Ravimohan Mavuduru

• Professor at Post Graduate Institute of Medical Education and Research

177Lu-prostate-specific membrane antigen-617 (177Lu-PSMA-617) has shown positive survival outcomes in metastatic castration-resistant prostate cancer. However, there are limited data in the hormone-sensitive setting. Here, in the CONSOLIDATE trial (177Lu-PSMA-617 Consolidation Therapy After Docetaxel in Patients with Synchronous High-Volume Metasta...

Symptoms of some fungal diseases can be similar to those of COVID- [1] 19, including fever, cough and shortness of breath . COVID-19 can become complicated by secondary invasive fungal infections (IFIs), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. The reported incidence...

Introduction Shear wave elastography is a new modality for the evaluation of erectile dysfunction by assessing the stiffness of corpora cavernosal tissue. We evaluated the shear wave elastography values in erectile dysfunction participants and compared shear wave elastography values between vasculogenic and non-vasculogenic erectile dysfunction par...

BACKGROUND Cesarean hysterectomy for placenta accreta spectrum disorder may be associated with severe hemorrhage because of placental invasion of the myometrium and the uterovesical space or parametrium. It leads to serious complications, such as massive hemorrhage requiring massive transfusion, coagulopathy, bladder and ureteric injuries, need for...

Introduction: The atypical urothelial cell (AUC) category in The Paris System (TPS) in urine cytology (UrCy) is a challenging area. This study aims to evaluate the UroVysion fluorescence in-situ hybridization assay(U-FISH) in predicting the outcome of AUC. Additionally, we explored the association of abnormal U-FISH results in high-grade urothelial...

Introduction Urinary cytology (UrCy) is highly sensitive to diagnosing high-grade urothelial carcinoma (HGUC) but cannot predict muscularis propria invasion. Further, the atypical urothelial cell category (AUC) may have variable outcomes. Image morphometry (IM) may be a valuable adjunct technique in this setting. Hence, we evaluated IM in the AUC a...

The unanticipated and incidental discovery of intestinal malrotation during radical cystectomy can generate few queries regarding the anatomic construction of the urinary diversion and can be a dilemma for the operating urologist. We describe such a case in which we navigated this anatomic surprise with simplicity and avoided unnecessary additional...

Contrast-enhanced computed tomography (CECT) underestimates the response to targeted therapy in metastatic renal cell cancer (mRCC) using Response Assessment Criteria In Solid Tumors (RECIST) v1.1, creating an unmet need for better imaging biomarkers for early response assessment. This study explores the feasibility of early response assessment to...

Introduction There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outco...

Introduction Prostate-specific antigen (PSA) is a reliable biomarker for identification of prostate cancer, although a biopsy is still the gold standard for detecting prostate cancer. Similar to higher PIRADS lesions on MRI, the maximal standard uptake value (SUV max) on PSMA PET is linked to a higher likelihood of prostate cancer. Can an mpMRI in...

Radical Cystectomy with Pelvic Lymph Node Dissection (RC + PLND) and Urinary Diversion (UD) is associated with significant post-operative morbidity in 50-60% of patients, most common being paralytic ileus & SSI. It was largely attributed to open urinary diversion. Robot-assisted surgery was believed to minimise this but the RAZOR trial, the only mu...

Whether performing open surgery or minimally invasive surgery, lost needles can cause operating surgeons' great anxiety and worry. The development of needle-retrieval techniques for misplaced needles have been attempted previously in a number of ways. Here, we report our experience with robot-assisted nephron sparing surgery in which the lost needl...

Urinary stones remain a major public health burden. A large number of people are suffering from the problem of urinary stones, all over the globe with an estimated annual incidence of 1%, prevalence of 3-5% and a lifetime risk of 15-25%. About 12% of the Indian population is expected to be affected by urinary stones in their lifetime, out of which...

PC-RPLND is technically challenging owing to proximity of the RPLNs to great vessels, and dense desmoplastic reaction associated with prior administration of chemotherapy. We share our experience of post chemotherapy RPLND in 15 patients operated during 2018-22.

RCC is a highly vascular tumor and anti-vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors targeting tumor neoangiogenesis form the first-line therapy of metastatic RCC (mRCC). Owing to the cytostatic nature of these drugs, structural changes require many months to develop and lead to underestimation of treatment respons...

