. Urolithiasis was the most common cause of PFK/NFKs in 66.5% of patients followed by pelvi-ureteric junction obstruction in 14.9%. Rate of conversion to open surgery was 5.3%. Final histopathology revealed chronic pyelonephritis in 82% patients and Xanthogranulomatous pyelonephritis (XGPN) in 14%. Multivariate analysis revealed presence of pre-operative fat stranding on imaging, larger kidney size, presence of XGPN and pyonephrosis to be significantly associated with longer operation times. Prior renal surgery, positive urine culture, presence of XGPN and a higher body mass index was associated with a longer hospital stay and increased rate of post-operative complications. CONCLUSION:LSNx is commonly employed for management of PFK/NFKs from various aetiologies, the most common of which is urolithiasis in our experience. Multiple clinico-radiological factors as described correlated with longer operative times and prolonged hospital stay, which aids in surgical planning and patient counselling.

OBJECTIVES:Lymphatic channels (LC) are not as prominent as blood vessels, so they tend to get damaged during surgical procedures. It can present with chyle leak in the postoperative period. We aimed to study the occurrence of chyle leak in patients undergoing nephrectomy and its management.METHODS:During the period of January 2021 and January 2023, 158 adult patients underwent nephrectomy for various reasons like non-functioning kidney, donor nephrectomy, and malignancy. We retrospectively analyzed data of patients who had chyle leak after nephrectomies.RESULTS:Eight patients out of the 158 patients (5.06%) undergoing nephrectomy developed chyle leak. One out of these eight patients underwent nephrectomy by open approach while seven underwent laparoscopic approach. All eight patients who had chyle leak undergone left sided nephrectomy. Six patients of chyle leak could be managed with dietary modification while two patients needed octreotide therapy for treatment. Higher Body Mass Index (BMI; p-value = 0.012), left sides nephrectomy (p-value = 0.013), h/o pyelonephritis (p-value = 0.005) were associated with higher incidence of chyle leak on univariate analysis. While on multivariate analysis no factor was found to be independently associated with chyle leak. Hospital stay was significantly prolonged in patients with chyle leak (p-value = 0.007).CONCLUSION:Chyle leak is not a very rare complication after nephrectomy. Patients with higher BMI, who undergo left sided nephrectomies and patients who had history of pyelonephritis or infectious complications had higher incidence of chyle leak. Most cases can be managed with conservative management (CM). Chyle leak is associated with a prolonged hospital stay.

Introduction: We present our initial experience with robot-assisted reconstructive surgeries with the Da Vinci Xi robotic system for benign ureteric pathologies.Materials and methods: This is a retrospective review of prospectively collected data of patients who underwent robot-assisted reconstructive procedures for benign diseases of the ureter at our department from April 2018 to November 2022. Demographic and perioperative details were recorded. Patients were followed up and surgical success was evaluated on the basis of symptomatic, functional, and radiological improvement.Results: A total of 34 patients underwent robot-assisted reconstructions for benign ureteric pathologies by various techniques. Mean age, body mass index (BMI), hospital stay and follow-up duration were 36 years, 24.1 kg/m2, 5.29 days, and 7.08 months respectively. Procedures included pyeloplasty in eight, primary ureteroneocystostomy (UNC) in seven, Psoas hitch UNC in five, Boari flap UNC in six, Ureteroureterostomy in four, ureterocalicostomy in two and ileal ureteral transposition in two patients. Mean docking time, total operative time, and estimated blood loss were 31.5 min, 178 min, and 64.3 ml, respectively. All patients had radiologic or functional improvement on follow-up after 6 months.Conclusion: Robot-assisted reconstructive surgery for benign ureteric and bladder pathologies imparted excellent short-term outcomes without major complications with all the advantages of a minimally invasive approach.

