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Year : 2018  |  Volume : 34  |  Issue : 5  |  Page : 7-72

Abstracts - USICON 2018

Date of Web Publication11-Jan-2018

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How to cite this article:
. Abstracts - USICON 2018. Indian J Urol 2018;34, Suppl S1:7-72

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. Abstracts - USICON 2018. Indian J Urol [serial online] 2018 [cited 2021 Nov 27];34, Suppl S1:7-72. Available from:

   Prize Paper Sessions Top

   Brij Kishore Patna Top

   BKP 01: Comparison of efficacy of Tamsulosin vs Tadalafil vs combination of both in lower urinary tract symptoms due to benign prostatic hyperplasia: a prospective randomised comparative study Top

Yogesh Taneja

Introduction: Lower urinary tract symptoms (LUTS) as a consequence of benign prostatic hyperplasia (BPH) are one of the most common complaints of a middle-aged or older patient in urology outpatient clinics.[1],[2] Lower urinary tract symptoms secondary to BPH include frequency, urgency, nocturia, incomplete emptying, and weak stream that can strongly worsen the quality of life (QoL). All these have been graded and ranged from mild to severe, depending on their occurrence. Initially, for several decades, surgery remained the gold standard of care for relieving symptoms due to BPH.[3] However, since the 1990s, there has been a dramatic change in the management of BPH and the time has seen a shift from surgical to medical therapy. In the current scenario, various drugs have been used for medical management of BPH with alpha adrenergic blockers being the first line of drugs.[4] The PDE5-Is act to ameliorate LUTS due to BPH and prostate, urethra, bladder, and LUTS vasculature are considered their potential targets.[5],[6],[7],[8 Tadalafil is a drug classified under PDE5 inhibitors group. It has been used effectively in the treatment of ED.[9] PDE5 inhibitors lead to increased cGMP, which is a second messenger in certain cellular signaling pathways.[10] Cost is an important factor while considering treatment in the Indian scenario. The aim of the present study is to determine and to define is it really worth giving the patient burden of the cost of two drugs by comparing efficacy of tamsulosin vs tadalafil vs combination of both in the treatment of LUTS due to BPH. AIM OF STUDY: To compare the efficacy of tamsulosin 0.4 mg vs Tadalafil 5 mg vs a combination of both in the treatment of patients with Lower urinary tract symptoms due to Benign prostatic hyperplasia. Objectives: To assess improvement in IPSS total, IPSS obstructive, IPSS irritative, IPSS QoL score at 1 month and at 3 months of treatment. To assess improvement in Qmax and Qavg at 1 month and at 3 months of treatment. Material and Methods: It was a prospective randomized comparative study. Ethics committee approval was sought. A total of 159 patients were enrolled in the study. Inclusion criteria - Patients more than 40 years with history of LUTS secondary to BPH, an International Prostatic Symptom Score (IPSS) of >8, maximum urinary flow rate (Qmax) <15 mL/second with minimum voided volume of >125 mL at screening, and willing and able to give written informed consent and comply with study procedures, PSA less than 4 ng/ml. Exclusion criteria – contraindications to investigational drugs including patients with known allergies/allergy to drugs under study, history of syncope, and orthostatic hypotension, bladder outlet obstruction due to cancer, calculi or stricture, previous transurethral resection of the prostate, any neurological disorders affecting storage and voiding functions, an episode of acute urinary retention within 4 weeks of study initiation, poorly controlled diabetes mellitus At the first visit (visit 0), a detailed clinical history was taken including medical history of present and past diseases and whether patient is on any other therapy. Prior to commencing therapy, all participants were given questionnaires of IPSS. Before commencement of study digital rectal examination, ultrasound KUB (for post-void residual urine volume), laboratory investigations (hematology, serum PSA, renal function tests, urine analysis) and uroflowmetry (to check Qmax and Qavg) were performed. The treatments was given to the eligible patients according to computer generated random table and randomized allocation to either tamsulosin 0.4 mg once a day (Group A), or the tadalafil 5 mg (Group B) or the combination of both (Group C) was done. Compliance and drug-related side effects were assessed at visit 1 and visit 2 (1 and 3 months, respectively after starting the treatment). Method of measurement of outcome of interest – At 3 months of the treatment, Primary efficacy end point was– improvement in total IPSS score, Secondary end points included IPSS obstructive, irritative and QoL index and objective (Qmax and Qavg) changes from baseline. Results: A total of 159 patients were enrolled in the study. All the patients were randomized into 3 groups of 53 patients each. Group A patients received tamsulosin 0.4 mg once daily. Group B patients were given tadalafil 5 mg once daily whereas group C received a combination of both. In group A two patients lost to follow up. In group B two and in group C three patients lost to follow up. One patient in Group B opted surgery due to no improvement. So a total of 51 patients were analysed in group A and 50 each in group B and group C were analysed.

   BKP 02: Prospective double blind randomised study to evaluate the efficacy of Siliodosin 8 mg as on demand, reversible, male oral contraceptive Top

Gajanan Bhat, Anuradha Bhat

General Hospital, Honavar, Karnataka

Objective: To evaluate the efficacy of Silodosin 8 mg as on demand, reversible, male oral contraceptive Patients and methods: After obtaining written informed consent, sexually active males were included in the study. Those with sexual dysfunction, infertility, previous surgery, anomalies / instrumentation of their GU tract were excluded. In the initial part, partcipants received silodosin 8 mg for 7 consecutive days, two hours prior to the proposed evaluation in the silodosin arm and those in placebo arm received placebo. Semen analysis and post ejaculation urine analysis was done after two hours of drug intake. From Day 8 to 15, both the groups received placebo followed by semen and post ejaculation urine analysis after two hours. During the second part, all were administered silodosin 8 mg two hours prior to the sexual intercourse for a period of six months. The efficacy of contraception was evaluated by number of unintended pregnancies. Results: The study period was January 2017 to July 2017 with a sample size of 63 and mean age of 31.84 years. In the intial part of the study, the semen and the post ejaculation urine showed no spermatozoa in the silodosin group for a consecutive period of 7 days, whereas the placebo group showed normal semen analysis. Later, on switching from silododin to placebo, normal semen analysis was reported from day 2 of switching of the drug. During the second part, no unintended pregnancy was reported. Conclusion: Silodosin 8 mg is a highly effective, on demand, reversible male oral contraceptive.

   BKP 03: Renal transplantation in abnormal lower urinary tract -Impact on graft outcomes, patient survival and complications Top

Jayanth S T, Dangi AD, Mukha RP, Chandrasingh J, Kumar S, Kekre N, Devasia A

Christian Medical College, Vellore

Introduction and objective: The study aimed to determine the graft outcomes and complications of renal transplantation in an abnormal LUT (Lower Urinary tract) as compared to matched controls. There is conflicting evidence regarding their outcomes in literature. Methods: This was a retrospective matched cohort study from single institution. We identified 32 patients with an abnormal LUT in our transplant database between 2006 and 2016. We took equal number of controls matched for age, sex and transferred glomerular filtration rate (GFR). The primary outcome was graft survival and secondary outcomes were overall survival and complications. Abnormal LUT was categorized into 1. Abnormal bladders; augmented or native on CISC (clean intermittent self-catheterisation), 2. Abnormal bladders not on CISC, 3. Urinary diversion (ileal conduit), 4. Urethral stricture. Results: The median age was 24 years (range: 12-45). On Kaplan Meier analysis, the estimated mean graft survival was 106 months in the abnormal LUT group versus 128 months in matched controls (p=0.47, Cox regression analysis). On subgroup analysis of abnormal bladders, the augmented bladders had the poorest mean survival (81 months, p=0.06). The mean estimated patient survival was comparable in both groups (109 months vs. 139 months, p=0.13). Infective complications and re- admissions were significantly higher in abnormal LUT (p<0.01) and most specifically in patients on CISC (p=0.03). Conclusions: Although infective complications were significantly higher in the abnormal LUT group, this did not adversely impact graft and patient survival over the follow up period of this study. Keywords: Abnormal lower urinary tract, graft survival, infective complications, renal transplantation.

   BKP 04: The “focus on aneurysm”: A novel classification based on site and principles of management of aneurysmal complications in arteriovenous fistula for hemodialysis access Top

Jena Rahul, Sureka SK, Bansal A, Kapoor R, Srivastava A

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

Introduction: Aneurysmal complications occur in 4-12 % patients harboring an arteriovenous fistula (AVF) for hemodialysis access in end stage renal disease. Our aim is to propose a clinically relevant classification of aneurysmal complications (both true and pseudoaneurysms) based on management strategy in light of our experience. Materials & Methods: We retrospectively evaluated the records of patients who have been managed for aneurysms and pseudoaneurysms associated with arteriovenous fistulae at our centre from January 2001 to July 2010. Demographics, site of fistula, type of aneurysm (true vs pseudoaneurysm), location of aneurysm (anastomotic site vs outflow vein vs inflow artery) and the management strategy were recorded in all patients. The basic philosophy behind this classification was based on the need for observation (a) or elective (b) or emergency(c) surgical management. Most common variety of complication was classified as type I with type IV being the least common. Results: A total of 3360 arteriovenous fistulae were created during the study period in our centre, out of which 176 patients (5.2%) developed aneurysms. Another 208 patients, referered from other centres, were managed for aneurysmal complications. A total of 384 patients were managed at our centre with aneurysmal (true aneurysm n=205, 53.3% ; pseudo-aneurysm n=179, 46.7%) complications of AVF. 55.2% were male (n=212) and rest were females. 302 patients had left limb aneurysms and 82 on the right. Out of 384 patients, 196 patients had radio-cephalic fistulae, 133 had brachio-cephalic fistulae and 55 had brachio-basilic fistulae. Location of pseudoaneurysm was at anastomotic site in 35.4 % patients (n=136), outflow vein in 9.3% (n=36) and inflow artery in 1.8 % (n=7). 39.5% patients were managed conservatively (n=152), 30.2% were managed by elective surgery (n=116) and 30.2 % needed emergency surgery (n=116). The indication of emergency surgery was intractable bleeding or impending rupture. Patients with no significant symptoms and no or minimal risk of bleed were closely observed. Based on our management strategy, a new classification system was proposed for AVF related aneurysms. Conclusion: A standardized classification system, that identifies AVF related aneurysmal complications that need emergency surgery is the need of the hour. This classification system is easily reproducible and will help surgeons in reporting and comparing their experiences. We observed that type 1a is most common aneurysm found in arteriovenous fistula and most of the patients can be managed conservatively.

   BKP 05: Correlation of MIR-100 expression with clinopathological parameters in bladder cancer Top

Kumar M, Sadasukhi N, Narayan TA, Bisnoi K, Singhal P

PGIMER, Chandigarh

Objective:- Bladder carcinoma is one of the most common tumors in the world and, despite the therapy currently available, most of the patients relapse. MicroRNA- 100 is downregulated in bladder cancer tissue in comparison to normal tissue, however, clinical significance of miR-100 in human bladder cancer has not been elucidated. The aim of study was to correlate miR 100 expression levels with tumor grade, stage and recurrence. Methods :- Expression of miR-100 in 26 pairs of bladder cancer and adjacent normal tissues were analysed by Sybergreen RT-PCR. The expression levels of miR 100 in tumor and normal were normalised with 18s gene. The expression levels of miR 100 expression were analysed in fold change(DDCT method). The difference between groups were analysed by student t test and Anova. Results Downregulation of miR-100 expression in tumor was an important finding in our study. miR-100 expression were decreased(n=24) in tumour tissue in comparison with normal bladder urothelium. Mean expression of miR-100(fold change) was 0.33+/-0.35 and significantly decreased on comparison to normal(1) (p=0.001) There is no correlation of miR-100 expression levels with gender and age (p=0.583). Mean expression of miR-100 in low grade was 0.41+/-0.38 whereas in high grade 0.22+/-0.26 (p=0.182). Ta tumors had mean (fold change) 0.42+/- 0.39, T1 had mean value of 0.25 +/- 0.30 and T 2 had mean value of 0.24 +/- 0.30.(p=0.463) miR-100 expression levels were decreased in MIBC(T2) more than NMIBC (Ta, T1) (p=0.473). Mean levels 2^-DDCT (fold change) in recurrent tumors were 0.16+/-0.19 whereas fold change in nonrecurring tumors was 0.40 +/-0.38.(p=0.045) 1 patient with T2 tumor underwent progression with all patients surviving till end of study. Conclusions:-miR-100 expression is downregulated in Bladder cancer tissue than normal bladder urothelium. The miR-100 expression levels were decreased in all bladder tumors however reaching significance in recurrent bladder tumor, suggesting use of miR 100 as potential marker for further risk stratification and prognosis in treatment of urinary bladder cancer.

   BKP 06: Change in ultrasonographic parameters after arterio-venous fistula Top

Singh Shanky, Kurup Satheesh, Vikas Vaibhav, Soni Jatin

Government Medical College, Trivandrum

Introduction: Arterio-venous fistula (AVF) is the preferred method of providing vascular access for haemodialysis in chronoic renal failure patients. Several changes are critical for the successful maturation of a new fistula. Doppler ultrasound has been postulated to be an important modality in assessing the changes after AVF. Aim: To assess the changes in the ultrasonographic parameters after arterio-venous fistula formation in chronic renal failure patients and compare them between mature and failed arterio-venous fistula. Materials and Methods: A total 50 of adult chronic renal failure patients aged 18-70 years were screened using color doppler ultrasonography. Data was expressed as mean + S.D and compared by Repeated measures ANOVA and analysed on SPSS (statistical Package for social Sciences) trial version 17.0 software. A p value of <0.05 was considered statistically significant. Results: In this study 50 patients were included. Four died and eight patients failed to follow up after 4 weeks of study and were excluded. In remaining 38, there were 8 fistula failures (26%), 2 of which were early failure (6%) that is within 4 weeks of fistula formation. Primary patency rate was 79%. Mean age group were 56 and 54yrs in mature and failure groups, respectively. There were 26 males and 12 females in the study. Conclusion: Doppler ultrasound provides information on the morphology and on the function of vascular access and is an important modality in assessing the changes after AVF as it is both non-invasive and safe. Keywords: Arterio-Venous Fistul (Avf) ; Doppler ; Mature

   Chandigarh Best Video Prize Session Top

   CBVP 01: Robotic renal recipient transplant operation: A travelogue of complications in first 40 cases Top

Kishore TA, Vishnu R, Ramaprasad MK, Roy John

Aster Medcity, Kochi

Aim: To share the authors experience with practising transplant surgeons about the pit falls and complications in Robotic Assisted renal transplant. Materials and methods: The video deals with various technical, complications encountered in robotic renal transplant. 1. A case of arterial thrombosis 2. Technical errors in application of bull dog clamps 3. How to tackle bleeder in hilum 4. How differentiate vascular spasm and arterial thrombosis 5. A case of venous kink 6. How to fix vascular leak and hilar bleeding 7. Lost needle Results: We have performed 40 cases of Robotic renal transplant with results that is comparable to that of contemporary literature. Conclusion: Robotic renal transplant is an evolving procedure and would be subject to more modifications. The pioneering surgeons should be encouraged to share their experience and caveats involved in this novel procedure

   CBVP 02: “Polar Flip Technique” in Laparoscopic Partial Nephrectomy for Posterior Hilar Renal Tumors Top

Mallikarjuna Chiruvella, Ghouse SM, Bendigeri MT, Purnachandra RK, Ragoori DR, Enganti B

Asian Institute of Nephrology & Urology, Hyderabad

Introduction: We present our experience and feasibility of “Polar flip technique” in Laparoscopic partial nephrectomy (LPN) for posterior hilar renal tumors, illustrated with video. Patient and Technique: Two male patients with right-sided posterior hilar renal tumors with normal renal function underwent LPN. Complete mobilization of kidney and pedicle is done. Upper pole is flipped infero-laterally and lower pole flipped supero-medially with renal hilum as fulcrum, to provide direct access to posterior hilum. Renal sinus is approached through Gil-Vernet plane and dissection in that will separate posterior lip of the kidney along with tumor from the renal sinus. Selective clipping of posterior segmental artery is done with Hem-o-lok clip. Kidney repositioned in the normal axis and pedicle control is established by laparoscopic Satinsky clamp. “Polar flip” as explained before is performed and tumor in the posterior segment of the kidney is excised with adequate rim of the renal parenchyma. Extension of the pelvi-calyceal system into the excised parenchyma is clipped or ligated. Adequate hemostasis by figure-of-8 Vicryl sutures is done for the interlobar vessels. Renorrhaphy is done with V-lock hemostatic sutures and kidney re-positioned. Results: Two patients underwent LPN, mean operative time of 95 minutes and warm ischemia time of 18 minutes. There were no postoperative complications with tumor negative margins. Conclusion: Polar flip technique during LPN for posterior hilar tumors enables direct access to renal hilum and tumor. Dissection in the Gil-Vernet plane and clipping of the posterior segmental artery will easen the procedure and decrease warm ischemia time.

   CBVP 03: Robot-Assisted Radical Nephrectomy with Level I IVC Tumour Thrombectomy: Our technique Top

Priyank Bijalwan, Ginil Kumar Pooleri

Amrita Institute of Medical Sciences, Kochi

Introduction: Invasion of the renal vein and inferior vena cava is seen in 4% to 10% of renal tumors. Laparoscopic nephrectomy with IVC thrombectomy has been slow to gain widespread usage as it is a formidable operation. Robotic assistance facilitates reconstructive component of complex procedures due to ease of intracorporeal suturing and increased dexterity. Our purpose is to describe our technique of IVC thrombectomy in a step-wise manner. Methods: A 53-year old lady was referred to us with an incidentally detected right renal mass on ultrasound abdomen. Other co-morbidities included COPD, β-thalassemia minor. Examination was unremarkable. CT abdomen was suggestive of 4.2 x 5.6 cm enhancing lesion with exophytic component in the right kidney with filling defect in right renal vein extending into inferior vena cava suggesting probable tumor thrombus (Level I). Patient underwent robot (Da Vinci Xi) assisted radical nephrectomy with IVC tumour thrombectomy. Operative details: Docking time was 30 minutes, Console time 270 minutes, blood loss 130ml. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Specimen was removed en-bloc, and the IVC was closed with Goretex 3-0. Post operative period uneventful. Drain and foleys removed on POD2 and patient discharged on POD 3. Conclusion: Robotic-assisted Radical nephrectomy with IVC tumour thrombectomy is a safe technique in well-selected patients with venous involvement. It combines the benefit of minimally invasive surgery with oncological outcomes similar to that of open surgery.

   CBVP 04: Robotic Renal Transplant Recipient Surgery - Refinements and Unusual Cases Top

Ramaprasad M K, Vishnu R, Roy P John, Kishore T A

Aster Medcity, Kochi

Introduction and Objective: Robot assisted renal transplantation recipient surgery is a recent technique added to the surgical arena. Here by, we present four technical modifications in this procedure. Methods: We present the edited videos of selected cases of robot assisted renal transplant recipient surgery. We have done all the procedures with da Vinci Si system. Results: The procedures presented include: 1. Large peritoneal flap reflected from the anterior abdominal wall: This helps us to completely extra-peritonealize the kidney. The advantages of this technique include prevention of peritoneal contamination in case of urinary or vascular leak, ease for renal biopsy procedure and prevention of torsion of the graft. 2. A case of left sided graft placement with anastomosis of double vessel after side to side anastomosis on the bench: This technique helps to reduce the warm ischemia considerably. 3. Inferior epigastric artery anastomosis of the small renal artery: This technique helps to maintain the perfusion of the territory supplied by small renal accessory artery. Robot helps us to perform this anastomosis with precision. 4. Dual renal transplantation in case of marginal donor: The robot decreases the anastomotic time compared to laparoscopy making this a feasible option. Conclusion: da Vinci surgical robot is a highly versatile tool which helps the surgeon to tackle difficult surgical situations effectively. It greatly enhances the precision of the vascular anastomosis and helps us to develop technical modifications like large peritoneal flaps, thus improving surgical and clinical outcome.

   CBVP 05: Casale's tube with VQZ Stoma: An alternative to “Double Monti” Top

Sharma D, Khattar N, Singla A, Sood R, Akhtar A

Dr RML Hospital & PGIMER, New Delhi

Introduction: Although Mitrofanoff appendicovesicostomy is the most commonly used technique, it may not be useful in conditions where appendix has been surgically removed or congenitally absent. An ideal channel is short, straight and has good blood supply. Various methods can be employed to make Ileal tube suitable for a Mitrofanoff procedure including a tapered ileal tube or a Double Monti procedure. The advantage of Casale over Double-Monti is absence of anastomosis which avoids kinking, angulation, false passage, stenosis and pouch formation. VQZ is a method to prevent stenosis of the tube at skin level which is a common and irritating complication. Case: 48 year old male on CISC for acontractile bladder (after surgery for spinal tumor) for last 26 years developed a pan-anterior stricture. A continent catheterizable stoma was planned for the patient to provide a channel to continue CISC. A jointless 10 cm Casale's tube was made from 4 cm of ileum. One end was anastomosed to bladder using Lich- Gregoir Technique and other end was brought out through the right lower quadrant of the abdomen using the VQZ technique. Results: The stoma was catheterizable and continent at 3-month follow up Conclusion: Casale Technique is a viable alternative to the Double Monti procedure in patients where appendicovesicostomy is not feasible. We have also used it in continent diversions for bladder cancer and Exstrophy.

   CBVP 06: Laparoscopic (Robot-assisted) Retroperitoneal Lymph node dissection in NSGCT: Video Demonstration & Single centre experience Top

Yuvaraja TB, Waigankar Santosh, Wagaskar Vinayak, Pednekar Abhinav

Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute

Introduction & Objectives: Laparoscopic RPLND (L-RPLND) in non-seminomatous germ cell tumors (NSGCTs) have limitations. The robotic approach attempted to overcome these. We aim to evaluate the surgical technique and outcomes of the robot-assisted retroperitoneal lymph node dissection (R-RPLND) for non-seminomatous germ cell tumors (NSGCT) at our institution. Material methods: 11 patients (2012-2017) underwent R-RPLND for NSGCT [Clinical Stage (CS) I-IIA and Post-chemotherapy residual masses]. Retrospective data on patient demographics, preoperative tumor characteristics, perioperative outcomes [open conversion rate, lymph node (LN) yield, rate of positive LNs, operative time, estimated blood loss (EBL), length of stay (LOS)] & tumor recurrence rates were recorded. Steps of R-RPLND include caecal mobilization upto ligament of treitz, full bilateral template dissection redocking & excision of the ipsilateral spermatic cord remnant. Results: The mean operative time was 190 mins, EBL was 103mL, and LOS was 2.4 days. Teratoma was the commonest pathology with mean LN yield of 22. At a mean follow-up of 15 (6–24) months, there were no recurrences. There were no intraoperative complications, 2 early postoperative complications (18%), no late complications. One patient (9%) with positive nodes received adjuvant chemotherapy. The 2-yr recurrence-free survival rate was 97% (95% CI: 82-100%). Conclusions: Robotic surgery is a safe and feasible method for resecting pelvic masses especially in areas difficult to reach via open or maneuver laparoscopically. Robotic approach with its 3D - Imaging system improves maneuverability & precision of the dissection in the retroperitoneum and cul-de-sac.

   CKP Menon Prize Paper Session Top

   CKP 01: “Modified Prom” based reporting of urethral stricture surgery outcomes at a single tertiary health care center in southern india Top

Deep K Jain, Chawla A, Hameed BMZ, Hegde P

Kasturba Medical College, Manipal

Objectives: To obtain a multi-domain, patient reported, response to urethral stricture surgery done at a tertiary health care center as a measure of standard of care and service evaluation benchmark. Material & Methods: The USS PROM questionnaire developed by Jackson et al. in 2011, comprising of six-item LUTS domain, a LUTS-specific QOL question, and a peeling's voiding picture score was modified with the addition of six-item IIEF, Four-item version of MSHQ-EjD and six-item oral morbidity evaluation domains, in an attempt to achieve a holistic approach to the evaluation of stricture surgery outcomes. All consecutive urethroplasty patients from June 2016 to January 2017 that consented to filling of questionnaire were enrolled into the study. Results: Thirty-three Bulbar, 28 penile and 16 PFUDD patients underwent urethroplasty during the study period. The median (range) follow-up was 20 (6–24) months. Total LUTS scores improved from a media of 20 at baseline to 8 at 2 yr. A total of 20 men (87%) felt their urinary symptoms interfered less with their overall quality of life, 2 (8.6%) reported no change, and 1 (4.4%) was worse 2 yr after urethroplasty. Overall, 72 men (94%) remained ''satisfied'' or ''very satisfied'' with the outcome of their operation. Conclusions: It is the first Indian study to prospectively evaluate urethral reconstruction using the 'modified PROM. Men reported continued relief from symptoms with related improvements in overall health status 2 yr after urethroplasty. These data can be used as a provisional reference point against which urethral surgeons can benchmark their performance.

   CKP 02: An insight in to the knowledge, attitude and perceived barriers towards the practice of evidence based urology (EBU) among urological trainees in india Top

Mukherjee P

Christian Medical College, Vellore

INTRODUCTION Evidence-based medicine is increasingly being incorporated in clinical decision making. With the number of journals and newer treatments increasing in our specialty, the extent to which urologists are aware of the principles of evidence-based practice is unclear. The aim of this study was to assess the attitude and knowledge of urology trainees towards evidence based urology (EBU) and their perceived barriers to its practice. METHODS This was a prospective questionnaire based study done on urology residents. Residents who consented were administered a questionnaire incorporating the McColl questionnaire and the BARRIERS scale. RESULTS 103 urology residents from 55 training centers in India responded to the questionnaire. Of the respondents, 63 (61.2%) were extremely welcoming towards EBU. However, 60 (58.3%) felt their colleagues were not as welcoming to EBU as they themselves were (p value 0.007). Formal training in an evidence based medicine workshop was received by 11 respondents (10.7%). Only 47 (46%) of the residents had access to the PUBMED at work. Inability to understand statistical analysis was the most common perceived barrier towards practicing EBU. CONCLUSIONS Although urological trainees have a positive attitude towards EBU, lack of formal training in appraising available literature and logistic factors such as lack of protected time and portals to access evidence at the work place, deter them from practicing the same.

   CKP 03: Evaluation of outcomes of autologous saphenous vein graft versus oral mucosal graft in urethroplasty for anterior urethral stricture: A comparative study Top

Rao Swatantra Nagendra, Khattar Nikhil, Goel Hemantl, Sharma Umesh, Akhtar Arif, Sood Rajeev

PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi

Introduction and Objective: Oral mucosal graft is gold standard for urethral substitution but has poor results in long anterior urethral strictures (>7cm) and in chronic tobacco exposed mucosa. Saphenous vein has been recently described for long segment anterior urethral stricture with successful initial results. The objective of this study was to assess outcome of autologous saphenous vein graft and oral mucosa graft for urethroplasty in long anterior urethral stricture. Methods: A total of 30 patients with diagnosis of anterior urethral stricture of size greater than 7 cm were admitted for substitution urethroplasty. 15 patients had healthy oral mucosa, underwent Oral mucosal graft urethroplasty (Group-1) and 15 patients had unhealthy oral mucosa due to chronic tobacco exposure, underwent everted Saphenous vein urethroplasty (Group-2). Outcomes were compared using IPSS, uroflowmetry, donor and recipient site complications at 1, 3 and 6 months while Retrograde Urethrogram and Micturating Cystourethrogram was done at 3 months in both groups respectively. Results: Mean stricture length and harvested graft length were 10.8 cm and 12.33 cm in group-1 while in group-2, were 13.6 cm and 15.73 cm respectively. At 6 months mean IPSS and Qmax were 9.07 and 22.63 ml/sec in group-1 while in group-2, were 9.36 and 20.53 ml/sec. Donor and recipients site complications were comparable in both the groups. Twelve patients (80%) in Group-1 and thirteen patients (86.67%) in Group-2 had successful outcome at 6 months. Conclusion: Saphenous vein is an excellent option in long segment anterior urethral stricture patients with chronic tobacco exposed oral mucosa.

   CKP 04: Radical cystectomy and W-shaped ileal orthotopic neobladder reconstruction with serosa lined tunneled uretero-ileal anastomosis: A critical analysis of Voiding pattern, Urodynamic outcome, Oncological results, Complications, and Quality of life assessment Top

Singh Dharmveer, Rahul Soni, Uday Pratap Singh, S Sureka, A Srivastav

SGPGIMS, Lucknow

Objective:To evaluate voiding pattern, urodynamic, complications, oncological outcomes along with QOL assessment of ''W'' ileal orthotopic neobladder, with non-refluxing extramural serosa-lined tunnel ureteroilealanastomosis after radical cystectomy. Methods: 26 patients underwent orthotopic neobladder were enrolled prospectively. Data were analyzed in terms of voiding pattern, urodynamic findings, oncological outcomes, and complications till last follow up. Health related Quality of life (HRQoL) was assessed using European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30) and the Ileal orthotopic neobladder-Patient Reported Outcome (IONB-PRO) questionnaire. Results: At 1-year, daytime continence was present in 92% and nighttime continence in 56.7% patients. 11 patients were incontinent: 7 had mild, 3 had moderate and 2 had severe incontinence at 1 year. However, nighttime incontinence rates improved to 71.4% at 2 years. The average capacity of neobladder was 436.3 ml. The maximum urine flow rate was 14.7 ml/sec with a post-void residual urine volume of 123.7 ml. Three patients of bladder cancer developed local recurrence and were treated with systemic chemotherapy. Two patients had reflux and no patient had uretero-ileal anastomotic stenosis. Deterioration of renal function was observed in two patients and UTI in 8 patients. Two pa¬tients required self-catherisation who complained of voiding difficulty ([Table 3]). “Cognitive” domain had highest and “global quality of life” domain had lowest level in EORTC QLQ-C30 questionnaire. “Nausea and vomiting; and Abdominal bloating and flatulence” domain had lowest level and “financial difficulties and urinary symptoms” had highest levelof symptomatology in EORTC QLQ questionnaire. The IONB-PRO questionnaire showed the highest level of functioning in “relation life” and lowest level in “ emotional life” domain. Conclusion: It provides and technically feasible, oncologically safe with accept¬able complication rate. The urodynamic and functional evaluation of patients demonstrated that it provides a near-normal storage capacity and voiding pattern. Urodynamic parameters of the neobladder were similar to those of a normal urinary bladder. The patients have a mild to moderate impairment of their HRQoL when investigated by means of generic, disease specific and IONB-PRO specific questionnaires.

