Ashwin Shekar

Sri Sathya Sai Institute of Higher Medical Sciences | sssihms · Department of Urology

Our study is an attempt to highlight the common problems faced in this small group of patients with congenital anomalies • By highlighting the unmet needs in the urology community we hope to increase in awareness and action in the management of this special patient population • More children with congenital anomalies surviving into adulthood • Grow...

Introduction Exstrophy of the bladder is a rare anomaly with an incidence of 1 in 30,000-50,000 live births. The variants of the exstrophy complex are even rarer and constitute about 8% of the total cases Inferior vesical fissure or fistula (IVF) is an extremely rare variant of bladder exstrophy in which the musculoskeletal findings of exstrophy,...

Introduction The management of a complicated duplex kidney remains a challenge for urologists. The aim of this study is to report a 13-year experience of the surgical management of complicated duplex kidney in a single tertiary care referring hospital. Materials and Methods: Clinical records of all patients who undergone a surgical procedure for co...

Single stage repair of adolescent exstrophy repair

Lower urinary tract obstruction leading to renal failure is well known in urological practice, with causes varying across age groups. Despite extensive evaluation, some patients lack an identifiable anatomical cause of obstruction. In such cases, videourodynamics may reveal functional bladder neck obstruction as the cause of lower urinary tract obs...

While most of the causes of urethrocutaneous fistulae are complications caused by hypospadias repair surgery, congenital anterior urethrocutaneous fistula (CAUF), in the isolated form, is an extremely rare anomaly that had been reported only a few times in literature. In this study, we report the case of 3-year-old uncircumcised boy, who presented...

Purpose: The retrograde urethrogram (RUG) has been a key diagnostic tool for over a century, remaining essential despite the availability of other imaging techniques for screening, diagnosis and follow up of Urethral strictures. However, interpretation of RUG images has to be done manually and needs experience on the part of the treating urologist,...

Iatrogenic enterovesical fistula (EVF) is a rare but serious complication of clean intermittent self-catheterization (CISC). This case report aimed to present a rare case of iatrogenic EVF following CISC and discuss the diagnostic and management challenges associated with this condition.

Traumatic pubic diastasis is a rare cause of post traumatic incontinence in males. This case report presents an interesting case of urinary incontinence in a 44 years diabetic male following a pelvic fracture. On evaluations found that an X ray of the pelvis showed wide pubic diastasis and a voiding cystourethrogram showed a wide open bladder neck...

Aim To compare the outcomes of two different protocols of antibiotic prophylaxis in patients with positive urine culture undergoing percutaneous nephrolithotomy (PCNL). Materials and methods Patients were prospectively enrolled for the randomised study to either group A which included patients where an attempt to sterilise the urine was made with...

Exstrophy of the bladder is a rare anomaly with an incidence of 1 in 30,000-50,000 live births. The variants of the exstrophy complex are even rarer, and constitute about 8% of the total cases. 1 , 2 , 3 , 4 , 5 Inferior vesical fissure or fistula (IVF) is an extremely rare variant of bladder exstrophy in which the musculoskeletal findings of exstr...

Purpose We evaluated the long-term renal function in patients after surgical reconstruction for tuberculous contracted bladder (TBC) and determined factors associated with decreased renal function (RF) during follow up. Materials and methods We reviewed the records of 61 patients who underwent augmentation cystoplasty (AC) or orthotopic neobladder...

The prostatic utricle cyst is usually an asymptomatic enlargement of the persistent remnant of Mullerian duct in males, especially seen associated with hypospadias and usually needs no active intervention. However occasionally they can become symptomatic and can present with complaints of impotence, ejaculatory pain, difficult voiding, urinary rete...

Though hypospadias (HP) is one of the most common congenital malformations of the male genitalia, decision-making with regard to surgical management has always brought forth many challenges to the treating surgeons, and these challenges further increase when it presents as a part of the spectrum of disorder of sex development (DSD) as ambiguous gen...

Aim: To determine the efficacy and outcome of pyeloplasty in poorly functioning kidneys in the pediatric population and whether pyeloplasty could be offered as an upfront procedure in such patient population, instead of nephrectomy. Materials and Methods: A retrospective data analysis of 83 patients who underwent pyeloplasty in poorly functioning k...

Acute Lobar Nephronia (ALN) is a rare infective condition of the kidney currently described only in case reports and small case series. The diagnosis of ALN is made by characteristic clinico-radiological findings. Differentiation from acute pyelonephritis, renal abscess and renal tumor is crucial for proper management and to avoid unnecessary diagn...

Posterior urethral valves have myriad presentations based on the severity of obstruction with the milder end of spectrum often termed as mini-valves. The simultaneous occurrence of ureteropelvic junction obstruction and urethral valves has not been described before and is most likely coincidental. Herein, we discuss the management of three boys who...

Extended summary Background Urogenital tuberculosis (UGTB) has traditionally being a diagnosis of adulthood and is supposed to be rare in children, as it is believed that the symptoms of renal tuberculosis do not appear for 10 or more years after the primary infection. While this may be true in developed countries, where childhood pulmonary tuberc...

Background The genitourinary tract is one of the commonest regions that can be affected by extrapulmonary tuberculosis where the diagnosis can be quite difficult. A high index of suspicion and an awareness of the atypical clinical manifestations of urogenital tuberculosis (UGTB) are important, especially in patients from regions where tuberculosis...

