OBJECTIVE:Robot-assisted spine surgery is expected to become increasingly common in the future as advancements in technology allow for even greater precision and efficiency. We share our experience with using the Excelsius global positioning system (GPS) spine surgical robot in spine surgery. METHODS:We analyzed 100 patients who underwent robotic-assisted transforaminal interbody fusion at our hospital. Demographic details, pedicle screw accuracy, and cranial facet joint violation were evaluated. Gretzbein Robbins classification was used for pedicle screw accuracy, and Yson classification was used to assess facet joint violation. RESULTS:A total of 424 screws were placed in 100 patients with robotic assistance. We found accuracy with robotic assistance was 98.10% and the grades 1 and 2 facet joint violation rates as 16.5% and 0%. CONCLUSION:Adding to the expanding body of knowledge on robotic-assisted spine surgery, sharing our early experience and useful tips and techniques will inspire other surgeons to embrace this cutting-edge technology for better patient care.

Objectives:The aim of this study was to evaluate and compare the efficacy, safety, opioid-sparing effect and functional outcomes of computed tomography (CT)-guided versus fluoroscopy-guided celiac plexus neurolysis (CPN) in managing pancreatic cancer pain. The study integrates pain phenotyping using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale to assess response in neuropathic subtypes. Materials and Methods:This was an ambispective observational study conducted at King George's Medical University, encompassing a retrospective cohort (January 2020-December 2022) and a prospective cohort (January 2023-December 2024). Sixty patients with histologically confirmed pancreatic adenocarcinoma and baseline pain scores of ≥7 on the visual analogue scale (VAS) were included. Patients underwent bilateral posterior retrocrural CPN under either CT (n = 30) or fluoroscopic (n = 30) guidance. Neurolysis was achieved using absolute alcohol (6-10 mL) mixed with 2% lignocaine (2-3 mL). Pain scores (VAS and LANSS), opioid use (in morphine equivalents) and functional outcomes (karnofsky performance status [KPS] and short form 36 health survey questionnaire [SF-36]) were recorded at baseline, immediate post-procedure, 1 week, 1 month and 3 months. Complication rates and opioid dose reduction were also evaluated. Statistical analysis was conducted using the Statistical Package for the Social Sciences v26.0 with a significance threshold of P < 0.05. Results:Both groups were comparable at baseline in terms of age, sex and initial pain scores. The mean VAS decreased from 8.9 ± 1.2 to 5.4 ± 2.1 in the CT group and from 8.8 ± 1.1 to 5.8 ± 2.3 in the fluoroscopy group at 3 months (P = 0.042). LANSS scores showed greater improvement in the CT group (baseline 13.8 ± 1.4-8.2 ± 2.1) compared to the fluoroscopy group (13.6 ± 1.5-9.5 ± 2.3; P = 0.038). Opioid dose reduction of ≥30% was observed in 66.7% (CT) versus 60.0% (fluoro). Functional improvement, assessed by KPS, was greater in the CT group (+15 points) than in the fluoroscopy group (+12 points). Complications were significantly lower in the CT group (20%) compared to the fluoroscopy group (46.7%, P = 0.019), with diarrhoea and hypotension being the most common. Conclusion:Both CT and fluoroscopy-guided CPN provide effective pain relief in pancreatic cancer. However, CT-guided CPN is associated with significantly greater pain reduction, especially in patients with neuropathic pain features, lower complication rates and better functional outcomes. Pain phenotyping using LANSS enhances procedural decision-making and supports a personalised approach to palliative care in pancreatic malignancy.

Orbital venous lymphatic malformations or lymphangiomas are choristomas of the orbit. Common in the pediatric population, the lesion is notorious for spreading into various anatomical spaces due to its infiltrative nature. Additionally, the vascular nature poses challenges to complete removal. Hemorrhages are not uncommon in the lesion, which may result in permanently compromised ocular function. Medical management involves injecting sclerosant into the cystic areas of the lesion, resulting in shrinkage and collapse, followed by total excision, which is the most suitable treatment option. The authors present a series of cases in which lymphangiomas have been completely excised using this minimal manipulative approach.