   CKP 05: DE-Ritis Ratio: An inexpensive tool to predict recurrence after resection of non-metastatic renal cell carcinoma Top

Singhal P, Singh SK, Mandal AK, Bora GS, Kakkar N

PGIMER Chandigarh

Introduction: Pre-operative De Ritis ratio – AST/ALT ratio – has recently been proposed as a prognostic marker after surgery in renal cell carcinoma (RCC). We conducted this study to determine the prognostic significance of AST/ALT ratio among patients of non-metastatic RCC in our population. Methods: In this retrospective and prospective observational study, all consecutive patients who underwent complete resection of non-metastatic RCC from January 2013 to September 2016 were included and followed till June 2017. Patients with other co-existing malignancy were excluded. The association of AST/ALT ratio was assessed with disease recurrence and mortality. Results: Total 331 patients met the inclusion and exclusion criteria. Total 29 (8.8%) patients had recurrence in mean follow up of 20.1 months. The mean value of pre-operative De Ritis ratio in patients with recurrence was significantly higher than patients without recurrence (1.48 ± 0.84 vs 1.11 ± 0.56; p=0.007). Low hemoglobin, high alkaline phosphatase, tumor pT stage, tumor size > 7 cm were other factors found significantly associated with recurrence. On multivariate analysis, tumor pT stage [HR 1.925 (95%CI 1.162-3.191)] and pre-operative De Ritis ratio [HR 3.421 (95% CI 1.323-8.846)] were found as independent predictors of recurrence. ROC analysis suggested that De Ritis ratio more than 1.087 predicted higher chances of recurrence of disease [15/106 (14.2%) vs 9/162 (5.6%); p=0.009] and overall mortality (p=0.007). Conclusion: Pre-operative De Ritis ratio >1.087 can be used as a simple tool to predict high risk of recurrence and mortality after surgical resection of localized RCC in our population.

   CKP 06: Hematogenous dissemination of tumour cells following standard transurethral resection of bladder cancer and its correlation with final histopathology Top

Sumit Saini, Rishi Nayyar, Alpana Sharma, Seema Kaushal, Prem Nath Dogra

All India Institute of Medical Sciences, New Delhi

Objective: Transurethral resection of tumour is the initial diagnostic and therapeutic procedure for Bladder Carcinoma. Hypothetically, tumour resection could induce hematogenous seeding of cancer cells into the circulation. In this study we tried to ascertain whether transurethral bladder tumour resection induces measurable seeding of cancer cells into the vascular system. Methodology: Patients newly diagnosed with bladder carcinoma based on the presentation and imaging studies, were enrolled. Peripheral venous blood samples were drawn, both before and after transurethral bladder tumour resection. It was then analysed using flow cytometry to ascertain number of circulating tumour cells (CTCs). The number of CTCs identified was compared in preoperative and postoperative samples. We also assessed for the correlation of CTCs with final histopathology of the specimens. Results: Out of 24 total patients studied, 1 was tested positive for CTCs in preoperative sample (8 CTCs in 10 ml of blood). Postoperatively in the same patient the number of CTCs increased to 14 in 10 ml of blood drawn. It was later found to be T4 disease. Another 3 patients, were tested positive for CTCs in the postoperative samples only (0 vs 6, 0 vs 4 & 0 vs 6). On final staging, 2 patients had T3 and 1 patient had T2 disease. All patients who tested positive for CTCs were high grade and muscle invasive. Conclusions: Our study confirms that tumour cells can be released into the circulation during transurethral bladder tumour resection, more specifically in patients with higher grade and higher stage of the disease.

   CKP 07: Percutaneous Nephrostomy in salvageability of giant hydronephrosis Top

U Venkatesh, AR Balaji, JVS Prakash, Vetrichander, Arasi

Government Stanley Medical College, Chennai

Introduction: The presence of over 1000 ml of urine in a hydronephŹrotic sac in an adult is usually categorised as giant hyŹdronephrosis. All patients with giant hydroneŹphrosis do not have similar anatomical configuration and functional status of renal units, and therefore treatment has to be individualized in every patient. Hence assessing the salvagability of these kidneys becomes all the more important. We have selected such cases for further evaluation with Doppler, Diuretic renogram, USG for cortical thickness and Percutaneous nephrostomy. Our aim was to study all these factors and conclude which investigation gives the best assessment of salvagability Aim and Objective 1. To assess the salvagability of Giant hydronephrosis, non visualized on IVU, using percutaneous nephrostomy 2. To compare various parameters used to estimate the recoverability of renal function Materials and methods: All patients admitted with giant hydronephrosis at government Stanley medical college between august 2013 and February 2016 were included in this study. Factors like cortical thickness, compensatoryhypertrophy, Diuretic renogram, Resistive index were studied in all these cases and renal salvagability is predicted. Then percutaneous nephrostomy was done in all these cases and pcn fluid analysis was done and renal salvagability is reassessed in these cases. Results: Predicting the salvagability of chronically obstructed kidneys basedon single parameter or combined parameters can be misleading. Percutaneousnephrostomy is a simple, objective assessment of the kidney function. In ourstudy, it has altered the management in 38% of patients. Based on our analysis, it can be safely concluded that Percutaneousnephrostomy is a useful tool in accurate assessment of chronicallyobstructed kidneys.

   CKP 08: Comparative study of outcomes of Ejaculation preserving TURP (epTURP) vs Conventional TURP: A Prospective Randomised study Top

Varinder Singh

Institute of Nephrourology, (INU) Bangalore

Introduction: Loss of antegrade ejaculation following transurethral resection of prostate (TURP) is such an unconquered morbidity that it has been taken as a sequelae of TURP. Given an option most sexually active men undergoing TURP are likely to prefer to have their ejaculation preserved. The aim of this study was to compare the functional and ejaculation related outcomes of a novel technique – epTURP vs conventional TURP. Methods: 90 sexually active patients with preserved antegrade ejaculation, aged between 43 to 77 years (mean age 60.88 ± 7.07 yr), with BOO due to BPH, entered the Prospective randomised study conducted from March 2016 to May 2017. After randomization, patients were divided into group A- underwent epTURP and group B – conventional TURP. The epTURP done in this study was based on the new hypothesis that the paracollicular and the supramontal prostatic tissue plays a role in preserving antegrade ejaculation. End points of study were change in objective (Uroflowmetry) and subjective (IPSS, Life Quality index LQI, IIEF-5 score, post coital urine R/M exam for sperms) parameters. Results: Antegrade ejaculation was preserved in 84.61% (38/45) patients who underwent epTURP as compare to 11.1% of conventional TURP. Mean IPSS, Qmax, PVR reduced significantly (p<0.05). The Quality of life (Qol) improved significantly in all the patients. Conclusion: Antegrade ejaculation can be preserved with the use of epTURP with excellent outcomes. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology and need to take into consideration the unnecessary retrograde ejaculation in TURP.

   CKP 09: Correlation of urodynamic parameters to long term outcomes following posterior urethral valve fulguration Top

Vinod Kumar P, Prasanna Venkatesh M K, Venkatesh Krishnamoorthy

NU Hospitals, Bangalore

INTRODUCTION AND OBJECTIVE: Posterior urethral valve (PUV) is the most common congenital obstructive uropathy where bladder dysfunction is one of the most important factors for renal deterioration. Urodynamic studies will help in identification of the type of bladder dysfunction and in planning management. Our aim was to evaluate the urodynamic parameters after PUV fulguration thereby correlating urodynamic parameters to long term renal outcomes. METHODS: 40 children with PUV from 1999 to 2016 fulfilling the inclusion criteria were studied. Urodynamics was done during follow up who had persistent hydroureteronephrosis or recurrent UTI. Independent't' test and Mann Whitney test were used to calculate p-value. After checking normality of the data, Pearson's coefficient (r) was calculated. RESULTS: On Urodynamics, 95% patients had normal sensation. Most children in all age groups had normal compliance except in 6-10 year age group where half of the children had poor bladder compliance. 27 children (67.5%) had normal bladder compliance. Overall, 13 children (32.5%) had detrusor overactivity. Five of Nine patients (55%) who had recurrent UTI showed poor compliance. Cystometric capacity showed significant association with APD of right pelvis, left pelvis and right ureter. Pdet Qmax showed significant association with APD of left ureter. There was a significant difference only between mean end filling pressure in those children with normal compliance when compared with poor compliance. CONCLUSION: Urodynamics is important during follow up of PUV children. Early intervention of abnormalities detected in bladder storage and/or emptying will improve drainage and may delay or prevent the onset of ESRD.

   SS Bapat Prize Paper Session For New Innovations & Technologies Top

   INT 01: Face, Content and Construct Validity of a Novel Chicken model for laparoscopic ureteric reimplantation Top

Abhishek Singh, Shrikant Jai, Arvind P Ganpule, Mohankumar Vijay Kumar, Sudharshan SB, Ravindra B Sabnis, Mahesh Desai

Muljibhai Patel Urological Hospital, Nadiad

Introduction and Objectives: Very few training model for reconstructive laparoscopic surgeries have been described. Aim of our study is to validate a cadaveric chicken trachea and crop model for laparoscopic modified Lich Gregoir type of ureteric re-implantation. Material and Method: In this Prospective observational study, 30 Novice surgeons and 20 trained laparoscopic surgeons were included. The relevant chicken anatomy and surgical steps were described to all the surgeons. The surgeons were asked to fill an eight-point questionnaire after finishing the procedure and score it on a scale of 1 to 5. The participant's performance was also recorded by an independent observer (AP) on a Performa. Investigator recorded dissection time, suturing time, quality of dissection, quality of suturing and integrity of anastomosis on a scale of 1-5. Results: All the participants gave a mean score of 3 or more to all the questions asked, except for one question pertaining to tissue feel. Both the groups rated the usefulness of the model very highly, with a mean score of 4.20 and 4.15 respectively. Difference in the time taken for dissection (9.63 ± 2.63 vs 6.95 ± 2.32 minutes, p=.001) and suturing (51.83 ± 14.73 vs 37.15 ± 13.29 minutes, p=.001) along with the quality of suturing were statistically significant in favour of the expert group. Conclusions: The Chicken model for laparoscopic ureteric re-implantation is useful, effective and a cognitive training tool. This model has a Face, Content and Construct validity to be used as a teaching and learning tool in laparoscopic urology.

   INT 02: Use of laptop/ tablet in place of imaging video display monitor in Endourology Top

Ankit Kayal, Tapan Kumar Mandal, Tapas Kumar Majhi, Sunirmal Choudhary

NRS Medical College, Kolkata

Introduction Various display monitors provide clear brilliant images on spacious widescreen display. Similar quality of picture with improved color reproduction and facility to the recording can be done on the laptop. Laptop and tablet can also be used as imaging video display monitor in Endourology. Material and methods We cannot connect S video output or HDMI output of the camera to the laptop directly. We have to connect it with the help of capture card which is regularly used in dish antenna. To make a connection we need S video to S video cord and one capture card. Every capture card has software which we have to install in your laptop. After that make a simple connection from camera output to S video cord, to S video cord to capture card and capture card to laptop. In a case where we use s video we have a similar one chip quality picture, while in case of HD capture card and HD Video cord we get HD quality pictures. Results There is insignificant time lag which does not hamper our endourology work. We can also record the endourology procedure simultaneously without extra recording system on the same laptop. Conclusion This is very easy and simple and effective tool to use the laptop as monitor for any endourology (like Cystourethroscopy, TURP/TURBT, URSL, PCNL ) procedures. It is also very cheap and avoids need for keeping extra monitor and recorder.

   INT 03: Development of an innovative Intrarenal Pressure Regulation System (IPRS) for MINI-PERC - A preliminary study Top

Ashish Rawandale, Arvind Ganpule, Lokesh Patni

Institute of Urology Dhule, MPUH Nadiad

Introduction Miniaturisation of PCNL has come with the necessity of high pressure irrigation systems to maintain visual clarity-resulting in increased intrarenal pressures and complications. We describe and validated our innovative, open platform, portable, automated pressure irrigation system which allows surgeon to control intrarenal pelvic pressures during miniPCNLs. Methods: The project was planned in four steps: Step 1. Pilot study to access the usual intrapelvic pressures during 15Fr miniPCNL Step 2. Prototyping of the IPRS Step 3. Evaluation in a Bench model Step 4. Initial clinical evaluation of IPRS Results: Step 1-5 pilot cases showed a maximum recorded pressure of 25 cm water. In Step 3 and 4 at different maximum pressure settings the IRPS was found to measure the intrarenal pressures accurately and prevented intrarenal pressure surge above the “Set maximum pressure limit on the IPRS”. In Step 4 the minimum pressures remained a little higher during the stone manipulation part of the surgery. Conclusions: Our Intrarenal Pressure Regulation System is the first of its kind open platform, portable unit that can be added on to the commercially available pressure pumps. This makes it affordable and universally adaptable and applicable. It precisely monitors and controls the intrarenal pressure. It has the potential to reduce the high irrigation pressure related complications associated with miniaturisation of PCNL

   INT 04: Dalela Triple J Stent: A new stent for minimizing dysuria Top

Divakar Dalela

KGMU, Lucknow

In order to minimize stent dysuria following ureteral stenting, a new stent design was developed wherein an additional J like bent was incorporated in the memory of lower end of the shaft of the stent about 6 cm proximal to the tip of lower end which, after stent deployment, helped to locate the lower coil towards the dome well away from the sensitive trigone of bladder. The present study was conducted to assess the impact of changes in stent design on dysuria. This study group comprised 37 patients who underwent either PCNL or URS and the control group comprised age and sex matched patients of PCNL/URS who were stented with conventional Double J stent. Each patient was telephonically asked to comment upon presence or absence of dysuria on post op day 3 and again on day 7. On 3rd PO day, in study Gp 25/33 (75.75%) were dysuria free as compared to 10/24 (41.66%) and on 7th PO day 30/33 (90.9%) in study Gp and 16/24 (66.67%) were dysuria free. 4 cases in study gp and 5 cases in control gp were excluded as they developed UTI. Thus, the TJ stent caused dysuria in less number of patients.

   INT 05: Recalcitrant Bladder Clot Evacuation By LASER Top

Goel Shailendra Kumar, Kumar Anant, Dassi Vimal, Chauhan Upwan, Kumar Anurag, Chaudhary Vishal

Max Super Speciality Hospital, Vaishali, Ghaziabad

Objective: To introduce an alternative innovative technique of removal of recalcitrant urinary bladder clot. Method: In this technique, Holmium LASER fiber of 600-micron size was introduced under vision through either working element of 26 F Resectoscope or working channel of 20 F cystoscope. Organised clot was resected / incised into pieces by LASER beam at low power setting (Ablation mode, 12 W,1000 mJ X 12 Hz). Clot fragments were evacuated using Ellick evacuator. Any bleeder or stone could also be dealt simultaneously with same LASER. Results: We tried this method in index case, after failed clot evacuation by Ellik evacuator, Mechanical cutting by Loop and Suction technique. LASER cutting of clot was easy and fast. Moreover, it was under endoscopic vision unlike other blind methods. Incidentally detected bladder stone was fragmented and removed by same LASER in same sitting. Thereafter, this method was applied upfront in next 7 cases of hematuria with clot retention. In 6 out of 7 cases, this method was found to be easy, effective and fast. In one case, vision was getting repeatedly blurred due to release of blood from fresh clots (<24 hours) after incising with LASER. In this case, clot could be successfully evacuated by suction and fishing technique. Conclusion: LASER clot resection is easy, fast, efficacious and under vision endoscopic technique of evacuation of recalcitrant bladder clot.

   INT 06: Cystoscopic Stent Removal Using Smartphone Top

Singh Shanky, Vikas Vaibhav, Soni Jatin

Government Medical College, Trivandrum

Sohn, in 2013, developed “Endockscope” which connects flexible endoscope but only with Apple iPhone 4S smartphone. Our study aims to demonstrate how to connect smartphone with cystoscope using commercially available universal “digiscoping” adapters during cystoscopic DJ stent removal when instruments, equipment and machines for video cystoscopy are expensive and not readily available in some hospitals. METHODS A vertical screw-in type “digiscoping” adapter Gosky smartphone adapter - model number: QHAP002 was used in our study. It was connected to an Android “camera-smartphone” Redmi note 4. When camera of smartphone was carefully aligned to cystoscope which was fitted with shims, DJ stent images viewed on screen of smartphone can be focused and zoomed in for desired size. DJ stent images viewed on screen of smartphone and on laptop monitor by wireless “screen mirroring”, were noted to be acceptable. Photographs of endoscopic DJ stent images were taken for review and then stent was removed. RESULTS This technique has been tried in 10 female patients at our institute. Of these, 4 had bilateral DJ stent. The stent could be removed in all the patients without any procedure-related complication. During “wireless screen mirroring,” there appears to be some delay in viewing image in laptop monitor. CONCLUSIONS Smartphone can be connected with cystoscope using commercially available universal “digiscoping” adapters during DJ stent removal. DJ stent images viewed from screen of smartphone or simultaneously in laptop monitor, as well as photographs of cystoscopic images, were acceptable during removal.

   Vijaywada Poster Prize Session Top

   VPP 01: Solitary Penile Nodule: Diagnostic Pitfall Top

Narang Vineet, Bhatyal Hardev, Arya Ankur

BLK Super Speciality Hospital, New Delhi

Introduction: Solitary painless nodule on the shaft of the penis in the sexually active elderly male is most commonly due to Peyronies disease. Other causes include penile cancer and penile metastasis. We report a case of metastatic prostate cancer presenting as a solitary penile nodule which was treated as peyronies disease for six months. Material and Methods: A 70 year old sexually active male presented to us with history of Mild LUTS and a painless nodule in the left shaft of penis of six months duration. He gave history of being treated for peyronies disease by means of intra-lesional steroid for the past 6 months with no response. On examination there was a 2 cm painless nodule on the left mid shaft region with no inguinal lympadenopathy. A DRE revealed a hard nodular prostate. PSA was within normal limits. Transrectal prostate biopsy done divulged prostate adenocarcinoma (gleason 4+5). PSMA PET revealed multiple PSMA avid lesions in prostate, bilateral corpus cavernosa, lungs and bones. FNAC from the cavernosal nodule showed metastatic adenocarnioma with PSA staining. Results: Solitary painless penile nodule as an Initial manifestation of metastatic prostate cancer. Conclusion: Penile nodules in the elderly are a matter of concern with penile cancer and penile metastasis as important differential diagnosis. Although penile metastasis is usually multiple it can also present as a solitary nodule. We advocate that penile nodules in the elderly should be closely followed and investigated (Imaging & Biopsy ) as they may be the first manifestation of metastatic disease.

   VPP 02: Isolated brain metastasis from prostate cancer: a case report Top

Ankit Singla, Pars Ram Saini, Amit Tuli, Prateek Laddha, Abhishek Singh, Krishna Murari, Kim Mammen

Christian Medical College Ludhiana

Introduction: Prostate cancer commonly metastasizes to the pelvic lymph nodes, and axial skeleton. Brain metastases from prostate cancer are rare. These metastases typically only occur in the context of widespread metastatic disease. It is even more uncommon to have brain as the sole site of metastatic prostate cancer. Material & Methods: 80-year-old male was initially diagnosed with prostate cancer after TRUS guided prostate biopsy following a high PSA value. Biopsy revealed adenocarcinoma prostate with Gleason's score of 3+4. Bone scan revealed no bony metastasis. In January 2017, the patient developed an episode of generalized tonic clonic seizure at home and was brought to the Emergency where MRI brain showed multifocal supratentorial enhancing lesions with mild to moderate perilesional edema, internal heterogeneity and blooming involving the right frontal lesion suggestive of metastasis. Patient started on antiepileptics. Patient improved and was discharged on these medications. Results: The ante-mortem diagnosis of a solitary metastasis to the brain from prostate cancer is exceedingly rare; our review of the literature identified 16 previously-reported cases in the literature over the past 25 years. Survival in these cases generally ranged between 2 to 20 months. For decades, surgical resection with adjuvant WBRT has been the standard of care for solitary metastases in the brain. Conclusion: Metastatic disease exclusive to the brain in prostate cancer patients remains extremely infrequent. This unique case of an 80 year old male with a isolated brain metastasis arising from prostate cancer demonstrates that palliative care treatment with antiandrogen and anticonvulsant is effective in managing brain metastasis at his age.

   VPP 03: Diagnostic efficacy of Gallium 68 Prostate Specific Membrane Antigen Positron Emission Tomography (PSMA PET) compared to Magnetic Resonance Imaging for lymph nodal staging in patients with intermediate and high risk prostate cancer Top

Ashwin Mallya, Indraneel Banerjee, Sachin AN, Tarun Jindal, Anil Mandhani, Rajesh Ahlawat

Fortis Escorts Kidney and Urology Institute, Delhi

Background and Aims: Current imaging techniques are insufficient to reliably stage lymph node metastases in Prostate cancer. This study was conducted to assess the role of PSMA PET in detection of lymph node metastasis in patients undergoing radical prostatectomy for intermediate (IR) and high risk (HR) prostate cancer. Methods: Between June 2016 and August 2017, 36 patients planned for robot assisted radical prostatectomy underwent PSMA PET CT (8/32 intermediate and 28/54 high risk). Extended lymphadenectomy was done in all patients and lymph nodes sent in separate packages. Pelvic lymph node findings on PSMA PET scan in terms of size and standard uptake unit (SUV) were compared with findings on MRI pelvis and final histopathology. Results: Lymph nodes were detected on PSMA PET in 67% (8/12) HR and 100% (1/1) IR patients. MRI could pick LN in 3 (25%) HR patients. Overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PSMA PET and MRI pelvis for lymph node staging in primary prostate cancer were 69%, 95%, 85%, 90%,80% and 20%, 97%,78%,75%, 78% respectively. Mean (range) Standard uptake value on PET and mean (range) size on MRI of positive lymph nodes was 5.4 (4.6-7.3) and 14 mm (12-16). Conclusions: PSMA PET is superior to MRI pelvis for lymph node staging in IR and HR prostate cancer. This would help in clinical decision making regarding lymph node management during surgery.

   VPP 04: Robot Assisted Renal Transplantation: Debunking the myths Top

Deshmukh C S, Ganpule A, Sudharsan S B, Singh A, Mohankumar V, Sabnis R B, Desai MR

Muljibhai Patel Urological Hospital, Nadiad

Aim: To analyze perioperative parameters in robotic renal transplantation (RRT) and impact of intraperitoneal approach for graft implantation on postoperative managements and outcomes. Material and Method: Sixteen end-stage renal disease patients underwent living donor RRT between October 2014 and July 2017 at single tertiary care center. Retrospective analysis of donor and recipient characteristics, intraoperative parameters, perioperative complications and graft survival during follow up was done. Requirement of any accessory procedure during follow up was also noted. Result: All 16 patients underwent successful robotic RRT without conversion to open. Mean age and BMI of patient was 39.25 years and 24.69 kg/m2. Mean warm ischemia and cold ischemia times were 4.9 minutes, 104.75 minutes. Mean operative and console times were 269.8 minutes and 226.6 minutes. One patient required graft ureter to native ureter anastomosis in view of topsy-turvy graft kidney. No patient had urinary, vascular or wound complication postoperatively. Four patients underwent renal biopsies in postoperative period with no post-procedure complications. No patient developed delayed graft function. Mean nadir S. Creatinine at discharge and at 1 year follow up (n=14) were 1.4 mg/dl and 1.33 mg/dl, respectively. Two patients developed right iliac fossa lymphocoele during follow up. One patient was managed with ultrasound guided aspiration and the other patient underwent laparoscopic marsupialization. Conclusion: Robotic renal transplant is a safe modality. It does not have a significant impact on graft survival irrespective of donor and recipient characteristics. Despite its intraperitoneal approach, renal biopsy can be performed safely and lymphoceles can occur which can be managed effectively.

   VPP 05: Safety and efficacy of supra-costal approach for PCNL in pediatric patients: Application of Clavien Classification System Top

Gupta Shashikant, Gaur Pankaj, Singh UP, Sureka SK, Shrivastava A, Ansari MS


Objective The purpose of study was to evaluate the success and morbidity of percutaneous nephrolithotomy (PCNL) performed through the 11th intercostal space and compare it with the subcostal approach. Study design and technique Data of patients with renal calculi under 18 years of age were prospectively collected between January 2010 and December 2015. Patients were divided into two groups those done with supracostal (group 1) and subcostal access (group 2). Patient characteristics, stone location, stone burden, number and location of the access point, operative time, visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared between group 1 and group 2. On day 1 of the operation, all patients were investigated for complete blood count (CBC) and any fall in the hematocrit level. Postoperative chest X-ray was routinely done in all cases in supra-costal access. Results Between January 2010 and December 2015, 75 paediatric patients underwent PCNL of whom 55 matched the selection criteria. Of these, 25 and 30 had a supracostal and subcostal access respectively. Stones bulk (median 2.5+1.9 cm) and locations were comparable in both the group. The stone-free rate was 84.8% and 85.36% in groups 1 and 2 respectively after one session of PCNL. Auxiliary procedures like relook nephroscopy, shock wave lithotripsy (SWL), ureteroscopy (URS) and RIRS were required in 5, 5, 1and 1 in both the groups. After the auxiliary procedures, stone-free rates increased to 96.0% and 97.6% in groups 1 and 2 respectively (p=0.982). Change in hematocrit level (p=0.261), visual pain score/ need of analgesia (p=0.368)), and hospital stay (p=0.231 ) were not statistically significant in two groups. A total of 27 (49%) complications were documented in the two groups according to modified Clavien classification. Overall complication rate was 28% in group 1 and 25% in group 2 (p value =0.799). Grade-I complications were recorded in 17 (30.1%), grade-II in 8 (14.5%) and grade IIIb in 2 (3.63%) patients. Grade-IIIb complications were recorded in group1 only; 1 in the form of nephropleural fistula which responded to repositioning of JJ stent and placement of a nephrostomy tube and another hydropneumothorax requiring intercostal tube drainage. There were no grade-IV or grade-V complications. Conclusion Supracostal PCNL in selected cases is effective and safe with acceptable complications in pediatric patients. The modified Clavien system provides a standardized grading system for complications of PCNL in pediatric patients.

   VPP 06: Look at Images…not only report…How Important is it for Endourologists to Look at Films Prior to Decision-making? Top

Haresh Thummar, Shivang D, Jigish V, Keya T, Nisha T, Nelson Z, Pokhraj S, Vithlani Dr


Introduction: The diagnosis and management of endourological conditions is highly dependent on imaging studies. Radiology reports do not always address all the issues relevant to decision-making, and on occasion can be inaccurate. To our knowledge, there is no data available in the endourological literature regarding the importance of self-viewing of images by treating physicians. We prospectively compared the diagnosis and management of endourology patients based on CT radiology reports alone vs. the viewing of images by an experienced endourologist. Materials and Methods: We randomly selected 46 new patients referred to an endourology practice who came with CT radiology reports for evaluation. A diagnosis was rendered and a treatment plan was formulated based on the report and history and physical exam. Following this, during the visit, the actual images were obtained and reviewed in detail and a final diagnosis and treatment plan rendered. Comparative findings and decisions were graded according to our protocol. Results: We saw changes in findings or treatment plan after reading of images in 29 patients (63.1%). Discrepant findings included wrong side in report, inaccurate stone size, missing stones, inaccurate location of stones, number of stones, degree of hydronephrosis etc. New findings included presence of AML, contralateral stones, crossing vessels, retrorenal colon, malrotated kidneys, duplicated collecting system, horseshoe kidney, scoliosis, and others. Missing information that affected treatment strategy included skin to stone distance, stone density, stone volume, and presence of encrustations on stent already in place. Grade 1 changes (defined as minor differences not affecting surgical plan) were observed in 11/29 (37.9%). Grade 2 changes (change in type of procedure) were noted in 7/29 (24.2%). Grade 3 changes (decision for observation vs. surgery) were observed in 5 (10.9%). Grade 4 changes (an additional procedure needed during surgery) were observed in 3 (6.5%). Grade 5 changes (potentially severe complication avoided, e.g. retrorenal colon in case of PCNL, change in side of surgery, crossing vessel at UPJ in patient candidate for endopyelotomy) were observed in 3 patients (6.5%). Conclusions: In 39% of randomly selected patients, viewing CT images rather than relying on a report alone results in a significant (grades 2 to 5) change in treatment plan and can potentially avoid complications in endourology patients.

