Arun Chawla

Manipal Academy of Higher Education | MAHE · Department of Urology

Purpose of Review The term neurogenic bladder (NGB) generally used for neurogenic lower urinary tract dysfunction (NLUTD) refers to storage and/or voiding dysfunction of the lower urinary tract, in patients after a neurological illness. The aim of management of NGB is to preserve renal function, achieving effective bladder emptying, urinary contine...

Percutaneous nephrolithotomy (PNL) has long been considered the bench-mark intervention for complicated urinary stones and has undergone important advancements since it was first described. Given the proven safety and efficacy of PNL, simultaneous bilateral PNL has been attempted for bilateral renal calculi to cut down on total procedure costs. To...

Citation: Reddy, S.J.; Reddy, B.S.; Chawla, A.; de la Rosette, J.J.M.C.H.; Laguna, P.; Hegde, P.; Shah, A.; Choudhary, A.; Kankaria, S.; Hiremath, V.K. Outcomes and Complications from a Randomized Controlled Study Comparing Conventional Stent Placement Versus No Stent Placement after Ureteroscopy for Distal Ureteric Calculus < 1 cm.

Introduction& Objectives: Surgical correction of deformity associated with Peyronie's disease is the definitive management for this debilitating condition. Surgery is also indicated when the patient reports concomitantly compromised erectile function, with the choice of procedure dictated by both the degree of penile deformity, as well as the level...

Introduction and Objective: The new SMP (Super-mini percutaneous nephrolithotomy) system utilizes an 8Fr miniaturized nephroscope and a 14.5 Fr suction irrigation sheath. SMP has been proved to be equivalent in efficacy as compared to standard PCNL for treatment of renal calculi upto 2cm with the advantage of lesser intraoperative and postoperative...

Upper tract Urothelial Cell Carcinomas (UTUCs) account for only 5–7% of urothelial carcinomas. Of these only 25% are located in the ureter. The imaging characteristics of these tumors can mimic certain benign entities like fibroepithelial polyps. The gold standard treatment for invasive upper tract urothelial carcinomas, regardless of the tu- mor’s...

DIVC may play a role as a confounding factor in imaging diagnostic tests and also may represent a hazard for inadvertent injury and bleeding during surgery. Careful interpretation Radiological investigations help to define such anomalies and avoid significant morbidity during surgical exploration. We present a case of renal cell carcinoma involving...

At specific genomic loci, miRNAs are in clusters and their association with copy number variations (CNVs) may exhibit abnormal expression in several cancers. Hence, the current study aims to understand the expression of miRNA clusters residing within CNVs and the regulation of their target genes in bladder cancer. To achieve this, we used extensive...

Introduction& Objectives: Bulbar urethra is the most common site of anterior urethral stricture and this stricture develops secondary to idiopathic (40%), iatrogenic (35%), inflammatory (10%), and traumatic (15%) causes. Traditionally transecting and non-transecting techniques of urethroplasty have been described for management of non-traumatic bul...

The objective of this prospective observational study was to assess the clinical significance of neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) as potential biomarkers to identify post-PNL SIRS or sepsis. Demographic data and laboratory data including hemoglobin (Hb), total leucocyte count (TL...

Vascular complications account for 3–15% of all allograft renal transplant complications, and extra-renal pseudoaneurysm caused by fungal arteritis is even rarer. The latter is a life-threatening complication of kidney transplantation that requires emergency graft nephrectomy. Very few cases have been reported in literature. We describe a case of m...

Complex vesicovaginal fistulas present a unique challenge to surgeons, and surgical reconstruction outcomes may be subopti- mal. The aim is to evaluate the patient’s characteristics as well as the factors influ- encing the functional outcome of complex vesicovaginal fistula surgical reconstruc- tion. From 2016 to 2020, the medical records of 28 p...

