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ABSTRACT: Crossed ectopia is a rare congenital anomaly. S-shaped (sigmoid) kidney is one of the varieties of crossed ectopia that is associated with absence of any renal tissue in the contralateral renal fossa. S-shaped malformation of an ipsilateral kidney with presence of the contralateral kidney is an extremely rare condition and, to our knowledge, has been described only once before in the literature. We present the case and discuss the hypothesis for this rare malformation.
Urology 11/2012; · 2.43 Impact Factor
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ABSTRACT: BACKGROUND: Recent innovations in technology and operative techniques have enabled safe performance of robot-assisted zero-ischaemia partial nephrectomy (PN), thus preventing the deleterious effect of warm ischaemia time. OBJECTIVE: To describe a novel technique of occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS) for zero-ischaemia robot-assisted PN (RAPN). DESIGN, SETTING, AND PARTICIPANTS: We used a prospective cohort evaluation of five patients who had imaging suspicious of renal cell carcinoma (RCC) treated at a single centre. SURGICAL PROCEDURE: We used computed tomography with three-dimensional reconstruction to identify renal arterial anatomy and its relationship to the tumour. Then, RAPN was performed with selective clamping and demonstration of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We prospectively collected data on baseline, perioperative, and postoperative parameters. RESULTS AND LIMITATIONS: We describe the effects seen on ultrasound contrast administration. Contrast flare is seen in the segment of the kidney that is perfused. When selective clamping is performed, a watershed (line of demarcation) between the perfused and nonperfused segments of the kidney is clearly seen, allowing excision of the tumour in a relatively avascular plane and ensuring an adequate oncologic margin, when feasible. The mean age was 68.2 yr of age (range: 36-85), and the mean tumour size was 29.6mm (range: 20-42). The mean intraparenchymal extension of the tumour was 22.6mm (range: 12-30). Three tumours were located on the right kidney and two on the left. The mean blood loss was 420ml (range: 200-1000). The histology revealed clear cell RCC in two patients, oncocytoma in two patients, and type 1 papillary RCC in one patient. All the surgical specimens had negative surgical margins. The mean decrease in glomerular filtration rate was 8.4ml (range: 0-24). The mean follow-up was 6.4 mo (range: 5-8), with no evidence of recurrence in any patient. The only limitation in adopting this technique is the need for an intraoperative ultrasound probe with a CEUS mode. However, most specialists who perform minimally invasive surgery for small renal tumours believe that intraoperative ultrasound scan imaging is essential to achieving adequate resection margins. CONCLUSIONS: Intraoperative CEUS can be a useful adjunct in determining whether zero-ischaemia RAPN is feasible by delineating the area of nonperfusion. This technique has several advantages over the currently available techniques, such as indigo carmine green and Doppler probes.
European urology 10/2012; · 7.67 Impact Factor
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Amrith Raj Rao
BJU International 08/2011; 108(3):E153. · 2.84 Impact Factor
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ABSTRACT: Botulinum neurotoxin (BoNT) is probably the most potent biological toxin that can affect humans. Since its discovery by Justinus Kerner, BoNT has seen use in a wide range of cosmetic and non-cosmetic conditions such as cervical dystonia, cerebral palsy, migraines and hyperhidrosis. We tried to trace its history from its inception to its recent urological applications.
Historical articles about botulinum toxin were reviewed and a Medline search was performed for its urological utility. We hereby present a brief review of historical aspects of BoNT and its applications in urology.
In 1793, the first known outbreak of botulism occurred due to 'spoiled' sausage in Wildebad, Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism (sausage poison). He was also the first to mention its potential therapeutic applications. In urology, BoNT has been used in bladder and urethral lesions with varying degree of success. Recently, BoNT applications were explained for prostatic disorders. BoNT applications in urology are in the treatment of detrusor external sphincter dyssynergia, detrusor overactivity, detrusor underactivity, spastic conditions of the urethral sphincter, chronic prostate pain, interstitial cystitis, non-fibrotic bladder outflow obstruction (including benign prostatic hyperplasia) and acute urinary retention in women.
Justinus Kerner is the godfather of botulism research. The role of BoNT in urology has evolved exponentially and it is widely used as an adjuvant in voiding dysfunction. In the future, its utility will broaden and guide the urologist in managing various urological disorders.
Urologia Internationalis 01/2010; 85(2):125-30. · 0.99 Impact Factor
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ABSTRACT: The discovery of prostate-specific antigen (PSA) was beset with controversy; as PSA is present in prostatic tissue and semen, it was independently discovered and given different names, thus adding to the controversy. In this review we document the early research in this field to describe the chronology of the discovery of PSA. Using a comprehensive Medline search of the historical aspects of PSA, all relevant papers were reviewed; communication with the scientists involved in the discovery of PSA was an invaluable contribution. In 1960, Flocks was the first to experiment with antigens in the prostate and 10 years later Ablin reported the presence of precipitation antigens in the prostate. In 1971, Hara characterized a unique protein in the semen fluid, gamma-seminoprotein. Li and Beling, in 1973, isolated a protein, E1, from human semen in an attempt to find a novel method to achieve fertility control. In 1978, Sensabaugh identified semen-specific protein p30, but proved that it was similar to E1 protein, and that prostate was the source. In 1979, Wang purified a tissue-specific antigen from the prostate ('prostate antigen'). PSA was first measured quantitatively in the blood by Papsidero in 1980, and Stamey carried out the initial work on the clinical use of PSA as a marker of prostate cancer. Thus the discovery of PSA is interesting and surrounded by controversy. Although the credit for purifying PSA goes to Wang, other eminent scientists published research on this antigen. The initial work on PSA in semen was to asses its properties as a forensic marker for rape victims, but soon its potential as a marker for prostate cancer became evident.
