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Tanuj Bhatia,
Aditya Kapoor,
Jatinder Kumar,
Archana Sinha,
Priyadarshi Ranjan,
Sudeep Kumar,
Naveen Garg,
Satyendra Tewari, Aneesh Srivastava,
Rakesh Kapoor,
Pravin K Goel
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ABSTRACT: Endothelial dysfunction is the postulated link between coronary artery disease (CAD) and erectile dysfunction (ED). Brachial artery flow-mediated vasodilatation (FMD) is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED (assessed using the International Index of Erectile Function (IIEF-5) questionnaire); ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD (6.40%±4.60% vs. 9.10%±4.87%, P<0.001) compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD (≤5.5%) was twice as common in ED patients (52% vs. 24% without ED). Patients with impaired FMD had higher ED prevalence (85% vs. 62%) and lower mean IIEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors (odds ratio, 2.33; 95% confidence interval: 0.59-9.23; P=0.03). An inverse correlation between FMD and ED severity was observed (r=-0.22; P=0.004). ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.Asian Journal of Andrology advance online publication, 27 May 2013; doi:10.1038/aja.2013.15.
Asian Journal of Andrology 05/2013; · 1.52 Impact Factor
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Jatinder Kumar,
Tanuj Bhatia,
Aditya Kapoor,
Priyadarshi Ranjan, Aneesh Srivastava,
Archana Sinha,
Sudeep Kumar,
Naveen Garg,
Satyendra Tewari,
Rakesh Kapoor,
Pravin K Goel
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ABSTRACT: INTRODUCTION: Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. AIM: To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. METHODS: In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. MAIN OUTCOME MEASURES AND RESULTS: Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41-141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11-111.09, P = 0.001). CONCLUSION: Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.
Journal of Sexual Medicine 01/2013; · 3.55 Impact Factor
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ABSTRACT: OBJECTIVE: Pediatric urolithiasis can cause significant morbidity and damage to the kidney, or even renal failure. We review our experience of the management of urolithiasis in pediatric patients at a tertiary referral center. PATIENTS AND METHODS: We reviewed medical records of all children with urolithiasis who were diagnosed and managed at our center from August 2003 to October 2011. Management was planned according to stone burden and location. We noted and statistically analysed data about age, sex, stone burden, clinical features, management, metabolic abnormalities and recurrence. RESULTS: There were 325 children with 378 stone sites. Age range was 3-17 (mean 8) years. The male to female ratio was 3:1. Most common presentation was abdominal pain in 257 children (79%), and the most common stone site was kidney in 215 (57%). Twenty-four (7%) children (stone burden ≤3 mm) were managed conservatively, while the rest received some form of intervention. Metabolic workup could be done in 154 (47%) children. A metabolic abnormality was seen in 67 (43%) children, normocalcemic hypercalciuria being the most common. Recurrence of urolithiasis was seen in 78 (24%) children after a mean follow-up of 3.2 (1-6) years, and was more common in those who had a metabolic abnormality or in whom small residual fragments were left in situ. CONCLUSIONS: Availability of smaller instruments has led to safer use of percutaneous endoscopy and ureteroscopy in children, with results comparable to those in adults and an acceptable complication rate. The presence of a metabolic abnormality is quite common and is a cause of recurrence.
Journal of pediatric urology 01/2013; · 1.38 Impact Factor
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ABSTRACT: Among the surgical complications in renal transplantation, the vascular complications are probably most dreaded, dramatic, and likely to cause sudden loss of renal allograft. We present our experience and analysis of the outcome of such complications in a series of 1945 live related renal transplants.
One thousand nine hundred and forty five consecutive live related renal transplants were evaluated retrospectively for vascular complications. Complications were recorded and analyzed for frequency, time of presentation, clinical presentation, and their management.
The age of patients ranged from 6 to 56 years (mean = 42). Vascular complications were found in 25 patients (1.29%). Most common among these was transplant renal artery stenosis found in 11 (0.58%), followed by transplant reznal artery thrombosis in 9 (0.46%), renal vein thrombosis in 3 (0.15%), and aneurysm formation at arterial anastmosis in 2 (0.10%) patient. The time of presentation also varied amongst complications. All cases of arterial thrombosis had sudden onset anuria with minimal or no abdominal discomfort, while venous thrombosis presented as severe oliguria associated with intense graft site pain and tenderness. Management of cases with vascular thrombosis was done by immediate surgical exploration. Two patients of renal artery stenosis were managed with angioplasty and stent placement.