   VPP 07: Staging Of Pelvic Lymph Nodes In Urothelial Carcinoma Of Urinary Bladder By 18-FDG PET CT And Diffusion Weighted MRI Of Pelvis: A Pilot Study Top

Kshitij Bishnoi, Mete Uttam, Sood Ashwani, Kakkar Nandita, Lal Anupam

PGIMER, Chandigarh

Introduction: Functional imaging modalities like Diffusion weighted MRI (DW-MRI) and PET CT have shown to be better modalities in identifying the malignant tissues. The presence of lymph nodal metastasis in urothelial carcinoma of bladder is an important prognostic indicator. We conducted the study to find the accuracy of these imaging modalities to stage the pelvic lymph nodes. Materials and methods: Fifteen patients of muscle invasive bladder cancer, July 2015 to Dec 2016, were included in the study. Patients then underwent DW-MRI and PET CT as per standard protocol. Diffusion restriction and SUVmax values of pelvic lymph nodes were recorded. Patients then underwent radical cystectomy and histopathological analysis of pelvic lymph nodes done. Results The sensitivity of PET CT and DW MRI has shown 100% sensitivity in identifying the LNs. The specificity was 75% of PET scan and 58.3 %. DW-MRI. The ADC values of the true positive nodes were 0.81x10-3,0.89 x10-3, 0.91 x10-3 respectively. However the ADC values of the false positive lymph nodes were >0.94 x10-3. SUVmax of true positive lymph nodes were >4 and false positive were either equal or below 4. Conclusion PET scan has shown to have better accuracy to the DW-MRI in identifying the positive LN. However this need to be further validated based on the larger group of patients.

   VPP 08: Persistent Chyle Leak: A Nightmare Post Retroperitoneal Surgery Top

Mahendra Pal, GaganPrakash, Ganesh Bakshi

Tata Memorial Hospital

a) Introduction and Objective Chyle leak (CL) is an uncommon and unwanted event after retroperitoneal surgeries and is occasionally difficult to manage. It can lead to nutritional and immunological imbalance. We present a case in which chyle leak had to be managed surgically after trying all known conservative measures. b) Methods – 23 years female with left renal mass and regional lymphadenopathy had undergone open left partial nephrectomy. Histopathology showed clear cell renal carcinoma with nodal metastasis. Patient subsequently was on observation and follow up CT scan showed para aortic nodal recurrence. After a negative metastatic workup, left radical nephrectomy with complete lymph node dissection was performed. Histopathology revealed no residual tumor in the kidney but metastatic lymph nodes. Post-operatively patient had CL which was refractory to conservative management. Later there was no option left other than surgical intervention. c) Results- On exploration active CL was found at multiple sites in the interaortocaval region. Pledgets of fibrinogen/thrombin-coated collagen sealant patch were placed at individual leak sites. Area was reinforced with omental flap. Postoperative CL had stopped. Patient was discharged. On follow up, no collection was seen on CT scan. d) Conclusions- CL has adverse nutritional, physical and psychological effects on patient. Surgical management is usually the last option in its management after dietary modification and other measures fail. Very few patients reach this end. Collagen sealant patches and tissue glues, help improve the surgical outcome in presence of friable tissues and bad nutritional state.

   VPP 09: Improved Sexual function after dorsal vaginal graft urethroplasty for Female urethral stricture: A prospective, single centre experience Top

Mahesh Chandra Tripathi, Manasa T, Nikhil Khattar, Hemant Goel, Anuj Varshney, Rajeev Sood

PGIMER & Dr RML Hospital, New Delhi

Introduction: The therapeutic options for definitive management female stricture disease is limited owing to its rarity. Although because of less risk of fistula formation, Dorsal graft Urethroplasty theoretically gives the best outcome but the risk to sexual function is the concern as dissection is very close to clitoral cavernosal bodies. We conducted a prospective study to evaluate the early stricture outcomes and sexual function after dorsal vaginal graft urethroplasty. Materials and methods: In a prospective observational study, we evaluated 71 women with obstructive LUTS and relief on prior urethral dilatations between November 2015 and April 2017. All women diagnosed with dense fibrotic stricture were offered dorsal vaginal graft urethroplasty. In addition to flow parameters, sexual function was assessed using Female Sexual Function Inventory (FSFI) scores at 3 months. Results: Out of 29 patients with stricture a dense fibrous stricture was present in seventeen. Thirteen women underwent surgery. The stricture site was mid urethral in 11 and distal urethral in 2 patients. With a mean follow up of 8.5 months, the mean improvement in AUA score, Q max and PVR was -11.076, 15.64ml/sec and 90.31ml respectively. 12/13 patients were successful at 3 months postoperatively. Contrary to the hypothesis, the FSFI scores showed a mean improvement of 6.42 in 12 successful urethroplasties. None of the patients has incontinence. Conclusion: Dorsal vaginal graft urethroplasty is an effective procedure with favourable early outcomes. We noticed improvement in sexual function which was likely similar to improved sexual function in men treated of their outlet obstruction.

   VPP 10: Percutaneous Nephrolithotomy (PCNL) – Does it negatively impact GFR? Top

Mahesh MS, Suresh Bhat, Fredrick Paul, Alvin

Government Medical College, Kottayam

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the preferred method to treat complex kidney stone disease. Stone removal improves renal function. However, PCNL procedure may itself negatively impact the function of the kidney as the Renal parenchyma is directly invaded with this approach. So in our study we assessed the function of kidney before and after PCNL using 99Tc DTPA renogram. OBJECTIVE: To study the impact of PCNL on renal function using diethylene triamine penta acetic acid (DTPA) renogram. MATERIALS AND METHODS: Prospective longitudinal observational study. Patients with renal calculi who underwent PCNL in our institution were included. Patients not willing to participate in the study, those with residual stones and those who lost to follow up were excluded. S. Creatinine, Non contrast CT scan (NCCT) KUB and DTPA renogram were taken pre operatively. Post operatively, NCCT KUB was done to assess residual stones. DTPA renogram and were done 3 months after the procedure in those with complete stone clearance. Statistical analysis was done by paired t test. RESULTS: In a total of 100 PCNL pts, The mean pre op GFR was found to be 32.99 and mean post op GFR was found to be 34.314. there was no statistically significant difference(P value-0.054 >o.o5) in the renal function following PCNL. However in 8 out of 100 patients, decrese in >5ml/min/1.73m2GFR was noted. CONCLUSION: Percutaneous nephrolithotomy (PCNL) procedure removes the stone burden and may improve GFR in majority patients although not statistically significant. However, in minority of the patients, it negatively impacts the GFR.

   VPP 11: Determining the role of urethral self calibration in the prevention of recurrence of urethral strictures after visual internal urethrotomy (VIU) Top

Maheshwari R, Jain A, Kumar M, Singh A, Ganpule A, Sabnis RB, Desai M

Muljibhai Patel Urological Hospital, Nadiad

INTRODUCTION Stricture urethra is a disease known to the mankind since long time. VIU has greatly improved the dismal outcome of stricture urethra. Urethral calibration following VIU may benefit by bringing down the costs of treatment significantly by preventing recurrence of stricture disease. AIMS AND OBJECTIVE To determine the role of self-calibration in prevention of recurrence of strictures after VIU. MATERIAL AND METHODS This study is prospective randomized control study. 64 patients of urethral stricture were selected and randomly divided into two group: Group A (VIU followed by self-calibration) and Group B (VIU only). Post procedure 18Fr Foley's catheter was inserted which was removed on second post-operative day. Group A was taught self-calibration with 16 Fr Tiemann catheter once daily for the first 6 months, then once in 2 days for 3 months followed by weekly for the next 3 months up to a total of 1 year. Patients were assessed subjectively with symptom score and objectively with uroflowmetry/PVR in their followup. RESULTS Self-calibration has a statistically significant protective affect against the recurrence of urethral strictures (P=0.019) with recurrence rates of 21.88% and 50 % in Group A and Group B respectively. Majority recurrences in Group A occurred after the initial 6 months as opposed in Group B which occurred in the initial 6 months. CONCLUSION Self-calibration significantly decreases the recurrence and increases duration of stricture free rates.

   VPP 12: Imaging based scoring system to predict subtypes of renal cell carcinoma Top

Maheshwari R, Sudharsan SB, Singh A, Ganpule A, Sabnis RB, Desai M

Muljibhai Patel Urological Hospital, Nadiad

INTRODUCTION Classification of renal cell carcinoma into subtypes has become area of interest because of their association with prognosis. CT has been widely used for the evaluation of RCC and only few studies have attempted differentiation of subtypes of RCC. OBJECTIVE The purpose of our study was to predict histology of renal cell carcinoma on the basis of preoperative CT scan. MATERIAL AND METHODS We retrospectively reviewed CT scans of four subtypes of renal cell carcinoma – 88 clear cell, 36 papillary, 6 chromophobe, and 13 oncocytoma. A scoring system was formulated based on five components on CT scan–pre-contrast HU, post-contrast HU, contrast enhancement, presence/absence of necrosis, homogenous/heterogenous to predict the subtype of renal cell carcinoma. Score ranged from 5-13. Then score was applied prospectively for consecutive to 100 patients of renal mass and accuracy of scoring system was validated. RESULTS Clear cell carcinoma showed stronger contrast enhancement than the papillary and chromophobe (p < 0.05). Score of 7 was 100 % sensitive and 51.42% specific to differentiate clear cell from papillary RCC whereas score of 9 was 89.23% sensitive and 91.42% specific for the same. Chromophobe RCC and oncocytoma were not considered in score calculation due to low number of patients in both groups. CONCLUSION Differentiation of clear cell from papillary RCC using this scoring system gain importance for correct identification/prognostication and for initiating targeted therapy in metastatic RCC. More multicentric prospective studies are required to validate if this scoring system can effectively replace the need for biopsy.

   VPP 13: Body Mass Index (BMI) and urolithiasis - is there an association? Multiparametric analysis of various factors involved Top

Paul Vincent D, Venugopal K, Ravichandran R

Meenakshi Mission Hospital & Research Centre, Madurai

Introduction and objective: The incidence of urolithiasis is on the rise. Lifestyle and dietary choices are important causative factors. Though there are studies suggesting a doubtful association between obesity and urolithiasis, the various metabolic factors involved have not been studied in detail. Methods: This was a prospective study from October 1st 2016 to July 31st 2017. Patients with urolithiasis aged 18-60 years, undergoing intervention with detailed metabolic evaluation were enrolled. Patients with elevated renal parameters (>1.8 mg/dL) were excluded. All patients had detailed metabolic evaluation – Serum creatinine, calcium, phosphorus, uric acid, electrolytes and 24 hour urine estimation for calcium, phosphorus, urate, citrate, oxalate and protein. Stone analysis was performed when feasible. Statistical analysis was performed using Fisher exact t test, unpaired t test and ANOVA test. 'p' value of < 0.05 was considered significant. Results: There were 88 patients after exclusion. They were stratified according to BMI – 39 normal, 28 overweight and 21 obese. Overweight and obese patients had high 24 hour urine levels of calcium, urate, protein, phosphorus, sodium and potassium which were statistically significant. In obese recurrent stone formers, the 24 hour urine citrate level was significantly low. In diabetics, increased BMI and uric acid stones were found to be significantly high. Conclusions: Increased BMI is a significant individual risk factor for urolithiasis with increased excretion of stone promoters as well as decreased excretion of inhibitors, more so in recurrent stone formers. Weight reduction should also be strongly promoted as a preventive measure for urolithiasis.

   VPP 14: Predictors of Recurrence and Progression in NMIBC:A Single Institute Experience Top

Praveen Gopi, Vasudevan S, Singh Rustam, Sunil R, Mohan Shailendra, Kewlani Narain

Government Medical College Trivandrum

AIM To determine the predictive factors of recurrence and progression of NMIBC managed in a single centre. MATERIALS AND METHOD -259 patients (males:227, female:32) initially confirmed NMIBC after transurethral resection (TURBT) between January 2012 and June 2016 were retrospectively reviewed and included in the study. -Complete transurethral resection of bladder tumour of all visible tumours was carried out in all patients, and the stage and grade were determined -Bivariable analysis (Chi square test & Mann U Whitney test) and multivariable binary logistic regression were used to identify predictors of recurrence and progression. -The studied parameters included age, sex, Hb, Serum Albumin, ESR, NLR, PLR, hematuria as presenting complaint, stage, grade, tumour size, multiplicity, macroscopic appearance of the tumour, and type of adjuvant intravesical therapy (BCG, Mitomycin, Chemotherapy). RESULTS -The median (range) follow-up was 23 months -Mean age was 63.417±9.81, hematuria was the chief complaints for 82.2% patients. -41%(107) patients received adjuvant therapy (BCG-63, Mitomycin- 24, Chemotherapy-19) -97 (37.45%) patients had recurrence and 49 (18.9%) patients progressed to higher stage. -On multivariate analysis, patients with size >3cm and multiple tumors were found to have 1.7 times and 3 times greater odd of recurrence respectively as compared to patients with size < 3cm and single tumor -Patients diagnosed with T1 stage and multiple lesions were found to have 1.9 times and 1.8 times greater odds of progression respectively as compared to patients with Ta stage and single lesion. -Quantitative factors, none of them were significantly associated for prediction for recurrence and progression. CONCLUSION In our study, Multiple tumors had increased risk for both recurrence and disease progression. Size > 3cm was risk factor for recurrence but not progression 1 stage factor had increased risk for progression of disease rather than recurrence.

   VPP 15: Mature Adrenal Teratoma: A unique report of a unique condition Top

Preetham Dev, Girish TD, Sachin Dharwadkar, Vijaykumar R, Dhayanand GS, KM Madappa

JSS Medical College, Mysore

INTRODUCTION Teratoma is a germ-cell tumor that commonly affects the gonads. Its components originate from ectoderm, endoderm, and mesoderm. Extragonadal occurrence is rare. Teratomas in the adrenal gland are a rarity;with only a few cases reported thus far. CASE REPORT 49 year old, female patient presented with left flank pain. Physical examination and laboratory investigations were unremarkable. A CECT KUB showed a well-defined, heterogeneous lesion containing large amounts of macroscopic fat, calcifications and solid soft tissue areas noted in left suprarenal region possibly arising from left adrenal gland measuring 13.5 x 12.5 x13.5 cm, causing moderate hydroureteronephrosis and displacement of the left the kidney inferiorly. A provisional diagnosis of angiomyolipoma was made. Left adrenalectomy was done; cut section revealed multiple cysts with brown coloured fluid, hair follicles, cartilage, calcifications admixed with abundant yellow adipose tissue. HPE showed normal adrenal tissue with a lesion composed benign histological features from all the three germ cell layers. No evidence of malignancy was noted CONCLUSION Mass lesions in region of adrenal glands, may be functional or benign. Large lesions, like in our patient, alwayspose a challenge for the treating physician. Mature teratomas always arise from gonadal tissue or in midline structures. High index of suspicion and radiological investigation are the mainstay of diagnosis. These singulartumours are likely to be benign and carry excellent prognosis after treatment with an overall 5-year survival of nearly 100%.

   VPP 16: A comparative study of laser with and without suction as energy source in Mini-PCNL Top

Shrikant Jai, A Singh, Sudharshan, V Mohan, A Ganpule, RB Sabnis, MR Desai

MPUH Nadiad

Introduction: Fragmentation of stone does not necessarily equate to stone clearance. Use of suction to remove stone dust as it is produced by laser would expedite the procedure. We propose use of laser with suction device, which can be used in mini-PCNL. Objective: To compare 'laser with suction' (LWS) with 'laser without laser' (LOS) in terms of safety, efficacy and feasibility in mini –PCNL. Method: Retrospective analysis of 200 patients (100 LWS vs 100 LOS). Mini-PCNL was done using energy source as either LWS or LOS. Results were tabulated and analysed. Results: Both the group were comparable in terms of demographic data. Mean stone size was 15.24±5.90 mm and 16.16±5.53 mm in LWS and LOS respectively. Mean HU of stone was 1285.64 and 1206.79 in LWS and LOS respectively. Operative time was less in LWS group (56.89±19.65min) as compared to LOS (62.01±28.81 min). Post-operative haemoglobin drop, hospital stay and pain scores were comparable. LWS group had one patient with clavien – dindo grade III complication. At one month follow-up radiological complete clearance was 96% in LWS and 92% in LOS. One patient in LOS required repeat nephroscopy for residual calculi; other residual calculi were managed conservatively. Conclusion: Laser is a powerful energy source for fragmentation of stone. Adding suction to laser should fasten the clearance of fragments thus decreasing the operative time, the same is seen in retrospective analysis. We propose a randomized control trial to prove the efficacy of this device.

   VPP 17: Restaging transurethral resection in non muscle invasive bladder cancer is it always necessary? Top

Suyog Shetty, Suresh Bhat, Fedrick Paul, Ashwin Giridhar, Siddalingeshwara

Government Medical College Kottayam

Introduction Transurethral resection of bladder tumors is believed to under-stage bladder tumors. This is the reason why re-staging trans urethral resection of bladder tumor (TURB) after primary surgery is the standard of care in all patients with non-muscle invasive bladder cancers (NMIBC). But to have a common management plan for all non-muscle invasive tumors is probably an over simplification of the process. Thus our study is an attempt to evaluate the difference in rates of residual tumor and stage progression among the subsets of NMIBC (i.e. T1 both low and high grade, high grade Ta CIS). Materials and methods All patients diagnosed as non-muscle invasive bladder cancers on TURB were included. These patients were subjected to restaging TURB. Patient details, tumor morphology, histopathology of primary and restaging resections were recorded. Results and observation A total of 125 cases were included in the study of which 3 were high grade Ta and 122 T1 lesions. Residual tumor was seen in 24 patients (25.6%) and stage progression in 8 cases (6%). Of the 84 T1 low-grade lesions none showed stage progression, while residual disease was found in 15 cases (17.8%). T1 High grade lesions showed stage progression in 8 of the 38 cases (21.05%) and residual disease in 15(39.47%). Conclusion Restaging TURB is an important step in the treatment of high-grade T1 tumors irrespective of the presence or absence of muscle tissue in the primary resection. But low-grade tumors even in the presence of lamina propria invasion were not upstaged on reTURBs in our study. Therefore restaging TURB in low-grade T1 maybe not be beneficial.

   VPP 18: “Are we getting better? Evaluation of 45 consecutive cases of Robot Assisted Radical Cystectomy with Intracorporeal Ileal Conduit Diversion” Top

Tamhankar A S, Goel V, Zafar F A, Ahluwalia P, Ahlawat R, Gautam G

Max Institute of Cancer Care, Max Superspeciality Hospital, Saket, New Delhi

Introduction Pasadena consensus panel concluded that Robot Assisted Radical Cystectomy (RARC) has a learning curve of about 30 cases. We conducted an audit of 45 consecutive cases of RARC with intracorporeal ileal conduit diversion (IIC) with specific focus on 30 day complications. Methods Initial 26 cases (learning curve- group A) were performed on Si system and last 19 cases (beyond learning curve- group B) were performed on Xi system. Initial 16 cases had Wallace plate reconstruction and subsequent 29 cases underwent Bricker's ureteroenteric anastomosis. Results Median total console time and console time for intracorporeal conduit in minutes for group A were 310, 115 and for group B were 270, 80. Median total console times for Wallace and Bricker types were 370 and 270 minutes. Median blood losses were 325 ml and 300 ml respectively. Median length of stay were 9 days and 6 days respectively. Overall 30D complication rates by Clavien grade were 50% in group A (30.7% grade 3 and above) and 42.1% (all grade 1 - 2) respectively. Re-exploration rates in the two groups were 11.5% and 0%. Median lymph node yields were 27 (15-44) and 31 (15-54). Positive surgical margins were in 11.5% and 0% respectively. Conclusions Despite being a technically challenging procedure, the perioperative outcomes of RARC + IIC improve rapidly beyond the initial learning curve. Once standardized, intracorporeal diversion may have a potential to improve the safety profile of this complex procedure while preserving the benefits of MIS in patients undergoing RARC.

   Moderated Free Papers Session: Podium Session - P1 Top

   P1-01: Indian Aquablation experience with the robotic AquaBeam system for the targeted and heat-free removal of prostate tissue for the minimally invasive surgical treatment of BPH Top

Abhishek Singh, Ravindra Sabnis, Mihir Desai, Nikolai Aljuiri, Chaitanya Deshmukh, Arvind Gapule, Mahesh Desai

Muljibhai Patel Urological Hospital, Nadiad

Introduction We report the 1-year clinical results from our experience on the use of the AquaBeamŽ System to treat LUTS secondary to BPH. This product is an image-guided robotic system delivering Aquablation, a minimally invasive waterjet ablation therapy for the targeted and heat-free endoscopic removal of prostate tissue. Methods In this study, men over 50 years of age with an International Prostate Symptom Score (IPSS) greater than 12, a maximum flow rate of 15 ml/sec, and/0r a prostate volume greater than 25 ml were treated using the AquaBeam System (PROCEPT BioRobotics). Clinical parameters are assessed out to 1 year after surgery. Results Forty-seven males with symptomatic BPH were treated with Aquablation. The mean age was 66 ą 6 years with a mean prostate size of 48 ą 24 ml. All procedures were technically successful with a mean total operative time of 34.25 ą 18.52 minutes and Aquablation resection time of 3.33 ą 2.32 minutes. At 1-year follow up, Mean IPSS reduced from 24.4 to 4.7, QoL from 4.5 to 0.1, PVR from 119 to 18ml at, and Qmax improved from 7.1 to 16.2 ml/sec from baseline. At six months, reductions from baseline in prostate volume, PSA and Pdet@Qmax were 45%, 47% and 46%, respectively. None of the patients developed retrograde ejaculation, urinary incontinence, or erectile dysfunction. Conclusions Aquablation appears to be safe, feasible and time efficient. The clinical and procedural outcomes observed during this clinical experience support further research in a prospective randomized controlled clinical trial.

   P1-02: Is ultrasound estimated bladder weight a good indicator to assess Bladder Outlet Obstruction? Top

Amlani P, Bhirud P, Abhilash S, Santhosh S, Chally P, Azeez A, Chally R

Baby Memorial Hospital, Kozhikode

INTRODUCTION AND OBJECTIVE: To assess the correlation of International Prostate Symptom Score(IPSS) with ultrasound estimated bladder weight in patients of bladder outlet obstruction. MATERIALS AND METHODS: between May 2014 to April 2016 a total of 111 patients of bladder outlet obstruction due to benign enlargement of prostate were included in the study. IPSS was calculated. Urinary bladder weight determined by ultrasound by filling bladder with 200ml. RESULTS: Mean age of patients was 64 years with range being 50-85 years. About 75.6% of patients were in 6th and 7th decade. Out of 111 patients studied 23 had IPSS of 8 to 19(moderate) and remaining 88 had a score of more than or equal to 20. Out of 111 patients 94 patients has Ultrasound estimated bladder weight in range of 50 to 100 grams. Only 3 had weight less than 50 grams and 14 patients had weight more than 100 grams. On statitical analysis there was no correlation of IPSS with ultrasound estimated bladder weight overall. IPSS in mild, moderate and severe grades was compared to respective bladder weights. It revealed trivial Correlation of IPSS with ultrasound estimated bladder weight in patients with moderate IPSS whereas no correlation was noted in IPSS score of 20to35. CONCLUSION: According to this study there was no correlation of IPSS with ultrasound estimated bladder weight. Hence ultrasound estimated bladder weight is not a good indicator of bladder outlet obstruction.

   P1-03: A prospective study on supracoastal access technique for PCNL procedures Top

Burman Alakesh, Bhat A, Bhat M, Singh T, Chhabra M K, Tomar V S

Dr SN Medical College, Jodhpur

Aim :The advantage of Supracoastal access in PCNL procedures is direct access to pelvicalyceal system and upper ureter. However, risk of thoracic complications has led to relative underutilization of this approach. We prospectively evaluated the safety of supracostal PCNL procedures and its complications. Materials and Methods: A prospective analysis of patients who had PCNL between December 2014 and July 2017 was done. 63 patients needed supracostal access and were evaluated regarding the stone characteristics, intraoperative findings, postoperative course in the hospital and the complications. Results: Out of 543 patients, 63 patients (11.60%) had supracoastal access tracts made, supra 12th in 58 cases (92.06%) and supra 11th in 5 (7.93%). Complete stone clearance mandated having a second access tract in 13renal units and 58 renal units (92.06 %) were rendered stone free after primary and ancillary procedures. Intraoperative hemorrahge (6.34%)was the most common complication noted. Out of 2 patients with pleural effusion, one patient (1.58 %) required a chest drain. In post-operative follow up ranging from 1 to 30 months all patients had recovered well and were asymptomatic. Conclusions: The supracostal access for PCNL provides excellent access and direct visualisation of almost all of the PCS and upper ureter, reasonable operative times and good stone clearance. A thorough understanding of the approach and necessary precautions can minimize potential complications.

   P1-04: A comparative study to evaluate various nephrolithiasis scoring systems for prediction of stone free rate in percutaneous nephrolithotomy Top

Chatterjee Souvik, Samanta K, Singha Mahapatra RK, Sharma PK, Mandal SN, Karmakar Dilip

Calcutta National Medical College and Hospital, Kolkata

INTRODUCTION & OBJECTIVES: The Guy stone score, S.T.O.N.E. [S-Stone size, T-Tract length (skin-to-stone distance), O-Degree of Obstruction (presence of hydronephrosis), N-Number of involved calices, and E-Stone Essence (stone density)] nephrolithometry and the C.R.O.E.S. [Clinical Research Office of Endourological Society] nephrolithometry nomogram were introduced for systematic and quantitative assessment of kidney stones. To date there has been no direct comparison of predictive ability of three nephrolithometric scores in respect to stone-free rates, perioperative variables (fluoroscopy time, operative time, estimated blood loss and length of hospital stay) and complications following PCNL in Indian scenario. MATERIALS AND METHODS: After fulfilling inclusion and exclusion criteria, total 150 adult patients underwent PCNL were included in this study. The study was conducted from September, 2015 to July, 2017. Three nephrolithometric scores were evaluated in each of these patients. They were evaluated prospectively in their post operative period for stone free rate, drop in haemoglobin level, operative time, length of hospital stay and complications (using the modified Clavien grading system). RESULTS: Each of the nephrolithometric scoring system had efficiently predicted the chance of achieving stone free status and other parameters. Most of them did not predict post operative complications. Comparison between them revealed each of them were equally effective for prediction of stone free status. CONCLUSION: Each of the scoring systems serves as disease stratification tool that allows the surgeon to more accurately predict PCNL outcomes to improve patient counselling and surgical planning.

   P1-05: A novel scoring system for pre operative prediction of peri operative complications for monopolar TURP Top

Das Priyabrata, G Venugopal, LR Rakhul, R Vashantharaja, S Darhan

Government Medical College, Trivandrum

Introduction and objective: Transurethral resection of prostate (TURP) is one of the most common urological procedures performed. In spite of the best of efforts to understand and prevent the various complications of endoscopic procedures, incidence of some of the inherent complications have remained the same and still daunt the urologists. In various literatures the peri operative complications found to be 5-8 %. This complications are significantly contribute for morbidity and hospital stay. This study is for developing and validating scoring system which can predict preoperatively the peri operative complications associated with Mono polar TURP Methodology: Prospective observational study. Between November 2016 to November 2017, preoperatively patients data from (1).age, (2).serum PSA,(3) Physical status according to ASA criteria,(4) duration of 5 alpha reductase inhibitor therapy treatment,(5) prostate size by USG were collected. Perioperative TURP compilcations (intraoperative + 2wks following surgery) were quantified using modified Clavien classification system. Regression analysis was used to calculate the strength of association of variables with complications. A scoring system developed based on above five parameters where each variable has scoring number ranging from 1 to 3. Results: Out of 110 patients 18 developed complications (16.36%) out of which Grade I complication present in 11 patients, 6 and 1 patients had Grade II & III complication respectively. One patient requires ICU care for 4 days, 4 patients required blood transfusions. Mean age is 68.4 yrs, mean size of prostate 54.6 gms, mean serum PSA value 3.4 ng/dl, mean duration of 5 alpha reductase inhibitor therapy 3 months. Conclsion: We developed a scoring system which ranges from 5-15. Where patients can be divided in to 3 categories. Category I with a score of 5-8, where as a score of 8-12 assigned as category II and categogy III with a score of 12-15. For category I rate of complication was 0-2%, for category II rate of complication is 3-12% and the category III bears the complication rate of 8-24% with sensitivity and specificity of 80% and 90%.

   P1-06: A Prospective Analysis of Intra-Calyceal vs. Intra-Pelvic Amplatz Sheath Placement during PCNL for Renal Pelvic Calculi Top

Himanshu Agarwal, Mukund G Andankar, Prashant P Pattnaik, Prajwal Mahatme, Vivek Jadhao, Chandrakant Pancholi

Bombay Hospital Institute of Medical Sciences, Mumbai

Introduction: Percutaneous Nephrolithotomy is the preferred treatment modality for large renal pelvic calculi. The positioning of Amplatz sheath during PCNL (Intracalyceal vs. Intrapelvic) varies as per the operating surgeon and no comparative analysis exists. Material and methods: A total of 60 patients who underwent PCNL for 15 to 25 mm pelvic calculus at our centre were studied. The patients were divided into two groups of 30 each. In the Intracalyceal group (IC) the inner end of the Amplatz sheath was positioned at the ampulla of the calyx throughout the procedure. In the Intrapelvic group (IP) the Amplatz sheath was advanced beyond the infundibulum and the stone was engaged in the sheath before lithotripsy. Patients were monitored with respect to intraoperative characteristics and postoperative outcomes. Results: The mean stone size in the IC and IP group was 23.3 and 22.1 mm. Stone clearance was achieved in 99.1% and 98.7% patients in a single puncture in IC and IP groups. The IC group had significantly less number of visible infundibular tears (n=4 vs. 12 patients in IP group, p=0.019). Fragment migration to upper calyx was seen less in IP group. The post op transfusion rates, stone clearance rates, and duration of hospital stay did not differ between the two groups. Conclusion: During PCNL the Amplatz sheath can be parked in either the calyx of entry or the pelvis. However, intrapelvic sheath placement is associated with significantly higher rates of injury to infundibulum but a lower rate of upper calyx stone migration.