INTRODUCTION:Bladder cancer is a common and serious disease globally, often requiring radical cystectomy as the preferred treatment. However, this procedure carries substantial risks and complications. To evaluate its success, pentafecta, a five-component measure, was introduced. This study investigates the attainment of pentafecta following radical cystectomy and examines factors that influence its achievement.METHODOLOGY:This retrospective, single-group study was conducted at AIIMS Jodhpur. The study population included 42 patients who underwent radical cystectomy for bladder cancer. Various data, including demographic characteristics, clinical features, surgical techniques, and postoperative outcomes, were collected from medical records. The primary outcome measure was the rate of achieving pentafecta, which comprises five parameters.RESULTS:Out of 42 patients, 26 (61.9%) achieved pentafecta. Age, gender, comorbidities and surgical approach did not significantly affect the attainment of pentafecta. Negative surgical margins were achieved in 95.2% of cases, and adequate lymph node dissection (>16 lymph nodes) was performed in 85.7% of cases. The absence of Clavien-Dindo grade 3-5 complications and recurrence was observed in 80.9% and 90.47% of cases, respectively. Uretero-enteric stricture was absent in 95.2% of cases.CONCLUSION:The study emphasizes the significance of negative surgical margins, thorough lymph node dissection, absence of complications, recurrence, and uretero-enteric strictures in evaluating the success of radical cystectomy as pentafacta outcomes. Patients with higher drain output and wound infections are less likely to achieve pentafacta outcome and indicates poorer outcome. By considering these factors, clinicians can assess patient outcomes and identify areas for improvement.

Introduction: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. Methods: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. Results: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Conclusion: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

To compare different specimen extraction techniques in laparoscopic simple nephrectomy among female patients, focusing on perioperative outcomes, complications, and postoperative recovery. A retrospective analysis was conducted on data from 45 female patients who underwent laparoscopic nephrectomy between September 2022 and July 2024. Patients were divided into three groups: laparoscopic transperitoneal nephrectomy with transvaginal extraction (LTN-TVS), Pfannenstiel extraction (LTN-PFN), and retroperitoneoscopic nephrectomy (RPN) with flank extraction. Demographic data, operative details, extraction times, postoperative outcomes, and sexual function scores were analyzed. The LTN-PFN group had the shortest operative (106.93 ± 20.89 min) and extraction times (18.00 ± 2.97 min) compared to LTN-TVS (127.80 ± 27.88 min, 30.13 ± 8.05 min) and RPN (130.8 ± 32.62 min, 18.93 ± 16.35 min) groups (P < 0.05). Initially longer extraction times were seen in the transvaginal group which decreased with experience. The LTN-TVS group had significantly lower pain scores at 24 and 48 h and reduced analgesic needs (P < 0.01) as compared to other groups. Scar assessment scores favored the transvaginal group. Incisional hernias occurred in 2 PFN and 1 RPN patient, but none in the TVS group. Hospital stay, pelvic floor, and sexual function scores showed no significant differences among the groups. The transvaginal extraction method offers a promising, minimally invasive alternative with superior postoperative outcomes and minimal complications, making it a preferred approach in female patients undergoing laparoscopic nephrectomy.

Crossing vessels is one of the important causes of pelviureteric junction obstruction (PUJO). Accessory lower polar vessels are commonly seen with congenital PUJO, but they are not always the cause of obstruction. We incidentally encountered a variation in the lower polar crossing vessel while doing laparoscopic pyeloplasty in a patient with congenital PUJO. We encountered a right accessory lower polar artery and vein along with a right gonadal artery arising from the accessory right renal artery and right gonadal vein draining into the right lower polar crossing accessory renal vein. Knowledge of variations in genitourinary vasculature is important in the current era to prevent inadvertent complications.

Radical cystectomy with pelvic lymph node dissection is the recommended treatment for managing muscle-invasive carcinoma of the urinary bladder. Early recurrence is observed in only about 4.1% of cases. Port-site metastasis following robot-assisted radical cystectomy is extremely rare. We encountered a challenging and a rare case of bladder cancer that manifested with port-site and peritoneal metastasis within 6 weeks of surgery.

High-flow renal arteriovenous fistula (AVF) can lead to complications such as hematuria, hypertension, high-output cardiac failure, and renal insufficiency.[1] [2] A 52-year-old female patient with no prior risk factors presented with dull aching pain in right lumbar quadrant for 1 month and hematuria for 7 days. There was no history of trauma to abdomen. She was hemodynamically stable at presentation. Her hemoglobin was 6.9 g/dL. Abdominal ultrasound showed a large anechoic cystic lesion in the right lumbar quadrant with only upper pole of right kidney being visualized and intense color flow within the lesion in color Doppler with low resistance biphasic waveform ([Fig. 1A]). Chest radiograph was normal. Computed tomography angiography revealed a large vascular pouch in the right kidney with a large arterial feeder and dilated early draining renal vein suggestive of renal AVF with large venous pouch ([Fig. 1B]). Diethylenetriaminepentacetate (DTPA) scan showed severely impaired renal perfusion and cortical function in right kidney with functioning parenchyma seen exclusively at upper polar region. She was counseled for endovascular treatment as upper pole of right kidney could be preserved.