Introduction: Renal cell cancer (RCC) is a highly vascular tumor with hypervascular metastasis. Therefore, tyrosine kinase inhibitors (TKI) targeting tumor neoangiogenesis through vascular endothelial growth factor receptors (VEGFR) form the first-line therapy of metastatic RCC. The therapeutic response to TKI is primarily assessed by contrast-enha...

This data article describes the whole-genome sequencing and in vitro activity data of Escherichia phage NTEC3 isolated from a community sewage sample in Chandigarh, India. The phage NTEC3 was active against multi-drug-resistant (MDR) and extensively drug-resistant (XDR) biofilm-forming Uropathogenic Escherichia coli (UPEC) strains. The genome of th...

Cushing’s syndrome uncommonly presents as an emergency with severe hypercortisolism causing: intractable hypokalemia, uncontrolled hypertension, acute psychosis. Medical management (Etomidate, Ketoconazole) may be ineffective. Emergency total bilateral adrenalectomy (TBA) is warranted in such refractory cases. Surgery and perioperative care can be...

The rapidly evolving clinical utility of prostate-specific membrane antigen (PSMA) PET/CT as an imaging modality for prostate cancer (PCa) has brought to the forefront a multitude of non-prostatic diseases also exhibiting PSMA radioligand uptake. We report a case of a 71-year-old male with PCa who underwent PSMA PET/CT for recurrence evaluation. Th...

Aim: We aimed to study host range, stability, genome, and antibiofilm activity of a novel phage vB_EcoA_RDN8.1 active against multi-drug resistant (MDR) and extensively drug-resistant (XDR) biofilm-forming Uropathogenic E. coli isolates. Methods and results: A novel lytic phage vB_EcoA_RDN8.1 active against UPEC strains resistant to third-genera...

Purpose: F-18 FDG positron emission tomography (PET) has limited value in renal cell carcinoma (RCC). As RCC is a hypervascular tumour and Prostate specific membrane antigen (PSMA) receptors are over-expressed on tumour neovasculature, the role of Ga-68 PSMA-11 PET in RCC needs to be explored. Methods: Eleven patients of RCC with suspected metastas...

Escherichia phage 590B, which was isolated from community sewage water in Chandigarh, India, exhibited lytic activity against an extensively drug-resistant uropathogenic Escherichia coli isolate. The genome of the phage is linear, double-stranded, and 44.39 kb long. Phage 590B is a member of the Siphoviridae family and is closest to phage vB_EcoS_X...

Introduction: Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and efficacy in this population. Materials ande methods: S...

PurposeTransurethral resection of bladder tumor is the standard of care for the management of patients with bladder mass. Primary objective of this study was to compare safety and efficacy of the two energy modalities used for TURBT (monopolar and bipolar).Materials and methodsSystematic literature search of various electronic databases was conduct...

Background: There is an ongoing need and search for a simple yet accurate nephrometry scoring system for predicting the postoperative outcomes after partial nephrectomy (PN). SPARE, a simplified version of PADUA has been proposed as a predictor of postoperative complications following PN recently. However, this score has never been externally valid...

Aims: Actinium‑225 (225Ac) labeled prostate‑specific membrane antigen (PSMA)‑617 is a novel treatment modality in the management of metastatic castration‑resistant prostate cancer (mCRPC). The present study was conducted to assess the impact of 225Ac‑PSMA‑617 therapy on the quality‑of‑life of patients with heavily pretreated mCRPC using the Nationa...

Tubular adenoma of the urinary tract is a recently recognized entity, and there is a paucity of clinicopathological information. We describe 2 rare cases of adenocarcinoma of upper urinary tract arising in the background of tubular adenoma with high-grade dysplasia. The first case was an extremely uncommon combination of multifocal tubular adenomas...

Background CSE is a novel combination of ceftriaxone, sulbactam and disodium EDTA with activity against multidrug resistant gram-negative pathogens. Methods Adult patients aged ≥18 years with a diagnosis of complicated urinary tract infections (cUTI), including acute pyelonephritis (AP), were randomized 1:1 to receive either intravenous CSE (1000m...

