Abstract Objectives This work aimed to determine the pathological yield of restaging transurethral resection of bladder tumour (re‐TURBT) in patients with non‐muscle‐invasive bladder cancer (NMIBC) managed at a contemporary tertiary‐care setting and to describe clinicopathological features among patients with positive restaging histopathology to select patients most likely to benefit from re‐TURBT. Patients and Methods This single‐centre retrospective observational case–control analysis within a re‐TURBT cohort included patients who underwent macroscopically complete index TURBT for presumed NMIBC and subsequently underwent restaging TURBT within the institutional pathway. Patients with muscle‐invasive disease at index TURBT, benign pathology, non‐urothelial carcinoma, variant histology, or ineligibility for re‐TURBT for any reason were excluded. The primary outcome was positive restaging histopathology, defined as residual urothelial neoplasia or pathological progression. In addition, clinicopathological variables were explored to identify factors potentially associated with positive re‐TURBT, including tumour size, multifocality, age, sex, tumour grade, detrusor muscle status, and carcinoma in situ on index histopathology. Results Among 188 TURBT records assessed, 79 patients underwent re‐TURBT and formed the analysed cohort. Median age was 64 years (IQR 56–69), 69 patients (87.3%) were male, and detrusor muscle was present in 77 index specimens (97.5%). Positive restaging histopathology occurred in nine patients (11.4%), comprising residual disease in eight (10.1%) and Ta high‐grade to T1 high‐grade progression in one (1.3%); no muscle‐invasive upstaging was observed. In the T1‐only analysis, positivity occurred in 8/69 (11.6%). Larger tumours, multifocality and CIS were more frequent among positive cases. Follow‐up recurrence admission occurred in 9 patients (11.4%). Conclusion In this contemporary re‐TURBT series, the pathological yield of restaging was low, with uncommon progression. Positivity clustered in those with larger tumours (≥3 cm) and high‐risk biology (multifocal disease and carcinoma in situ on index histopathology). These findings are hypothesis‐generating and support prospective evaluation of selective restaging strategies in the contemporary era.

Chronic pelvic pain syndrome (CPPS) is a complex and prevalent condition in men, but with few long-term treatment options. Yoga can reduce pain and pelvic floor dysfunction, but there is no evidence comparing yoga with medical management in men. Effects of yoga Therapy (YT) with medical therapy (MT) in men with CPPS are compared in this study. We performed a prospective randomised crossover study at a tertiary referral centre. We randomised 40 men aged ≥18 years with CPPS (as per European Association of Urology criteria) to either MT followed by YT or YT followed by MT with a 1 week washout period in between. In MT, alfuzosin 10 mg daily and titrated amitriptyline 10–50 mg daily was given for 6 weeks. YT comprised of supervised structured 1 h daily yoga for 6 weeks. Primary outcome was recorded as the change in total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score. The secondary outcomes consisted of pain, urinary, and quality-of-life subdomain scores. This trial has been registered on Clinical Trials Registry of India (CTRI/2022/05/042706). All patients who were randomised completed both phases of treatment. There was a mean improvement in NIH-CPSI total score of −10.8 points with MT and −8.4 with YT. This resulted in a difference of −2.4 points (95

A male in his early 70s presented with complaints of bilateral flank pain for seven months, hematuria for 2 days along with the passage of clots associated with an increased frequency of urination and nocturia. The patient had a history of deep vein thrombosis and was on anticoagulation. On ultrasound, multiple calculi with posterior acoustic shadowing were seen in bilateral kidneys, corroborated by Computed Tomography (CT) urography. Laser lithotripsy with DJ stent placement was conducted. The follow-up CT urography showed an inferiorly displaced DJ stent within the right distal ureter and the DJ stent herniating through the right obturator foramen. The right-sided DJ stent was removed after a month. For obturator hernia, the patient is being kept in the follow-up. This case report reviewed the literature and discussed the diagnosis and complications associated with the obturator hernia with the ureter as the content.