Background: In addition to ensuring cancer control, prevention of incontinence which significantly impact patients' quality of life, is also an important issue in robot-assisted radical prostatectomy (RARP) operations. In this study, we aimed to find the correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy. Methods: This study included 162 patients treated with RARP with perioperative data and at least 1 year of follow-up. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. The continence recovery rate in our study was assessed at 6th week, 3rd month, 6th month, 9th month, and 12th month, post-surgery. Logistic regression analysis evaluated the association between the predictive factors and urinary continence recovery in the early and late stages. Results: The majority of patients with prostate cancer present in sixth decade of life. The majority of our patients (56.7%) were categorized as high risk using D'Amico classification. The continence rate in our study at 6th week, 3rd month, 6th month, 9th month, and 12th month were 40.1%, 72.2%, 85.2%, 89.5%, and 91.4%, respectively. No improvement in continence status was observed after 1 year in our study. There was significant correlation of age with continence status at 6th week, 3rd month, and 6th month. The young age is associated with early recovery of continence. At 3 and 9 months, the non-diabetics cases achieved significantly higher continence rates than diabetics (p < 0.05) which shows that diabetes causes delay in attainment of continence. Conclusion: The young age may be associated with early recovery of continence, but further validation requires large number of cases. We attributed good continence recovery rate to meticulous dissection and preservation of good urethral length.

Background: The studies have shown that GS given after assessment of the entire prostate gland on the radical prostatectomy specimen may differ from GS given after examination of a small sample from needle core biopsy. We conducted this study to assess discrepancies in the Gleason score between NCB and RP specimens and to find out the correlation between the clinical stage and pathological stage. Methods: The study included 174 patients with carcinoma prostate which underwent robotic-assisted radical prostatectomy (RARP). Pre-operative Gleason score was determined on 12-core biopsy samples under trans-rectal ultrasound (TRUS) guidance. The Gleason score obtained from the radical prostatectomy specimen was compared with that of the NCB Gleason score to find out differences. Results: The preoperative Gleason score (GS) ranges from 6 to 9 with a mean GS of 6.97 ± 1.02. The post-operative GS ranges between 6 and 10 with mean and GS of 7.5 ± 1.10. On the pre-operative assessment of biopsy specimens, 70 (43.2%) patients had a GS of 6, while 44 patients had a GS of 7 (27.1%) and 48 (29.8%) patients had a GS of more than 7. On the postoperative assessment of specimens, 31 (19.1%) patients had post-operative GS of 6, while 66 (41%) patients had GS of 7 and 74 (41.1%) patients had GS of more than 7. When pre-operative GS and post-operative GS were compared, no changes were observed in the GS of 79 patients, whereas 83 patients showed the difference in GS, with 75 patients showing up-gradation and eight patients marked as down-graded Conclusion: concordance between biopsy and the pathology results directly affects the prognosis of the patient. The results of our study demonstrated the rate of discordance between Gleason scores obtained from transrectal prostate biopsy and RP surgical specimens. This rate brings into question the accuracy of the chosen treatment.

Active surveillance (AS), radical prostatectomy (RP), and radical radiotherapy (RT) are the three options for localized prostate cancer. Only a few studies have been conducted in developing countries or in centers in their initial learning curve that predict the outcomes of RARP. Therefore, this study aimed to present data from a novice center; how we started and progressed, and to compare our results with the rest of the world. This is a retrospective analysis to study the outcomes following robot-assisted radical prostatectomy and to identify the predictors of quadrifecta outcomes, i.e., the patients who were continent, did not have complications, were biochemical recurrence free with at least 1 year of follow-up and had negative surgical margins. In our data, we excluded the erectile function as one of the parameters as the majority of our patients were not sexually active or did not want to discuss this parameter. Seventy-two patients were included in this study, and 50 (69.4%) of these achieved the quadrifecta outcomes. Of all the factors, studied, seven factors were statistically significantly different between Group I (quadrifecta achieved) and Group II (quadrifecta not achieved), namely, BMI, co-morbidities like CAD, COPD, ASA grade, pre-op D’Amico risk stratification groups, clinical staging, positive lymph-node status, and hospital stay. With this study, we reported outcomes of RARP in a newly established robotic center and the results were fairly comparable with the well-developed center in India and abroad, emphasizing the short learning curve, and so, the requirement of establishing more robotic surgery centers in developing as well as developed countries.