Major vascular complications are relatively uncommon after renal transplantation but still constitute an important cause of graft loss in early postoperative period. Aneurysm and vessel thrombosis usually require graft nephrectomy. Transplant renal artery stenosis is amenable to correction by endovascular techniques.
Indian Journal of Urology 01/2013; 29(1):42-7.
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ABSTRACT: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? For long complex anterior urethral stricture augmentation urethroplasty is considered the standard procedure but the best substitute material is still to be ascertained. Preputial/penile skin is a very good substitute especially when used as a dorsal onlay. It demonstrates exceptional functional and cosmetic results even in patients with unsuitable oral mucosa. OBJECTIVE: • To present our experience of single-stage reconstruction of urethral stricture with preputial/penile skin flap, as a dorsal onlay flap (DOF) where there is an adequate urethral plate and as a tubularized flap (TF) where there is a compromised urethral plate, in cases of complex anterior urethral strictures. MATERIALS AND METHODS: • We retrospectively reviewed 144 patients, who underwent single-stage repair of pendular /bulbar urethral strictures with preputial/penile flap as either a DOF or a TF, between January 2001 and December 2008. • Patients were divided into three groups: Group 1 consisted of patients who underwent transverse preputial DOF; Group 2 consisted of those who underwent tube urethroplasty; and Group 3 consisted of those patients who were circumcised and for whom the penile skin was used as a DOF (circumpenile flap). • Patients were followed up by physical examination, retrograde urethrography, uroflowmetry and post-void residual urine measurement. RESULTS: • The mean follow-up was 40.1 months (range 36-84 months). • The primary success rates at 1 year follow-up were 90, 85 and 93.3% for Groups1, 2 and 3, respectively, and at 3-years follow-up they were 85, 75 and 86.7%, respectively. • Half of the recurrences were successfully managed with a single visual internal urethrotomy or dilatation. • The secondary success rate was defined as recurrent stricture managed by a single endoscopic procedure and was 5, 10 and 6.8% in Groups 1, 2 and 3, respectively. The overall success rate was 90.85 and 93.3%, respectively. • A total of 75% of the patients in the study completed 60 months of follow-up with no additional recurrence. CONCLUSIONS: • A preputial/penile flap for complex anterior urethral stricture is a good treatment option, with results similar to other techniques, has acceptable donor site morbidity and is effective even in circumcised patients and for those patients with unsuitable oral mucosa. • A DOF is less likely to lead to diverticula formation and post-void dribbling. TFs have a higher failure rate than DOFs but, when combined judiciously with secondary endoscopic procedures, can provide good results.
BJU International 08/2012; · 2.84 Impact Factor
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ABSTRACT: We assessed the specific preoperative sonographic and urinary factors that may be important in predicting renal function outcomes after pyeloplasty.
We prospectively studied 52 consecutive patients with ureteropelvic junction obstruction who underwent pyeloplasty at our tertiary care center between September 2009 and January 2011. Mean ± 2 SD patient age was 4.26 years (range 3 months to 18 years), and minimum followup was 6 months. Preoperative ultrasound findings recorded were pelvic anteroposterior diameter, pelvic cortical thickness, pelvic volume and pelvic cortical ratio. Spot urine protein-to-creatinine ratio from the renal pelvis and bladder was measured intraoperatively. Based on changes in differential renal function on diuretic renogram, patients were divided into 3 groups. Group 1 had stable differential renal function with less than 5% change, group 2 had improved differential renal function greater than 5% and group 3 had deterioration of differential renal function greater than 5%. Data were analyzed using SPSS®, version 17 with cross-tabulation, nonparametric tests and logistic regression.
On ultrasound only anteroposterior diameter (p = 0.018) and pelvic cortical ratio (p = 0.038) were significantly different among the 3 groups. Difference in bladder sample protein-to-creatinine ratio was not significant (p = 0.69), while pelvic urine protein-to-creatinine ratio was significant (p = 0.001). Anteroposterior diameter, pelvic protein-to-creatinine ratio and pelvic cortical ratio were less than 50 mm, 0.5 and 15, respectively, in all patients with improved renal function.