Extended Summary Background Pediatric urethral strictures are an uncommon entity, with the anterior urethra being the most common affected location, similar to adults. The, literature on outcomes in these strictures is limited, especially in the non-traumatic group, as most of the studies have included hypospadias related “neourethral” strictures...

Ascites and oliguria with an increasing serum creatinine level are often observed in patients with acute renal failure. However, these symptoms are also noted in individuals with intraperitoneal urinary leakage and can be mistaken for acute renal failure. This rise in creatinine in such patients is called pseudo renal failure and it happens by a pr...

Urethral coitus is a rarely reported cause of female urinary incontinence and has been most commonly described in women with vaginal and hymenal anomalies. Herein,we report a 41-year-old woman with a complex obstetric history,who presented with continuous urinary incontinence. On evaluation, she was found to have an abnormally dilated urethral orif...

Background Ureteric avulsion is a disastrous intraoperative complication that can happen to any urologist during a common endoscopic procedure like ureteroscopy. The aim of this study is to evaluate the various management options of ureteric avulsion during ureteroscopy and also report our relevant experience in this topic. Results The Preferred R...

Pelvic lipomatosis is a rare, proliferative disease with unknown etiology involving an overgrowth of normal fat in the pelvic retroperitoneal space. ¹⁻⁵ Cystitis glandularis or cystitis cystica can be observed in 75% of patients with pelvic lipomatosis. ⁵ We describe a 44-yr-old chronic smoker with suspicion of bladder mass who was referred to us f...

Background Association of the ureterocele and proximal ureteral valve is a rare congenital anomaly which can lead to quick detoriation of renal function due to double obstruction. Though ureteral valves have been associated with other ureteral anomalies, this specific association is extremely rare. Case presentation A 7-month-old boy was referred...

Background: Post-ablation urethral strictures are a rare but devastating complication following transurethral ablation of posterior urethral valve which can be more difficult to treat than the valve itself. Though with the miniaturization of scopes the incidence of these strictures has decreased, sadly they still continue to occur. Hence, literatu...

Extended summary Background Non-operative management of higher-grade renal injuries has gradually become accepted in pediatric circles following multiple studies over the past decade which showed good renal salvage rates. However, some children do fail this conservative approach and need interventions which are mostly minimally invasive. There is...

Introduction and hypothesisCircumferential vesicourethrovaginal fistula is a severe form of obstetric injury that is challenging to repair and carries a poor prognosis related to eventual continence. Here, we report the successful repair of a circumferential vesicovaginal fistula associated with near total loss of the urethra. The use the anterior...

The delayed or prolonged second stage of labour occurs when the foetal head exert pressure against the anterior vaginal wall and it results in ischemia and necrosis of bladder base and urethra. The ischaemic injury can result in Vesicovaginal Fistula (VVF) and Urethrovaginal Fistula (UVF). Most of the time it is related to Stress Urinary Incontinen...

Mucinous cystic neoplasms of the pancreas are the most common pancreatic cystic neoplasms. A 54-year-old female presented with an abdominal mass and was diagnosed to have a multilocular hydatid cyst from the left kidney by imaging. During surgery, a large thick-walled cyst with multiple loculi was seen arising from the upper pole of the left kidney...

Renal replacement lipomatosis (RRL) is a rare condition characterized by extensive fat deposition in hilum with parenchymal thinning and progressive detoriation of function.1, 2, 1, 2 Though uncommon, it should be considered as a possibility in patients with history of intervention for stone disease.⁵,⁶ Correct diagnosis can be easily established b...

Nutcracker syndrome is a complex of clinical symptoms due to compression of the left renal vein between abdominal aorta and superior mesenteric artery. Hematuria and pelvic or back pain are the most common presenting symptoms with varicocele being an uncommon clinical finding in these patients especially in children. Doppler ultrasound, computed to...

Internal ureteral stents (IUS) have become an integral part of urologic practice to relieve intrinsic as well as extrinsic upper urinary tract obstruction.¹,² Missed IUS is a serious potential complication that is associated with increased patient morbidity and is especially a problem in developing countries due to poor patient compliance, lack of...

The term ''putty kidney'' was first used in 1906 by Dr. F. Tilden Brown, a genitourinary surgeon, to describe a well-defined density seen in kidney region on standard radiograph which is caused by a ''putty-like'' substance that had formed a cast inside a tuberculous kidney. The putty kidney is a classic imaging sign, rarely seen nowadays which rep...

Anterior urethral valves are a rare cause of obstructed voiding in adolescent children and are often unheard by adult urologists. In this case report, we discuss the management of two adolescent patients who were referred to us with obstructive voiding symptoms with a diagnosis of neurogenic bladder and posterior urethral valves respectively but on...

Diaphragmatic herniations are the rarest form of ureteral herniations with only around 9 cases reported since 1958.1-10 Though uncommon, it should be considered in the differential diagnosis of a posterior diaphragmatic or paraspinal opacity with associated hydronephrosis. Correct diagnosis is of paramount importance and can be easily established b...

Objective: To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. Materials and methods: Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into two groups: supracos...

Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of...

Ureteral triplication is a rare congenital anomaly of urinary tract with wide spectrum of presentation. The presentation with incontinence has usually been taken as a sign of ureteral ectopia in these cases. However, ectopia cannot explain all cases with incontinence. We report a case of a 14-year-old girl with ureteral triplication with contralate...

Background: Urethral stricture disease in children is not uncommon as assumed; however, most of the information about the etiology, features, and natural history of pediatric strictures is extrapolations from adult series as the literature on this common entity is sparse, and most of the studies are small series. Objective: The current etiology...