Prostate cancer (PCa) remains the second leading cause of cancer-related deaths in men, largely due to late-stage detection. Current diagnostic methods suffer from high false-positive rates, leading to overdiagnosis and unnecessary treatments. Given their low predictive value, there is an urgent need for precise and reliable biomarkers to enhance early detection and disease monitoring. Holding to that perspective, with the help of analytic and computational methods, we have elucidated the role of miRNA 1827 as a diagnostic biomarker with therapeutic potential. The expression analysis of miRNA 1827 was achieved by qPCR and its diagnostic potential was evaluated using receiver operating characteristic (ROC) curves. The application of bioinformatic tools recognized the miRNA–mRNA interactions. The study reveals significant downregulation of miRNA 1827 in both PCa serum and tissue. The ROC curve indicates the significant (p < 0.001) and greater AUC of 0.904 with 92.5

Introduction This study aimed to investigate the relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in a North Indian population, as well as to assess the influence of age, serum prostate-specific antigen (PSA), and testosterone levels on this association. Materials and methods A cross-sectional study was conducted at King George's Medical University, Lucknow, India, involving 183 men aged ≥50 years presenting with LUTS or benign prostatic hyperplasia (BPH). The severity of ED was assessed using the International Index of Erectile Function-15 (IIEF-15), while LUTS severity was measured using the International Prostate Symptom Score (IPSS). Serum PSA and testosterone levels were evaluated. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2018; IBM Corp., Armonk, NY, United States), with a significance level set at p < 0.05. Results The patients' mean ± SD age was 63.13 ± 8.98 years. The severity of LUTS was classified as mild in 67 patients (36.6%), moderate in 62 (33.8%), and severe in 54 (29.5%). ED was categorized as mild in 92 patients (50.3%), moderate in 73 (39.9%), and severe in 18 (9.8%). A significant correlation was found between ED severity and increasing age (p < 0.001), as well as with higher IPSS (p < 0.05). Additionally, ED was significantly associated with comorbidities, including hypertension (HTN) and diabetes mellitus (DM) (p < 0.05). Furthermore, IIEF-15 scores showed a significant correlation with testosterone levels (r = 0.679, p < 0.001). No significant correlation was found between ED severity and serum PSA levels. Conclusions This study found a significant association between ED and the severity of LUTS in men with BPH. The data revealed that patients over 79 years of age tended to have lower testosterone levels, and the presence of comorbidities such as HTN and DM emerged as major risk factors for ED. These findings highlight the significance of adopting a comprehensive, multifactorial approach to assess and manage ED in patients with LUTS.

Background:Accurate placement of the pedicle screw is vital to avoid neurovascular injury. In transforaminal lumbar interbody fusion (TLIF), a known risk factor for adjacent segment degeneration (ASD) is superior facet joint (SFJ) infringement during pedicle screw insertion. This study aims to compare pedicle screw accuracy and violation of facet joint in minimally invasive transforaminal lumbar interbody fusion (MITLIF) and robotic-assisted transforaminal lumbar interbody fusion (RATLIF).Material and Methods:We studied 100 patients operated on for TLIF and analyzed facet joint violation and pedicle breach using a computed tomography -based grading system (Yson and Gertzbein Robbins) and peri-operative radiation exposure (preoperative and intraoperative (POIO) and intraoperative (IO)) and compared between these two groups.Results:The incidence of SFJ violation in RATLIF (17%) and MITLIF (13%) was comparable (P = 0.428). We found the accuracy concerning medio-lateral breach (Grade 0 or Grade 1 breach) to be higher with the robotic group (98.275%) than minimally invasive spine surgery group (84.069%) (P = 0.00001). The rate of radiologically significant pedicle breach (Grades 2 and 3) was more in MITLIF (15.928% [36/226]) than in RATLIF (1.724% (4/232)). The mean POIO radiation in RATLIF (10.57 +/- 3.6 mSv) was higher than MITLIF (3.13 +/- 0.91 mSv) (P = 0.00001), whereas the mean IO radiation exposure is more in MITLIF group 2.93 +/- 0.907 > 1.36 +/- 0.425 mSv (P = 0.00001).Conclusion:The SFJ violation rates in the MITLIF and RATLIF groups were comparable. However, RATLIF effectively increases pedicle screw accuracy and results in lower radiation exposure to the healthcare staff than the minimally invasive group.