Sonographic and urinary biochemical parameters may predict improvement in renal function after pyeloplasty. Pelvic anteroposterior diameter, pelvic cortical ratio and pelvic urine protein-to-creatinine ratio are the most useful parameters.
The Journal of urology 05/2012; 188(1):262-5. · 4.02 Impact Factor
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ABSTRACT: PURPOSE: Orchialgia after laproscopic renal surgery has been rarely reported in literature, and gonadal vein ligation is considered the main etiology. Our objective was to study the incidence, intensity and to find out any specific factors that could lead to orchialgia. MATERIALS AND METHODS: All patients planned for laproscopic renal surgery between Jan 2009 and July 2011 had a history and physical examination before surgery, in postoperative period, and after discharge. Pain was scored on a standard 10-point scale approved by the NIH. Baseline, perioperative, and postoperative data were collected prospectively. RESULTS: A total of 460 laproscopic renal surgeries were performed on males out of which 440 met our criteria of evaluation. A total of 38 patients had ipsilateral orchialgia (8.52 %). The pain was more common for left-sided procedures. Mean pain intensity was 3.2. On statistical analysis, there was no difference in the operative parameters between patients of pain and those without pain except that the level of ligation of ureter and that of gonadal vein were significantly associated with orchialgia (p value <0.001 and 0.003, respectively) with the odds ratio for ligating them below the crossing of iliac vessels being 6.443 (3.098-13.397) and 4.457 (2.165-9.176), respectively. CONCLUSION: Ipsilateral orchialgia is common in patients undergoing laproscopic renal surgery specially after radical nephroureterectomy and nephrectomy specially when the ureter and gonadal vein are taken down at or below their crossing of iliac vessels. Taking down ureter above, rather than below, the iliac vessels whenever possible may be preventive as is the preservation of gonadal vein.
World Journal of Urology 04/2012; · 2.41 Impact Factor
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ABSTRACT: Disease spectrum of upper tract transitional cell carcinoma (TCC) in Indian patients is not known. Herein, we present data on clinical presentation, pathological characteristics, and the outcome of treatment of upper tract TCC.
Clinicopathological data of patients who were diagnosed for upper tract TCC between January 2000 and January 2010 were collected from the hospital information system and case records. Preoperative diagnosis was based on contrast-enhanced computerized tomography of the whole abdomen and urine cytology. Cross tab and logistic regression analysis was done on the effect of various clinicopathological characteristics on the outcome and cancer-specific and recurrence survival were derived.
There were total 40 patients, 35 (87.5%) of them were male. The mean age was 62.7 ± 7.9 years. The most common symptom was gross hematuria present in 30 (75%). Mean tumor size was 2.8 ± 1.2 cm. Median duration of follow up was 36 (12 to 100) months. Laparoscopic nephroureterectomy was done in 27 patients along with bladder cuff excision and seven patients underwent open surgery. Thirty two (88.8%) patients had invasive T stage and high-grade lesions were seen in 24 (66.6%). Lymphovascular invasion was found only in one case and necrosis in 30 (83.3%). Necrosis was found to be the poor prognostic factor. Five-year recurrence-free and cancer-specific survivals were 36.33% and 26%, respectively.
Patients with upper tract TCC present very late with a high-stage disease and a very low 5-year cancer-specific and recurrence-free survivals.
Indian Journal of Urology 04/2012; 28(2):174-8.
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Saurabh S Chipde,
Priyadarshi Ranjan,
Hira Lal,
Vivek Singh,
Ram Naval,
Rungmei S Marak,
Anand Prakash,
Dharmendra Bhadoria,
R K Sharma,
Rohit Kapoor,
Manas Ranjan Pradhan,
Manmeet Singh,
Jatinder Kumar,
Mohammad S Ansari,
Anil Mandhani, Aneesh Srivastava,
Rakesh Kapoor
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ABSTRACT: Isolated renal zygomycosis is a life-threatening infection and difficult to diagnose ante mortem due to varied presentations. Most reports in the literature are case reports. We are presenting our experience of 10 patients.
