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ABSTRACT: OBJECTIVE: To determine the safety and efficacy of silodosin in the management of acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS: From January 2011 to May 2012, 60 men over 50 years of age with AUR were equally randomized to either silodosin 8 mg once daily or placebo for 3 days followed by trial without catheter (TWOC). If the patient re-experienced urinary retention or if postvoid residual urine volume was >150 mL, he was re-catheterized and considered to have a failed TWOC. All patients with a successful TWOC on day 3 were started on silodosin regardless of which arm they had belonged initially. Uroflowmetry, postvoid residual volume and International Prostate Symptom Score (IPSS) were noted at TWOC and after 2 weeks. RESULTS: Baseline patient demographics and clinical characteristics were similar in both groups (P >.1). The success rate of TWOC was 76.7% in the silodosin group and 36.7% in the placebo group (P = .002). On multivariate analysis, patients in silodosin group had lesser odds of having a failure (0.13) when compared to those not given treatment (P = .008). Among the clinical parameters, a retention volume more than 800 mL (P = .038) and an IPSS score more than 25 (P = .042) had significantly greater odds of failure. There were no adverse effects related to the use of silodosin. CONCLUSION: Silodosin significantly increases the chances of successful TWOC after AUR.
Urology 04/2013; · 2.43 Impact Factor
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ABSTRACT: Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.
Urology Annals 01/2013; 5(1):50-2.
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ABSTRACT: PURPOSE: Bleeding is a significant morbidity associated with percutaneous nephrolithotomy (PCNL). This study was conducted to evaluate the safety and efficacy of the anti-fibrinolytic agent tranexamic acid in reducing blood loss in patients undergoing PCNL. MATERIALS AND METHODS: A total of 200 patients planned for PCNL were randomized into two equal groups. Patients in tranexamic acid group received one gram of tranexamic acid at induction followed by three oral doses of 500 mg over 24 hours, while those in control group did not receive tranexamic acid. Patient demographics and clinical data of the two groups were compared. RESULTS: The baseline patient demographics were similar in both the groups. The mean hemoglobin drop in the tranexamic acid was significantly lower than that of the control group (1.39 vs 2.31 g/dL, p < 0.0001). Mean operative time in tranexamic acid group was significantly lower than that of control group (48.3 min vs 70.8 min, p < 0.0001). Stone clearance rate was similar in both the groups (91% vs 82%, p = 0.06). The blood transfusion rate was lower in the tranexamic acid group (2% vs 11%, p = 0.018). The complication rate was lower in tranexamic acid group (33% vs 59%, p < 0.0001). Two patients with solitary functioning kidney in tranexamic acid group required ureteric stenting to relieve anuria due to clot obstruction. CONCLUSIONS: Use of tranexamic acid in PCNL is safe and is associated with reduced blood loss and lower rate of complications.
The Journal of urology 10/2012; · 4.02 Impact Factor
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ABSTRACT: To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection.
Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months.
The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture.
Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length.
Korean journal of urology 09/2012; 53(9):614-8.
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ABSTRACT: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation.
We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes.
A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up.
A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.
Korean journal of urology 07/2012; 53(7):492-6.
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ABSTRACT: Large pelvic masses pose unique diagnostic and therapeutic challenges due to varied aetiology, paucity of characteristic imaging features, lack of therapeutic algorithms and surgical difficulties in resection inside the narrow confines of the pelvis with close proximity of vital structures.
Records of 22 patients with large pelvic masses in the last six years were analysed. Their demographic and clinical features were noted, along with imaging features, preoperative biopsy, surgical procedure, intraoperative difficulties, complications, adjuvant therapy and outcome.
