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.

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.

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.

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.

Objectives: Cancer pain has all the components of total pain such as physical, social, psychological, and spiritual. These components contribute to the overall pain experience in cancer patients. Many instruments have been developed till date to assess the effect of pain in cancer patients but none of the instruments include all components of total pain. In this article, we describe the development and validation of the total pain scale (TPS) for the evaluation of total pain in cancer patients with pain. This study aimed to develop and validate a questionnaire for the evaluation of total pain in cancer patients with pain. Material and Methods: This study included a review of existing pain questionnaires for cancer pain for item pool generation. Items were generated in the Hindi language by six stakeholders to create 23 items to develop TPS. TPS was applied to 300 Hindi-speaking cancer patients. Bivariate correlation was used to reduce the number of items as well as construction of the domain followed by factor analysis to finalise TPS. Confirmatory factor analysis (CFA) was performed for testing the validity and reliability of TPS. Results: TPS is an 18-item scale composed of four domains (physical, social, spiritual and psychological domain). The internal consistency of TPS and its subscales was found to be very good (a = 0.84–0.88). CFA and structural equation modeling Goodness of fit has confirmed that model 4 is the best fit as it yielded a lesser root-mean-squared error of approximation value of 0.062 and a greater comparative fit index, Tucker-Lewis index value of 0.944. The convergent and divergent validity of TPS and its domain was good. Conclusion: This study reports TPS to be a brief (18-item), valid, and reliable questionnaire in the Hindi language for assessment of all components of total pain in cancer patients with pain.

Aim: To compare the effect of different analgesic regimens on the time to initiate breastfeeding (BF) and ambulation after cesarean section (CS). Methods: This prospective, double-blinded, placebo-controlled randomized study included 300 women (20-40 years of age) of the American Society of Anesthesiologists status 1 or 2 with singleton term pregnancies scheduled for CS under spinal anesthesia. Women were allocated to three groups of 100 each by computer-generated randomization. As an adjunct to 1,000 mg intravenous acetaminophen, Group 1 received 100 mg rectal diclofenac, Group 2 received 100 mg rectal tramadol, and Group 3 received rectal glycerin suppository. The time to initiate BF and ambulation was compared between different analgesic regimens and corelated with pain score. Results: BF (both with and without support) was initiated significantly earlier in Groups 1 and 2 as compared with control Group 3 (p < 0.001). A significantly shorter time was taken to initiate BF without support in Group 1 as compared with Group 2 (p = 0.028). The time to start ambulation (both with and without assistance) was significantly lower in Groups 1 and 2 as compared with Group 3 and in Group 1 versus Group 2 (p < 0.001). A significant positive correlation was found between the time to initiate BF with support and ambulation without assistance and postoperative pain score at 0, 1, and 6 hours. Conclusion: Effective post-CS analgesia affects early initiation of BF and ambulation in the immediate postnatal period. The inclusion of rectal diclofenac suppository in post-CS analgesic regimens is a promising approach to postoperative delivery care.

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

Arteriovenous fistula (AVF) is the preferred route for vascular access in patients with chronic kidney disease on maintenance haemodialysis. Many studies have demonstrated the positive effects of perioperative hand exercise on fistula maturation. Here, we present our experience of radio cephalic AVF creation in patients with neuromuscular disorders who had difficulty performing isometric hand exercises. We created AVF in three patients with neurological disorders. First patient had essential tremor, which created difficulty during hand exercises and surgery while the other two patients had right hemiparesis. Perioperative isometric exercises have been shown to help in maturation of AVF. Due to neurological involvement, our patients had difficulty performing hand exercises. All had successful AVF despite taking longer than usual time to mature. Creation of AVF in neuromuscular diseases is feasible. A preoperative Doppler ultrasound to assess the vessels might help in making an informed decision. This might spare such patients the only functional arm.

The incidence of urethral recurrence after radical cystectomy is 1% to 8%, with most cases occurring within the first 2 years of surgery. Prophylactic urethrectomy is rarely performed nowadays due to no known survival benefit and increased morbidity due to the procedure. However, we encountered a rare case of delayed urethral recurrence presenting as recurrent urethral collection 4 years after radical cystectomy with ileal conduit diversion, posing a diagnostic dilemma.

Extrarenal calyces (ERC) is a rare renal anomaly. First described in 1925, and till now, >60 cases have been reported worldwide. The association of ERC in ectopic kidneys with ureteropelvic junction obstruction (UPJO) is a very rare presentation. We encountered a case of an adult male with ERC in a pelvic kidney with UPJO, in which the dilated ERC mimicked the ureter and created intraoperative confusion.