Retrospective data of 10 consecutive patients with primary renal zygomycosis, including 2 post-transplant patients, in our tertiary care center was analyzed. Epidemiological characteristics, predisposing conditions, clinical presentation, diagnostic findings and treatment outcomes were recorded. Characteristic radiological findings were recorded. Localized disease was managed by supportive treatment or percutaneous drainage and extensive disease with unilateral or bilateral nephrectomy. Renal involvement was confirmed in all patients by histopathology.
The mean age of presentation was 35 years. Five patients who had bilateral renal involvement presented with oliguric acute renal failure, hematuria and abdominal pain. Three had unilateral renal disease and presented with flank pain and fever. The two post-transplant patients presented with fever and graft dysfunction. Even after aggressive treatment 5 patients died, accounting for a mortality rate of 50%.
Isolated renal zygomycosis can be diagnosed with typical radiological findings, combined with clinical, laboratory and histopathological features. This study describes the newer ante mortem radiological diagnostic criteria and prognostic predictors of the disease.
Urologia Internationalis 02/2012; 88(3):282-8. · 0.99 Impact Factor
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ABSTRACT: OBJECTIVE: To determine the effectiveness of gabapentin as an add-on therapy in children presenting with overactive bladder (OAB) not responding to conventional anticholinergics. MATERIALS AND METHODS: Children with refractory OAB were included prospectively from March 2009 to February 2010. The inclusion criterion was persistence of symptoms while on conventional anticholinergics for 6 months. Gabapentin was prescribed as an add-on therapy. The patients were followed 4 weekly with bladder diary and urodynamic study was repeated at 3 months. RESULTS: There were 31 children, 26 of neurogenic OAB and 5 of non-neurogenic origin. Mean±SD age was 8.5±5.3 years. Data were analyzed in 30 patients as treatment was terminated in 1 due to adverse effects. Continence improved in 16 (53.3%) patients. Voiding volume improved from 175±90 to 320±110ml (p<0.03). Objective assessment of OAB symptom relief showed marked improvement (p<0.05). Mean maximum cystometric bladder capacity improved from 210±94 to 360±110ml (p<0.02). The maximal detrusor contraction decreased from 75±35 to 25±15cmH(2)O (p<0.02). Fourteen patients (46.7%) failed to respond to gabapentin therapy. These patients had baseline maximum cystometric bladder capacity <60% for age and maximum detrusor contractions >50cm of water (p<0.03). CONCLUSIONS: Gabapentin gives moderate results in children with OAB refractory to conventional anticholinergics. In general, the drug is well tolerated with fewer adverse effects.
Journal of pediatric urology 11/2011; · 1.38 Impact Factor
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ABSTRACT: Nephrolithiasis is common in patients with autosomal dominant polycystic kidney disease (ADPKD). Percutaneous management of nephrolithiasis is challenging because of a large number of parenchymal cysts and distorted calyceal anatomy. These patients also have varying grades of chronic kidney disease and are at increased risk of bleeding, which further increases the challenge. The objective of the study is to study the efficacy and safety of PCNL in ADPKD.
We retrospectively analyzed twenty-two patients of ADPKD with renal calculi managed by percutaneous nephrolithtomy (PCNL) from January 2000 to January 2010. Patients were divided into two groups: group I (serum creatinine ≤ 1.5 mg%), group II (serum creatinine >1.5 mg%).
PCNL was done in 25 renal units among 22 patients. Sixteen patients had chronic kidney disease, and the average stone burden was 2.4 cm ± 0.8 cm. The overall success rate (complete stone clearance/residual fragments <4 mm) was 88% (22/25). Two patients required relook PCNL for residual stone and one required ESWL for the incomplete clearance. Mean preoperative serum creatinine in group I was 0.9 ± 0.1 mg% and in group II 3.1 ± 1.2 mg%. There was improvement in serum creatinine in group II (1.4 ± 0.5 mg%) postoperatively. Three patients required blood transfusion (13%) and four patients had fever postoperatively (18%). None of the patients required angioembolization.
Despite the distorted calyceal anatomy and associated chronic kidney disease, PCNL is safe and effective in managing nephrolithiasis in polycystic kidney disease.
International Urology and Nephrology 11/2011; 44(3):725-30. · 1.47 Impact Factor
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ABSTRACT: Commonly used measures such as serum creatinine level and glomerular filtration rate do not actually reflect decreased total number of nephrons. There is a need to identify early the subset of patients who are at increased risk for renal failure.