   P1-07: A retrospective study on the association of Metabolic syndrome and urological malignancies Top

Karthik Meyyappan

Mahatma Gandhi Medical college and Research Institute, Pondicherry

   P1-08: Use of tranexemic acid as a topical agent to reduce bleeding during TURP: a novel technique! Top

Saurabh Mittal, Surya Kant Choubey, Gotam Pipara

St Johns Medical College, Bangalore

INTRODUCTION The gold standard of treatment for BPH is transurethral resection of the prostate (TURP). However, complications like bleeding and TURP syndrome are well known with TURP. Tranexamic acid (TNXA) is synthetic antifibrinolytic helps in reducing blood loss. Its use has been done intravenously in the various urological procedures till date. However there is always a concern about the safety of systemic administration of TNXA. In our study we have, used TNXA as a topical agent with the irrigation fluid during TURP. This study is the first of its kind in literature. MATERIALS AND METHODS A prospective randomized control trial was conducted with 60 men in the age group of 50-75yrs who underwent TURP. They were randomized into 2 groups of 30 each as study (group A) and control(group B). In the study group, TNXA was added in irrigation fluid and control group included patients in which irrigation fluid without TNXA was used. RESULTS Mean hemoglobin in group A was 12.7gm/dl whereas in group B was 12.5. In group A, the average blood loss intraoperatively was 145.4 ml while in Group B was 197.5 ml, P value < 0.05 – statistically significant. The amount of hemoglobin lost per gram of resected tissue was 0.032grams in group A and 0.062 grams in Group B (P value < 0.05 – statistically significant). Operative time was almost same in both the groups. However intraoperative vision was better with Group A owing to less intraoperative bleeding. CONCLUSION-TNXA when used as a topical agent during TURP with the irrigation fluid decreases the blood loss and hemoglobin fall per gram of prostatic tissue resected.

   P1-09: Supracostal Puncture for PCNL: Evaluation of safety and efficacy in the treatment of renal and upper ureteric stones Top

Shyam Babu Prasad, Prasoon Saurabh, Ravi Shanker Singh

R N Institute Of Nephro-urology

Introduction: The approach of puncture is important for the success of PCNL in terms of clearance of stone, complications and duration of surgery. Aim: Prospective analysis of safety and efficacy of Supracostal Punctures in the treatment of moderate and high volume renal and upper ureteric stones. Materials and Methods: Seventy two (n=72) patients with renal or/and upper ureteric stones who needed supra-costal puncture were included in this study. Patients were grouped in three categories on the basis of site of puncture- Group-1 : 12th – 11th intercostal space (n=33) Group-2 : 11th – 10th intercostal space (n=27) Group-3 : 10th – 9th intercostal space (n=12) Safety was studied in terms of Clavien Classification System. The efficacy of the procedure was studied in terms of stone clearance, number of tracts, duration of surgery and duration of hospital stay. Results: Stone clearance rate was not statistically different in different study groups (Group 1, 2,3 - 93.93%,92.59%,91.66% respectively). The average stone clearance rate was - 92.72%. 1 out of 27 patients in Group -2 (3.70%) required intervention in terms of ICD insertion. None of the 12 patients in group - 3 developed hydrothorax or pneumothorax. Conclusion: Supracostal punctures are safe and effective in selected cases with acceptable complications. Hydrothorax or pneumothorax can be minimized even above 10th rib puncture with precautions.

   Podium Session - P2 Top

   P2-01: Prognostic significance of modified glasgow score in patients with non-metastatic clear cell renal cell carcinoma Top

Garg A, TP Rajeev, Barua SK, Sarma D

Gauhati Medical College

Objective - The aim of this study was to evaluate the usefulness of the modified Glasgow Prognostic Score (mGPS) as a prognostic factor in patients with non-metastatic clear cell renal cell carcinoma (RCC). Methods - Between Aug. 2010 and July 2015, 336 patients with RCC underwent radical or partial nephrectomy at our hospital. Among these patients, 18 with non-clear cell type histology and 22 with lymph-node or distant metastasis were excluded. The medical records of the remaining 296 patients were retrospectively reviewed. The mGPS was calculated using a selective combination of C-reactive protein (CRP) and serum albumin. The prognostic significance of various clinic pathological variables including mGPS was analysed using univariate and multivariate analyses. Results - Of the total 296 patients, 30 patients (10.14%) developed local recurrence or distant metastasis and 13 patients (4.3%) died of disease during the follow-up period. The univariate analysis identified CRP, mGPS, thrombocytosis, T stage, Fuhrman's nuclear grade and lympho vascular invasion as significant prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS). The multivariate analysis indicated that mGPS (p<0.001) is an independent prognostic factor for RFS and CFS. Conclusions-The mGPS is an independent prognostic factor for RFS and CSS in patients with non-metastatic clear cell RCC treated with radical or partial nephrectomy. Results of the present study suggest that mGPS should be used for predicting recurrence or survival in patients undergoing nephrectomy for non-metastatic clear cell RCC.

   P2-02: Role of prostate-specific membrane antigen - positron emission tomography / computer tomography as a predictor of positive/negative prostate biopsy in patients of suspected carcinoma prostate Top

Harsh Jain, Goel H, Kumar A, Sharma U, Singla A, Sood R

PGIMER & Dr RML Hospital, New Delhi

INTRODUCTION AND OBJECTIVE Prostate-specific-membrane-antigen (PSMA)-positron-emission-tomography (PET)/ computer-tomography is a promising diagnostic tool for patients with prostate cancer (PCa). This study is done to assess the role of PSMA-PET-CT as a predictor of prostate biopsy results. It also evaluates maximum standardized uptake values (SUVmax) of PSMA avid lesions in PET-CT, and correlate it with biopsy results. Methods: In this prospective study, men suspected of PCa, with raised prostate specific antigen (psa) between 4-20 ng/ml, or suspicious digital rectal examination (DRE) findings were included. PSMA-PET/CT was done in all patients followed by Trans-rectal-ultrasound (TRUS) guided prostate biopsy. SUVmax was measured and correlated with biopsy results. Results: Out of 47 patients, 18(38.3%) patients were found to have malignancy in biopsy and 29 patients (61.7%) had negative biopsy findings. Median (Inter Quartile Range (IQR)) SUVmax of biopsy negative patients (n=29) was 3.4(0 -5.5) and that of biopsy positive patients was 10.3(6.3 -15.6)(p<0.0001). Receiver-operating-characteristics (ROC) curve revealed an area-under-curve (AUC): 0.853(95% Confidence interval (CI): 0.739 - 0.968) p<0.001 and an optimal SUVmax cut-off value of 6.75 for the discrimination of biopsy positive or negative patients. By applying this cut-off, PSMA-PET/CT demonstrated 78% sensitivity, 86% specificity,78% positive predictive value, 86% negative predictive value, and 83% accuracy for predicting the outcome of prostate biopsy. Conclusion: PSMA-PET/CT is well suited for detecting suspicious lesions in prostate and our findings indicate a significant correlation of PSMA-uptake as determined by SUVmax values with biopsy results. Moreover, we were also able to determine SUVmax value below which we may avoid prostate biopsy.

   P2-03: Long term survival after radical nephrectomy with inferior vana caval thrombectomy - a study of 165 cases Top

Jadhao Vivek G, Kulkarni Jagdeesh N., Agarwal Himanshu, Mahatme Prajwal, Pancholi Chandrakant

Bombay Hospital Institute of Medical Sciences, Mumbai

Introduction-RCC with invasion into the vascular system itself implies aggressive behaviour of the tumour. It is also challenging to treat these patients when the life-threatening complications like massive bleeding & pulmonary embolism are well known. We thus decided to review our experience with such cases in terms of presentation, surgical technicalities, results and factors affecting survival. Methods-Retrospective analysis of 165 patients who underwent radical nephrectomy with IVC thrombectomy at our institute between 1991 and 2017 was done. Chi-square analysis was used to calculate statistical significance Results-Of the 165 cases, long term survival was analysed for 112 patients. 64 of them had infra-hepatic, 33 had retro-hepatic and 15 had supra-hepatic IVC thrombus. The overall 5yr survival was 62.50% whereas 5yr disease free survival (DFS) was 49.10%. Overall 7 yr survival was 37.50% and 7yr DFS was 27.67%. Patients with tumour grade II had better survival as compared to grade IV (63.5% Vs 8.33%, p < 0.05). Patients with nodal histology positive had poorer DFS (24.13% Vs 61.05%, p < 0.05). Patients with granular cell histology and those with peri-nephric invasion had poorer prognosis but the difference was not statistically significant. Major post-operative complications were encountered in 38.39% patients and the mortality was 4.46% Conclusions-Radical nephrectomy with IVC thrombectomy remains the most effective treatment offering reasonable long-term survival rates in patients of RCC with thrombus extension into IVC. Although the surgery is complicated and has high post-operative complication rates, a multi-disciplinary approach can further lower down complication rates and mortality

   P2-04: Patterns of recurrence following radical cystectomy for bladder cancer Top

Prakash G, Bakshi GK, Niyogi D, Shinde R, Pal M, Murthy V

Tata Memorial Hospital Mumbai

Objective To assess the patterns of recurrence after Radical cystectomy (RC) done for muscle invasive bladder cancer Material and Methods We retrospectively audited data of RC done at our institution between January 2013 to December 2016. Recurrence patterns were categorized as local (within urothelium), regional (within pelvis) and distant (outside pelvis) Results Between January 2013 and December 2016, we performed 190 RC with urinary diversions.152 were for Muscle Invasive bladder cancer, 25 for high risk non muscle invasive bladder cancer and 13 for non urothelial cancer. After a median follow up of 20 months, 20 % (n=38) patients recurred. Amongst those who recurred, 1 patient (2.63%) had T1 disease, 15.78% (n=6)had T2 disease, 73.68% (n= 28) had T3 disease and 3 patients (7.89%) had T4 disease. 26.31% (n=10) had recurrences within the true pelvis (soft tissue or nodal). 39.47% (n = 15) patients had recurrences outside pelvis. Among these, 4 patients (26.66%) had bone only metastases, 4 (26.66%) had diffuse peritoneal metastases with ascitis, 5 (33.33%) recurred in the retroperitoneal nodes and 2 patients (13.33%) in the liver. 28.94% (n=11) had multiple sites of recurrence (lung, bone, liver etc). Two patients recurred in urothelium 1 in ureter and 1 in urethra. Conclusion An understanding of the recurrence pattern post RC could form the basis of trials assessing the role of adjuvant local therapy. It would also help in planning surveillance and in comparing recurrence patterns with those after minimally invasive cystectomy.

   P2-05: Whether simple clinico-radiological parameters predict difficulty in radical perineal prostatectomy ? Top

Singh Kunal, Sood Rajeev, Khattar Nikhil, Goel Hemant, Sharma Umesh

Dr Ram Manohar Lohia Hospital & PGIMER, New Delhi

Introduction & Ojectives – The prediction and selection of the easier cases of localized prostate cancer and prior distinction of the potentially difficult cases may be helpful to urologists in planning radical perineal prostatectomy (RPP). We aimed to assess feseability of difficulty prediction by simple clinical and radiological parameters in RPP preoperatively. Methods - Eighteen sequential RPP cases were divided into two groups according to the estimated difficulty of the operation (Group I: Easy, Group II: Difficult) which was assessed by using a RPP difficulty score, constituted by three surrogate markers of difficulty (operative time, blood loss, and surgeon's perception) each ranging between 1 and 3 points. The demographic variables (Age, height, weight), clinical variables (S.PSA, Gleason score), clinical measurements as skin-to-prostatic apex (SPAD) and skin-to-prostatic base (SPBD) distances and distance between ischial tuberosities (ITD) were noted. The ultrasonographic variables as, prostate divergance angle (PDA) and prostate volumes (PV) were recorded. These pre operative parameters were compared between the groups. Results - In Group I (n = 8) and Group II (n = 10), the difficulty scores were 3.88 ± 0.84 and 7.5± 0.85, respectively (<0.001). The demographic data, clinical variables and measurements, ultrasonic variables were not stastically different between groups. However, the surrogate markers for difficulty were significantly different. Conclusions –The pre operative parameters were unable to predict difficulty in RPP. The practical selection of easy and difficult cases based on simple preoperative parameters could be difficult for urologist, while planning RPP operation in initial learning curve.

   P2-06: Clinicopathological correlation of pre biopsy quantitative PSMA uptake in patients with persistently raised serum PSA : initial experience in 71 patients with simulatenous 68-Ga PSMA PET/MRI Top

Venkatesh Kumar, Aru Singh, Amarnath Jena, Rajesh Taneja

Indraprastha Apollo Hospitals, New Delhi

Purpose To analyze 68Ga PSMA uptake pattern of prostate and its correlation with PSA, DRE as well as Gleason's score in the assessment of diagnostic value of Ca Prostate Method 71 patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous PET/MRI for diagnosis or staging of CaP between June 2015 and August 2017 were enrolled for this study. Patients who presented with persistently raised serum PSA (>4 ng/ml) and normal urine routine and negative culture were included in the study. DRE was done in all patients and was qualified benign or suspicious for malignancy as 0 7 1. PI-RADSTM v2 assessment was used to calculate five point scale showing likelihood of cancer with the combination of mpMRI findings. 68Ga PSMA was recorded at two time points, one early and a delayed one. ROC curve analysis was performed to test the diagnostic accuracy of PSMA uptake and mpMRI individually as well as in combination. Spearman analysis was used to assess the correlation between PSMA uptake and clinicopathological parameters. A p value of 0.05 was considered to be statistically significant. Results We observed significant positive correlation between PSMA delayed uptake (SUV Max) with the PIRADS score (p<0.001, ρ-0.750), PSA level (p<0.001, ρ-0.414), DRE (p<0.002, ρ-0.400), and gleasons score (p<0.300, ρ-0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions (p<0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an AUC of 0.91 while the difference between early and delayed uptake a AUC of 0.92. ROC analysis of PIRADS score derived from mpMRI gave an AUC to 0.87. Combined ROC analysis of PIRADS score derived from mpMRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion Quantitative PSMA uptake improves accuracy of classifying malignant vs benign prostate lesions and compliments mpMRI in lesion characterization. The correlation with clinicipathological features like PSA, DRE as well as Gleasons score could be used in prognostication of prostatic lesion along with PSMA PET/MRI.

   Podium Session - P3 Top

   P3-01: A new graft for urethral strictures-(Eureka) !!! Top

Arjun N, Nagaraj HK, Tarun J, Prakash B

Ramaiah Medical College, Bangalore

Introduction and Objective – The repair of inflammatory urethral stricture has been confronted with failures and frustration and many procedures have been designed for the same. A variety of grafts are used for this, however there is limited information regarding the use of PTFE for urethroplasty. Our objective was to assess the role of PTFE as a patch graft in urethroplasty for urethral stricture disease. Methods – A prospective study of 3 years duration was conducted at our institute involving 12 patients. All male patients with inflammatory strictures less than 3 cms in size where substitution urethroplasty was planned were included in the study. All patients were followed up for a period of 3 years with catheter removal at 3 weeks, uroflowmetry monthly after catheter removal for 3 months and then 6 monthly. Cystoscopy was done for documentation at 6 months. RGU was done at 1 year. Results were tabulated and analyzed. Results – Of the 12 patients, only 1 patient presented with soiling of the garments with blood. Cystoscopy done showed exuberent granulation tissue along the suture line which was fulgrated endoscopically. Voiding was satisfactory with no complaints in the rest till the end of follow up. Conclusions - PTFE patch urethroplasty is a viable alternative in urethral stricture disease with the advantage being its ability to maintain graft length and width without shrinkage and lesser morbidity. However a longer follow up is required to assess the results of this material as a substitute for the same.

   P3-02: To Compare The Outcomes Of Lingual Vs Buccal Mucosal Graft In Substitution Urethroplasty For Anterior Urethral Stricture And Donor Site Morbidity Top

Kewlani Narain, Songra M C, Shrivastava S

Gandhi Medical College, Bhopal

INTRODUCTION Incidence of urethral stricture is on the rise due to rise in high velocity trauma rendering it a major problem to urologists. Stricture affects the quality of life of patients. Priniciple operative procedures for stricture urethra surgery are regeneration procedures, anastamotic and substitution urethroplasty. Oral mucosa is the best donor tissue for substitution urethroplasty (buccal graft from inner cheek and lingual graft from lateral and undersurface of tongue). AIMS 1. To compare outcomes of lingual versus buccal mucosal graft urethroplasty. 2. To compare the morbidity of donor site. MATERIAL AND METHODS Study Design : Retrospective and Prospective study (6 years) Total 30 patients were included in the study (Group A- 15 patients of lingual graft prospectively and group B- 15 patients of buccal mucosal graft retrospectively). Outcome was compared in terms of patency (urethrogram), stream, uroflometry, restricture rate and donor site morbidity. RESULTS Urethrogram done after 1, 3 and 6 months showed that group A patients were better in terms of lumen patency compared to group B. Uroflometry revealed that postoperative mean peak flow rate was 0.8 ml/sec better in group A than group B patients. One patient in group B had restricture while none in group A (on 6 months follow up). There was significant donor site morbidity in group B. However, slurring of speech was seen only in one patient of group A. CONCLUSION Our study showed that lingual graft is better than buccal graft for substitution urethroplasty (both for the donor and recipient site).

   P3-03: Re - Redo Urethroplasty in Pelvic Fracture Urethral distraction defects Top

Pankaj Joshi, Hazem Orabi, Sandesh Surana, Omkar Joglekar, Mohammad Alkandri, Sanjay B Kulkarni

Kulkarni School of Urethral Surgery

Introduction : Primary repair of pelvic fracture urethral distraction defects (PFUDD) has a high success rate. While redo anastomotic urethroplasty after failed primary repair is usually surgically feasible with still high success rate, a second or more failure of posterior urethroplasty is expected to be difficult and technically demanding. Materials : We retrospectively reviewed all patients with failed 2 or more urethroplasties from 2012 to 2016. Preoperative retrograde urethrography, micturating cystourethrography, penile Doppler, urine analysis and culture was done. Failure of surgery was considered with decreased urine flow and/or need for instrumentation. Results: 61 patients with 2 or more failed urethroplasties included. 56 patients had complete follow up. Age range from 12 to 61 years with a mean of 30.5 years and stricture/gap mean of 4.85 cm. Follow up period extended from 6 to 48 months. Three main findings were found: inadequate mobilization of bulbar urethra, incomplete scar excision and need for inferior pubecomy. In addition, bulbar shortening including bulbar necrosis was found in 23.2% of the cases, a percentage higher than that found in primary or one redo cases. Operative procedures done included 4 different procedures; anastomotic urethroplasty (n=37), substitution urethroplasty (n=13), diverticulectomy (n=4) The overall success rate was 79 %, similar to our success rates of single redo cases. Conclusions: PFUDD with failed 2 or more urethroplasties are more commonly associated with bulbar shortening that may require circumferential urethral substitution. Redo posterior urethroplasty should be always performed by expert reconstructive urologists and has high success rate.

   P3-04: Unexpected nightmare complications following Buccal Mucosa Graft Urethroplasty - a self critique Top

Purohit SP, Kurne C, Kulkarni AV

Bharti Vidyapeeth Deemed University Medical College Hospital, Sangli

Introduction & Objective : Surgery of urethral strictures has been a constantly evolving process. Buccal mucosa has received increased attention in the field of reconstructive urosurgery for reasons known to all concerned, specially relatively low rate of serious complications. Here we report & critically analyze on three cases who unexpectedly developed serious, nightmarish complications after dorsal onlay buccal mucosa graft urethroplasty for recurrent strictures. Materials & Methods : Twenty one patients underwent dorsal onlay buccal mucosa graft urethroplasty over period of 6 years. Being a tertiary referral center, all patients were referred after multiple attempts of VIU and / or dilatations. Of these, 3 patients unexpectedly developed serious, nightmarish complications. 1. Diabetic & CKD patient - After uneventful first 4 weeks, developed retropubic, periprostatic abscess leading to necrosis of entire urethra & mucosal graft with development of urethro-rectal fistula. Died with urosepsis. 2. Presented 2 years after urethroplasty with acute retention. Had extensive stricture at either ends of buccal mucosa graft anastomosis. Grafted portion was healthy. 3. Had undergone penile skin substitution urethroplasty 6 months before. Evidence of devascularisation of ventral penile skin was noted on 5th post-operative day. By 12th day complete, full thickness necrosis of penile skin & ventral urethra developed at the junction of skin & buccal mucosa anastomosis. Dorsally placed graft was healthy. Results : Critical self analysis of these disasters pointed to different predisposing possibilities. 1. Review of RGU suggested possibility of flaring up of dormant prostatic infection as the cause for fatal infection. During operation there was no indication of local infection at all, otherwise procedure could have been staged. 2. After remaining stable for 2 years, original stricture pathology extended at either ends of graft, keeping graft healthy, Thus proving again 'once a stricture, always a stricture!' 3. Probably, previous skin flap design might have in some way compromised blood supply to ventral penile skin & underlying urethra. Conclusions : We could relate each of these nightmares to different possibilities in each case. 1. Flaring of dormant infection. 2. Extension of original stricture pathology. 3. Vascular compromise after previous penile skin flap. We hope this experience will help in better evaluation of natural history of stricture & planning.

   P3-05: Analysis of functional effects of urethroplasty on ejaculatory function Top

Siddharth Pandey, Goel A, Sankhwar S N, Singh V, Singh B P, Sinha R J, Kumar M

King George's Medical University, Lucknow

Introduction and Objective: Men with urethral stricture disease often complain of concomitant ejaculatory dysfunction. Sexual morbidity is significant in determining overall satisfaction after reconstructive surgery and few groups have specifically evaluated ejaculatory dysfunction in men with urethral stricture disease. The objective of this study was to evaluate the effects of urethroplasty on ejaculatory function using a validated questionnaire. Materials and Methods: All patients above 18 years age who underwent urethroplasty at our institution from November 2016 to March 2017 were included in the study. They were asked to fill the male sexual health questionnaire - ejaculatory function domain (MSHQ-EjD) with 7 questions pre-operatively and at 6 months post surgery. Results: A total of 22 patients were included in the study, all patients were less than 45 years of age and were sexually active. Eighteen patients underwent Oral mucosal graft urethroplasty and 4 underwent end to end anastomotic urethroplasty. One patient underwent bulbo-spongiosus sparing urethroplasty. Out of the seven domains of MSHQ-EjD, painful ejaculation was present consistently in the study population. There was no statistically significant difference (p>0.05) in MSHQ-EjD score pre operatively and at 6 months post operatively. Conclusion: Ejaculatory function in patients with urethroplasty has not been studied extensively. A more objective way of quantifying ejaculatory function in these patients is required. A larger sample size and a longer follow up may better clarify outcome of urethroplasty in terms of ejaculatory function.

   P3-06: Evaluation Of Substitution Urethroplasty In The Management Of Stricture Urethra Top

Tejinder Pal Singh, Bhat Mahakshit, Bhat Amilal, Burman Alakesh, Saran RK, Chhabra MK, Dar BA

Dr SN Medical College Jodhpur

Objective: Comparison of results of dorsal onlay inner preputial skin flap and buccal mucosa graft urethroplasty in a prospective single centre study. Method: From January 2015 to August 2016, 46 patients underwent urethroplasty using inner preputial skin flap (25 patients) and buccal mucosa graft (21patients) with follow-up at 3, 6 and 12 months with IPSS and uroflowmetry. Success was defined with improvement of IPSS and Qmax >20 mls/. Any further instrumentation was considered a failure. Results: With mean age of 43.54 years(range 18-72 y) and mean stricture length of 8.3 cms(range 3.9 to 13.3cm), 28, 16 and 2 patients belonged to idiopathic, inflammatory and post traumatic stricture etiology respectively. Mean graft size was 9.0cms and 9.5cms in inner preputial skin and buccal mucosa respectively with overall success rate of 87%(preputial skin flap 84% and bucaal mucosa graft 90.5%). At 1yr, IPSS improved to 4.5 and 3.1 with Qmax> 20ml/sec in both groups. 6 failure cases were reported (13%) where 4 patients(67%) were reported in inner preputial skin group and 2 patients(33%) in buccal mucosa group. Complications included postvoid dribbling (12%), superficial penile skin necrosis and fistula formation (4%each) in inner preputial skin group and altered sensation in cheek (24%), post void dribbling (9.5%) and infection(4.7%) in buccal mucosa group. Conclusion- Excellent rates of success with minimal complications were reported with comparable results inner preputial skin flap and buccal mucosal free graft in substitution urethroplasty. However, longer follow up with more patients are needed to judge the long term efficacy.

   Podium Session - P4 Top

   P4-01: Androgen receptor expression in Hypospadias Top

Goutham Reddy, Dhanvanth Rajesh Balaji, Ramesh Babu, Venkatramanan S Leena Dennis Joseph, Lawrence D'Cruze, Sandhya Sundaram

Sri Ramachandra University

Aims: To study the androgen receptor expression & hormone levels in hypospadias patients and compare them with those found on normal. Methods: Group 1 involved patients who underwent circumcision while group 2 involved hypospadias patients who did not receive any pre-operative testosterone. Preoperative hormonal assay included LH, FSH and fTST levels in all the patients. The skin specimen was analysed for AR expression using immuno-histochemistry (anti AR antibody Pathnsitu, clone R441, 1/100 dilution). AR IHC staining was expressed as H-score. The H-score was calculated by multiplying the intensity of staining and the percentage of stained cells showing cytoplasmic positivity at high power (×40). Results: There were 27 patients in group 1, while 16 in group 2. There was no significant difference in the age distribution between the groups. The testosterone, LH & FSH levels were not significantly different between the groups, The AR IHC expression was significantly elevated in group 2. The mean H-score was 189.5 in group 2 compared to 97.5 group 1 (p<0.05). Conclusion: Our study has shown that AR expression was significantly elevated in hypospadias patients probably due to androgen insensitivity and end organ over expression. A decreased testosterone level was not found in hypospadias patients.

   P4-02: Comparison of Ultrasonography and Renogram findings in children with Prenatally Detected Hydronephrosis: Can Ultrasound form the basis of a new algorithm to manage Prenatally Detected Pelvi Ureteric Junction Obstruction Top

Gyanendra Sharma, Anshu Sharma

Chitale Clinic Pvt. Ltd

Objective To differentiate a Non-obstructive dilatation from an Obstructive dilatation in prenatally detected presumed pelvi ureteric junction obstruction so that intervention can be planned before irreversible damage can occur to the renal unit. Materials and Methods From January 2012 to December 2016, all patients with prenatally detected or asymptomatic incidentally detected presumed pelvi ureteric junction obstruction were evaluated by ultrasonography and renogram. The anteroposterior diameter of the renal pelvis was measured in supine and prone position. Presence of calyceal dilatation in prone position was noted. They were categorized into obstructed, non-obstructed and equivocal groups based on sonography findings. The differential renal function and the cortical transit time (CTT) was calculated and compared with the sonography groups. Results Of the 98 patients, 72 were in the obstructed, 18 in the non-obstructed and 8 in the equivocal category. All except one in the non-obstructed category had a function of > 40% with CTT of < 3 minutes. 70 patients in the obstructed category had a CTT of > 3minutes, while 61 had function < 40% on initial evaluation. 11patients in the obstructed category with an initial function of > 40% had CTT of > 3minutes. All of them showed increasing hydronephrosis and deterioration of function during follow up necessitating pyeloplasty. All patients in the equivocal group had function > 40% and CTT < 3minutes. Conclusion Ultrasonography along with CTT can help to differentiate non-obstructive from obstructive dilatation

   P4-03: Ureteric reimplantation for vesicoureteral reflux in children : a single center experience Top

Mahatme PV, Punjani HM, Agarwal H, Pancholi C, Jadhav V

Bombay Hospital Institute of Medical Sciences

Introduction and objective: The aim of management of VUR is to prevent further episodes of UTI and to avoid progressive renal scarring. Various surgical options are available for the same. In this study, we share our experience with regards to different surgical procedures performed and outcomes. Methods: All the children (n = 48) who underwent reimplantation for VUR during past 5 years were analyzed. Children with secondary VUR were excluded from our study. Extravesical reimplantation (EVR) was performed bilaterally in 5 children and unilateral in 8, while bilateral Cohen's reimplantation was performed in 17 and unilaterally in 18. Parameters compared were length of the surgical procedure, average duration of stay in the hospital, postoperative bladder spasms, significant hematuria, obstruction, etc. Results: The mean age at operation was 55.4 months. The mean postoperative stay was significantly lower in extravesical reimplantation as compared to intravesical reimplantation for unilateral cases but there was no significant difference in bilateral cases. Postoperative hematuria was significantly lower in unilateral as well as bilateral extravesical reimplantation as compared to intravesical reimplantation respectively. There was no significant difference in the mean duration of surgery and postoperative bladder spasms. One patient of bilateral Cohen's reimplantation developed bilateral obstruction which was treated surgically. On 1 year follow up, none of them had any evidence of ureteral obstruction. Conclusions: In our study, we found that both techniques were equally effective in treating reflux. However, EVR has less postoperative hematuria and shorter hospital stay compared to Cohen's reimplantation.