To study the effect of intravesical instillation of alkalinized lignocaine (AL) solution on pain scores and patient tolerance in patients undergoing cystoscopy. Bladder distension, trigonal irritation, and bladder neck irritation during cystoscopy under local anesthesia contribute significantly to patient discomfort. This was a retrospective case–control study performed at a single center from January 2023 to July 2023 (Institutional Ethics Committee approval: T/IM-NF/Urol/23/194). Prior to cystoscopy, patients in control group (Group A) (LG group) received only 10 ml of 2

To conduct a comparative analysis of autologous adult live cultured buccal epithelial cells (AALBEC) and minced buccal mucosal graft endourethral urethroplasty (MBGEU) in treatment of bulbar urethral stricture disease (USD) by evaluating and comparing their efficacy, safety, and patient outcomes. This study was conducted in a tertiary-care center and included 90 males with primary, < 4 cm bulbar USD. In AALBEC arm (30 patients), AALBEC was implanted after DVIU. While in the MBGEU arm (60 patients), a 1 × 1 cm buccal mucosal graft was harvested, minced, centrifuged, and suspended in fibrin glue, and after DVIU, the suspension was instilled via a 5-Fr ureteric catheter over the urethrotomy site. The primary objective was to compare success rates. The secondary objectives were to compare changes in the American Urological Association (AUA) symptom score, peak flow rate (Qmax), and post-void residue (PVRU) post-operatively and also to look for any adverse events related to surgery. The success rate of AALBEC was 73.33

INTRODUCTION:While the ideal catheterisation time following augmentation urethroplasty is unknown, there is emerging evidence of comparable long-term results of decreasing it in male urethroplasties. This has not been studied in females. Prolonged catheterisation leads to increased patient discomfort and catheter-related urinary-tract-infections (CAUTI). We attempted to study the feasibility and efficacy of catheter removal on the seventh postoperative day following ventral inlay buccal mucosal graft urethroplasty (VI BMGU) for female urethral stricture (FUS). METHODS:This was a single-centre, prospective observational pilot study conducted between May 2023 and July 2024. [Ethics committee approval: T/IM-NF/Uro/22/177; Clinical Trials Registry of India: CTRI/2023/05/066957]. Consenting females undergoing VI BMGU for FUS were included. The primary objective was success rate at a minimum follow-up of 6 months, while secondary objectives were a comparison of the American-Urological-Association (AUA) symptom score, maximum urinary flow rate (Qmax) and Postvoid Residual volume (PVR) and CAUTI rate per 1000 urinary catheter days. RESULTS:Twenty three patients were recruited, and 22 were included in the final analysis with a median follow up of 12 (9-15) months. There were three recurrences, with an estimated success rate of 84% at 18 months. Compared to preoperative parameters, there were significant improvements in median AUA scores, Qmax and PVR. The CAUTI rate per 1000 urinary catheter days was calculated at 12.42. CONCLUSION:Catheter removal on day seven following VI BMGU is a safe and effective strategy offering durable outcomes while reducing the risks associated with prolonged catheterisation. Larger randomised studies are warranted with a comparison of different surgical techniques.

OBJECTIVE To compare the outcomes of dorsal-onlay (DO) and ventral-inlay (VI) buccal mucosal graft urethroplasty (BMGU). This is the first Clinical Trials Registry-India registered randomized clinical trial on female urethral stricture disease. METHODS Women with USD underwent either DO-BMGU or VI-BMGU between September 2021 to July 2023. The primary objective was the success rates of the two techniques. The secondary objectives were duration of surgery, amount of blood loss, pain scores as assessed by Visual Analog Scale, and change in American Urological Association score, Qmax and postvoid residual. RESULTS Of the 47 randomized participants, 20 patients in each group were taken up for final analysis. The median follow-up period was 21 months and those with less than 1 year follow-up were excluded. One patient in each group had failure at 1 year follow-up, giving a success rate of 95% in each arm. The median blood loss [15 mL (10-15) vs 10 mL (5-12.5), (P .012)] and median duration of surgery [44.5 minutes (40-52.5) vs 30 minutes (22-38), (P < .001)] were significantly less for VIBMGU than for DO-BMGU. The median Visual Analog Scale scores at 6 and 24 hours were significantly lower (P < .001) for the VI-BMGU group but not at 48 hours. The VI-BMGU group required less analgesia (P < .01) as well. Small sample size and single institutional experience are limitations. CONCLUSION The outcomes of VI-BMGU are similar to those of DO-BMGU, with the additional advantages of shorter operative time, lesser blood loss, and less pain.