Crossed fused renal ectopia (CFRE), second most common renal fusion anomaly of the kidney. These patients were mostly asymptomatic and present with complaints due to associated conditions. The management of these conditions was complicated not only by the approach to be picked, but also by the investigation to be performed. The following study was...

Introduction Emphysematous pyelonephritis (EPN), an acute necrotizing infection of the kidney and surrounding tissues, is associated with considerable mortality. We evaluated how existing critical care scoring systems could predict the need for intensive care unit (ICU) management for these patients. We also analyzed if CT-imaging further enhances...

Lésion d'Antopol-Goldman (Antopol-Goldman lesion) is a rare condition characterized by renal pelvic subepithelial hematoma simulating a neoplastic process. A 71-year-old lady presented with macroscopic hematuria and hypoenhancing mass lesion at the upper pole of left kidney. The patient underwent a radical nephrectomy for suspected renal cell carci...

Purpose Arteriovenous fistula(AVF) is preferred vascular access for hemodialysis but has primary failure in 20–60%. Studying predictors of AVF failure would help plan appropriate management.We studied AVF outcomes, clinical and vascular factors predicting their failure in patients requiring hemodialysis. Methods Retrospective study of patients wit...

Many different types of dressings for hypospadias repair have been developed with varying degrees of popularity. There are probably as many types of hypospadias dressing as there are procedures described. Dressings are used to provide immobilisation and prevent haematoma and oedema. No one dressing type is universally accepted as superior over othe...

Objective To compare the effectiveness and safety of Super-Mini PCNL (SMP) and Retrograde Intrarenal Surgery (RIRS) in the management of renal calculi ≤ 2 cm. Patients and methods A prospective, inter-institutional, observational study of patients presenting with renal calculi ≤ 2 cm. Patients underwent either SMP (Group 1) or RIRS (Group 2) and w...

Introduction and objective: To minimize stent-related symptoms (SRS), a modified complete intra-ureteral stent with extraction suture was designed. The objective was to compare SRS of the conventional DJ stent and the complete intraureteral stent using the validated Ureteral Stent Symptom Questionnaire (USSQ). Materials and methods: We randomize...

Introduction and hypothesisFemale urethral stricture (FUS) is an uncommon entity. Although there is no clinical consensus on the best modality of treatment, several studies have been published describing different techniques of FUS management. We carried out a literature review of the different surgical techniques used in the management of FUS and...

Background: To evaluate the functional and sexual outcomes of Primary DVIU and Non- transecting bulbar urethroplasty (NTA) for short segment (<2 cm) bulbar urethral strictures using the Modified USS PROM. Methods: The USS PROM questionnaire comprising of a six-item LUTS domain, a LUTS-specific QOL question, and a peeling’s voiding picture score was...

Objective To compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones.Methods Consecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm....

Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and outcomes. Demographic data collected included age, gender,...

Objectives To comparatively evaluate the outcomes of standard percutaneous nephrolithotomy (PCNL) versus a 36 Fr PCNL in terms of operative time, complications, hospital stay, and stone free rates. Patients and Methods The data of 125 PCNL cases, out of the 168 PCNLs done from January 2014 to December 2015, was retrospectively analyzed within two s...

Objective: To compare efficacy and safety between standard and super-mini PNL (SMP). Patients & methods: 150 patients presenting with renal calculi < 2 cm were randomized to standard (group 1) or SMP group (group 2). Randomization was based on centralized computer-generated numbers. Variables studied included stone free rates, operating time, in...

The first case is a 45-year-old man who presented with complaints of right-sided indirect hernia. On examination the left hemiscrotum was empty. Open hernioplasty and mesh fixation with orchiopexy of both testes were done in the same hemiscrotum, followed by MRI for further evaluation. The second case is a 26-year-old man who presented with penoscr...

Introduction: Epithelioid sarcoma is a malignant mesenchymal neoplasm with evidence of epithelial differentiation. All the cases reported in the solid organs are of “proximal type” occurring in adults. We report a primary epithelioid sarcoma arising in the adrenal gland of a young male. Case report: An 11-year-old male patient presented with right...