Introduction Left ventricular end diastolic area (LVEDA) less than 10 cm2 in mid-papillary para short axis view of transthoracic echocardiogram indicates hypovolemia.1 We compared the efficaciousness of an algorithm based on LVEDA to the standard clinical practice during subarachnoid block (SAB) in the prevention and treatment of post spinal hypote...

Background and objectives There is conflicting literature regarding the clinical significance of pretreatment testosterone (T) levels and development of prostate cancer (PCa). In the current study we investigated the association of serum T levels with PCa and compared it with that of controls of benign enlargement of prostate (BEP). Association of...

Background and objectives There is conflicting literature regarding the clinical significance of pretreatment testosterone (T) levels and development of prostate cancer (PCa). In the current study we investigated the association of serum T levels with PCa and compared it with that of controls of benign enlargement of prostate (BEP). Association of...

Introduction: The last few years have seen the emergence of multi-drug resistant (MDR) Gram-negative infections, which are associated with high morbidity and mortality. The indiscriminate use of colistin has led to the development of resistance, which can be diagnosed effectively by broth microdilution. Studies from India are limited, and this stu...

Introduction Rational use of antibiotics and strict adherence to practice guidelines is essential to prevent antibiotic resistance. The best surgical prophylaxis protocol requires tailoring of the available guidelines in accordance to the local bacterial flora. We designed a protocol for surgical prophylaxis to check the rampant abuse of antibiotic...

Introduction: Programmed cell death-1/programmed cell death ligand-1 (PD-1/PDL-1) inhibitors are the newest class of approved drugs for advanced urothelial cancer (AdUC). This review aims to collate the evidence for their effcacy and safety in various treatment settings. Methods: Extensive search of databases was performed (updated May 2018) and th...

Background: Historically, the incidence of prostate cancer in India and in nonresident Indians is lower than that in Western populations. Our study aims to assess complications and short-term outcomes of robotic assisted radical prostatectomy (RARP) among postoperative patients from a tertiary care center of a developing country. Materials & Method...

Introduction&Objectives:Robotic-assistedradicalcystectomy(RARC)withextracorporealdiversionhasbecomeanestablishedalternativetoopenradicalcystectomy(ORC)inmanyspecialistcentresworldwide.Morerecently,wehaveseentheevolutionofroboticintracorporealilealconduit(RICIC)formation,althoughthisisstillrelativelyinitsinfancyandislimitedtoahandfulofcentres.Wewish...

Introduction: Tadalafil and Tamsulosin have both been approved for use in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). This study compared the differential effects of these two on BPH-LUTS using a cross over study design. Methods: Men ≥45 years of age, with an International Prostate Symptom...

Perineal angiomyxoma is a rare entity, more commonly seen in females. We report a case of a 44 year old male who presented with a perineal swelling which became prominent with penile erections. Magnetic Resonance Imaging (MRI) revealed a T1 hypointense and T2 hyperintense midline lesion (4.6 × 2.5 × 5 cm) in relation to corpus spongiosum, with ill...

Egger's plot for publication bias

Galbraith plot for heterogeneity

Background CSE, a novel combination of Ceftriaxone, Sulbactam and Disodium EDTA (Class 1 Antibiotic Resistance Breaker), is being developed for the treatment of patients with serious Gram-negative infections and has completed a Phase-3 clinical trial (NCT03477422) for treatment of complicated urinary tract infections (cUTI), including acute pyelone...

Introduction: Transurethral resection of bladder tumor (TURBT) aims at complete resection of all the visible tumors. Existing guidelines recommend restage TURBT in all patients with T1 and high-grade tumors, to avoid under-staging. However, restage TURBT may not be plausible/feasible at all the times. This study was performed with an aim to better...

Background: Cesarean hysterectomy for adherent placenta is associated with increased maternal morbidity due to massive hemorrhage requiring large volume blood transfusion, bladder or ureteric injury, intensive care unit (ICU) admission and prolonged hospital stay. There is an ongoing effort to improve the outcome of these women and measures to red...

Bladder pheochromocytoma is the most common extra-adrenal genitourinary tumor. Endoscopic management is feared due to the risk of intra-operative hypertensive crisis. We described a case of successful endoscopic management of a bladder pheochromocytoma and discussed its technical aspects. Keywords: Transurethral resection, Bladder, Pheochromocytoma...