There were 14 men and 8 women with a median age of 45 years. Presenting symptoms were abdominal mass, pain, lower urinary tract symptoms, urinary retention and constipation. Imaging was mostly unable to determine the organ of origin of the tumour. Histopathology revealed pelvic fibromatosis (2), chondrosarcoma (1), liposarcoma (1), haemangioendothelioma (1), lymphangioma (2), fibroleiomyoma (1), leiomyosarcoma (3), schwannoma (4), malignant nerve sheath tumour (1), rectal gastrointestinal stromal tumour (1), retrovesical hydatid cysts (3), sacral chordoma (1) and Ewing's sarcoma (1). In 5 patients complete excision was not possible because of extension into vital structures. Fifteen patients were alive at 1-5 years of follow-up.
Urologists, being the 'gatekeepers of the pelvis', are usually involved in the management of large pelvic masses. Good outcome can be achieved with careful surgical planning.
Urologia Internationalis 02/2012; 88(2):215-24. · 0.99 Impact Factor
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ABSTRACT: Optical internal urethrotomy is the most commonly performed procedure for the management of anterior urethral stricture. This study was performed to compare the safety and efficacy of spongiosum block along with intraurethral lignocaine with intraurethral lignocaine alone for optical internal urethrotomy.
Fifty patients with anterior urethral stricture were prospectively randomized to undergo optical internal urethrotomy under spongiosum block along with intraurethral lignocaine (group 1=25 patients) and intraurethral lignocaine only (group 2=25 patients). The procedure-related pain was noted using the visual analogue scale. Postprocedure evaluation was performed by uroflowmetry and urethral calibration. Retrograde urethrography and micturating cystourethrography were performed as needed.
Optical internal urethrotomy was successfully completed in all patients. The mean visual analogue score for pain in group 1 (1.5 ± 1.4) was significantly lower than the score in group 2 (2.7 ± 1.8) (P=0.006). At 6 months follow-up, recurrent strictures developed in three patients in group 1 and five patients in group 2.
Spongiosum block with intraurethral lignocaine has a better anesthetic effect than intraurethral lignocaine alone for performing optical internal urethrotomy. Spongiosum block with intraurethral lignocaine is a viable alternative for regional and general anesthesia in the management of anterior urethral stricture with optical internal urethrotomy.
Journal of endourology / Endourological Society 02/2012; 26(8):1049-52. · 1.75 Impact Factor
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ABSTRACT: Although oxidative stress is implicated in renal cell carcinoma pathogenesis, to our knowledge changes in oxidative stress parameters in patients who undergo surgery for renal cell carcinoma have not been studied previously. We investigated the status of oxidative stress in patients with renal cell carcinoma.
Reactive oxygen species, nitric oxide and glutathione were measured in the blood of 68 patients with renal tumor and in 30 age matched normal controls. Levels were measured again 1 week, and 1 and 2 months postoperatively in patients who underwent surgery for renal cell carcinoma. Levels of superoxide dismutase, catalase and lipid peroxidation were measured in tumor tissue and in normal renal parenchyma in 51 patients with renal tumor.
Significantly increased reactive oxygen species and nitric oxide, and decreased glutathione were observed in patients with renal cell carcinoma compared to normal subjects and in patients with benign tumors. Superoxide dismutase and lipid peroxidation were increased and catalase was decreased in tumor tissue compared to normal renal tissue. Oxidative stress correlated with renal cell carcinoma grade and stage but decreased after curative resection. Patients with metastatic disease had persistently increased oxidative stress parameters. Antioxidant enzyme levels in benign tumor tissue were significantly higher than in renal cell carcinoma.
Patients with renal cell carcinoma have increased oxidative stress, which is effectively alleviated by curative resection. In patients with benign tumors antioxidant defense mechanisms maintain normal redox status.
The Journal of urology 02/2012; 187(4):1172-6. · 4.02 Impact Factor
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BJU International 01/2012; 109(2):E6; author reply E6-7. · 2.84 Impact Factor
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European urology 08/2011; 60(2):e9; author reply e10. · 7.67 Impact Factor
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ABSTRACT: Post percutaneous nephrolithotomy (PNL) bleeding is an uncommon yet serious complication and is almost always related to a surgical cause. Nevertheless, medical cause of bleeding is rarely encountered as a cause of this dangerous complication. Dengue has been rarely reported as a cause of post operative bleeding. Bleeding diathesis in dengue occurs not only due to thrombocytopenia but also due to dysfunctional surviving platelets and increased fibrinolysis. We report a patient who developed bleeding after an uneventful PNL due to dengue hemorrhagic fever. Medical causes of bleeding such as locally endemic viral hemorrhagic fevers should also be kept in mind and evaluated especially when a surgical cause of the bleed is not found or suspected in bleeding after any surgery.