Central vein stenosis (CVS) is a complication primarily affecting chronic hemodialysis patients, frequently resulting in vascular access dysfunction and decreased dialysis efficacy. While CVS has a variable mortality rate, its impact on dialysis access is profound, including arm edema, facial swelling, and venous hypertension. We describe the prevalence, clinical presentation, and treatment outcomes of CVS for vascular access in hemodialysis patients. We conducted a prospective observational study from July 2023 to June 2024, on patients undergoing maintenance hemodialysis (MHD) at a tertiary care center in South India who had CVS detected by CT Venography. Demographic information, comorbidity, access type, stenosis location, clinical presentation, treatment, and outcome data were collected and analyzed. Of the 152 patients on MHD, 20 (13.1

Introduction This study aimed to assess the prevalence of andropause symptoms and testosterone levels in male patients with symptomatic benign prostatic hyperplasia (BPH), as well as to explore the relationship between these factors. Methods A total of 183 male patients aged 50 years and older with diagnosed lower urinary tract symptoms (LUTS) due to BPH were included. Andropause symptoms were evaluated using the Male Andropause Symptoms Self-Assessment Questionnaire (MASSQ), while testosterone levels were measured using a chemiluminescent immunoassay. LUTS severity was assessed through the International Prostate Symptom Score (IPSS) and erectile function via the International Index of Erectile Function-15 (IIEF-15). However, the cross-sectional design and it being conducted in a single center limit the study. Results The mean andropause symptom score was 57.24 ± 12.62, indicating moderate to severe symptoms. A significant correlation was observed between increasing lower urinary tract symptom (LUTS) severity and higher andropause symptom scores (p < 0.001). Testosterone levels were significantly lower in patients with severe LUTS (285.94 ± 106.9 ng/dL) compared to those with mild LUTS (544.09 ± 109.8 ng/dL). Additionally, comorbidities such as diabetes mellitus and hypertension were associated with increased severity of both LUTS and erectile dysfunction (ED). Conclusions The study highlights a significant prevalence of andropause symptoms in men with BPH, emphasizing the correlation between declining testosterone levels and LUTS severity. These findings underscore the importance of comprehensive assessments and management strategies that address both hormonal deficiencies and urinary health in older men.

Introduction Ureteroscopy (URS) is a minimally invasive endoscopic technique commonly used to manage ureteric stones. This study prospectively reports and grades the complications associated with semirigid URS for ureteric stone removal and aims to identify factors contributing to these complications. Methods Prospective data were collected from 160 consecutive patients who underwent semirigid URS for ureteric stones at a single center between June 2021 and December 2022. Intraoperative complications were classified using Satava's system, while postoperative complications were categorized according to the Modified Clavien-Dindo classification. Results The overall complication rate was 19.4%. Intraoperative complications occurred in 9.4% of cases, postoperative complications in 10.6%, and 0.6% experienced both. The most frequent intraoperative complication was failure to reach the stone (3.8%), while postoperative fever was the most common postoperative complication (4.4%). Larger stone size (p = 0.03), proximal stone location (p < 0.001), and presence of comorbidities (p = 0.012) were significantly associated with higher complication rates. Conclusions Semirigid URS is generally a safe and effective treatment for ureteric stones, especially in patients with favorable stone characteristics and comorbidity profiles. However, caution is advised when managing larger or proximally located stones and in patients with multiple comorbidities, as these factors increase the risk of complications. Future research should focus on multicenter studies with larger cohorts and longer follow-up periods to better understand late complications such as ureteric strictures. Additionally, investigating the impact of surgeon experience and patient demographics on complication rates could help optimize case selection and management strategies in URS.

BACKGROUND:Early diagnosis remains a challenge for prostate cancer (PCa) due to molecular heterogeneity. The purpose of our study was to explore the diagnostic potential of microRNA (miRNA) in both tissue and serum that may aid in the precise and early clinical diagnosis of PCa.MATERIALS AND METHODS:The miRNA expression pattern analysis was carried out in 250 subjects (discovery and validation cohort). The Discovery Cohort included the control (n = 30) and PCa (n = 35) subjects, while the Validation Cohort included the healthy control (n = 60), benign prostate hyperplasia (BPH) (n = 55), PCa (n = 50), and castration-resistant PCa (CRPC) (n = 20) patients. The expression analysis of tissue (Discovery Cohort) and serum (Validation Cohort) was carried out by quantitative polymerase chain reaction (qPCR). The diagnostic biomarker potential was evaluated using receiver operating characteristics (ROC). Bioinformatic tools were used to explore and analyze miRNA target genes.RESULTS:MiRNA 4510 and miRNA 183 were significantly (p<0.001) upregulated and miRNA 329 was significantly (p<0.0001) downregulated in both PCa tissue and serum. ROC curve analysis showed excellent non-invasive biomarker potential of miRNA 4510 in both PCa (area under the curve (AUC) 0.984; p<0.001) and CRPC (AUC 0.944; p<0.001). The panel of serum miRNAs (miRNA 183 and miRNA 4510) designed for PCa had significant and greater AUC with both 100% sensitivity and specificity. Computational analysis shows that the maximum number of target genes are transcription factors that regulate oncogenes and tumor suppressors.CONCLUSION:Based on ROC curve analysis, miRNAs 4510, 329, and 711 were identified as potential non-invasive diagnostic biomarkers in the early detection of PCa. Our findings imply that a panel of miRNAs 183 and 4510 has high specificity for distinguishing PCa from healthy controls and providing therapeutic targets for better and earlier PCa therapy.