Although laparoscopic radical nephrectomy (LRN) is the standard of care for large and complex malignant renal masses, the location of the incision for kidney retrieval remains a point of debate, and no clear-cut guidelines exist. This study aimed to compare the outcomes of kidney specimen retrieval after LRN using either a Pfannenstiel incision (PFN) or an iliac fossa incision (IFN). This was an open-labelled, parallel-group, randomised trial. The calculated sample was 52 [26 = each arm]. The primary endpoint was the surgical site pain in the immediate postoperative period measured by the Universal Pain Assessment Tool, every fourth hour till 48 h. Secondary endpoints were total operative time, incision length, blood loss during specimen retrieval, length of postoperative hospital stay, wound site cosmesis [Manchester scar scale] at 3 months postoperatively, and wound complications between the groups in the early postoperative period. Demographic characteristics were comparable in both groups. Pain scores demonstrated a significant difference in favour of the Pfannenstiel incision group, particularly at 12, 16, 20, 24, 36 and 40 h postoperatively. There were no significant differences between groups on the other parameters. The PFN has significantly less operative site pain than IFN following LRN.

Introduction: Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake. Methods: A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals > 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration. Results: After randomization (n = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; P ≤ 0.001) and solid diet (median 2 vs. 3 days; P = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; P = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; P = 0.002). Conclusion: Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements.

OBJECTIVE:To compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS). MATERIAL AND METHODS:This study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative American Urological Association (AUA) symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient's last visit were compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up. RESULTS:Seventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 (11.00-55.00) versus 14 (7.00-17.00) months, respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89%, respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the 2 groups. CONCLUSION:The ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on FUS with the largest follow-up period of 90 months.

OBJECTIVE:To evaluate the effects of Prostate artery embolization (PAE) and open simple prostatectomy (OP) on lower urinary tract symptoms and urodynamic parameters in subjects with prostate size >80cc³. METHODS:PoPAE study (OP or PAE) was a randomized, open-label controlled trial performed between January 2020 and May 2022. Subjects with large prostates (>80cc³), urodynamic parameters meeting obstruction criteria (Bladder Outlet Obstruction Index-BOOI>40), and good detrusor function (Bladder contractility index>100) were included. The primary and co-primary endpoints were the variation in peak flow rate on uroflowmetry (Qmax) and BOOI. The secondary endpoints were the IPSS and ultrasonographic changes. RESULTS:Twenty three and 25 subjects underwent PAE and OP were evaluated, respectively. At baseline, the 2 groups have shown similar clinical, radiological, laboratory, and urodynamic parameters. After 6 months, Qmax improved 8,3 ± 4.17 mL/sec in PAE and 15.1 ± 8.04 mL/sec in OP (mean difference 6.78 in favor of PE; P = .012 [CI -9.00 to -3.00]). After treatment, 88% of those men underwent OP were classified as unobstructed or equivocal (BOOi<40). On the other hand, 70% of subjects underwent PAE remained obstructed (BOOI>40) and none of them shifted to unobstructed status (BOOI<20). It was observed a similar reduction in IPSS and PVR in both groups. CONCLUSION:PAE was inferior to conventional surgery for releasing BOO and improving peak urinary flow in large prostates. Nevertheless, PAE was able to improve symptoms and PVR, and might be an alternative method in selected patients.