   P4-04: Comparative study of surgical techniques for hypospadiac meatal stenosis in hypospadias repair Top

Manoj Kumar Bamaniya, Sher singh Yadav, Tomar Vinay, Priyadarshi Shivam, Nachiket Vyas, Agarwal Neeraj

SMS Medical College Jaipur

Objective-The aim of our study was to compare outcomes of different techniques for management of hypospadiac meatal stenosis in Snodgrass repair. Material and Method-A prospective and comparative study was performed on 67 patients from January 2016 till date and all patients have meatal stenosis with hypoplastic urethra. The patient were assigned into two group. Group I had 31 patients managed by dorsally incise urethral plate. 36 patients in group II managed by ventral incision through the hypoplastic urethra up to normal urethra. Result-The results were analysed in view of complication rates especially fistula and stricture at hypoplastic urethra. Period of hospital stay varies between two groups. In group I period of hospital stay was 8 to 10 days and in group II period of hospital stay was 10 to 14 days. Follow up in both groups varied from 1 month to 1 year with a mean of 6 month. In group I, hypospadias were distal penile in 27(85%) and mid penile in 4(15%) while in group II, it was distal penile in 28(77.5%) and mid penile in 8(22.5%). Urethral fistula was encountered in 3(9.6%) patients in group I and in 6(16.66%) in groupII. Meatal stenosis was noted in 3(8.33%) patients of group II which is responded to urethral dilatation. No stricture urethra noted in both group. Conclusion-Dorsally incised urethral plate technique has a lesser incidence of post op urethrocutaneous fistula and meatal stenosis when compared to ventrally incised urethra.

   P4-05: Paediatric renal transplantation in India: Assessment of quality- of-life (QOL) of children and parental issues Top

Soni Rahul, Dharmveer Singh, Rahul Jena, Ankur Bansal, S K Sureka, A Srivastava, MS Ansari


Aims & Objective Renal transplantation is now the ideal management option in paediatric patients with end stage renal disease. The majority of the criteria which assess the success of renal transplant focus on graft survival and improvement in medical conditions. This study evaluated multidimensional QOL after renal transplant to find the physical, psychosocial, and economic issues after paediatric transplant. Materials & Methods This cross-sectional study was conducted during August to October 2016 at our tertiary care institute. The inclusion criteria were recipients with age of less than 18 years at the time of assessment, with a minimum 1 year follow up after successful renal transplant (defined as nadir creatinine value of less than 1.5 mg/dL), and their parents who accompanied them for a regular transplant follow up in clinics. Cases with less than 1 year post transplant follow up and having language barriers were excluded from the study. Sixty- two patients under the age of 18 at the time of assessment were asked to complete WHO QOL questionnaires (WHOQOL-BREF questionnaire) for assessment of change in quality of life. Assessment of behavioural and emotional status of child, problems of parents, and Socioeconomic (SEC) status of family were also performed by different validated questionnaires. Results The beneficial effect of transplantation was observed across all domains of QoL (physical, psychological, social, environmental, and overall QoL). The greatest change was observed in QoL domains that dealt with overall satisfaction (81.28±15.76 vs 45.32±10.98; P<.0001). The domain dealing with environmental factors showed the least variation after transplantation (65.58±17.45 vs 51.34±17.81; P<.0001). Feelings of happiness and peer group socialization were re-ported in 81% and 69% of patients, respectively. There was no marital disharmony in 52% of families. However, SEC deteriorated in 16% of families and 59% of the families availed financial assistance. Sixty- nine percent of children had not attended school after one year of transplantation, but returned to school after transplant was reduced to 8% at 5 years. Conclusion Post-renal transplant QOL had significant improvement in all of its dimensions compared to pre transplant status. Pre- and post- transplant social and psychological support may help these patients and their families to adjust in society and have a positive outlook in their future.

   P4-06: To study the role of different surgical interventions, effect of these interventions on symptom modifications and complications arising from them while managing the patients of posterior urethral valves Top

Velhal RC, Patwardhan SK, Patil BP

Seth GS Medical College and KEM Hospital, Mumbai

Aims and objective-To study the role of different surgical interventions, effect of these interventions on symptom modifications and complications arising from them while managing the patients of posterior urethral valves. Materials and methods:This was prospective and retrospective observational study conducted from November 2015 till July 2017. Data regarding the initial presentation, investigations, interventions, effect of interventions on disease progression, their complications and ultimate renal outcome were recorded. Results:Total 35 patients studied with age of presentation varied from 6months antenatal period to 34 years. Each patient underwent diversion/fulguration after initial presentation. Four patients required dialysis for uremic symptoms at presentation. All patients divided into 2 groups depending upon creatinine level at 1 month post initial intervention. Fourteen out of 16 patients(87.5%) with high creatinine progressed to CKD. In the second group where creatinine level decreased 11 out of 19 patients (57%) progressed to CKD. Multiple interventions required in 20 patients (60%) [vesical/supravesical diversions], amongst them 13 patients (65%) became CKD,2 patients progressed to ESRD and underwent transplant. Fourteen patients (40%) required no other interventions than PUV fulguration(6 required refulguration), amongst them 8 patients (57%) developed CKD. Seven patients with bladder instability(total-14) required surgical management, one patient underwent botox instillation. Eighty eight percent(88%) of patients had improvement in their symptoms post fulguration. Post interventions UTI was seen in 71.4%patients. Eight patients(23%) developed significant post surgical complications requiring additional intervention, increased morbidity and financial burden to parents. Conclusions:1)Symptomatic improvement does not correlate with progression to ESRD. 2)The number of interventions also does not predict progression to ESRD. 3)Patient requiring interventions have high(23%) post operative further procedures increasing their morbidity. 4)At one month of intervention, the patients with decreasing serum Creatinine levels have lower incidence of ESRD than the group with increasing level of Creatinine

   P4-07: Retrospective analysis of 141 children with urolithiasis at a tertiary care center : Evolution of guidelines for stone management Top

Wagholikar HD, Modi PR, Pal BC, Rizvi SJ

Institute of Kidney Diseases and Research Centre, Ahmedabad

Introduction : Urolithiasis in pediatric population can cause significant morbidity and permanent damage to the kidney. We review our experience of the management of pediatric urolithiasis at our center. Patients and methods : We retrospectively analysed clinical data of children treated for urinary stone disease at our center from September 2015 to april 2017. Data regarding clinical presentation, stone burden, stone location, given management and outcome was analysed. Management was planned according to child's age, stone burden and location. Results : 141 children (97 boys, 44 girls) with 187 stone locations were included. The mean age at diagnosis was 6.6 years (range 0.3–16 years). Most common stone location was pelvicalycal system (PCS) followed by ureter and urinary bladder accounting for 127 (67.5%), 44 (23.5%) and 16 (8.5%) locations respectively. Extracorporeal shock wave lithotripsy (ESWL) was given to 107 stone locations (82 in PCS, 25 in ureter) with mean stone size 12.73 mm (range 8 – 23 mm). Success rate of 88.7% was achieved with ESWL alone. Percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) were done for 40 renal stones and 19 ureteric stones respectively. Nephrectomy was required in 3 patients for non functioning kidney with stone disease. Mean follow up period was 4 months (range 2–8 months). Major mineral according to stone analysis was calcium oxalate (59.2%). Conclusion : ESWL is highly effective in children for stones < 20 mm, irrespective of stone location. Miniaturization of endoscopes has led to safer use of percutaneous endoscopy and ureteroscopy in children.

   Podium Session - P5 Top

   P5-01: Testicular sperm for ICSI in men with high DFI Can it be made a Recommendation ? Top

Arun Karthik P, Vasan SS, Karthik KN, Madhumitha M

Manipal Fertility Centre, Kurinji Hospital

Introduction Despite clear break through in the field of ART we are still unable to pull up the pregnancy rates beyond 35-40%. What is it that we are MISSING??? Sperm DNA fragmentation has emerged as an important biomarker for assessing male fertility potential. Many studies have postulated that one of the mechanisms involved in sperm DNA fragmentation is ROS-induced DNA damage during co-migration of mature sperm with ROS-producing immature sperm through the seminiferous tubules and epididymis. This can be bypassed by testicular sperm aspiration. Materials and methods Retrospective, observational, cohort study conducted at our Fertility center from June 2015 till December 2016. Group A : Ejaculate-ICSI n=37 Group B : Testicular-ICSI n=39 Inclusion criteria Infertility duration >1 year Couples undergoing IVF-ICSI No abnormality noted in the medical history, physical examination and endocrine profile Persistent high SDF levels (>30%) in two semen specimens, SDF performed using the SCSA flowcytometry analysis No evidence of subclinical genital infections and/or leukocytospermia Women with average to good quality oocytes on retrieval Exclusion criteria Severe male factor infertility (severe oligoasthenoteratozoospermia, <5 million/mL; and azoospermia) Women with history of poor response to ovarian stimulation, including those fitting the Bologna criteria for expected poor responders Patients in whom oocyte or sperm donation was used Any uterine pathology like fibroid uterus, Adenomyosis which could impact implantation Results The two groups were homogeneous regarding to age, endocrine profile, infertility duration and the proportion of females with an associated infertility problem No difference in no of oocytes retrieved in the two groups. Fertilization rate was lower in the Testicular -ICSI group (64.6%) compared to Ejaculate- ICSI group (73.6%), however not statistically significant. Pregnancy rates were higher in the Testicular- ICSI group 48.7% vs Ejaculate ICSI 38.7% Miscarriage rates were remarkably low in Testicular-ICSI group than the Ejaculate ICSI group(15.7%vs 35.7%) It was noted that the pregnancy rates in men with DFI in the range of 30-40 was not different. (53.3% in Ejaculate and 46.1% in Testicular group) A significantly higher pregnancy rate was observed in the Testicular group when the ranges of DFI was higher than 40 Interestingly it was observed that in patients with DFI more than 50 pregnancy almost never occured with ejaculate sperms and better pregnancy rates were observed with Testicular sperms. Conclusion DNA fragmentation index is an important biomarker for assesing male fertility potential and should be made a part of routine evaluation. Testicular sperm is associated with improved ICSI outcomes in men with high DFI. DFI cut off for Labelling a patient with high DFI needs reconsideration.

   P5-02: Circulating matrix metalloproteinases and their tissue inhibitors as markers of pelvic floor tissue integrity Top

Diaa EE Rizk, Al-Kafaji G, Jaradat AA, Al-Tayab D, Bakhiet M, Salvatore S

Arabian Gulf University, Manama, Kingdom of Bahrain

Introduction and Objective: To measure plasma matrix metalloproteinases (MMP)- 2 and - 9 and their tissue inhibitors (TIMP)-1 and -2 as surrogate markers for pelvic floor tissue integrity in healthy multi-ethnic women. This could explain the ethnic vulnerability to support-related pelvic floor dysfunctions. Methods: Plasma levels of MMP-2 and -9 and TIMP-1 and -2 were measured by ELISA technique in nulliparous and young (18-29 years) women volunteers (n=85) from five ethnic groups (n=17´5; Bahrainis, other Arabs, Filipinos, Indians/Pakistanis and Europeans/Caucasians) and compared with Caucasians as the reference group. Results: There was significant correlations between BMI and plasma MMP-9 levels (r=0.26, p=0.02) and between age and TIMP-2 levels (r=0.23, p=0.045) in all groups. Plasma MMP-2 levels were significantly higher in Caucasians than in Bahrainis (p<0.001) and Filipinos (p<0.001) but lower than in Indians/Pakistanis (p=0.013). Plasma MMP-9 levels were significantly higher in Caucasians than in Bahrainis (p=0.009) and Indians/Pakistanis (p=0.015). Plasma TIPM-1 levels were significantly higher in Caucasians than in other groups (p<0.001) but significantly lower than in Filipinos (p=0.003). There was a negative correlation between plasma MMP-9 and TIMP-1 levels and a positive correlation between plasma MMP-2 and TIMP-2 levels but both correlations were not significant. Conclusions: Nulliparous and healthy Caucasian women have higher plasma MMP-2 and -9 but lower TIMP-1 and -2 levels than non-Caucasian women. This could indicate higher tendency forcollagenolysis and weaker connective tissue with increased risk to develop pelvic floor dysfunctions.

   P5-03: Knowledge, Attitude And Perception(KAP) Of our Urology Operation theater Health Care Providers On Radiation Safety Measures-A Questionnair Based Study Top

Kumar Vijay, Sreerag KS, Dorairajan LN, Manikandan R, Jain Amit

JIPMER, Puducherry

Introduction: like anywhere in urology centers, endourology is important section and mostly depends on fluoroscopy. This exposes all health care providers in endourology operation theater to high radiation exposure. So all health care providers in endourology OT is a important occupational group and should use radiation protective measures. Methods: The questionnaire was given in form of hard copy to 70 Operation theater Health Care Providers in our urology department who are working or likely to work for at least 1 month. And same was collected personally and assessed. Results: A total of 70 questionnaires were collected from urology Operation theater Health Care Providers. All of the respondents reported that they were routinely exposed to ionizing radiation, and 41 (58.06%) were exposed more than 3 times per week. Despite the common but not sufficient use of lead aprons (80.64%), use of other radiation protection measures was very low. 19.35% of the respondents had attended an education program The level of knowledge about ionizing radiation was low among urology Operation theater Health Care Providers, and approximately half of responders had no idea that commonly used imaging modalities have a fatal cancer risk. Conclusion: The results of this study showed the lack of knowledge and awareness about the importance of ionizing radiation protection and radiation safety measures among Urology Operation theater Health Care Providers in our hospital. We therefore suggest radiation safety courses in every step of medical life for doctors, especially for endourologists.

   P5-04: Are we over diagnosing female urethral stricture? Top

SB Viswaroop

Vedanayagam Hospital & Postgraduate Institute, Coimbatore

Introduction - Female urethral stricture (FUS) is rare. This audit from single institution looks at the issue of clinical diagnosis of urethral stricture in females and role of urethral dilatation(UD). Material and Methods - We reviewed discharge summaries of all female patients who had urethral stricture and or UD from June 2014 to June 2017. Presenting symptoms, duration, possible etiology, prior dilatation, time to last dilatation and whether on self calibration were noted. Type of evaluation, cystoscopy findings, including need for a guide wire, ease of dilatation and postoperative outcome including need for self calibration were studied. Failure to pass 14Fr integrated cystoscope was considered as evidence of urethral stricture. Results - Between June 2014 to June 2017, 84 patients had Cystoscopy under anaesthesia for possible diagnosis of urethral stricture. Median age was 56years (range 4yrs to 85yrs). Majority were idiopathic with post RT eight, malignancy one, Iatrogenic three and two had BXO. MCU was done in 17 and three had urodynamics. Of 53 patients who had uroflowmetry, 41 had Qmax <10ml/min. Surprisingly, only 32 had evidence of stricture on cystoscopy. Nearly 1/3rd had prior dilatation. Of them 60% had dilatation only once and were symptom free for a median period of 6.7years. Time to last dilation ranged from 9months to 16years with median of 9years. Substitution urethroplasty was done in three with 70% success. Conclusion - Female Urethra Stricture is not uncommon but there is significant over diagnosis and over use of UD. UD is a good option initially with reserve of urethroplasty for recurrent stricture.

   P5-05: Retroperitoneal vs. transperitoneal robot-assisted partial nephrectomy: a propensity score weighted comparison in a multi-institutional setting Top

Sohrab Arora, Mahendra Bhandari, Craig Rogers, James R Porter

Multi-institutional (VCQI collaboration)

Background: Robot-assisted partial nephrectomy (RAPN) can be performed via transperitoneal (TP) or a retroperitoneal (RP) approach. With both having some advantages and disadvantages, and with the increasing adoption of RP-RAPN, there is need to evaluate these approaches in a multi-institutional setting. Methods: Post hoc analysis of the Vattikuti Collective Quality Initiative prospective database from November 2014 until January 2017. 486 consecutive patients undergoing RAPN by 22 surgeons at 14 centers in nine countries were included. Inverse probability of treatment weighting was done to account for potential selection bias between RP and TP cohorts by adjusting for age, American Society of Anesthesiologists score, age-adjusted Charlson Comorbidity Index, and clinical tumor size. Results: 72 patients underwent RP-RAPN and 415 patients underwent TP-RAPN. The hospital stay in days (median [IQR] 3.0 [2.0-4.0] TP-RAPN vs. 1.0 [1.0-3.0] RP-RAPN; p<0.001) and estimated blood loss in millilitres (median [IQR] 100 [75-200] TP-RAPN vs. 100 [50-200] RP-RAPN; p=0.007) were less in RP-RAPN group. There was no difference in operative time (p=0.462), warm ischemia time (p=0.510), intraoperative complications (p=0.116), postoperative Clavien grade ≥ 3 complications (p=0.268), positive surgical margins (p = 0.195), and drop in estimated glomerular filtration rate (p=0.474). Conclusions: RP-RAPN is a safe and technically feasible option for nephron sparing surgery in both anterior and posterior renal masses. Both RP-RAPN and TP-RAPN have comparable operative and perioperative outcomes except for hospital stay, which was shorter in RP-RAPN.

   P5-06: Auto-transplantation in management of reno-vascular hypertension- can we consider it first line treatment? Top

Umesh Ravikant Shelke, Sujata K Patwardhan, Bhushan Patil, Yash Pamecha, Neeraja Tillu, Shashank Kamat

Seth GSMC & KEM Hospital, Mumbai

Introduction- In patients with main renal arterial stenosis, kidney can often remain viable due to collateral vessels. Reconstruction of renal artery can be followed by improved renal function and resolution of hypertension. Methods- This study was a prospective observational study conducted from August 2010 to June 2016. Young patients (< 45 years of age) diagnosed to have reno-vascular hypertension, with uncontrolled blood pressure on medical management and renal arterial disease unfavorable for percutaneous intervention were included in study. All patients were evaluated with computed tomography with angiography and DTPA scan. After reconstruction of vessels on bench, native kidney was auto-transplanted in iliac fossa to major iliac vessels. In case of accessory artery, anastomosis was done to external iliac artery in end to side manner Results- Total nine patients were included in the study. All underwent auto-transplantation. All were relatively young (mean age- 26.89 years). Seven patients were male and two were female. Of these patients, seven patients had bilateral stenosis of renal artery and two patients had unilateral stenosis of renal artery. After auto-transplantation, initially five patients became free of anti-hypertensive medicines, but on follow up at one year, two patients showed rising trend of blood pressure. Evaluation revealed narrowing at anastomosis site in both patients with salvageable kidney function in one patient. Angioplasty with stenting was done in this patient. Other patient with unsalvageable auto-transplanted kidney underwent nephrectomy. Till at least two years of follow up, four patients required no anti-hypertensives medicines. Conclusion- It appears that auto-transplantation can be a successful treatment of severe reno-vascular hypertension and should be considered in young patients and patients with renal arterial disease unfavorable for percutaneous intervention.

   Podium Session - P6 Top

   P6-01: Efficacy of peri-operative intercostal nerveblockade in PCNL- A prospective cohort study Top

Piyush Gupta, Manikandan, Shanmughadas KV, Madhavan, AT Rajeevan, AV Venugopal, Felix Cardoza

Government Medical College, Calicut

Objective:To access the efficacy of peri-operative intercostal nerve blockade in PCNL Materials and methods :In period between January 2016 to Dec 2016, 60 cases of PCNL performed at our institute were enrolled into this prospective cohort study out of which 31(51.7%) patients were in the study group and 29(48.3%) were in control group. At 3 intercostal nerve sites, supplying site of puncture site, 10 ml of 0.25% bupivacaine in group S was infiltrated while group C was placebo. Postoperative pain was assessed by visual analogue scale (VAS) (score between 0 and 10) at rest and during deep breathing and coughing (DVAS- dynamic visual analogue scale score between 0and 10) every 4 hours till 24 hours. Results were as follows. Males comprised of (83.9%) 26 and (82.8%) 24 while females comprised 16.7% and 16.2% (5 each) in study and control group respectively. The average age, weight and operative time of the patients in Study group was 43.65yrs, 61.42kg and 63.71min while in control group was 44.69 yrs, 61.90kg and 69.31min. VAS score at 4, 8, 12, 20 and 24 hrs was significantly less compared to control group (p<0.05) while DVAS at 4, 12, 16 and 20 was significantly less compared to control (p<0.05). Mean demand of 1st pain killer and total demand of pain killer in first 24 hours was also significantly less. The average postoperative hospital stay in Study group was 3.77days and in control group was 4.72 days which was also significantly low. Conclusion Our study demonstrated that peri-operative intercostal nerve blockade was effective in reducing overall pain scores with less demand for post-operative analgesia and decreased duration of stay. Keywords: Intercostal nerve blockade, VAS, DVAS, Demand of pain killer

   P6-02: Outcome of Renal transplant arterial anastomosis : Internal iliac artery versus external iliac artery with spatulation based on Poiseuille's law – A prospective randomized controlled study in a single centre Top

Rakesh K Janna, D Ramesh, Prasad Mylarappa, Sandeep Puvvada, Aravind Nayak, Prarthan Joshi, Vivek Gowda

Ramaiah hospital, Bengaluru

INTRODUCTION: We compared the best technique for arterial anastomosis in kidney transplantation, already proven technique end-to-end anastomosis of renal artery to internal iliac artery versus end-to-side anastomosis to the external iliac artery with spatulation of the donor renal artery. End Stage Renal Disease is a common ailment in Indian scenario. All patients reqiuiring renal transplant were on hemodialysis. These patients were cross-matched and ethical committee clearance obtained for renal transplantation with end-to-side anastomosis of the external iliac artery with spatulation of donor renal artery. Materials and Methods: A total of 45 patients with end-stage renal disease who received a kidney transplant from a live related donor were randomized into two groups in order to undergo either end-to-end anastomosis to the internal iliac artery (group 1) or end-to-side anastomosis to the external iliac artery with spatulation (group 2) based on Poiseulle's law. Poiseuille's law describes the relationship between flow, pressure and resistance (F=°P/R). Length of arterial anastomosis, cold ischemia time, hospital stay, serum creatinine level, recovery of urinary output, and surgical and clinical complications during hospitalization were evaluated. After 3 years, in the patients with a functioning allograft, creatinine clearance measure, Colour Doppler ultrasonographic study, overall survival, graft loss, and erectile function were compared between the two groups. Results: Postoperative analyses showed better recovery of urinary output (P =.39) and creatinine (P =.95) in end-to-side anastomosis of the external iliac artery with spatulation compared to end-to-end anastomosis of internal iliac artery. Better results were seen in clinical (P =.55) and surgical (P =.80) complications or in hospital stay (P =.90) in end-to-side anastomosis of the external iliac artery with spatulation. The total study period was 5 years. The 3-year follow-up demonstrated better results in Colour Doppler ultrasonography results, creatinine clearance (P =.80), patient survival (P =.22), and graft loss (P =.72) in patients who underwent end-to-side anastomosis of the external iliac artery with spatulation. Erectile dysfunction was less in group 2, compared to group 1. Conclusion: End-to-side anastomosis to the external iliac artery with spatulation had better outcome in Colour Doppler ultrasonography results, creatinine clearance, patient survival and graft loss than end-to-end anastomosis to the internal iliac artery. Erectile dysfunction was less in group 2. Key words :- kidney transplantation, erectile dysfunction, transplant renal artery anastomosis, Poiseulle's law, renal artery resistive index.

   P6-03: The 'U' technique for laparoscopic knot tying shortens the learning curve Top

Shyam S Matanhelia, I Rajendran, J Woodward, J Johnson, R Date

Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom

The fundamentals of suturing and knot tying are the same for open, laparoscopic and robotic-assisted surgery. However, mastering laparoscopic skills has a longer learning curve due to the challenges of working with two-dimensional images, limited availability of space and the fulcrum effect. Traditionally, knot tying has been taught with the 'C' and 'D' technique that involves a different movement of the needle holder tip, and a different direction of pull of the suture. Due to this complexity of movements, beginners find it difficult to grasp the concept of knot tying. We have developed a new 'U' technique, which is easier to learn. In this technique, the left hand is fixed, and repetitive movement of the right hand completes the knot. These movements of the needle holder tips are similar to open surgery. In this pilot study, 20 novices were equally divided in two groups. Each group received supervised training for two hours on laparoscopic simulators. The first group was taught the 'U' technique, and the second group was taught the 'C' and 'D' technique. Both groups were assessed on time taken to make five knots and ten knots. The average time to tie each knot for the 'U' technique group was 35 seconds in comparison to 49 seconds by the 'C' and 'D' technique group. We believe that the beginners should be initially taught the 'U' technique, which is easier to learn. Once proficient in this, the 'C' and 'D' technique can be introduced.

   P6-04: Pre-transplant laproscopic bilateral native nephrectomy- common port approach Top

Upwan K Chauhan, V Dassi, Shailender Goel, Anurag Kumar, Anant Kumar

Max Superspeciality hospital, Delhi-NCR

Introduction-End -stage renal disease patients in some cases may require removal of one or both naitive kidneys before renal transplantation. The main indication for bilateral nephrectomy are persistent symptomatic renal infections due to obstruction or bilateral renal calculi, vesicoureteric reflux (VUR), severe renal proteinuria, hypertension resistant to medical management and polycystic kidneys. OBJECTIVE: To discuss our common port technique and results of simultaneous bilateral laparoscopic naitive nephrectomy done before a subsequent renal transplant. Methods: 18 patients who under went bilateral laparoscopic native nephrectomy from April'2010 to August'2017 were reviewed. Review was performed with respect to indications, surgical approach, complications and cosmetic results. Three 10 mm ports were put in the midline, which were used as common ports for both sides and one 5 mm port for kidney retraction was put on each side. The specimen along with ureters were dropped into the pelvis one by one, and then removed via 5-6 cm Pfannenstiel incision. Results: In our series of 18 patients,8 patients underwent bilateral nephrectomy because of VUR having pyelonephritis (n=9), b/l obstructive renal calculi (n=3), uncontrolled hypertension (n=3), glomerulonephritis with protienuria (n=2), and polycystic kidney disease(n=1). Mean age was36 ryears and operative time was 3-5 hrs with mean blood loss 230 stay 4 patient was converted to open due to adhesions and one had renal vein injury. CONCLUSION:Simultaneous b/l laparoscopic native nephrectomy is feasible with low morbidity and good cosmesis.

   P6-05: Renal Replacement Lipomatosis Top

Vishal Kadeli, Rajendra Nerli, Prasad Magadum

Dept Of Urology, KLE Hospital, Belagavi

Introduction: Renal replacement lipomatosis (RRL) is a rare condition that occurs at the end of the spectrum of renal tissue replacement by fat. It is usually unilateral and occurs as a result of severe renal atrophy or destruction usually due to chronic calculus disease, chronic pyelonephritis and renal tuberculosis. The most commonly used diagnostic investigation remains CECT (contrast enhanced computed tomography) scan. Here in we report our series of patients with total renal replacement lipomatosis treated by nephrectomy. Materials and Methods: We retrospectively reviewed our hospital data for cases of RRL, presented and treated during the period Jan 2006 - Dec 2015. The age, gender, presenting symptoms, clinical and laboratory findings were noted. The indications for surgery, postoperative outcomes and complications were similarly noted and analyzed. Results: Five patients (three females and two males) with a mean age of 48.4ą3.2years presented with symptoms of pain. Computed tomography (CT) in these patients showed the affected kidney to be completely distorted and replaced by ill-defined fatty attenuating lesion. Open Nephrectomy was done in all these patients. HPR revealed features of RRL with renal calculi. Conclusions: Renal replacement lipomatosis is an uncommon entity, and one should have a high index of suspicion when dealing with suspicious lesions similar to xanthogranulomatous pyelonephritis. Specific imaging, operative, and pathological differences may provide clues for the differential diagnosis.

   P6-06: A novel scoring system based on histopathological features in anterior urethral strictures secondary to lichen sclerosus. Does it correlate with disease severity? Top

Chaudhary K, Devasia A, Mukherjee Partho, J Chandrasingh, Kumar S, Mukha R, Kekre N

Christian Medical College, Vellore

Introduction: Lichen Sclerosus(LS) related urethral strictures have higher rates of treatment related morbidity and disease recurrence, necessitating accurate staging and diagnosis. Aims and objectives:1. To assess and grade the histopathological features of LS related urethral strictures with a scoring system. 2. To correlate radiological and intra operative disease severity with histopathology. 3. To evaluate histopathology of proximal urethra, visibly perceived to be normal. Material and Methods: Prospective observational study of 35 men with stricture clinically suggestive of lichen sclerosus. Assessment of stricture length and caliber was with RGU and MCU and intra-operatively using a ureteric catheter. Samples were taken for histology from the stricture segment and proximal normal urethra. Histopathological scoring system was formulated based on five specific tissue features: Thickness of the epidermis, vacuolar degeneration of basal cell layer, sub-epithelial hyalinization, lichenoid plasmacytic infiltration and hyperkeratosis. Results: Mean age was 38.3 years and all presented with voiding LUTS. Median stricture length on imaging was 24 mm(6-90mm) and intra operatively was 20 mm, (9.5-30mm). Stricture length and caliber intra-operatively and on imaging correlated positively. (p=0.031 and p=0.034). Stricture length on imaging correlated positively with histological score although not statistically significant (p=0.0752). Fifty percent of the patients had a high histological score suggesting severe disease. Proximal urethra was negative for disease in ninety percent. Conclusion: Histopathological scoring augments operative and imaging findings in assessment of disease severity in LS strictures.