Air quality index instrument is used for air quality monitoring. These five pollutants use for AQI indexing, NO 2 , PM 2.5 , CO, PM 10 , Ozone was used to study air quality in Jodhpur during lockdown (2019-2021). The mean value of NO 2 , PM 2.5 , CO, PM 10 , Ozone were in 189.8, 86.2, 28.8 , 53.3 μg/ 𝑚𝑚 3 and 1.15mg/ 𝑚𝑚 3 in observed in 25 March to 31 March 2019 and NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 214.4, 1 06.4, 40.7, 51.8μg/ 𝑚𝑚 3 and 1.20mg/ 𝑚𝑚 3 in observed in 1 April to 31 April 2019 and NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 241.7, 11.4, 34.4, 63.6 8μg/ 𝑚𝑚 3 and 1.2320mg/ 𝑚𝑚 3 in observed in 1 May to 31 May 2019. The mean value of NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 85.4, 44.0, 21.8, 43.0, μg/ 𝑚𝑚 3 and 1.07mg/ 𝑚𝑚 3 in observed in 25 March to 31 March 2020 and NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 98.5, 48.0,20.5, 40.5μg/ 𝑚𝑚 3 and 0.61mg/ 𝑚𝑚 3 in observed in 1 April to 31 April 2020 and NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 138.0, 69.8, 20.5, 50.1μg/ 𝑚𝑚 3 and 0.64mg/ 𝑚𝑚 3 in observed in 1May to 31 May 2020 . The mean value of NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 256.0, 108.3, 27.1, 46.2 μg/ 𝑚𝑚 3 and 0.82mg/ 𝑚𝑚 3 in observed in 25 March to 31 March 2021 and NO 2 , PM 2.5 , CO, PM 10 , Ozone ar e in 212.5, 88.9, 29.0, 40.9 μg/ 𝑚𝑚 3 and 0.82mg/ 𝑚𝑚 3 in observed in 1 April to 31 April 2021 and NO 2 , PM 2.5 , CO, PM 10 , Ozone are in 154.8, 66.5, 16.6, 32.5 μg/ 𝑚𝑚 3 and 0.79mg/ 𝑚𝑚 3 in observed in 1 May to 31 May 2021.

Carcinoma prostate is the second most common malignancy in males. It starts with a relatively indolent course and maybe asymptomatic during the initial stages. However, metastasis is highly common in Carcinoma prostate. The sites of metastases include bone, lung , liver, pleura and adrenals with cutaneous metastasis being one of the rarest sites being less than 1%. In our case report we present one such rare finding of Carcinoma prostate with cutaneous metastasis.

Genetic diversity among 50 barley genotypes was investigated using 18 different agro-morphological and seed vigour traits under timely and late growing conditions. The Euclidean cluster analysis assigned 50 barley genotypes into eight distinct clusters indicating presence of substantial genetic diversity in the evaluated breeding material. The average inter-cluster distance was found to be maximum between the cluster VIII and V (11.207) under timely and between cluster VI and IV (8.167) under late sown condition. The improvement in barley could be achieved through the use of genotypes assigned in clusters I and VII under timely sown, whereas the genotypes which contained in cluster II and VI might be considered as potential parents under late sown to obtain high heterotic response. Under timely sown condition, cluster I comprised of six genotypes, exhibited minimum number of days to heading and maturity, moderate plant height and number of tillers per meter and had highest cluster means for number of grains per spike, grain yield per plot and harvest index. Cluster IV comprised of seven genotypes, also had high cluster means for number of tillers per meter, number of grains per spike, grain yield per plot and harvest index. Similarly, under late sown condition, cluster II which comprised of two genotypes had low cluster mean for days to heading; moderate for plant height; high for number of tillers per meter, 1000 grain weight and biological yield per plot; and highest for grain yield per plot as well as harvest index. Cluster VI, contained five genotypes recorded for minimum number of days to heading; shortest plant height; high number of tillers per meter; highest 1000 grain weight along with high mean values for grain yield per plot and harvest index. Number of grains per spike, electrical conductivity and days to maturity under timely sown and days to heading, number of grains per spike and accelerated ageing (72 h) under late sown contributed maximum towards divergence. The contribution of various characters towards the expression of genetic divergence should be taken into consideration as a criterion for choosing parents for crossing programme for the improvement in such characters.