We studied children diagnosed with posterior urethral valve at our institution between August 2007 and December 2008. Renal function reserve was measured at least 6 weeks after initial fulguration of posterior urethral valve. Glomerular filtration rate was obtained by calculating plasma clearance of (99m)technetium labeled diethylenetriamine pentaacetic acid. Renal function reserve was calculated as the difference between stimulated (after protein load) and baseline glomerular filtration rate, and reported as percentage increase in baseline glomerular filtration rate. Patients were divided into 2 groups depending on the presence (group 1) or absence (group 2) of renal function reserve. Less than 10% increase in renal function reserve after protein load was defined as absence of renal function reserve.
A total of 25 children with a median age of 30 months (range 24 to 60) were studied. Median serum creatinine at presentation and nadir value were 1.53 mg/dl (range 0.6 to 4.0) and 0.75 mg/dl (0.6 to 1.0), respectively. Mean ± SD baseline glomerular filtration rate was 59.88 ± 10 ml/min/1.73 m(2) body surface area (range 22 to 124). Mean protein load induced renal function reserve was 32.23% (range 2.3% to 96.70%). After protein load glomerular filtration rate increased in 16 patients (64%) by a mean of 32.23%, remained unchanged in 4 (16%) and decreased in 5 (20%) by a mean of 12.5%. Patients with absent renal function reserve had a greater degree of bladder dysfunction on urodynamic study and more severe vesicoureteral reflux (grade III or higher, p <0.05). At a median followup of 13 months (range 7 to 36) median serum creatinine was 0.78 mg/dl and 1.3 mg/dl in the 2 groups, respectively (p <0.05).
In more than a third of patients with posterior urethral valves renal function reserve is completely depleted at presentation. Decreased or absent renal function reserve may be used as an early indicator of long-term renal deterioration.
The Journal of urology 06/2011; 185(6):2329-33. · 4.02 Impact Factor
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ABSTRACT: Polymorphisms in the drug transporter gene (ABCB1) may play a significant role in individualizing cyclosporine (CsA) and tacrolimus (Tac) dosage and subsequently the allograft outcome in renal transplant recipients. In total, 225 recipients on CsA and 75 on Tac-based immunosuppression regimen were recruited, and 6 common polymorphic sites in the ABCB1 gene were analyzed for association with dose-adjusted levels of CsA/Tac. Furthermore, association of ABCB1 single-nucleotide polymorphisms (SNPs) with allograft outcome was examined. GG and CC genotype patients at ABCB1 2677G>T and ABCB1 3435C>T were associated with lower dose-adjusted levels of CsA and Tac at 1 month (P = .057, P = .034), 3 months (P = .001, P = .015), and 6 months (P = .043) posttransplantation. Wild-type patients at 1236C>T (log P = .025) and 2677G>T (log P = .002) in CsA and 2677G>T (log P = .008) and 3435C>T (log P = .015) in Tac therapy patients demonstrated lower mean time to allograft rejection. No influence of ABCB1 haplotypes on CsA/Tac dose-adjusted levels was observed. Wild-type patients at ABCB1 2677G>T and 3435C>T were associated with lower dose-adjusted levels and thereby were at increased risk of allograft rejection because of under-immunosuppression in the early part of posttransplantation. Thus, genetic evaluation may be helpful to identify patients at risk for allograft rejection and also to individualize immunosuppressant dosing.
The Journal of Clinical Pharmacology 04/2011; 51(4):603-15. · 2.91 Impact Factor
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ABSTRACT: To determine the efficacy and long-term outcome of pyeloplasty in poorly functioning kidneys in the pediatric age group.
Retrospective data analysis was performed on patients who underwent pyeloplasty in 2000-2008. The parameter analyzed was postoperative outcome. Success was defined on the basis of either improvement in symptoms or better drainage on postoperative Tc-99m DTPA renography done after 3 months and yearly thereafter.
A total of 39 patients with a mean age of 8.6 years (4 months to 13 years), and male to female ratio of 3:1, with poor function on isotope renogram (<30%) were included in the study. Left to right side ratio was 1.3:1. Dismembered pyeloplasty was done in all patients. Laparoscopic pyeloplasty was done in 27 (66.7%) and open in 12 (33.3%) patients. Follow-up renograms were available for 35 patients: 31 showed improvement in drainage and no further deterioration in renal function and 4 showed an obstructed pattern; of these, two patients had significant deterioration in split function and the other two underwent redo pyeloplasty by open technique. At a mean follow up of 41.6 months (8-75), overall success rate was 90%.