   Moderated Poster Session - 1 Top

   MP1-01: Boari flap vesicocalycostomy in Graft kidney with intrarenal pelvis for PUJ obstruction due to Tuberculosis Top

Abhay Anand, Surdas R, Ravikumar Karunakaran

Aster MIMS, Calicut, Kerala

We report the case of a gentleman who underwent Renal transplant 6 years back and had normal postoperative course. He developed progressive graft dysfunction since last 10 months. Ultrasound examination showed new onset allograft Hydronephrosis. He underwent kidney biopsy which provisionally showed Granulomatous nephritis and the patient was started on antitubercular therapy. But he continued to have rise in serum creatinine. so he underwent CT guided PCN insertion and Nephrostogram showed PUJ obstruction with intrarenal pelvis. He underwent Boari flap vesicocalycostomy and serum creatinine gradually came down to 2mg% from 6.2mg%. The purpose of this report is to highlight Boari flap reconstruction is easier to do than native ureteropyelostomy.

   MP1-02: Perihilar Corduroy Sign - A novel CT scan Finding in chyluria and chylohaematuria Top

Dharmveer Singh, Rahul Soni, K Madhavan, S K Sureka, R Kapoor, A Srivastava


Introduction Chyluria is a significant health problem, particularly in the rural populations of Asia, Africa and parts of Central and South America. No definitve radiological diagnostic findings has been sugested in literature. We have identified a typical persistent findings on contrast enhanced computed tomography scan of chyluria and chylohaematuria patients. There is hypodense soft tissue sheath like structures present particularly at renal hilum and retroperitoneum encasing the hilar structures which we termed it as Perihilar Corduroy Sign. Materials And Methods We prospectively analysed 25 patients from period of January 2014 to march 2017 at our tertiary care institute, who presented to us with complaint of recurrent chyluria or chylohaematuria and/or with clot retention due to it. Primary diagnosis of chyluria was made on presence of triglycerides cholesterol in the urine. Initial management consists of a fat-restricted, high-protein diet with the addition of fats containing medium chain triglycerides (TGs), anti-filarial drugs and high fluid intake. Out of twenty five patients CECT KUB was conducted in 21 patients and NCCT KUB in 4 patients due to raised serum creatinine. Images were recorded and reporting done by Radiologist. We also performed filarial antigen or antibody detection tests in all patients. Results Out of the twenty five patients we found a specific pattern hypodense sheath like reticulations near the renal hilum encasing the renal and great vessels in 18 patients. These structures are not showing any post contrast enhancement. In five cases, there is communication of these reticulations with renal pelvis on delayed urographic images. Due to its appearance as longitudinal thread like pattern, We described this persistent feature as Perihilar Corduroy Sign. Filarial antigen or antibodies were positive in 19 (76 % ) of cases. Clot evacuation was performed in 7 patients. Twenty out of 25 patients responded well to conservative management while remaining 5 refractory cases responded well to unilateral intrapelvic betadine instillation. Conclusion Perihilar corduroy sign on CT scan in chylohaematuric patients will lead to early diagnosis and prompt management. Most common cause is filarial infection which responded well to conservative management.

   MP1-03: Hard prostate with raised PSA is not always cancer Top

Lanka PK, Bora GS, Sudheer KD, Bansal A

PGIMER, Chandigarh

Introduction Malakoplakia is an inflammatory disorder which affects the genitourinary system with urinary bladder being the commonest organ involved. Prostatic malakoplakia is a rare disorder with fewer than 200 cases reported and is mostly diagnosed on needle biopsies done for prostatic lesions which are suspected to harbour malignancies. Materials and methods A 55 year old patient who presented with symptoms of obstructive LUTS and fever of 15 days duration and had reported to the hospital with history of acute retention of urine requiring catheterisation and examination revealed a hard nodular grade 2 prostate and a PSA was ordered in view of clinical findings. Urine culture showed E. Coli sensitive to Amikacin and Ciprofloxacin. PSA was 25.8ng/ml and a TRUS guided biopsy was done under antibiotic cover which revealed exuberant histiocytic proliferation with ill formed granulomas comprising lymphoplasmacytic cells with occasional histiocytes containing intracytoplasmic inclusion bodies (Michealis Guttmann bodies) without any evidence of Atypia or malignancy. VonKossa and PAS stain confirmed malakoplakia Results He was managed conservatively with alpha blockers and targeted antimicrobials following which he improved symptomatically and a successful trial without catheter was given. PSA was 3.2ng/ml and urine culture was sterile. He is voiding well and was asymptomatic during the last follow up Conclusion Prostatic malakoplakia is a rare inflammatory disorder which can mimic prostatic adenocarcinoma and can sometimes mask atypical cells and hence additional special staining is mandatory before malakoplaia is diagnosed and symptomatic treatment suffices in most cases

   MP1-04: A case of Emphysematous Cystitis presenting with acute urine retention in an immunocompetent host Top

Mukesh Kumar Gupta, Kalpesh Mahesh Parmar, Tushar aditya narain, Aditya prakash Sharma, Sudheer Kumar Devana, Shrawan Kumar Singh

PGIMER, Chandigarh

Introduction-Emphysematous cystitis is a very rare form of urinary tract infection. It commonly presents with suprapubic pain associated with LUTS in immunocompromised hosts. The most common predisposing factors are old age, diabetes mellitus, female gender, urinary tract obstruction and neurogenic bladder. Here we present a case of emphysematous cystitis presenting with acute urinary retention in an immunocompetent host. Method - A 54 year old chronic smoker with peripheral vascular disease presented to our emergency department with complaints of painful acute urinary retention. Patient was in severe discomfort and systemic examination revealed soft abdomen and a tender palpable urinary bladder upto umbilicus. A 16 Fr Foleys catheter was placed and 800ml of cloudy appearing foul smelling urine was drained immediately. Patient underwent abdominal ultrasound which revealed multiple air foci in the bladder wall and contrast enhnaced computed tomography scan showed emphysematous changes in the bladder wall. Result - Broad-spectrum antibiotic were empirically started and patient showed increased appetite, normalized leukocyte count and clear urine output in follow up. A repeat urine culture was sterile and Foleys catheter was removed on day 14 and the patient was voiding well. Conclusion - Our index case highlights the fact that emphysematous cystitis could be kept as a rare possibility in the differential diagnosis of an elderly male patient presenting with acute urinary retention. It also reemphasizes that emphysematous cystitis can even occur in patients without any immunosuppressive state.

   MP1-05: Management of Atypical Mycobacterial Infection of PCNL Tract Top

Nishant R Kathale, Gaurang Shah, Tanvi Shah, Javed Khan, Charalampos Mamoulakis

Saifee hospital, Mumbai

Introduction and Objectives: India, known for renal stones, has many charitable institutes doing high volume PCNL at low cost. The needles and amplatz sheaths are reused to lessen the expenses. Common OT's and high prevalence of TB has increased atypical mycobacterial infection rate. The objective of this study is to bring awareness about AMB disease, its clinical diagnosis, and elucidate guidelines for treatment. Materials/Methods: This includes two case series. The 1st is of 13 patients from Mar/Apr, 2010 and 2nd series of 9 patients from Mar, 2015. In all these patients common needle dilators/amplatz sheath were reused. The diagnosis was established by wound biopsy. The sterilisation used glutaraldehyde. Later, all reused instruments were gas sterilised Results: The discharge stopped within 10 days. Granulation tissue disappeared in 3 weeks. The wound became normal after 6 weeks. 15 of 22 patients had weight gain. 2 patients had drug intolerance. None developed Urogenital Koch's. The gas sterilisation decreased AMB unless cracks were present. Conclusions:To avoid AMB infection during reuse of disposable material, avoid using broken material and do gas sterilisation. The early clinical diagnosis should be made when patient comes after 3 weeks with non healing wound. In case of inflammation less than 2 cm, 2 drug therapy is sufficient. If inflammation radius is more than 2 cm then 5 drug treatment is required. If inflammation is more than 5 cm with discharging abscess then excision of tract up to deep fascia with 5 drug treatment is required.

   MP1-06: Vascular control in laparoscopic donor nephrectomy Top

Rakesh Khera

Apollo Hospital, Fortis Hospital, Medanta The Medicity

OBJECTIVES: Laparoscopic donor nephrectomy has become the method of choice for removal of living donor kidneys. The ENDO GIA stapler is commonly used for division of the renal vessels, but it can lead to some loss of graft vascular length. Besides, stapler malfunction can occur. In this study, we report our experience using polymer locking clips for vascular control, compared with experience using the ENDO GIA stapler MATERIALS AND METHODS: 2100 underwent laparoscopic donor nephrectomy from june 2001 to july 2017. Renal artery was ligated with polymer locking clips with LT clips in 2065 and from june 2017 till july 2017 endo gia stapler was used on the same on arteries on 35 patients. The results with the endo gia stapler are presented herewith on the artery and vein RESULTS: With the polymer locking clip, we harvested nearly the entire renal arterial length. There were no vascular complications or graft loss. The endo gia stapler was used on the vein with 1 stapler misfire and bleed. The stapler was used on arteries with 2 gross bleed and 15 minor bleeds. There was conversion to open in 4 cases for staplers due to malfunction of the ENDO GIA stapler device. CONCLUSION: In our series, there vascular complications with staplers on the renal artery and vein but no device failure during vascular control using polymer locking clips on arteries. We believe that polymer locking clips are safe, yielding greater vessel length during laparoscopic donor nephrectomy

   MP1-07: Haemodynamics and histopathological study of spermatic veins in varicocele testis - a preliminary study Top

Rawal K, Shimpi RK, Sharma SD

Ruby Hall Clinic, Pune

INTRODUCTION: Varicocele is the most frequently encountered, surgically correctable cause of male infertility. The incidence in general population is 10–23%, but 35% of all men evaluated for infertility have a varicocele. The pathogenetic mechanism through which varicocele causes testicular dysfunction and subsequent alteration in spermatogenesis, is, however, not completely understood. OBJECTIVES: Present work is aimed at studying hemodynamics of varicocele, the histopathological alterations in patients with varicocele and possible communications with pelvic veins which could be a factor for failure or recurrence. MATERIAL AND METHODS: A prospective, observational study involved 53 Patients aged 18–35 years who underwent microsurgical varicocelectomy from May 2016 to May 2017. Testicular hemodynamic was evaluated by color Doppler study. The venous anatomical details were evaluated by intraoperative venograms, testicular venous pressure studies, and histopathological findings. Postoperative results of semen analysis and testicular blood flow were compared with preoperative values. RESULTS: The haemodynamic study shows a reduction in the testicular blood flow prior to surgery. The spermatic venography showed the precise anatomy of the pampiniform plexus and possible small venous communications with pelvic veins. The hypertrophy of the muscularis explains the high venous pressure in the pampiniform plexus, morphologic changes of the venous wall may lead to impaired venous return which promotes the development of varicocele and its pathogenetic effect on spermatogenesis. CONCLUSION: The study shows that the arterial blood flow to the testis improves after microsurgical varicocelectomy. Abnormal communications between veins also explain the recurrence of varicocele after varicocelectomy.

   MP1-08: Novel technique For Traumatic Giant Renal Artery Pseudoaneurysm. Literature review and Case Study Top

Sarmukh S, Putera MP, Tan KL, Chew LG

Hospital Serdang, Selangor, Malaysia

Renal artery pseudoaneurysm is an uncommon vascular lesion. Early detection and treatment of renal artery pseudoaneurysm is important because it can rupture and can lead to life-threatening hemorrhage. Recent advances in endovascular interventions can prevent potentially challenging open surgery. We are describing a new approach on a 66 year old patient who presented with a painful abdominal mass measuring 13.5 cm. CT scan show a giant renal artery pseudoaneurysm. In our case we have anticipated with endovascular intervention. A selective right renal artery angiogram with embolization using complex helical coils packed at end artery over the leaking siteboth open surgery and endovascular surgery. Followed by an angiostenting of right renal pseudoaneurysm using Amplatzer AVP I stent. As a conclusion this patient was treathed endovascular techniques

   MP1-09: Vascular Disasters in Laparoscopic Donor nephrectomy and Disaster management Top

Sonawane P, Singh A, Ganpule A, Sabnis R, Desai M

Muljibhai Patel Urological Hospital, Nadiad

Introduction and Objective Laparoscopic donor nephrectomy (LDN) is the norm across most centers in the current transplantation era. LDN should be a zero error procedure with no morbidity to donor. Objective of this presentation is to highlight the unwarranted vascular complications during LDN and the strategies employed to overcome them. Methods A retrospective analysis of vascular complications that occurred during LDNs performed from 2011 to 2016(n=858) at a single tertiary care institute. All donors who had a complication intraoperatively were followed up postoperatively for assessment of overall condition and renal functions for minimum 1 year. There were 2 cases of renal vein injury, one renal artery injury, one inferior vena caval injury, one aortic injury (n=5,0.58%). Primary outcome was perfect hemostasis intraoperative and secondary outcome was long term morbidity (Clavien-Dindo classification) or mortality associated with the complication. Results Primary outcome i.e. perfect hemostasis was achieved in all 5 cases. Though no mortality was seen, grade 1 morbidity was noted in 2 cases and one case had grade 2 morbidity requiring blood transfusion. At 1 year follow up none of the patients had long term grade 1 or higher morbidity. Conclusion Meticulously studying the CT angiography on console just before surgery will act like a global positioning system (GPS) for the operating surgeon. Not to panic and being well versed with the rescue measures for laparoscopic repair of vascular injuries is of paramount importance for surgeons aspiring to be experts in laparoscopic donor nephrectomy.

   MP1-10: Renal allograft hydronephrosis (HDN): do we always need to intervene? Top

Vikas Jain, Saurabh Jain, Suman Lata Nayak

Institute Of Liver and Biliary Sciences, New Delhi

Introduction: Renal allograft hydronephrosis is not uncustomary. Obstructive HDN is one of the most common reversible causes of graft dysfunction. The clinical significance of obstruction lies in the fact that it may silently result in graft dysfunction/loss, if not addressed appropriately and timely. On the other hand of spectrum is unnecessary overtreatment of non-obstructive dilatation of urinary tract. Differentiating between the two is important before embarking on treatment. The present study envisages our experience in the management of graft hydronephrosis. Materials and Methods: A total of 17 graft HDN were included in the study. Thirteen of these cases were our operated patients (9/151, incidence: 5.9%) and 8 patients were under our follow-up after being operated elsewhere. Male to female ratio was 11:6. Age range included 17-58 years. Mean duration of presentation after surgery was 2.5 months to 3.2 years. The most common presentation was an incidental finding on routine ultrasonography (14 cases), followed by asymptomatic rise in serum creatinine in three patients. Four of these 17 hydronephrosis were obstructive and required intervention. Rest all were found to be non-obstructive and are being regularly followed-up. Results: All the four patients underwent endourological interventions. While three responded well to it, one required surgical ureteric re-implantation for persistent obstruction. Conclusion: Dilatation of the graft pelvi-calyceal system is usually asymptomatic, therefore passed unnoticed at times. Early recognition and prompt treatment of significant obstruction is prudent to prevent nephron loss. Endourological treatment is primary option, with surgery kept reserved for persistent obstruction. The present study proposes the management algorithm of graft HDN.

   MP1-11: Cripple Peyronie's Disease- Hybrid Reconstruction Technique Top

Y P Singh Rana, Aditya Pradhan, Ashish Kumar, Harish Kumar Sinha

BLK Super Speciality Hospital, New Delhi

Introduction Peyronie'sdisease(PD) is an acquired condition of tunica albuginea with excessive fibrosis and plaque formation. This is disabling initially when there is painful erection and with due course of time pain subsides and there is curvature of penis. The curvature might preclude the patient for intercourse. Treatment options are medical and surgical. As medical treatment rarely works in treatment of Peyronie's disease, surgical correction remains the treatment of choice. Though surgical correction may lead to penile length shortening. We have to choose the technique which corrects the curvature and causes minimal or no penile length shortening. We share a case of Peyronie' disease with severe curvature precluding sexual intercourse leading to marital disharmony. Penile curvature was treated with combined excision and incision of plaque with grafting technique. Case presentation: 45 years gentleman presented with inability to indulge in sexual intercourse due to severe penile dorsal curvature for 2 years. He also had pain and heaviness in right hemiscrotum. He has normal libido and erectile function. He has no history of penile trauma, intracavernousal injections. No history of previous penile surgery. He has no comorbidities. Local examination revealed multiple plaques involving dorsum of penis with hourglass deformity leading to curvature of 70 degrees and grade 3 right varococele. Method: Penile length and curvature was assessed in erect position. Penis was degloved till base of penis and plaques were treated with excision and incision. Right spermatic cord was exposed and right varicocelectomy done with procurement of testicular vein and small length of anterior rectus sheath as graft. Anterior rectus sheath was placed at site of excision and testicular vein was placed as graft at incision site. Adequacy of penile curvature assessed with Gittes test. Outcome : Post operative course was uneventful. Follow up visit revealed normal penile curvature and he could resume sexual intercourse after 3 months. Conclusion: Surgical correction remains mainstay of treatment in Peyronie's patient. Hybrid technique with grafting at excision and incision site provide an optimal penile correction and patient satisfaction in cases of severe curvature.

   MP1-12: Dual kidney transplant with an elderly cadeveric donor Top

Zaman W, Arora R, Chhabra Y, Mathur RP

Max Superspeciality Hospital, Shalimar Bagh, New Delhi

Introduction and Objective A 61 year old man with end stage renal disease underwent unilateral dual kidney transplant. The cadeveric donor was a 77 year old man with acutely impaired renal function. Methods The cadeveric donor was a 77 year old hypertensive man who suffered a fatal head injury due to alleged history of fall in park. His serum creatinine on admission was 0.83mg% and increased to 2.43mg% during maintainance in Intensive Care Unit (ICU). The recipient was a 61 years old diabetic and hypertensive man. He had end stage renal disease and was on regular maintenance hemodialysis. The recipient underwent unilateral dual kidney transplant in view of an elderly donor with an acutely raised serum creatinine. Both kidneys were transplanted in right iliac fossa. The donor left kidney was anastomosed to common iliac artery and external iliac vein and right kidney was anstomosed to external iliac artery and external iliac vein. All the anastomoses were end to side. Results The recipent required postoperative hemodialysis twice. He was managed conservatively and recovered completely with a serum creatinine of 1.1 mg% on day 10 of surgery. Cold ischaemia time was 9 hours 10 minutes. Conclusions Dual kidney transplant had excellent clinical outcome with an elderly marginal donor. Its use in expanded criteria elderly donors will increase the pool of available donors and circumvent the shortage of organs.

   Moderated Poster Session - 2 Top

   MP2-01: Almost Total Ureteral Loss following URSL – A Rare Complication Top

Akshita Bhat, Bhat Amilal, Bhat Mahakshit, Tomar Vikas Singh, Dar Bilal Ahmad, Singh Tajendra, Burman Alkesh

Dr SP Medical College Bikaner and Dr SN Medical College Jodhpur

INTRODUCTION: The most serious complications of ureteroscopic lithotripsy include ureteral perforation (0.5%), stricture (0.4%) and avulsion (0.4%). We report a case of iatrogenic upper ureteral perforation requiring ileal transposition on account of its rarity. METHOD: A 40 years female had a ureteral perforation during URSL for upper ureteric stone. Patient's DJ stent was removed prematurely for severe stent symptoms. Patient presented after few days with fever and a palpable lump in left lumbar region. USG revealed retroperitoneal collection (15x9x8cm) below the left kidney and IVU showed moderate dilatation of collecting system for which DJ stent was reinserted and CECT showed large retroperitoneal collection for which a peri-nephric drain was placed. Urine continued to drain in drain tube in-spite of D J in situ after 1month. URS revealed DJ stent in a false passage in upper ureter. Mal-positioned DJ stent was removed and another inserted. Drain outut became nil and patient was discharged. Patient developed urinoma with hydronephrosis after removal of DJ and a nephrostomy was done. 2 months later, AGP showed dilated collecting system with cut off at PUJ, while RGP revealed complete stricture 5cm proximal to VUJ. Ileal interposition was done for the ureteral stricture involving upper and middle ureter to save the renal unit. RESULT: Convalescence was uneventful, an IVU one year after the procedure showed a normal the collecting system with satisfactory renal function and sterile urine culture. CONCLUSION: Total ureteral loss without avulsion is uncommon and ileal replacement of ureter is advisable to salvage the kidney

   MP2-02: Comparative study of VIU alone vs VIU with Injection Tri Mix Top

Ankit Singla, Amit Tuli, Prateek Laddha, Abhishek K Singh, Pars Ram Saini, Nagesha S, Kim Mammen

Christian Medical College, Ludhiana

INTRODUCTION: Male urethral stricture is one of the oldest known urological diseases. Visual internal urethrotomy has been suggested as a procedure of choice for urethral stricture. However it has been associated with high recurrence rate. Several adjuvant therapies, including brachytherapy, injection of captopril, steroids, and mitomycin has been proposed to minimize the recurrence rate. MATERIAL AND METHOD This was a 1 year prospective, randomized and comparative study of efficacy in outcome of VIU as monotherapy [Group I] Vs. VIU and intralesional Injection of the TriMix-injection (Triamcinolone, Mitomycin C, and Hyaluronidase) [Group II] in the treatment of anterior urethral stricture. RESULTS: Both groups had improvement in IPSS scoring i.e. in Group I preoperative mean IPSS was 21.9 + 2.789 and post operative it was 6.1 + 2.049 at six month follow up. In Group II mean IPSS were 21.27 + 2.511 and post-operative it was 5.727 + 0.8827 which was statistically significant (p.0.0003). Quality of life improved significantly in Group Il [Pre op:- 5.409+0.513, Post Op (6months):- 2.364+0.492]. Significant improvement in the mean Q-max and Q-ave was seen in the Group II in comparison to the Group I. There was statistically significant improvement in Q-max from 9.05+2.40ml/s preoperative to 20.36+4.783ml/s post operative in Group ll and 6.46+3.22ml/s pre-operative to 18.21 +5.937 post operative in Group l(p:0.03367). Group II had significant decrease the recurrence rate in comparison to the Group I (4.54% in Group II Vs. 15% in Group I). There was no serious adverse effect with any of the study medication. CONCLUSION: To conclude there is enough evidence to support the use of Tri-Mix as combination in treatment of anterior urethral stricture patients.

   MP2-03: Milk of Calcium in a Pyelocalyceal Diverticula Masquerading as Renal Calculus Top

Anup Krishnan, Praveen Sundar, Appu Thomas

Amrita Institute of Medical Sciences, Kochi

Milk of Calcium (MOC) refers to a colloidal suspension of calcium salts. The occurrence is rare and it has been reported to occur most commonly in pyelocalyceal diverticula of Kidneys. Cases of MOC in gall bladder and breast has also been reported. MOC has distinct features on X-Ray, Ultrasonography and Computed Tomogram (CT). The MOC cysts of kidneys are frequently mistaken for renal stones on X-rays and could arise suspicion of a complex renal cyst on CT. In this report, we describe the endoscopic management (Flexible Ureteroscopy with laser) of a case of MOC in a pyelocalyceal diverticulum, which initially presented to us with loin pain, and diagnosed as a renal calculus as per CT findings.

   MP2-04: “Pcnl Simplified” - One Step Tract Dilatation for 24 Fr Pcnl vs Serial Alken Dilatation: Results of a Prospective Comparative Study Top

Ashish Chhajed

Apollo Hospitals, Indore

Introduction & Objective PCNL is the standard of care for renal calculi. Various techniques of tract dilatation have been described each having their advantages & disadvantage. In this study we selected patients with simple renal calculi (2-4 cm), all by same surgeon, using 2 different dilatation techniques alternately & then compared results. Results were compared in terms of stone clearance rates, X-ray time, Total operative time, dilatation complications, Postoperative Hb drop, other complications & surgeon satisfaction(subjective). Conclusions- “ One-step Dilatation simplifies PCNL, reduces Xray time, operative time & blood-loss “

   MP2-05: Poor compliance for lifestyle modifications and its significance in recurrent stone formers with recommendations for improvement Top

Cardoso AL, Prabhudesai MR, Lawande PR, Mandrekar PTN, Chari PD, Thatte SW

Goa Medical College, Goa

INTRODUCTION & OBJECTIVE: Poor compliance to lifestyle modifications and medical treatment is a major cause for recurrent stone formation. Our aim was to analyse the cause for this poor compliance and to give recommendations for improvement. METHODS: 60 recurrent stone formers were interviewed from Jan'16-Jan'17 with multi-dimensional questionnaire to evaluate compliance. High risk stone formers were excluded. Factors/sub factors studied were 1)Socio-economic factors - income level - socio economic level - cultural and lay beliefs 2)Patient factors - knowledge of disease - motivation - lack of family support 3)Therapy related factors - treatment duration - immediacy of beneficial effects - side effects of drugs 4) Health care system related factors - doctor's communication skill - doctor's qualification - long distance to treatment center 5) Disease related factors - severity of first attack - presence of co morbidities - presence of renal units lost Result: All patient & therapy related factors were significant (p<0.05). Low income and low level of education were not significant (p<0.05). Combination of certain factors was also significant: -poorly motivated patient with cultural/lay beliefs -poorly motivated patient treated at a peripheral health centre -poor knowledge of disease with co-morbidities Conclusion: Patient and therapy related factors were mainly responsible for poor compliance. Association of certain factors (as enumerated above) was also significant. Doctor must impart knowledge about the disease besides cure. General practitioners must be educated and updated regularly on stone disease. Electronic and print media must be engaged to change cultural and lay beliefs of society.

   MP2-06: Assessment of donor site morbidity of buccal mucosa graft Top

Kaurav Rustam Singh, S Vasudevan, Gopi Praveen, Rakesh, Narayan, Sunil

Government Medical College, Trivandrum

INTRODUCTION-Reconstruction of male urethra poses a continuing urological challenge. The ideal material for substitution urethroplasty remains controversial. Although the results of buccal mucosal urethroplasty are most satisfactory, there are certain complications associated with it. This study was about the donor site complications of buccal mucosal graft urethroplasty. OBJECTIVE: Assessment of donor site morbidity of buccal mucosa graft. MATERIALS & METHODS: This was a prospective study in which 48 cases of long segment anterior urethral stricture who underwent BMG urethroplasty were included. The Patients with stricture segment of size more than 2 cm, had undergone buccal mucosal augmentation urethroplasty. Two surgical team worked simultaneously and after graft harvesting donar site closed with chromic 3-0 sutures in 21 cases and 27 cases were left unstitched. Short term results, up to 30 days and long term results, upto 1 year were assessed and data was analyzed for its significance. RESULTS: Out of 48 patients, majority of patients were young adults having mean age of 37 years. The mean stricture length was 6.5cms (range 2-15). The mean follow up was 21 (range 6-56) months. Pain, swelling and tightness were detected as early donar site complications respectively in 12,10 and 04 patients. Out of 48 cases, only 2 cases(4.16%) reported presence of Hypertrophic scar as late donar site complication where as 46 cases(95.83%) were healthy. CONCLUSION: Buccal mucosa gives good and viable option for substitution urethroplasty for long segment strictures. Pain, swelling and tightness of mucosa were the common early complications which were subsided with symptomatic treatment. Hypertrophic scar was the late complication of BMG donar site, but not much common.

   MP2-07: Co-existing Pelvi-ureteric Junction Obstruction and urolithiasis: Is Endoscopic treatment a single shot solution? Our experience Top

Kaushik VN, Vincent DP, Ravichandran R, Konanki KV

Meenakshi Mission Hospital and Research Centre, Madurai

Introduction and objectives: Over the past few decades, Endoscopic pyelotomy has emerged as a viable and efficacious method to treat Pelvi-ureteric Junction Obstruction (PUJO). Endopyelotomy has been shown to be a shorter procedure, with less morbidity and high success. Additionally, 20% of cases of PUJO have co-existing stones. Endoscopic management of the two conditions can be done simultaneously by antegrade or retrograde approach. We present a case series of 8 patients who underwent endoscopic management (ante/retrograde) of PUJO and stones at the same time in the last 2 years. Methods: At our institution, 8 patients underwent ante/ retrograde intra-renal stone surgery and endopyelotomy over a period of 2 years between August 2015 to July 2017. 6 patients underwent antegrade procedure with Sachse's knife (3) or monopolar hook (3), while 2 patients underwent retrograde procedure with monopolar hook electrode. DJ stent was left in situ for 6 weeks. Postoperative success was determined by lack of symptoms, absence of stones and adequate drainage by a diuretic renogram or CT Urogram. Results: Age of the patients ranged from 9-65 years. 4 patients had co-existent contralateral urolithiasis as well. Postoperatively, all patients had relief of symptoms (100%) as well as obstruction (100%). Conclusions: Endoscopic management of PUJO with urolithiasis is a feasible, efficacious, minimally invasive and safe treatment modality with shorter operative times than laparoscopic surgery, and can be done either by antegrade or retrograde approach.

   MP2-08: All four-limbs peripheral gangrene: an unusual complication of ureteroscopy Top

Pankaj N Maheshwari, Rahul Pandit, Anita Mathews, Dhruti Amlani, Sitaram Prasad

Fortis Hospital Mulund, Mumbai

PURPOSE: Gram negative sepsis is a dreaded complication of any upper tract endourology procedure. We report all four-limbs peripheral gangrene, a rare and unfortunate complication after ureteroscopy. METHODS: A 38-year non-diabetic lady presented with a history of flank pain with fever of 5-day duration. With a diagnosis of lower ureteric calculus, she underwent ureteroscopy at a peripheral centre. Within hours of the procedure, she landed in severe gram negative sepsis (fever, hypotension, respiratory distress needing ventilation) and was transferred to our center for intensive care. On presentation, she had acrocyanosis in all four limbs which progressed to all four-limb peripheral gangrene within next 3-4 days. RESULTS: Although the patient survived, she needed right side below knee and left side above wrist amputation. Despite aggressive attempts at limb conservation, she suffered loss of all fingers and toes of the remaining two limbs. We believe this gangrene resulted due to a combination of vasospasm and vasopressors that were needed to maintain her blood pressure. Other factors like infective emboli and hypovolemia may also be responsible for the tissue necrosis CONCLUSIONS: Awareness of the potential infective complications of endourologic procedures is very important. It is important to resist the temptation of proceeding with ureteroscopy in presence of active infection. Development of acrocyanosis and increase in serum lactate levels may be indicative of impending peripheral gangrene.