Urological Research 06/2011; 40(2):177-9. · 1.23 Impact Factor
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ABSTRACT: The purpose of this study was to analyze the various risk factors for urosepsis following percutaneous nephrolithotomy (PNL) and to study the role of 1-week nitrofurantoin before PNL in reducing the risk of urosepsis. All patients undergoing PNL from April 2007 to November 2008 were prospectively included and grouped into four cohorts according to the following inclusion criteria: group A: stones ≤ 2.5 cm, no hydronephrosis, sterile urine; group B: diabetes mellitus, serum creatinine > 2 mg/dl, positive urine culture, stag horn stones, presence of nephrostomy or simultaneous bilateral PNL; group C: stones ≥ 2.5 cm and/or hydronephrosis, sterile urine; group D: similar to group C, but received nitrofurantoin 100 mg bid for 7 days before operation. Preoperative urine culture, intraoperative renal pelvic urine culture and stone cultures were obtained. Fever > 380°C and leukocyte counts > 12,000 were considered as systemic inflammatory response syndrome (SIRS). Endotoxemia was assessed in serum samples. A total of 205 patients were included in the study and grouped into four cohorts as group A (n = 50), group B (n = 54), group C (n = 53) and group D (n = 48). Overall 23% patients had positive renal pelvic urine and/or stone culture, 25% had endotoxemia and 34% developed SIRS. Female gender, chronic renal failure, anemia, hydronephrosis, stones larger than 2.5 cm and prolonged surgery were found to be risk factors associated with urosepsis. Nitrofurantoin prophylaxis resulted in decreased culture positivity (30.2 vs. 8.3%, odds ratio 0.36, p = 0.087), endotoxemia (41.9 vs. 17.5%, odds ratio 0.22, p = 0.001) and SIRS (49 vs. 19%, odds ratio 0.31, p = 0.01). In conclusion, female gender, chronic renal failure, anemia, hydronephrosis, stones larger than 2.5 cm and prolonged surgery were risk factors for urosepsis. Nitrofurantoin is beneficial in the prevention of endotoxemia and urosepsis especially in patients with larger stones and hydronephrosis.
Urological Research 05/2011; 40(1):79-86. · 1.23 Impact Factor
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ABSTRACT: A middle-age man presented with acute urinary retention and a history of passage of urine and stones through a fistula at the root of the penis of 7 years' duration. Computed tomography of the soft tissue penis revealed multiple calculi in the urethra. After an initial suprapubic cystostomy, he underwent Johanson's Stage I urethroplasty with excision of the fistulous tract and retrieval of the urethral stones. Intraoperatively, dense stricture of the distal penile urethra was found, with complete obliteration in places. A urethral stricture, if not promptly managed, can lead to devastating complications necessitating complex surgical management.
Urology 05/2011; 79(2):e1-2. · 2.43 Impact Factor
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ABSTRACT: Ureteral injury is usually iatrogenic after gynecologic or obstetric surgeries. Ureterouterine fistula is a rare complication. It most commonly occurs after a caesarean section. A 24-year-old woman presented with paradoxic incontinence 1 week after caesarean section. Intravenous urography revealed a left ureterouterine fistula. She was treated successfully by laparoscopic ureteroneocystostomy.