Supernumerary kidney, a rare congenital anomaly, defined as an additional kidney with a separate capsule, collecting system and blood supply draining into the native ureter or a separate ureter. Small fused supernumerary units may be difficult to differentiate from renal moiety with complete separate ectopic ureter without complete evaluation. We r...

Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology. Despite the wealth of information accumulated over the years and the richness of existing literature, the knowledge about the definition, treatment and outcomes of res...

Amyloidosis is characterized by the deposition of fibrillar proteins by either plasma cells or derived from circulating proteins, the former especially involved in pathogenesis of localised amyloidosis. We describe a case of primary localised amyloidosis involving the urethra, in a 54-year-old diabetic patient, presenting with symptoms of stricture...

Intra Uterine Contraceptive Device (IUCD) is the most popular method of reversible contraception in India because of their high efficacy for fertility regulation, low-risk, low-cost, and lack of required maintenance. Uterine perforation remains one of the most serious complications, with an incidence 0.87 per 1000 insertions. The IUCD strings are u...

Background Crossed renal ectopia with fusion is the abnormal migration of the kidney to the opposite side of the insertion of the ureter to the bladder. It is the second most common congenital anomaly of the kidney and urinary tract preceded by horseshoe kidney. The following article serves to highlight the anomaly in a conglomeration of 17 unique...

Background Percutaneous Nephrolithotomy (PCNL) is the gold standard for endoscopic management of large renal stones. Various modifications have been done to bring down the morbidity of this procedure. Ambulatory PCNL (APCNL) defines PCNL as day-care procedure, avoiding overnight hospital stay which is less than 24 hours. Totally tubeless makes fast...

Presence of renal calculi (kidney stones) in human urethra is being increasingly diagnosed over the last decade and is considered as one of the most painful urological disorders. Accurate analysis of such stones plays a vital role in the evaluation of urolithiasis patients and in turn helps the clinicians toward exact etiologies. Two highly complem...

Primary malignancies of Seminal Vesicle (SV) are rare. When involved, it is most commonly due to secondaries or by contiguous spread from adjacent organs. Primary tumours that can arise in SV can be epithelial and mesenchymal. Adenocarcinoma is most common epithelial tumour, and the Clear Cell variant of Adenocarcinoma (CCA) so far has not been rep...

Background: Renal ectopy and fusion are the second most common congenital anomalies of the kidney and urinary tract preceded by horseshoe kidney, and represent the signature disruptions of the normal embryologic migration of the kidneys. Patients are asymptomatic and diagnosed incidentally. Those diagnosed clinically, symptoms at presentation are r...

Advanced-stage cervical cancer almost always presents either with abnormal vaginal bleeding or with foul-smelling vaginal discharge. We present here a rare case, where a postmenopausal lady presented almost silently with stage IVA cervical cancer. Fortunately, timely referral, correct diagnosis, and multispecialty team work could save her life.

We report a case of a 27-year-old man who presented with a slowly growing left testicular swelling associated with mild pain over a period of 3 months. He was evaluated by his family physician with scrotal ultrasound and testicular tumour markers. He was diagnosed and treated as epididymo-orchitis and managed with antibiotics. When he later present...

Urinary incontinence has emerged as one of the leading medical problems for the geriatric population worldwide. Women are affected physically, mentally and socially and face embarrassment, depression and isolation. Increased life expectancy further adds to the prevalence of the condition and social, economic and health care burden. Although not sin...

Supernumerary kidney is a rare anomaly and most of the times it is incidentally detected. On occasions it may present with symptoms due to stones, tumours and infections. Supernumerary unit if small and dysplastic may easily escape detection. In this case report, supernumerary kidney presented as vesicoureteric reflux in a 4-year-old male child.