   MP2-09: Bilateral Percutaneous Nephrolithotomy After Radial Cyctectomy And Ileal Conduit Top

Ram Saini Pars, Singla Ankit, Laddha Prateek, Tuli Amit, Ram Saini Pars, Singh Abhishek, Mammen Kim

Christian Medical College, Ludhiana

INTRODUCTION: Stone formation in ileal conduit patients is a common complication. These patients are at an increased risk of development of stones in the upper urinary tract, largely due to metabolic derangements and sepsis. CASE HISTORY: 48 year old male was diagnosed to have MIBC for which radical cystectomy and urinary diversion done in June 2013. 4 years later he came with obstructive Uropathy due to B/L nephrolithiasis and B/L ureteric calculi. Bilateral PCN was done. Patient underwent bilateral PCNL. Intra-operatively few fragments went down the ureter for which 6/7.5 Fr rigid ureteroscope was used to retrieve fragments. These fragments along with the pre-existing bilateral ureteric calculi were managed with ureteroscopy through the PCN. There was successful stone clearance bilaterally. DISCUSSION: The reservoir and pouch are more prone to develop stones. The patients with ileal conduit have urinary stasis contributing towards urinary stone formation. Hyperchloremic metabolic acidosis because of increased reabsorption of solutes across intestinal mucosa is mainly responsible for calculus formation. The techniques used for management include PCNL, ESWL, antegrade or retrograde ureteroscopic lithotripsy. PCNL is the standard of care for renal stones, abnormal renal anatomy and stones not amenable to ureteroscopy. But in a setting of ileal conduit accessing the upper ureter through the PCN is difficult. ESWL is a good treatment option in these patients because of difficulties in endoscopic access of the ureter. CONCLUSION: In patients with ileal conduit, neo ureteric orifices being narrow are difficult to visualize and it is difficult to gain percutaneous renal access since contrast cannot be infused into the collecting system.

   MP2-10: Is holmium laser cystolithotripsy under local anaesthesia effective, safe and tolerable? Top

Stephen L Sailo, Lakiang A, Passah M, Zothansanga

North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong

OBJECTIVE: To find out the effectiveness, safety and tolerability of Holmium Laser cystolithotripsy under local anaesthesia. MATERIALS AND METHODS: This prospective study included consecutive adult patients with bladder stones who presented to the Department of Urology, between February 2016 and July 2017. Exclusion criteria were children, paraplegia, multiple stones, concomitant ureteric stone and benign prostatic hyperplasia. Patients underwent Holmium laser cystolithotripsy under local anaesthesia using 8F ureterorenoscope. The pain score using Visual Analogue Scale during operation was assessed. The pain score was compared to that of patients who underwent double J stent removal under local anaesthesia using the same ureterorenoscope. Following cystolithotripsy, no urethral catheter was kept. Pelvis X-ray was done the following day to look for residual stones and patients discharged. Patients were followed up as outpatients. RESULTS: Forty-one patients were treated during this period. Six patients were excluded from the study. All the treated patients were male with mean age of 34.91 years. The most common presentation was acute urinary retention (71.43%). The mean stone size was 14.17x10.15 mm. The procedure was well-tolerated and no significant difference was found in the mean pain score between the patients who underwent cystolithotripsy (3.66) and stent removal (1.8) with p value of 0.09. All the stones were fragmented completely and all of them except one voided following the operation. All patients except one were discharged the next day. There was no major complication or mortality. CONCLUSIONS: Holmium laser cystolithotripsy under local anaesthesia is effective, safe and well-tolerated.

   MP2-11: A Gigantic Prostrate Top

Tanvi Shah, Nishant Kathale, Gaurang Shah, Mangesh Patil

Saifee hospital, Mumbai

Introduction Prostate weighing more than 500 g is defined as Giant prostatic hyperplasia (GPH). This case reports 650 g prostrate removed successfully by millins prostatectomy. Case report A 62-year old man, weighing 82 Kg came to OPD, with history of increased frequency, decreased flow since 2 years and past history of open surgery of the prostrate (details unavailable). On examination- non-tender dull mass in the suprapubic area. DRE- large, rubbery prostrate, no nodules and upper borderunreacheable. Usg- heterogenous mass 10.7x8.6x9.8 cm, 482 cc volume, suggestive of recurrent prostatic mass. Serum PSA- 54.63 and later 8.71ng/ml. TRUS biopsy- benign prostatic tissue with chronic prostatitis. The patient underwent millins prostatectomy. Intraoperative findings revealed massiveleft lobe of prostate with pseudocapsule pushing urethra to the right with large tortuous veins. Complete enucleation done and communication between fossa and urethra established. Capsule was closed with a 2/0 vicryl. 22FR 3 way Foleyperurethra, 20FR SPC and 28 no. drain placed. Estimated blood loss 800 ml. Drain removed on POD5, SPCremoved on POD7, patient discharged on POD8, perurethralcatheter and stitchesremoved on POD 15. On 1 month follow-up, patient was continent and voiding satisfactorily. The specimen weighed 650 g and 16x8 cm. Histopathology revealed BPH, chronic prostatitis with squamous metaplasia. Conclusion Prostates weighing more than 100 g have been recorded in 4% of men above 70 years. Only eight cases of BPH where prostate weighed more than 700 g have been reported. This prostrate is probably the largest removed in India.

   MP2-12: Post Cystectomy Urinary Diversion: SKIMS experience Top

Aashaq Hussain, Magray Javed, Iqbal Muzzain, Khawaja A Rouf, Hamid Arif, Wani M Saleem

Sher-i-Kashmir Institute Of Medical Sciences (SKIMS) Srinagar

INTRODUCTION: Cystectomy warrants urinary diversion. Urinary diversion could be continent/ incontinent type. Ileal conduit is the Gold standard of urinary diversions. However over the last decade construction of orthotropic neobladder has been on rise. MATERIAL & METHODS: Data was retrieved from the patient case sheets and medical record section. Post cystectomy different forms of urinary diversions were fashioned depending upon the underlying disease status and patient factors. Viability and effectiveness of various diversions was assessed, recorded and analysed. RESULTS: A total of 64 diversions were performed in our centre over the last 7 years out of which 59 were for Muscle Invasive Bladder Cancer(MIBC) and 5 for benign diseses. Majority 41 (64%) were Ileal conduits, 13(20.31%) had Mainz II while 8(12.5%) patients had Orthotopic Neo-bladder (ONB). One patient each was managed with Continuous Cutaneous Urinary Diversion (CCUD) and cutaneous Ureterostomy. 18(23.3%) patients had electrolyte imbalance while 5(7.8%) developed sub-acute intestinal obstruction. Majority 56(87.5%) of the patients were discharged before 10th POD. 75% of Neo-bladders were continent at 6 months. CONCLUSION: With more anatomical & functional resemblance & significantly maintaining a good quality of life Orthotopic Neobladder should be the preference of every urologist. However in case of adverse disease and patient related factors, Ileal conduit continues to be a gold standard procedure of urinary diversion in majority of patients

   Moderated Poster Session - 3 Top

   MP3-01: A case report of an unusual late complication of radical cystoprostatectomy with ileal conduit as urinary diversion Top

Anshuman Aashu, Pramod K Sharma, Sudipta K Singh, Souvik Chatterjee, Kanishka Samanta, S N Mandal, Dilip Karmakar

Calcutta National Medical College, Kolkata

Introduction Radical Cystoprstatectomy (RC) is an established procedure for the management of muscle invasive bladder cancer (MIBC) with ileal conduit used as a popular technique for urinary diversion. We report here a case of urinoma presenting as a late complication of RC with ileal conduit procedure. Case Report A 60 years old hindu male underwent RC with ileal conduit used as the mode of urinary diversion for MIBC. Postoperatively, the patient was discharged in a stable condition with optimum timely recovery. He presented to us after 2 months of his surgery with pain in periumbilical region along with anorexia and weakness. On physical examination, abdomen was soft without any tenderness with an ill-defined cystic swelling palpable in periumbilical region. Daily urine output was more than a litre through the ileostomy. Blood examination revealed decreased hemoglobin, raised creatinine and mild metabolic acidosis with normal electrolyte levels. Ultrasonography (USG) and noncontrast computed tomography suggested bilateral hydroureteronephrosis with a fluid collection in relation to the conduit. USG guided percutaneous nephrostomy was done bilaterally and the urinoma was aspirated. Bilateral antegrade nephrostogram along with loopogram was done which didn't show any leak. Bilateral antegrade stenting was done. Conclusion RC with ileal conduit as urinary diversion is an established procedure for management of MIBC. Urine leak leading to urinoma is a known complication following this procedure occurring in upto 2% of patients. Most of these present early after surgery. We report a case of urinoma as late complication after the procedure which is rare.

   MP3-02: Complete resolution of idiopathic thrombocytopenic purpura after surgery in renal cell carcinoma Top

Bhalla Vidur, Gupta Aman

Government Medical College Hospital, Chandigarh

Introduction and Objective : Association of RCC with idiopathic thrombocytopenic purpura (ITP) is very rare. The number of reported cases in literature is small. In most of the them, resection of tumor alone could not improve thrombocytopenia and patient did need either splenectomy during surgery or treatment was continued even after surgery in the form of steroids, interferon or immunoglobulin. Material and Method : We report two cases of RCC with thrombocytopenia where resection of tumor was sufficient treatment for malignancy associated ITP. First patient was a sixty year male with Known comorbidities of Diabetic mellitus and hypertension. He presented with hematuria and had platelet counts of 30000, He had a 7 cm x 6.5cm left renal SOL. He was started on steroids but platelets counts only rose to 50000 at the time of surgery. Bone Biopsy showed megakaryocytic thrombocytopenia without any tumor infiltration. He underwent Left Radical Nephrectomy. His platelet count rose to 71000 on POD4 and 97000 on POD6 without any transfusion. Second patient was 45 year male with a left exophytic left renal SOL (3 cm x 3.5cm) with platelet count of 57000. Left nephron sparing surgery was perfomed after taking due precautions. No platelet or blood transfusion was required. His platelet count rose gradually transfusion and reached to two lakhs in the post operative follow up. Results: In both the patients surgery was smooth. Post-operative recovery uneventful. HPR was Renal Cell Carcinoma, clear cell type. Both the patients maintained normal platelet count without any further treatment during the follow up period. Conclusion: Radical Nephrectomy and Nephron Sparing Surgery can be safely performed in the patients of Renal Cell carcinoma associated with thrombocytopenia. Removal of primary cancer may be curative, though some patients may require adjuvant treatment including corticosteroid, splenectomy, I/v immunoglobulins, vincristin, interferon in addition to primary treatment

   MP3-03: Laparoscopic partial nephrectomy for renal tumors: trifecta and perioperative outcomes- a single institutional experience Top

Bhavatej Enganti, Chiruvella Mallikarjuna, Ghouse SM, Bendigeri MT, Purnachandra RK, Ragoori DR

Asian Institute of Nephrology & Urology, Hyderabad

Objectives: To analyze the perioperative outcomes and trifecta of Laparoscopic Partial nephrectomy (LPN) for renal tumors. Material and Methods: We retrospectively analyzed patients who underwent LPN between April 2014 and March 2017 for renal tumors with a minimum follow-up of 6 months. Patient demographics and perioperative data was collected and analyzed. Complexity of renal tumors was assessed by R.E.N.A.L. scores. Trifecta was defined as a combination of warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications. Functional outcomes were assessed by Glomerular filtration rate estimation (eGFR) preservation, and chronic kidney disease (CKD) upstaging. Results: Overall, 80 patients were enrolled in the study. The mean tumor size was 38.0 (22.0-72.0) mm and the mean R.E.N.A.L. scores were seven. The mean operation time was 160 minutes, warm ischemia time was 20.2 min and estimated blood loss was 150 ml. Blood transfusion rate was 13.7%. Positive surgical margin rate was nil and overall complication rate of 17.5%. The rate of achievement of Trifecta rate was 62.5%. Mean postoperative hospital stay was 4.3 days. On follow-up, 91.25% of the cohort had eGFR preservation and 12 (15%) patients in our study had CKD upstaging. Conclusion: LPN for renal tumors is safe and feasible if performed by an experienced surgical team. Precise stratification of patients and renal tumor is recommended for optimal Trifecta achievement during nephron sparing surgery. In our study, perioperative outcomes for all the three components of Trifecta, short term oncological and renal functional outcomes were encouraging following LPN.

   MP3-04: Synchronus renal pelvic and urinary bladder urothelial carcinoma in a patient of lynch syndrome type 2 with MSH2 mutation —a case report Top

Bibhas Chandra Mukhopadhyay, TK Mondal, TK Majhi, S Chowdhury, A Koyal, S Dhanuka, M Mondal

Nilratan Sircar Medical College & Hospital, Kolkata

INTRODUCTION AND OBJECTIVES-Lynch syndrome, the most common cause of hereditary colorectal carcinoma, is caused by a germline mutation in one of the mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2. Besides the high risk of developing colorectal carcinomas of 10–80%, Lynch syndrome family members are at increased risk of developing several extra-colonic cancers. The lifetime risk of upper urinary tract cancer in Lynch syndrome varies in different studies from 0.4–20%. Patients of Lynch syndrome with MSH2 mutation are associated with more risk of urinary bladder carcinoma. We are reporting a case of type 2 Lynch syndrome with MSH2 gene mutation with synchronous urothelial carcinoma of upper tract and bladder. MATERIAL AND METHODS-A 65 years male presented with synchronous renal pelvic sol and bladder lesion with past history of right hemicolectomy at age of 39 years for mucin secreting adenocarcinoma ascending colon and family history of mother died from colon cancer, elder brother died from glioblastoma brain, two younger brothers suffered from mucin secreting adenocarcinoma stomach. RESULTS-Radical nephroureterectomy with TURBT was done, histopathology, high grade invasive urothelial carcinoma and on genetic analysis form blood lymphocytes the patient was a carrier of pathogenic mutation of MSH2, mismatch repair gene. CONCLUSIONS-Patients with Lynch syndrome carrying an MSH2 mutation are at increased risk of urinary tract cancer including bladder cancer.

   MP3-05: A novel treatment for prolonged urinary leakage after partial nephrectomy with oral desmopressin : a case report Top

Charan Kanwal Singh, Sarabjeet Kaur, Santosh K Dhakad, Yogesh Taneja, Kishan R Karanth, Satish Kumar P

SSSIHMS Prasanthigram

Introduction: Partial Nephrectomy(PN) is considered the standard treatment for most T 1A lesions. Prolonged extravasation after PN is a bothersome situation for both the patient and the doctor. The contact between urine and the edges of the wound also delay healing of the wound. In this situation, the first thing to do is to break the contact between the wound and the urine by inserting a DJ stent. Sometimes, this process is not enough. We approached this problem with a novel treatment method for a case involving prolonged drainage even after inserting a DJ stent. Case presentation: a 52-year-old male patient who presented at our clinic with left flank pain was operated on due to a left lower polar mass, and partial nephrectomy was performed. On follow-up, prolonged urinary leakage was observed, which did not subsided even after putting a DJ stent and a desmopressin treatment was started on the patient. Drainage was greatly reduced after desmopressin was started and there was no drainage on the fifth day. Conclusion: Prolonged extravasation is a bothersome situation and there can be many reasons for this. Whenever traditional approaches are not enough, oral desmopressin therapy can be started reliably if there are no contraindications for the patient. Eventually, contact between urine and the suture site will cease and therefore the fever and healing time will be shortened.

Keywords: desmopressin treatment, partial nephrectomy, renal leakage

   MP3-06: Isolated IgG4 related kidney disease causing obstructive uropathy Top

H Krishna Moorthy, Devesh Bansal, Manas Babu, Naveen MN, Sony Mehta, Biju S Pillai, Mohan P Sam

Lourdes Hospital, Kochi

Introduction: Immunoglobulin G4-related disease is a fibro-inflammatory condition most commonly associated with autoimmune pancreatitis. We describe an unusual case of isolated IgG4 related disease with renal involvement causing diagnostic dilemma in a patient with obstructive uropathy. Case report: A 66-year-old female presented with backache and progressive renal failure with no other symptoms. She had history of taking taking NSAIDs since 2 years. Her Creatinine was 3.1 mg/dl and Blood Urea was 145mg/dl)). Abdominal USG revealed 4.8 x 3.3 cm. irregular soft tissue mass at left renal pelvis encasing the aorta and upper ureter with bilateral hydronephrosis. Plain CT KUB revealed possibilities of TCC upper ureter with lymph node metastasis. Urine cytology was negative for malignant cells. Bilateral ureteric stenting was done and the renal functions got normalised. CT urogram revealed 4.3 x 3.5cm contrast enhancing mass lesion infiltrating the left renal hilum and extraureteral compression of the right ureter at the region of pelvic brim causing bilateral hydronephrosis. Open biopsy from mass lesion revealed suspicion of Non Hodgkins lymphoma. Rituximab infusion was started by the Oncologist. However after two cycle of therapy no improvement was observed. Repeat CT guided tru-cut biopsy was suggestive of IgG4RKD based on specific diagnostic criteria. The patient serum IgG 4 level was 384mg/dl. Oral prednisolone was started at a dose of 40 mg daily. CFollow up investigations suggested near total resolution of mass lesion and hydronephrosis. Conclusions: IgG4RKD may present as hydronephrosis arising in the renal pelvis and ureter, mimicking a ureteral tumor and causing diagnostic dilemma. Early recognition of this disease is important since most patients respond well to glucocorticoids

   MP3-07: The relation between low serum testosterone and prostate cancer behaviour Top

Panda P K, Pradhan S, Mohanty P K, Panda S, Swain S, Singh G P, Hota D

SCB Medical College Cuttack

Introduction & objective: In developed countries carcinoma of the prostate gland is more common in the elderly male population compared with younger men. Around 15% of men diagnosed to have cancer of the prostate in developed world when compared to only about 4% of men in developing nations. Prostate cancer is a hormone dependent cancer and the clinical course of prostate cancer varies with individual and again it varies within the individual in relationship to serum testosterone levels. The present study is to find out the role of low serum testosterone level in predicting prostate cancer behavior in comparison with normal serum testosterone level patients and to find out the relationship between low serum testosterone level and serum PSA levels in TRUS biopsy proven cancer prostate patients. Methods: This study is a prospective study of analyzing the relation between prostate cancer behavior with low serum testosterone and normal testosterone in the Department of Urology and Renal Transplantation, between 2014 to 2016 in all newly diagnosed prostate cancer (TRUS guided biopsy proven ) patients with age more than 40 years. Result: In our study patients with low serum total testosterone were associated with higher Gleason score and less favorable pathological stage and an increased incidence of positive surgical margins in the resected specimen, extra capsular extension of tumour either unilateral or bilateral and finally positive Seminal Vesicle invasion. Conclusion: Low total serum testosterone is associated with higher proportion of predominant Gleason pattern 4, an indicator of aggressive prostate cancer. Patients with low serum testosterone levels were associated with an increased serum PSA levels compared with patients in normal serum testosterone levels.

   MP3-08: Primary urethral adenocarcinoma in a young male: an uncommon malignancy and its management Top

Priyatosh Dey, Supriya Basu

R G Kar Medical College, Kolkata

Introduction- Primary Urethral Carcinoma is considered as rare tumour, accounts for less than 1% of all malignancies and an incidence rate of four cases per million patients. No definitive protocol for urethral adenocarcinoma due to lack of prospective study and scarcity of the cases. Case report- A 33-year male C/O protruding mass from perineal urethrostomy for 1 month. He had H/O 1st stage Johanson's urethroplasty six months back for urethral stricture. During urethroplasty, there was no suspicious lesion present, hence no biopsy was taken. On examination a non-tender, hard left inguinal LN was found. Incisional biopsy from the margin, showed adenocarcinoma. MRI done. CPE showed prostatic urethra was involved. Radical cystectomy, pan urethrectomy and total penectomy with ileal conduit were done. Simultaneously bilateral PLND done & B/L ILND was performed. HPE report showed well-differentiated adenocarcinoma of urethra (T2). Pelvic LN were reactive. Left side inguinal LN showed metastatic deposits (N1). Adjuvant chemotherapy was given. On follow up for last nine months, no recurrence has been seen yet. Conclusion- Primary urethral adenocarcinoma in a male although very uncommon, but It should be considered as one of the differential diagnosis for any urethral mass, obstructive voiding and bleeding per urethra. No definite protocol for treatment and follow up of UC due to the scarcity of cases and heterogenicity of disease. Treatment is individualized and depends on the location and stage of the tumour.

   MP3-09: A rare complication of pelvic lymph node dissection in robot assisted radical prostatectomy Top

Ramaprasad M K, Vishnu R, Ramesh GN, Shagos GS, Roy P John, Kishore TA

Aster Medcity, Kochi

Introduction and objective: To present a rare complication of pelvic lymph node dissection in robot assisted radical prostatectomy. Methods: A 74 year old gentle man presented to us with progressive increase in abdominal girth for 4 months duration. He had undergone radical prostatectomy with bilateral extended pelvic node dissection 6 months back. On presentation, his serum PSA was 0.013ng/mL. An ultrasound scan of the abdomen revealed gross ascites. No hepatic, renal or cardiac causes could be identified for the ascites. Results: Aspiration and examination of the fluid was suggestive of chylous ascites (ascetic fluid trigylcerides higher than 110 mg/dL). A medical gastroenterology consultation was done with institution of conservative management including low fat diet and octreotide. The condition did not respond to the conservative treatment. A whole body lymphscintigraphy was also done which showed a suspicious area in the left iliac region. As the patient was symptomatic with the non-invasive management, he was taken for robot assisted pelvic exploration under general anaesthesia. The whole of the pelvic lymphatic station was dissected bilateral and all the lymphatics were ligated both cephalad and caudal. Post-operative follow up to date has not shown recurrence of the ascites. Conclusion: Chylous ascites after pelvic lymph node dissection in radical prostatectomy is a rare complication. All the lymphatics should be meticulously ligated during the surgery to avoid this complication.

   MP3-10: NMIBC- Can CKD act as an independent risk factor for progression and recurrence ? Top

Samarth Agarwal

KGMU, Lucknow

INTRODUCTION: Bladder Cancer Is A Common Urological Malignancy. 80% Of Bladder Cancers Are Not Muscle Invasive. Treatment Strategies For NMIBC INVOLVES Transurethral Resection With Intravesical Instillation. While Diabetes And Smoking Continue To Be An Independent Risk Factor For NMIBC, the Role Of CKD Is Still Confounding. Recently Estimated Glomerular Filtration Rate Has Emerged As A Prognostic Factor For NMIBC Recurrence. So present study envisages the correlation between CKD and NMIBC Materials and methods: A retrospective study design was done at Dept of Urology. 210 patients underwent TURBT for NMIBC from January 2015 to January 2016. Median period of follow up was 12 months (1-22 months). Recurrence was observed in 96(45.7%). Recurrence rates at 1 year was 26%, and the median time to the first recurrence was 7 months. CKD was seen in 52 patients of those who recurred. Progression was observed in 4 patients (5.2%). Patients were classified as per Criteria for CKD of the Kidney Disease Improving Global Outcomes guidelines (2012 version) in those having GFR&lt;60ml/min and those above it. Results: CKD patients had significantly shorter times to recurrence and progression. On multivariate analysis, CKD(eGFR below 60 mL/min/1.73m 2 ) independently and significantly predicted a nearly 1.8-fold increased risk of recurrence and 2.2 –fold increased risk of progression compared with a non Ckd patients. Conclusion: Patients with NMIBC and CKD should be intensely monitored for upper and lower urinary tract as they are at a high risk of progression and surveillance.. These patients should be treated more aggressively.

   MP3-11: A frontal bone swelling guided to reach the diagnosis of rcc: a rare case report Top

Satyajit Samal, Panda SK, Panda S, Singh GP, Hota D

SCB Medical College, Cuttack

Objective: Clinical presentation of a malignant tumour is either due to the primary organ involved or as a result of its metastatic spread. When the metastasis is at a verynunusual site and act as sole presentation, the diagnosis of primary becomes difficult and may modify the treatment modality when diagnosis reached. Materials and Methods: We report a case of recurrent frontal bone swelling operated two times assuming it to be a benign tumour of skull. Following initial excision histopatholgy revealed 'Clear cell Hidradenoma', a rare benign tumour of apical sweat gland. Further radiological survey showed a left renal mass which was confirmed to be clear cell RCC(ccRCC) on histopathological study after surgery. Results: The initial histopathological(HP) finding of the excised lesion showed clear cell Hidradenoma. The HP findings of the same lesion after re-excision revealed vascular network within homogeneous nests of cells with clear cytoplasm suggestive of ccRCC. Computed tomography(CT) of brain after recurrence which showed a lytic mass in right superior aspect of frontal bone with avidly enhancing soft tissue component suggestive of probable metastatic lesion.CT of abdomen revealed heterogeneous enhancing soft tissue mass in upper and mid pole of left kidney. Conclusion: The treatment of a tumour only be started after certain diagnosis with HP study. There is no boundary margin for a specialist while evaluating a tumour and vice versa. A higher stage of the disease is expected if the diagnosis is delayed and modify treatment modality.

   MP3-12: Renal plasmacytoma Top

Shreedhar GK, Dr Ginil Kumar P, Dr Apputhomas

Amrita Institute of Medical Sciences

Introduction: RCC is primarily a radiological diagnosis. Contrast enhanced multi phasic CT and MRI are recommended for work up of patients with RCC and are considered equal for both staging and diagnosis. Here we present case, whom presented with left renal mass with skeletal metastasis which turned out to be a plasmacytoma. Case Report: A 66 year old gentleman who came abdominal discomfort, generalised weakness and loss of weight was evaluated. USG abdomen done showed left renal mass. Since his creatinine was elevated he was underwent MRI with Contrast. MRI showed Large heterogenously enhancing mass involving upper and mid pole of left kidney infiltrating perirenal fat and involving gerota's fascia abutting psoas muscle and displacing pancreas anteriorly with loss of fat plane between pancreas and the lesion, Multiple lymph nodes noted around the mass, No involvement of left renal vein or IVC, Mass is adherent to left adrenal gland and crura of left hemidiaphragm, No focal lesion in liver. Focal lesions involving right upper shaft of femur, left head of femur and right ischial tuberosity of pelvic bone - suggestive of metastasis. MRI Features suggestive of left renal malignancy / RCC with bony metastasis. Staging - T4N1M1. CT chest showed Small nodules of 5 and 7 mm located in the left lower lobe posterior basal segment and medial basal segment ? Metastatic. DTPA showed a split function of 52:48 (total GFR 44ml). He was planned for Biopsy followed by Radiation. He was started on Pazopinib. He underwent radiation for the painful mets in femur. Biopsy was suggestive of poorly differentiated Neoplasm. IHC -tumour cells are positive for CD138, MUM 1 and negative for CK, LCA, CD10, S100, Synaptophysin, CD56 and cyclin D1. Kappa/lambda shows lambda restriction Findings are of plasma cell neoplasm. Bone marrow showed blood dyscariasis and was started on chemotherapy. Discussion: Renal plasmacytoma is extremely rare, presenting diagnostic challenges due to its unusual location and non-specific or absent symptoms. Here if the biopsy has not been done, it would have been treated as Metastatic RCC. To the best of our knowledge about 30 cases of Renal plasmacytoma was reported. However, more cases may have occurred, as this tumor is underdiagnosed and underreported. Conclusion: Plasmocytoma of the kidney is a rare clinical entity, presenting diagnostic challenges due to its unusual location and nonspecific or absent symptoms. Imaging evaluations may illustrate the existence, size and location of the tumor but are unable to indicate a specific diagnosis. Here one such case is presented.

   Moderated Poster Session - 4 Top

   MP4-01: VHL with adrenal pheochromocytoma needs multidisciplinary approach – a case report Top

Cardoso Amanda, Prabhudessai MR, Lawande PR, Gaude V, Mandrekar PTN, Oza U

Goa Medical College

Materials and Methods: A case report of the management of a 30 year old young female who presented with hypertension and was subsequently diagnosed to have VHL with adrenal pheochromocytoma. Result: 30 year old female presented with headache, palpitation, epistaxsis for 2 months. On examination: Bp 210/110 mmHg, physical examination unremarkable. On Investigation: Ultrasound revealed a Rt adrenal mass and a pancreatic mass, which was confirmed on a CECT abdomen pelvis. A CECT brain revealed a cerebellar haemangioblastoma. With these findings diagnosis of probable VHL made. Patient then underwent molecular genetic testing and was found to have heterozygous mutation in C293A.C in the VHL gene. Metabolic workup and Bp control was done by endocrinology After adequate BP control patient posted for adrenalectomy. Patient underwent an uneventful adrenalectomy. On HPE the diagnosis of adrenal pheochromocytoma was confirmed. Department of neurosurgery performed surgery for cebellar haemangioblastoma and in the GI surgery department were she underwent a distal pancreaticospleenectoy. Patient was then desirous of pregnancy. Department of OBG counselled her and she had a planned conception. She was managed for severe pre eclempsia, pregnancy in a fibroid uterus by OBG and endocrinology, and she delivered a healthy chid. Patient is presently a controlled hypertensive and is on regular follow up. Conclusion: Multi-disciplinary treatment is essential for the management of syndromic patients.