Background & objectives Overcoming the challenge of early diagnosis of prostate cancer (PCa) by exploring molecular biomarkers is urgently needed. With this objective, this study was designed to explore the biomarker and therapeutic potential of miRNA (miR)-363-3p in PCa pathogenesis. Methods Total participants (n=188) were enrolled, and blood and tissue samples were collected from individuals categorized into the control group (n=55), benign prostate hyperplasia (BPH) group (n=60), PCa group (n=48), and castration-resistant PCa (CRPC) group (n=25). MiR expression profiling was carried out using quantitative polymerase chain reaction (qPCR), and biomarker analysis was conducted employing receiver operating characteristics (ROC) curve. The miR-363 target genes were predicted by in silico tools like Target Scan and starBasev 2.0 and its expression was validated by qPCR and association among them was established by using the STRING database. Results The results showed that the tumour-suppressive nature of miR-363-3p in both PCa tissues and serum were significantly higher than the control with a greater area under curve (AUC) was 0.969 (sensitivity: 85%; specificity 100%) and 0.988 (sensitivity: 97.5%; specificity: 87.5%), respectively. The targetome analysis of miR-363-3p revealed five target genes-NRAS, E2F3, PTEN, MDM2, and CCNE2 which were strongly associated with cell division and proliferation. The expression analysis of the target genes showed a significant tumour-suppression of PTEN gene and significant upregulation of oncogenic genes such as NRAS, E2F3, MDM2, and CCNE2. Interpretation & conclusions Collectively, the findings of this study suggest that miR-363-3p may be a potential biomarker in differentiating individuals with PCa and CRPC from healthy controls. The miR-363-3p triggers various oncogenic genes (MDM2, NRAS, E2F3, CCNE2) and tumour suppressor genes (PTEN) that are actively involved in PCa progression and development.

INTRODUCTION:We aim to compare the clinical and urodynamic profile of lower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period. MATERIALS AND METHODS:Fifty-one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation-induced, and complex fistulae were excluded after cross-sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed the American Urological Association Symptom Score questionnaire and underwent a dual channel pressure-flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared. RESULTS:All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty-two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty-six patients reported some LUTS at a median follow-up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty-seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients. CONCLUSIONS:In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction.

Background To assess the feasibility of partial penectomy under local anesthesia and penile nerve blocks. Methods A total of 45 patients underwent partial penectomy under local anesthesia over the last 15 years at our institute. These patients were included in group A. We took 45 age-matched controls for comparison in group B. All patients underwent partial penectomy with the standard technique. The control group underwent partial penectomy under general or spinal anesthesia, and the intervention group underwent partial penectomy under local anesthesia. Patients’ tolerance to anesthesia and surgery was compared, and postoperative pain and other complications were assessed. Results Mean age was 53.5 years in group A (case) and 52.8 years in group B (controls). Out of 45 patients in group A, 9 were ASA I, 16 were ASA II, 8 were ASA III, and 12 were ASA IV patients. Out of control patients, 35 underwent surgery under spinal and 10 underwent surgery under general anesthesia. All patients tolerated the anesthesia and surgery well. The duration of anesthesia and surgery was shorter in group A ( p < 0.05). Postoperative pain scores between the two groups were comparable after 6 h. Postoperative recovery was comparable in both groups, and hospital stays were shorter in local anesthesia/nerve block group but were statistically insignificant. There was no positive margin in any group. Conclusion Partial penectomy under local anesthesia is a satisfactory alternative in selected cases or with limited availability of anesthesia services.

[This corrects the article DOI: 10.1016/j.prnil.2023.06.002.].