Purpose Preservation of renal function after nephron-sparing surgery (NSS) is multifactorial and the impact of individual factors on it is still a debate. This prospective study investigates the impact of factors responsible for quantitative and functional outcome after NSS. Patients and Methods Fifty-two patients of localized renal mass (≤7 cm) w...

Microinvasive squamous cell carcinoma (SCC) is a known premalignant lesion of carcinoma cervix. It is also reported from other sites such as the oral cavity, larynx, and vulva. Microinvasive SCC is very rarely reported from the penis. We report the occurrence of microinvasive SCC in a long-standing erythematous lesion of glans penis in a patient, w...

A 43-year-old farmer presented to us for evaluation of multiple, itchy, tense vesicles and bullae, containing clear to hemorrhagic fluid, surmounting an urticarial background on his thighs and inguinal area for 20-days (Figure 1a). He was also undergoing evaluation for bilateral metastatic inguinal lymphadenopathy detected 3 months back that had re...

Traditionally, bilateral UPJO in adults was managed by the staged approach during the open surgery era, because of need for two separate incisions and change of patient positioning. In addition, there was a feared risk of post-operative bilateral renal obstruction. Even with advent minimal invasive laparoscopic surgery, simultaneous pyeloplasty did...

Post chemotherapy residual masses are considered extremely challenging to remove even by the most experienced laparoscopic surgeons. Robotic technology has added a new dimension to the management of such cases and has lessened the fear and discomfort associated with such challenging surgery but is still evolving. We present our experience of manage...

Introduction and hypothesis: Open transabdominal repair of vesicovaginal fistula (VVF) requires a long cystotomy incision, suprapubic drainage and delayed recovery. Laparoscopic repair is limited by difficult suturing in pelvic procedures. Therefore, the utility of robotic assistance is being increasingly explored. We share our initial experience...

Management of pelvi-ureteric junction obstruction (PUJO) in a duplex system is technically challenging as dissection at the pelvis may jeopardize the vascularity of the normal moiety ureter. Anastomosing the pelvis to the one single ureter will have a risk of future development of stricture which then will risk both the moieties. Robotic assistance...

The potential challenges encountered for setting up a robotic assisted surgical facility in developing country like India are many. We describe the initial hurdles and troubleshooting in establishing a facility of such kind. This experience might help to decrease initial hiccups in setting up such an innovative technology at other institutes.

Robot-assisted partial nephrectomy has become a safe and feasible procedure for small renal masses (SRM). Similarly, robot-assisted adrenalectomy has also been well established. Robotic surgery has provided the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy. We describe in this video the...

The amount of data that is being generated in health care is enormous, especially with the widespread availability of multimedia devices. However, the data keeping in developing countries is still unstructured. Lots of this Big Data is therefore vulnerable to loss. In the current report we highlight the problem and suggest the need for cost effecti...

Background: Chylocolporrhea or chylous vaginal discharge is an extremely rare manifestation of chylous reflux syndrome. Continuous loss of chyle adversely affects quality of life and results in increased morbidity due to the chronic loss of nutrients. Diagnosis and management of this condition is very challenging. Case history: A 35-year-old mul...

Pheochromocytomas of extra-adrenal origin are known as paragangliomas. Urinary bladder is the most common site of genitourinary paragangliomas. The variable functional status of these tumors presents a surgical challenge in their management by minimally invasive surgery. Robot-assisted partial cystectomy offers the advantage of minimal handling of...

Von Hippel-Lindau (VHL) disease is a disorder with multiple systemic manifestations. We report a case of VHL undergoing robot assisted nephron sparing surgery for recurrent renal cell carcinoma. The anesthetic concerns in perioperative management of a patient with VHL are also described.

Material and methods: Two hundred and thirty seven patients presenting with ED at andrology OPD were evaluated for ED by a self administered IIEF (International Index of Erectile Function) questionnaire. Patients were systematically randomized by computer generated random table into two groups groups namely, group A: Tadalafil only group, group B:...

Isolated renal mucormycosis is a rare entity in immunocompetent subjects. It is usually a rapidly progressive disease with poor prognosis but it can mimic renal abscess with a protracted course.

Cystic fibrosis (CF) is usually considered a rare disease in the Indian population. Two studies have reported on the frequency of cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in Indian males with congenital absence of the vas deferens (CAVD), however data on the spectrum of CFTR gene mutations are still lacking. Therefo...