Journal of endourology / Endourological Society 04/2011; 25(4):603-6. · 1.75 Impact Factor
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ABSTRACT: The aim of this study was to prospectively evaluate the efficacy and outcome of percutaneous nephrolithotomy in patients with nephrolithiasis and chronic renal insufficiency. Between January 2006 and June 2009, 30 patients (20 males and 10 females; mean age 45 years, range 18-65; mean serum creatinine 6.3 ± 1.57 mg%) with calculus nephropathy were treated in our department. In 25 patients with obstructed and infected systems preliminary percutaneous nephrostomy or double J stenting was done. After stabilization and treatment of sepsis, percutaneous nephrolithotomy was done. Eight patients underwent bilateral procedure and 22 underwent unilateral procedure. Twenty-two patients needed a single sitting while eight patients needed two sittings for stone clearance. The renal function was monitored by serial creatinine estimations. Of the 30 patients, 27 patients achieved complete clearance. Renal function was improved in 27 patients. Six patients developed postoperative sepsis. Two patients required angioembolization for uncontrollable bleeding. There was no mortality. Patients with calculus nephropathy can be salvaged using PNL with good improvement in renal function and acceptable morbidity when appropriate preoperative preparation and perioperative care are given.
Urological Research 04/2011; 39(2):111-5. · 1.23 Impact Factor
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ABSTRACT: The objective of the study was to compare the efficacy of dimethyl sulfoxide (DMSO) mixed with lignocaine and eutectic mixture of local anesthetics (EMLA) cream as topically applied surface anesthetics in relieving pain during shock wave lithotripsy (SWL) in a prospective randomized study. Of the 160 patients, 80 patients received DMSO with lignocaine and 80 patients received EMLA cream, applied to the skin of the flank at the area of entry of shock waves. SWL was done with Seimens lithostar multiline lithotripter. The pain during the procedure was assessed using visual analog and verbal rating scores. The mean visual analog scale scores for the two groups were 3.03 for DMSO group and 4.43 for EMLA group. The difference of pain score on visual analog scale was statistically significant (p < 0.05). Similarly, the pain scores as rated on the verbal rating scale were also evaluated; the mean score on verbal rating scale were 2.34 for DMSO group and 3.00 for the EMLA group. The difference between the pain score on verbal rating scale was also found to be statistically significant (p < 0.05). Our study showed that DMSO with lignocaine is a better local anesthetic agent for SWL than EMLA cream. The stone fragmentation and clearance rates are also better in the DMSO group.
Urological Research 10/2010; 39(3):181-3. · 1.23 Impact Factor
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ABSTRACT: Background: Large pelvic masses pose unique diagnostic and therapeutic challenges due to varied aetiology, paucity of characteristic imaging features, lack of therapeutic algorithms and surgical difficulties in resection inside the narrow confines of the pelvis with close proximity of vital structures. Methods: Records of 22 patients with large pelvic masses in the last six years were analysed. Their demographic and clinical features were noted, along with imaging features, preoperative biopsy, surgical procedure, intraoperative difficulties, complications, adjuvant therapy and outcome. Results: There were 14 men and 8 women with a median age of 45 years. Presenting symptoms were abdominal mass, pain, lower urinary tract symptoms, urinary retention and constipation. Imaging was mostly unable to determine the organ of origin of the tumour. Histopathology revealed pelvic fibromatosis (2), chondrosarcoma (1), liposarcoma (1), haemangioendothelioma (1), lymphangioma (2), fibroleiomyoma (1), leiomyosarcoma (3), schwannoma (4), malignant nerve sheath tumour (1), rectal gastrointestinal stromal tumour (1), retrovesical hydatid cysts (3), sacral chordoma (1) and Ewing’s sarcoma (1). In 5 patients complete excision was not possible because of extension into vital structures. Fifteen patients were alive at 1–5 years of follow-up. Conclusions: Urologists, being the ‘gatekeepers of the pelvis’, are usually involved in the management of large pelvic masses. Good outcome can be achieved with careful surgical planning.
Urologia Internationalis 08/1970; 88(2):215-224. · 0.99 Impact Factor
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Indian Journal of Pathology and Microbiology 54(4):847-8. · 0.68 Impact Factor