Pyeloplasty gives good intermediate-term results in poorly functioning kidneys in the pediatric age group.
Journal of pediatric urology 02/2011; 8(1):25-8. · 1.38 Impact Factor
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Indian Journal of Anaesthesia. 01/2011;
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Indian journal of anaesthesia 01/2011; 55(1):81-2.
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ABSTRACT: Matrix metalloproteinases (MMPs), especially basement membrane-degrading MMP-9 and MMP-2, play an important role in immune-mediated tissue destruction of the allograft by allowing influx of leucocytes and mononuclear cells into the graft. The present study was, therefore, undertaken to investigate the association of functional polymorphisms in MMP-9 (836A>G, 1721G>C and 2003G>A) and MMP-2 (-735C>T) genes with risk of allograft rejection in renal transplant recipients of North India.
Three hundred and six renal transplant recipients categorized into 228 non-rejecters and 78 rejecters were genotyped for MMP-9 and MMP-2 polymorphisms by polymerase chain reaction-restriction fragment length polymorphism methodology.
A significant difference in genotype/allele frequencies was observed between healthy individuals in comparison to non-rejecters/rejecters for MMP-9 836A>G, MMP-9 2003G>A and MMP-2 -735C>T. Mutant allele carriers for MMP-9 2003G>A [GA+AA-; odds ratio (OR) = 0.45, 95% confidence intervals (95% CI) = 0.24-0.85, P = 0.014] and MMP-2 -735C>T (CT+TT-; OR = 0.40, 95% CI = 0.18-0.91, P = 0.029) demonstrated significantly reduced risk for allograft rejection. The mean time to first rejection episode was significantly higher in GA/AA and CT/TT genotype recipients for MMP-9 2003G>A (log P = 0.026) and MMP-2 -735C>T (log P = 0.003), respectively. Haplotypes with mutant alleles for MMP-9 1721C>G-2003G>A and mutant allele genotype combinations for both MMP-9 2003G>A and MMP-2 -735C>T conferred significantly reduced risk for allograft rejection.
Mutant alleles for MMP-9 2003G>A and MMP-2 -735C>T are associated with reduced risk for allograft rejection and improved allograft survival in North Indian transplant recipients and could serve as an ideal marker to predict pre-transplant allograft outcome.
Nephrology Dialysis Transplantation 04/2010; 25(10):3393-401. · 3.40 Impact Factor
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ABSTRACT: To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation.
The study group consisted of 150 men with a median (range) age of 40 (18-73) years who underwent 168 urethral reconstructive procedures for anterior urethral stricture disease between October 2003 and May 2009. We evaluated sexual functioning using the O'Leary Brief Male Sexual Function Inventory before and after surgery.
The median follow-up was 33 months (range 4-72). There were no significant changes in sexual drive and erectile function scores postoperatively for men in the 20-29, 30-39, 40-49, 50-59 and 60-69 years age groups. Overall, there was a significant improvement in ejaculatory function scores after surgery. This improvement was most robust in men in the 20-29, 30-39 and 40-49 years age group.
Overall, anterior urethral reconstruction appears no more likely to cause postoperative sexual dysfunction. Different types of urethroplasties, surgical complexity with long stricture excision and the use of buccal graft, preputial flap/tube did not influence outcome.
Indian Journal of Urology 04/2010; 26(2):188-92.
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ABSTRACT: During evaluation of a partial Siamese twin for removal of nonviable parasitic part in an 8-year-old male child, a fully functional kidney was found. The functional status of the extra kidney was found to be within acceptable limits for the purpose of transplant, which was subsequently done in a 24-year-old patient with end-stage renal disease. The recipient is healthy 19 months after the surgery. The possibility of using organs from a partial Siamese twin makes this a unique case report.
Indian Journal of Urology 04/2010; 26(2):289-91.
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ABSTRACT: To analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN).
Clinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five).
The overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow-up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy (P < 0.001) and death (P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%).
Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management.
BJU International 11/2009; 105(7):986-9. · 2.84 Impact Factor