Emphysematous infection of the urinary tract is a hazardous condition and is life-threatening if not managed quickly. We report an 82-year-old woman with uncontrolled diabetes mellitus and urethral stricture who presented with emphysematous cystitis with the gas reaching up to the pelvicalyceal system on the left side (emphysematous pyelonephritis) and appearing in X-ray as air pyelogram. The patient was managed with drainage and intravenous antibiotics and she recovered.

Calculus in the urethra of the female is very unusual. The patient remains asymptomatic or uncommonly presents with symptoms of dysuria, post-void urinary dribbling, and dyspareunia. If asymptomatic, it can be diagnosed incidentally on gynecological examination. Being hard in consistency, it may mimic metastatic lesion. We present a case of a female who presented to us for management of ovarian mass. On routine examination there was a hard mass in her vagina which was suspected to be a metastatic lesion. This mass on evaluation came out to be a urethral diverticulum with a large calculus. Very large urethral calculus are a very rare presentation in a female.

Journal Article Nimesulide-induced severe leukocytoclastic vasculitis leading to penile and limb gangrene: a case report Get access Deepak P Bhirud, Deepak P Bhirud Department of Urology, All India Institute of Medical Sciences Jodhpur, Jodhpur, 342001, India Search for other works by this author on: Oxford Academic Google Scholar Amit Aggarwal, Amit Aggarwal Department of Urology, All India Institute of Medical Sciences Jodhpur, Jodhpur, 342001, India https://orcid.org/0000-0002-2827-3700 Search for other works by this author on: Oxford Academic Google Scholar Shashank Tripathi, Shashank Tripathi Department of Urology, All India Institute of Medical Sciences Jodhpur, Jodhpur, 342001, India Search for other works by this author on: Oxford Academic Google Scholar Vikram Singh, Vikram Singh Department of Urology, All India Institute of Medical Sciences Jodhpur, Jodhpur, 342001, India Corresponding author. Department of Urology, All India Institute of Medical Sciences Jodhpur, Room Number 550, OPD Block 5 C, Jodhpur, Rajasthan, 342001, India. E-mail: vikramsingh812922@gmail.com Search for other works by this author on: Oxford Academic Google Scholar Mahendra Singh, Mahendra Singh Department of Urology, All India Institute of Medical Sciences Jodhpur, Jodhpur, 342001, India Search for other works by this author on: Oxford Academic Google Scholar Arjun S Sandhu Arjun S Sandhu Department of Urology, All India Institute of Medical Sciences Jodhpur, Jodhpur, 342001, India Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, qgad066, https://doi.org/10.1093/postmj/qgad066 Published: 03 August 2023 Article history Received: 22 June 2023 Revision received: 17 July 2023 Accepted: 18 July 2023 Published: 03 August 2023

Background and Study Design:Role of 18F-fluoro-2-deoxy-2-d-glucose positron emission tomography-computed tomography (FDG PET-CT) in evaluation of renal cell cancers (RCC) and urinary bladder cancers is not standardized, and the COPPER-T trial, which is a single centre prospective randomized study, was designed to compare it with conventional imaging for staging of clinically localized high risk RCC and urinary bladder carcinoma (Stage T2 and above). Patients and Methods:There will be two subgroups of patients: RCC and urinary bladder carcinoma. In each of these, the patients will be randomized to either Arm A or Arm B. In each of the arms, each patient will be subjected to diagnostic imaging by FDG PET-CT. The CT scan will be a contrast-enhanced scan like that in conventional staging. A radiologist and nuclear medicine specialist will report the scan independently. The radiologist will not have access to the PET scan sequences and will only review the contrast-enhanced computed tomography (CECT) images. In Arm A, the report of the conventional imaging modality, that is, CECT and bone scan if done, will be reviewed first by the clinician, and based on this report, a management plan will be made. Then, the PET-CT report will be reviewed, and change in the management plan will be noted. New findings or equivocal findings if any in the PET-CT report would be noted. In Arm B, the report of the PET-CT report will be reviewed first by the clinicians, and a management plan will be made. Then, the CECT and/or bone scan reports will be reviewed, and any change in the management plan will be noted. Outcome and Significance:Final analysis of the data after completion of the trial will help in clarifying the role of FDG PET-CT in high risk RCC and transitional cell carcinoma (TCC) of the bladder, its diagnostic accuracy compared with conventional imaging and the impact of using it on patient management.