BJU International 02/2008; 101(1):5-10. · 2.84 Impact Factor
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ABSTRACT: Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such hernias as they get obstructed due to the narrow neck. We report this rare presentation in an elderly gentleman with obstructed incisional hernia through the SPC site, which was reduced and subsequently had a successful mesh repair.
Hernia 03/2007; 11(1):61-2. · 1.84 Impact Factor
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ABSTRACT: Raman spectroscopic and microscopic techniques have been used for nondestructive characterization of tissues and to differentiate benign and malignant tissues. The discovery of the principles of spectroscopy is credited to Sir C.V. Raman of India, who in 1930 brought the Nobel Prize in Physics to the East side of Suez. We present the life and work of Sir C.V. Raman with brief review of the uses of Raman spectroscopy in urology.
Journal of Endourology 02/2007; 21(1):8-11. · 1.85 Impact Factor
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ABSTRACT: The use of postoperative drains date back to Hippocrates. We report an iatrogenic case of migrated drain into the retroperitoneum. A novel technique using a rigid cystoscope for retrieval is described that prevented another laparotomy.
The New Zealand medical journal 02/2007; 120(1252):U2496.
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ABSTRACT: Pilonidal sinus affects different regions of the body, gluteal cleft being the most common. This condition affecting the penis is extremely rare with only a few case reports around the world. It is prone for complications like infection, actinomycosis, abscess formation, erectile dysfunction and phimosis amongst others. We present a case of Pilonidal sinus of the penis where a pre-operative diagnosis was made and appropriate treatment in the form of circumcision prevented complications.
International Urology and Nephrology 02/2006; 38(3-4):607-8. · 1.47 Impact Factor
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ABSTRACT: OBJECTIVE
To determine the number of peer-reviewed publications arising from the abstracts presented at the annual meetings of the British Association of Urological Surgeons (BAUS), and to assess urological trainees’ attitudes to research in relationship to the pursuit of Specialist Registrar (SpR) training numbers and their perception of academic urology in the UK.METHODS
Publications resulting from presentations at the annual meetings of the BAUS 2001 and 2002 were searched for using the PubMed database. Variables that might influence the subsequent publication of abstracts in peer-reviewed journals were analysed. Whether institutions from other countries had similar publication rates to those in the UK was also assessed. SpRs were interviewed about their motivation to convert presentations to publications before and after their appointment to SpR training.RESULTSIn July 2004, 142 of 449 abstracts presented at BAUS 2001 and 2002 were published, giving a publication rate of ≈ 42% on Kaplan-Meier analysis. The rate of publication appeared to continue to the end of the period of searching for publications. The publication rate arising from UK presentations was lower than that from the non-UK presentations (hazard ratio 0.75, 95% confidence interval 0.49–1.15, P = 0.14). Publication rates from podium and poster presentations were similar. Urology journals accounted for 75% of the publications. Of the SpRs evaluated, 83% did research and presented papers to obtain a training number rather than because of an inherent interest to pursue an academic career.CONCLUSIONS
The conversion rate from BAUS presentation to peer-reviewed publication at 36 months was similar on Kaplan-Meier analysis to that of the American Urological Association (AUA, 38%). Interestingly, the rate of publication from the AUA seems to be faster than from BAUS. In addition, presentations from outside the UK appeared to be published faster than those from the UK. Delegates attending these conferences need to consider this when deciding whether a particular presentation will influence their practice. British urology requires academics who are interested in pursuing high-quality research, and which is presented at major conferences with an intention to publish it in peer-reviewed journals.
BJU International 01/2006; 97(2):306 - 309. · 2.84 Impact Factor
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The Journal of Urology 01/2006; 174(6):2427-8; author reply 2428. · 3.75 Impact Factor
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Urology 12/2005; 66(5):1106-7. · 2.43 Impact Factor
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BJU International 08/2005; 96(1):187-8. · 2.84 Impact Factor
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BJU International 08/2005; 96(1):190-1. · 2.84 Impact Factor
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The Journal of Urology 06/2005; 173(5):1827-8. · 3.75 Impact Factor
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BJU International 04/2005; 95(4):680-1. · 2.84 Impact Factor
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BJU International 04/2005; 95(4):679. · 2.84 Impact Factor
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ABSTRACT: A trichobezoar with a calculus in the center was diagnosed in a young woman on long-term urethral catheter drainage. Urologists need to be aware of this potentially preventable complication to save patients from significant morbidity.
Journal of Endourology 07/2004; 18(5):493-4. · 1.85 Impact Factor
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ABSTRACT: The ureter is often involved in pelvic malignancy, leading to obstruction, hydronephrosis, and deterioration of renal function. Decompression is provided either by retrograde stenting or by nephrostomy followed by antegrade stent insertion. We present an interesting case where an iatrogenic accident during antegrade stenting led to the placement of the lower end of the stent in the rectal stump. Although this led to a favorable outcome, in that it provided internal continent drainage, it cannot be recommended for emulation. However, it does show that a physician should not only have conventional wisdom but also a good measure of innovation and pragmatism.
Journal of Endourology 03/2004; 18(1):57-8. · 1.85 Impact Factor