There are few reports about the treatment of moderate to severe hyponatremia associated with malignant liver metastasis. Here, we report using intravenous salt poor albumin infusion to treat hypervolemic cirrhosis related hyponatremia. A 58-year-old female with ascites secondary to metastatic breast cancer was referred to our department with sympto...

To study the safety, feasibility and efficacy of tubeless simultaneous bilateral percutaneous nephrolithotomy. We retrospectively studied 85 patients who underwent tubeless simultaneous bilateral percutaneous nephrolithotomy in the Department of Urology, Kasturba Medical College, Manipal, Karnataka, India, from July 2006 to June 2013. The demograph...

A rare case of large adrenal mass which was non-functioning is presented. It is difficult to make preoperative diagnosis in these cases as the imaging findings are non-specific. Radical excision is mandatory as preoperative malignancy cannot be ruled out.

Renal cell carcinoma (RCC) is a lethal malignancy with a propensity for metastatic spread to any part of the body. The common sites of metastases from RCC include lungs, adrenals, intestines and brain and most intra-abdominal organs which may present as synchronous or metachronous to the primary tumour. A long follow-up is advised to deal with the...

Background: Thirty minutes has been considered as the thresholdfor tolerable warm ischemic time (WIT). Recent reports demonstraterecovery of renal function after longer WIT. We assessed renalhistology according to different WIT in a 2-kidney porcine model.Methods: Twelve female pigs were randomized to an open orlaparoscopic group. Each pig was furt...

Background: There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrolog...

Genitourinary histoplasmosis is very rare and to our knowledge only four cases of epididymal histoplasmosis and nine cases of prostatic histoplasmosis have been reported in literature. We hereby report a case of a middle-aged male, who presented three years after renal transplant, with complaints of fever, pain, and swelling in the scrotum. Imaging...

Medical educators have called for new teaching methods and materials that supplement the traditional lecture format, and education in a range of health professions, including medicine, nursing, and pharmacy, is using a game-based approach to teach learners. Here, we describe a novel teaching tool in a case-based debate using the game format. Two te...

Learning laparoscopic urethrovesical anastomosis is a crucial step in laparoscopic radical prostatectomy. Previously we noted that practice on a low fidelity urethrovesical model was more effective for trainees than basic suturing drills on a foam pad when learning laparoscopic urethrovesical anastomosis skills. We evaluated learner transfer of ski...

The mechanism of proteinuria in many common kidney diseases involves glomerular hemodynamic effects and local expression of angiogenic, fibrogenic, and vasoactive factors. Transforming growth factor (TGF)-β has been associated with many diseases involving proteinuria and renal fibrosis. TGF-β has been shown to induce podocyte dedifferentiation in v...

Conventional methods like smear and culture for Mycobacterium tuberculosis are of limited sensitivity and specificity. Histopathological examination (HPE) for the tissues obtained gives inconclusive diagnosis in the absence of caseous necrosis or stained acid-fast bacilli. This study was conducted to determine the utility of tissue PCR for diagnosi...

W.W. Baig, R.P. Attur, A. Chawla, S. Reddy, S. Pillai, L. Rao, G. Rao, K. Ashok, P. Yegneswaran. Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India. Transpl Infect Dis 2011: 13: 489–491. All rights reserved Abstract: An unusual case of epididymal and prostatic histoplasmosis is reported from Karnataka State...

At our institution we have developed unique ways of teaching nephrology and attracting medical students and residents to the field of nephrology. One of the ways we have achieved this is doing talks and sessions using puzzles. This teaching tool was designed to enhance resident learning and to complement resident's role as a teacher, while they wer...

Thirty minutes has been considered as the threshold for tolerable warm ischemic time (WIT). Recent reports demonstrate recovery of renal function after longer WIT. We assessed renal histology according to different WIT in a 2-kidney porcine model. Twelve female pigs were randomized to an open or laparoscopic group. Each pig was further randomized w...