   MP4-02: Femoral nerve entrapment neuropathy following psoas hitch operation: A case report Top

Das Nabajeet, Sarma D, Baruah S J, T P Rajeev, Barua S K, Bagchi P K, Phukan M P

Gauhati Medical College Hospital, Guwahati

INTRODUCTION AND OBJECTIVE The femoral nerve arises from the lumbar plexus (L2, L3, L4) to descend through the psoas major muscle. Any abdominopelvic surgery can cause femoral nerve neuropathy. Here we report case of FN neuropathy following psoas hitch vesicopexy in ureteral reimplantation in a patient with hutch diverticulum. We discuss the etiology and clinical manifestations of this condition. PATIENT A 30-year-old male with symptomatic right hutch diverticulum and right renal calculus underwent open vesical diverticulectomy and ureteroneocystostomy, along with psoas hitch using silk 2-0. In the postoperative follow-up, the patient reported parasthesia in right leg and significant right leg weakness. Although such presentations are compatible with FN neuropathy, they were initially attributed to anesthesia side-effects. However, the diagnosis was confirmed by decreased conduction velocity of right FN in EMG. Physiotherapy in form of quadriceps strengthening excercise and hip flexion excercise was done for at least 3 months. Patient improved significantly in 3 months. CONCLUSION This case illuminate on the potential for nerve injury following psoas hitch procedure in urologic operations and the significance of early recognition of this complication. It is recommended that sutures should be placed carefully in the belly of psoas major muscle avoiding the FN to prevent this complication. Lastly if there is partial injury to the nerve complete recovery is possible conservatively with sincere physiotherapy.

   MP4-03: Intra Gerotal Extra Corporeal (IGEC) transperitoneal laparoscopic simple nephrectomy vs Standard transperitoneal simple nephrectomy for giant hydronephrotic kidneys: Feasibility and outcome of IGEC of initial case series Top

Jena Rahul, Sureka SK, Kapoor R, Madhavan K, Srivastava A, Rustagi S

Sanjay Gandhi Postgraduate Institute of Medical Sciences

Introduction: Laparoscopic simple nephrectomy is now the standard of care for non-functioning kidneys. The large, floppy sac and altered anatomical relationships make surgical excision difficult during standard transperitoneal simple nephrectomy. We developed a novel surgical technique, which minimizes problems encountered during dissection, clamping and division while dealing with such kidneys. Materials and methods: A total of 16 patients with giant hydronephrotic, non-functioning kidneys underwent Intra Gerotal Extra Corporeal transperitoneal laparoscopic simple nephrectomy (group A), over a period of 2 years at a tertiary care institution. These were compared with 14 patients who underwent totally intracorporeal laparoscopic simple nephrectomy (group B) for similar indications, by the same surgeon. The two groups were compared with respect to renal size, mean operative time, blood loss, and conversion to open procedure and post op recovery. Mann Whitney U test and Student T-test were used to compare the two groups. Results: There were no open conversions in group A whereas there were two in group B (one due to bowel injury and other due to non-progression). The two groups were comparable in terms of age, sex and body weight of the patients (p>0.05). There was no significant difference between kidney sizes between the two groups. Significant differences were seen in mean operative time (99.68 + 10.271 mins vs. 118.92 + 9.41 mins, p = 0.007) and mean blood loss (117.18 + 9.418 ml vs 190 + 42.61 ml, p = 0.005) in group A vs group B. The median length of hospital stay was also significantly less (p<0.001) in group A as compared to group B. Conclusion: The IGEC laparoscopic approach is a feasible and attractive alternative technique for simple nephrectomy for giant hydronephrotic kidneys. Larger case series using this technique are required to establish the safety and feasibility of this technique.

   MP4-04: Calyco-calycoplasty with ureterocalycostomy in pediatric patients: A novel reconstruction technique Top

Kapashi K A, Pal BC, Modi PR, Rizvi SJ, Wagholikar HW, Goyal K

IKDRC-ITS, Ahmedabad

Aims and objectives: Ureterocalycostomy is well described major reconstructive technique for long segment upper ureteric stricture or scarred pelvis in secondary UPJO. We describe novel reconstruction technique of calyco-calycoplasty with ureterocalycostomy for blocked calyx with infundibular stenosis and UPJO in GUTB and post open pyelolithotomy secondary UPJO in pediatric patients. Methods:First case is 5years female with GUTB with Right upper hydrocalycosis due to infundibular stenosis with left poorly functioning kidney, normal bladder capacity and normal s.creatinine, underwent right calyco-calycoplasty with ureterocalycostomy. Second case is 7years female with post open pyelolithotomy secondary UPJO and infundibular stenosis of upper calyx, also underwent similar procedure Results: Case one is at one year follow up, has completed AKT and left nephrectomy has been done for poorly functioning kidney. Her s.creatinine is 1.4mg% at present. Case two is also tube free and doing well at 6 months follow up. Conclusions: Calyco-calycoplasty with ureterocalycostomy may be a feasible option for renal unit salvage in situ ations with simultaneous UPJO and infundibular stenosis. Surgery is technically demanding major reconstruction and gives good results when done by expert hands.

   MP4-05: IgG4 related disease presentaing as non healing epididymal mass - a rare entity Top

Leela Krishna K, Sriram Krishnamoorthy, Hariharasudhan Sekar, Susruthan. M, Rajendiran. S, Venkat Ramanan

Sri Ramachandra Medical College & Research Institute

CASE REPORT : ImmunoglobulinG4 related disease is a fibro inflammatory condition characterized by dense lymphocytic infiltrate rich in IgG4-positive plasma cells and storiform fibrosis. It is usually associated with elevated serum IgG4 levels. We report a case of a 54 yr-old-male presenting with non healing discharging sinus from the anterior left scrotal surface for the past one month. The sinus was found to be adherent to the left epididymal mass. On evaluation, there was a moderate leukocytosis with predominant lymphocytosis. With a clinical diagnosis of left epididymal tuberculosis, he was posted for excision of the epididymal mass. Intra operatively the mass was found to be densely adherent to the left testis and inseparable, necessitating left total orchidectomy. The histo pathology report was suggestive of chronic orchitis with focal spindle cell proliferation, increase in number of plasma cells and keloid like collagen. Immuno histo chemistry for Vimentin and IgG4 (20%) were positive and negative for CD 34. Serum levels of IgG4 was 1.63 g/l. MATERIALS AND METHODS : NIL CONCLUSION : IgG4 related disease is a newly recognized condition. The presentation as epidermal sinus is extremely rare. The final confirmation is by immuno histochemistry and elevated serum IgG4 levels. The purpose of this report is to highlight the rarity of such condition and also to increase the awareness of such rare disease amongst the clinicians and treating urologists. To the best of our knowledge, this is the first ever such case to be reported in Indian literature.

   MP4-06: Simple Renal Cyst causing Inferior Venacaval compression; An unusual presentation Top

Mohammed Aslam, Prakasa Rao, Sridhar

Guntur Medical College

INTRODCUTION Renal cysts are classified into 4 categories by Bosniak CT grading. Simple renal cysts are benign with a thin wall, without septae or calcifications and do not enhance with contrast. They are usually asymptomatic and rarely present with pain due to haemorrhage or increase in size of cyst. Here we present an unusual way of presentation of simple renal cyst by inferior vena cava (IVC) compression. CASE HISTORY A 45 year old male presented with history of right loin pain since 3 months and dilated veins over abdomen since 1 month. On examination there was no palpable mass. Ultrasound of abdomen revealed a cyst arising from upper pole of right kidney causing IVC compression. Contrast enhanced CT showed a cyst of 12x10 cm arising from upper pole of kidney with no calcifications, septae or contrast enhancement. Cyst was extending medially and causing IVC compression with dilated collateral vessels between IVC and superior vena cava territory. Intraoperatively cyst was arising from upper and mid pole of right kidney. Adhesions were present to inferior surface of liver, adjacent bowel and IVC. Aspirate from the cyst was serous. Cyst was excised partially, marsupialization of edges was done and cavity was packed with omentum. Postoperatively patient recovered well and histopatholgic examination of cyst wall was benign. CONCLUSION Simple renal cysts are usually asymptomatic and are incidental findings on radiologic investigations. Contrast enhanced CT is imaging of choice to classify renal cysts and guide further management. Simple renal cysts may rarely present with pain due to haemorrhage within the cyst and sudden increase in size. Cysts associated with congenital renal anomalies may rarely cause compressive effect due to massive enlargement of the kidney. Simple renal cysts rarely cause compressive symptoms and simple cyst causing IVC compression is an unusual presentation with no known previously reported cases in the literature. BIBLIOGRAPHY O'Sullivan DA, Torres VE, Heit JA, Liggett S, King BF. Compression of the inferior vena cava by right renal cysts: an usual cause of IVC and/or iliofemoral thrombosis with pulmonary embolism in autosomal dominant polycystic kidney disease. Clin Nephrol 49: 332-334, 1998.

   MP4-07: Incidence, management and outcome of renal trauma: a retrospective study Top

Rakesh Ranjan, Sharma V, Singh R, Kewlani N, R Sunil, S Vasudevan

Government Medical College, Thiruvananthapuram

OBJECTIVE: This study was aimed to know the incidence, management and outcome in case of renal trauma patients at a tertiary centre. METHODS: From August 2016 to July 2017 patients who presented with renal trauma were enrolled and retrospectively reviewed. Total 70 patients were enrolled. RESULTS: 59 (84.28%) patients were male. 68 (97.14%) patients had injury due to blunt trauma and rest due to penetrating trauma. On AAST renal injury scale, 28(40%) patients had Grade I injury, 25 (35.71%) had Grade II injury, 7 (10%) patients had Grade III, 5(7.14%) patients had Grade IV, and 5 (7.14%) patients had Grade V injury. 8 (11.42%) patients underwent surgical intervention. 5 (7.14%) patients died due to hypovolemic shock and multiple organ failure. 1 patient of Grade IV renal injury, managed conservatively, developed renal arterio-venous fistula, for which angio-embolization was done. CONCLUSION: The kidney is the organ most commonly associated with urological trauma and is involved in 1-20% of trauma cases. Non- operative management has become more common in recent times with advent of interventional radiology and improvement in imaging. Open surgical intervention is done in patients who remain haemodynamically unstable despite resuscitation with crystalloid and blood products. A stepwise approach and high index of suspicion in patients with higher grade injuries who fail to progress with conservative management are required to avoid adverse outcome and morbidity.

   MP4-08: An unique case of testicular rupture mimicking as penile fracture Top

Samanta K, Chatterjee S, Aashu A, Singh SK, Sharma PK, SinghaMahapatra RK, Karmakar D, Mandal SN

Calcutta National Medical College and Hospital, Kolkata

Introduction: Blunt trauma to the male external genitalia is a relatively common occurrence resulting in a myriad of injuries to both testis and penis. The aubergine sign (also known as egg-plant sign or deformity) is a classic clinical sign of fractured penis and is exceedingly rare in a traumatic injury to flaccid penis. Case presentation: A 45 year old man presented in the casualty department at midnight with history of road traffic accident resulting in blunt trauma to his penoscrotal region against the lid of the oil tanker. There was no blood at the meatus and he had passed urine normally once following the accident. The penis had a S-shaped curvature typical of 'egg-plant deformity' seen in penile fracture accompanied with bilateral scrotal swelling with bluish discoloration. Since there was no provision for urgent ultrasound at such late hour early aurgical exploration was planned. It revealed a large hematoma beneath penile skin, however the tunica albuginea and urethra were intact. Scrotal exploration revealed a right sided testicular rupture beyond salvage which required an orchidectomy. Post operative recovery was uneventful. Conclusion: The presentation of typical egg plant deformity of penis following trauma to flaccid penis with associated testicular rupture is a very rare event and color Doppler study followed by surgical exploration is recommended in such a case.

   MP4-09: A retroperitoneal bronchogenic cyst mimicking an adrenal cyst - a case report Top

Shree Vishnu Siddarth R, Balashanmugham TS

PSG Hospitals - PSGIMSR, Coimbatore

Retroperitoneal bronchogenic cysts are very rare and a good mimicker of adrenal and pancreatic cystic lesion. Though benign and malignant potential of this variety have been reported, only very few case reports are available till date. We present a case of a 43 year old female with left hypochondial pain and imaging modality was suggestive of an 8x7 cm left adrenal cyst. Patient was planned for laparoscopic retroperitoneal cyst excision. Intra-operatively an 8x7 cm thick walled cyst was seen firmly adherent to the left adrenal, stomach and left hemi diaphragm. Histopathology was suggestive of bronchogenic cyst. To our knowledge less than 40 case of retroperitoneal bronchogenic cysts have been reported worldwide.

   MP4-10: Laparoscopic partial nephrectomy with clipping of feeding vessels in addition to hilar clamping : our technique and initial results in 15 cases Top

Singh Amrinder, Sood Swapan, Agarwal Suresh

Patel Hospital, Jalandhar

Introduction and Objective Laparoscopic partial nephrectomy (LPN) is preferred for selected renal tumors. Postoperative bleeding may occurs in 4.2% to 6% of the cases. Aim of the study was to describe our technique and initial results Methods 15 patients underwent LPN with clipping of feeding vessels in addition to hilar clamping from January 2013 to June 2017. RENAL scoring and CT angiogram were done preoperatively and feeding vessels to tumor identified. The technique involved hilar dissection and isolation of renal vessels. Furthur dissection along the artery was done to expose the segmental artery and feeding branches supplying the tumor area which were clipped before hilar clamping. Blood loss, operation time, warm ischemia time and complications were recorded.CT was performed after 3 months. Results Operation time ranged from 100 min to 160 minutes. No patient had significant bleeding from tumor bed on hilar unclamping. Mean warm ischemia time was 20 minutes. Mean blood loss was 120 cc. 2 patients had low grade hematuria which resolved itself. No patient had significant hematuria, collection or urine leak. CT scan showed normal residual parenchyma Conclusion Clipping of feeding vessels in addition to hilar clamping may decreases the risk of post operative bleeding by decreasing the chances of AV fistula and pseudoaneurysm formation It may decrease warm ischemia time by providing line of demarcation, allowing faster cutting and decreasing incidence of reclamping. However long term studies with more sample size are required

   MP4-11: Iatrogenic Ureteric strictures and management dilemma Top

Sonawane P, Mohankumar V, Singh A, Ganpule A, Sabnis R, Desai M

Muljibhai Patel Urological Hospital, Nadiad

Introduction and Objective Iatrogenic ureteric strictures and not uncommon even in the current era of advances in endourology. Less frequent causes include Gynecological and other abdomino pelvic surgeries. Objective of this presentation is to highlight the different causes of iatrogenic ureteric strictures and treatment modalities in current practice showing good end outcomes. Methods 23 patients presented to our institute with iatrogenic ureteric stricture from January 2015 to June 2016. None of the patients had calculous disease or ureteric edema accounting for obstruction. Of these 13 followed endourological procedures,3 followed open urological surgeries, 5 followed Gynecological surgery, 2 followed open abdominal surgeries. Results Endourological procedures successfully corrected the problem in 9 patients and consisted of Ballon dilatation with Double J stent (DJS) in 7 cases and Two DJS insertion alone (2). Endourological procedures failed in 2 other cases, both of which had undergone ballon dilataion with DJS. Of the remaining 12 cases, 2 underwent open Boari repair while 5 patients underwent Robotic ureteroureterostomy, 4 Robotic ureteric reimplant and 1 Robotic ureterolysis. Of the 2 cases which failed endourological management, 1 required laparoscopic pyeloplasty while the other progressed to chronic renal failure (CKD3). 1 case of robotic ureterolysis also failed to improve and required long term DJS insertion. Overall treatment success rate was 86.9%. Endourological procedures had success rate of 81.8%, Robotic repair 90% and Open Boari repair 100% at 1 year followup. Conclusion Endourological procedures though useful in treating small segment and soft iatrogenic strictures, definitive reconstruction is required in the dense, long segment strictures and in failed endourological cases. Definitive reconstruction has better results compared to endourological procedures at 1 year followup.

   MP4-12: Penile TB - A rare entity Top

Vinit Singh, Mujeeburahiman, Altaf Khan, Nischith D'souza, Rahul Bhargava, Abdul Adsar

Yenepoya Medical College Mangalore

Introduction: Genito urinary tuberculosis is the second most affected site for extrapulmonary TB after lymph nodes. TB affect whole male genital system most common in order of kidney, epididymis, seminal vesicle, vas deferens, bladder and penis. Penile TB is very rare and most time confused with carcinoma. It is very difficult to diagnose and differentiate between the penile TB and penile cancer. Materials and Methods: 67 male presented with voiding LUTS & swelling in bilateral inguinal region, H/o partial penectomy. FNAC of the inguinal lymph node was done suggestive of formed granulomas composed of epitheloid cells, lymphocytes, giant cells and fibroblast and wedge biopsy s/o TB. Results: Patient was considered a case of penile tb and ATT has been started. Discussion: As penile TB is a rare entity proper and complete investigation must be done before any surgery.

   Moderated Poster Session - 5 Top

   MP5-01: Female Pelvic Fracture Urethral Injury (PFUI) with Long distraction defect; managed successfully Top

Agarwala Ankur, Khattar Nikhil, Rakeshkumar Vadher, Mishra Prafull, Mittal Varun, Gupta Narmada

Medanta The Medicity, Gurgaon

Introduction and Objective: Unlike in males, the recommendation in female PFUI is for immediate exploration and repair as delayed repair after initial SPC leads to extreme fibrosis and complicate later reconstruction. We present a case of female PFUI managed with initial SPC due to resulting in long distraction defect managed successfully Methods: A 26 year old female sustained Blunt injury abdomen and pelvic fracture urethrovaginal injury after being crushed between a train and railway platform. Ileostomy, bladder repair and Vaginal repair were performed elsewhere. She presented to us 6 months later with a long defect and bladder neck could not be identified on cystoscopy. We found distal 3 cm of urethra to be intact. Exploration, vesicourethral anastomosis to a new formed bladder neck at the most dependent area was done. A vaginal tear during dissection was covered with a Martius flap fed in retropubic space. Results: Apart from prolonged drainage from perianastomotic drain for two weeks, the recovery was uneventful. After 6 weeks, patient voided successfully with and was fully continent. Discussion: Female PFUI usually present with a vaginal injury in almost all cases. Initial surgeon could not find the proximal urethra to anastomose. Additionally, the bladder was closed as a sphere with an SPC. The challenge in this repair will be to maintain the patency of arbitrarily made bladder neck. Also, because of history of bowel injuries, we avoided entering the peritoneum and performed entire procedure extraperitoneally and fed a Martius flap up to cover the vaginal tear successfully.

   MP5-02: Silodosin on premature ejaculation new treatment targets by a highly selective α 1a-adrenoceptor Top

Ankit Kayal, Tapan Kumar Mandal, Tapas Kumar Majhi, Sunirmal Choudhary

NRS Medical College, Kolkata

Introduction Premature ejaculation is underreported a common sexual disorder in India. Most recent available medical therapies for PE, except topical agents, act through the central nervous system, although their full mechanisms are not understood. The most common drug used is dapoxetine, which has adverse effects limiting its long-term use. Hence, we decided to evaluate the effectiveness of silodosin 4 mg in patients with premature ejaculation. Material and methods The study included 60 patients who reported premature ejaculation who were not satisfied with the treatment with dapoxetine 30 mg, either due to its adverse effects or because of its overall inefficacy. They were divided into two groups of 30 and 30 respectively by simple randomization, with Group A treated with on demand silodosin 4 mg three hours prior to intercourse, whereas Group B was treated with placebo. Pre- and post-treatment intravaginal ejaculatory latency time (IELT), premature ejaculation profile (PEP) and clinical global impression of change (CGIC) for premature ejaculation were evaluated. Results Patients in Group A (silodosin 4 mg) reported statistically significant improvement (p <0.005) in intravaginal ejaculatory latency time (IELT), premature ejaculation profile (PEP) and clinical global impression of change (CGIC) for premature ejaculation, with 6 patients reporting absence of ejaculation (no projected ejaculation with orgasm ) Conclusions Silodosin 4 mg is an effective treatment option with very few adverse events in those patients suffering from premature ejaculation. Silodosin significantly improved PE and its related problems than control drug. Our current results suggested the clinical feasibility of a new concept for PE treatment by a highly selective α1A-adrenoceptor antagonist silodosin.

   MP5-03: Intraoperative Pyelography to diagnose Pleural Violation during Supracostal Access in Percutaneous Nephrolithotomy Top

Gyanendra Sharma, Anshu Sharma

Chitale Clinic Pvt Ltd

Introduction Supracostal access for percutaneous Nephrolithotomy is associated with a small but significant risk of pleural violation. This could result in hydro/ hemo thorax. Screening of costophrenic angle at the end of the procedure and a post op chest X ray are the tools to diagnose a collection in the chest. The aim of this study is do find if an intra operative pyelogram/ nephrostogram can diagnose pleural violation Materials & Methods From January to August 2017, a total of 90 PCNL were done of which 36 were supracostal punctures (25 supra 12th & 11 supra 11). At the end of the procedure a glide wire was passed down the ureter through the amplatz sheath the pelvi calyceal system was opacified either via the ureteric catheter or through the amplatz sheath and the sheath was removed. The flow of the contrast through the nephrostomy tract was seen on C arm fluroscopy. Any gross extravasation of contrast was looked for. The costophrenic angle was then screened with C arm and any accumulation of contrast looked for. Post op chest Xray was done in the first 20 cases but then later on was not done Results. None of the cases showed any collection of contrast in pleural cavity. Absence of contrast extravasation in the pleural cavity co related with the cinical findings and post op chest X ray Conclusion Intraoperative pyelogram/ nephrostogram can obviate the need for doing chest Xary post operatiely in cases where supracostal access has been achieved

   MP5-04: Surgical Management of Vascular Injury due to obturator kick Top

Joglekar Omkar, Shailesh Puntambekar, Sandesh Surana, Pankaj Joshi, A Alkandari Mohammad, Jyotsna Kulkarni, Sanjay Kulkarni

Kulkarni Endosurgery Institute &Reconstructive Urology Centre

Surgical Management of Vascular Injury Due To Obturator Kick Aim and Objective: Trans urethral resection (TURBT) is the most common surgical technique used for the diagnosis and treatment of bladder cancer. Obturator kick is a known problem during TURBT. Bladder perforation with vascular injury is rarer but it can be life threatening. Materials and Methods: Female age 75 years, non diabetic, hypertensive came to clinic with painless haematuria with clots. Ultrasonography revealed bladder tumour on right lateral wall. During TURBT she had violent obturator kick. Bladder perforation with perivesical fat and gush of blood was noted. During retroperitoneal exploration blood was seen welling from the bottom of the incision. An oncosurgeon was called for help. The wound was packed with Benzoin roller gauze. This roller gauze was brought out from separate stab wound. Under anaesthesia pack was removed slowly after 48 hours with blood cross match reserved. No active bleeding was noted. The patient was discharged from hospital.3 months later LASER fulguration of bladder tumour was done. The same oncosurgeon was invited by different urologists to treat 5 other vascular injury cases treated in similar way over a period of 20 years. Discussion: Early recognition and immediate exploration is the key to success for vascular complications occurring during TUR of bladder tumours. Open surgery with Tincture Benzoin soaked pack and delayed pack removal is viable option for such patients. Conclusion: Life threatening complication due to vessel injury after TURBT can be successfully managed with immediate exploration and tincture benzoin pack.

   MP5-05: Robot assisted retroperitoneal lymph node dissection : early experience and lessons learnt Top

Khanna Ashish, Mavuduru RM, Bora GS, Sharma P Aditya, Singh SK, Mandal AK

PGIMER, Chandigarh

Introduction : Retroperitoneal lymph node(LN) dissection is technically challenging. Robotic technology has potential to reduce the fear and discomfort associated with such challenging surgery but is still evolving. We describe our initial experience of robot assisted retroperitoneal lymph node dissection(RA-RPLND). Materials: Retrospective review of all patient records, radiology, videos and histopathology who underwent RA-RPLND was done. The procedurewas performed in lateral positions with 60 degree tilt using Da Vinci Si robot. The robot was dedocked and subsequently redocked after the patient was repositioned in bilateral dissections. Descriptive statistics were used to analyse the data. Results : RA RPLND was successfully performed in 6 patients(3 primary and 3 post chemotherapy). Mean age-34 years(25-50 years). Bilateral template dissection was performed in 3 patients and modified template dissections in the rest. Primary testicular pathology was non seminomatous germ cell tumor in 5 patients and seminoma in 1. Mean(SD) operative time was 206(30)min and mean estimated blood loss was 275(99) ml. Mean LN yield was 16(14-20). Histopathology of the LN revealed malignancy in 2 patients. In the patient with seminoma, intense desmoplastic reaction was found intraoperatively. Postoperatively one patient with post chemotherapy RPLND had transient transaminitis which was managed conservatively and one patient had prolonged drain output. Mean LOS was 10.5 days. One out of the 6 patients has had a recurrence in pre-sacral region at median follow up of 375 (267-866) days. Conclusions: RA-RPLND is safe and feasible in both primary and post chemotherapy settings.

   MP5-06: Early radical cystectomy in high grade (T1 G3) NMIBC gives best pathological staging opportunity Top

Mahendrakumar Sharma, Venktesh Kumar, Anshuman Agarwal

Indraprastha Apollo Hospitals, New Delhi

Introduction: Management of high-grade (T1 G3) NMIBC represents a challenge for both physician and patient. It remains difficult to accurately identify life-threatening, high-grade T1 tumors. Multiple tumors, larger size (more than 3 cm), carcinoma in situ (CIS) and tumor at first follow-up cystoscopy after treatment are associated with greater risk of disease progression and reduced survival. The accuracy of staging is poor, with only 50% of clinical T1 patients accurately staged. Several reports have shown that approximately 30 % of patients treated with radical cystectomy for high-grade T1 disease have pathological up gradation to ≥T2 stage and 10%-15% of patients have lymph node metastases. Patients with clinical stage T1 cancers who undergo early rather than delayed cystectomy have substantially better 5-year recurrence-free survival rates (90% vs 62%). Therefore, with current limitations of staging modalities, waiting for muscle-invasion before performing cystectomy may be too late for optimal quality of life and oncologic outcomes in patients with high grade T1 bladder cancer. Patients & Methods: In our experience, four patients of high grade non muscle invasive bladder cancer (T1 G3) has undergone early radical cystectomy. Three patients showed pathological up gradation with muscle invasion and one patient showed lymph node involvement without muscle invasion out of four patients. Conclusion: Early radical cystectomy in selected high risk patients of NMIBC gives best chance of pathological staging with substantially better 5- year recurrence-free survival. Taken together, these data imply that radical cystectomy should be performed sooner rather than later for recurrent high grade T1 cancers.

   MP5-07: Technical issues in upper polar heminephrectomy in duplex kidney - Our experience with 12 cases Top

Mohanty NK, Panda Rakesh, Swain S, Singh GP, Hota D

SCB Medical College Cuttack

INTRODUCTION: Ipsilateral upper polar heminephrectomy in duplex kidney with poorly functioning upper pole moiety either laparoscopically or open surgery presents with varied complications. It may present as urinoma due to urinary fistula, hematoma due to hemorrhage, cysts in the resected area or atrophy or loss of function of remnant moiety due ischemia. It needs delicate handling of vessels around the upper pole and hilum and carefully removing out the nonfunctional upper pole. We present our experience on technical issues about upper polar nephrectomy in 12 cases of duplex kidney those who detected postnatal. MATERIAL & METHODS: From 2016 to 2017, 12 patients with duplex system anomalies with poorly functioning upper pole moiety undergone open or laparoscopic heminephrectomy. All of them undergone thorough clinical examination, routine investigations with DTPA scan. We did upper polar heminephrectomy with excision of as much as ureter below. Patients characteristics, presentations, operative techniques and results were collected retrospectively. RESULTS: Mean operative time for laparoscopic surgery was 206 minutes and for open surgery 255 minutes. No major intraoperative or post operative complications. Mean hospital stay for open surgery and laparoscopic surgery were 6.4 days and 3.4 days respectively. After 48 months of follow up there were no similar symptoms or UTIs. CONCLUSION: Whether open or laparascopic upper polar heminephrectomy in duplex with poorly functioning upper moiety, careful dissection around the upper pole with perfect identification of vessels and plane of dissection can prevent from disastrous complications.

   MP5-08: Bipolar TURP versus monopolar TURP in management of BPH Top

Rahul Eknath Patil, Paul Vinsant, K Venugopal, R Ravichandran

Meenakshi Mission Hospital & Reserch Centre, Madurai

Introduction Bipolar and monopolar transurethral resection of prostate (TURP) are both widely used for surgical treatment of benign prostatic hyperplasia. Aim: Compare perioperative outcomes between conventional M-TURP versus B-TURP Materials & Methods: In this prospective comparative study, patients were assigned to two groups, M-TURP (n=62) and B-TURP (n=62). Data on patient's demographics, prostate volume, volume of irrigation fluid used, changes in hemoglobin, serum electrolytes (Na+, K+) were analyzed. Blood samples were taken before surgery, at one hour & after 24 hour of surgery. To compare efficacy of procedure IPSS, QoL score, Qmax, PVRU were recorded preoperatively & post operatively at 1, 3, 6 months of follow up. Result: No significant difference in resected volume of prostate (P= 0.4864), volume of irrigation fluid (p=0.9872), resection time (p=0.3409) in both groups. Drop in post operative hemoglobin concentration (p=0.1305) was statistically insignificant. Mean (SD) fall in post operative sodium concentration was 5.8(2.68) mEq/lit for M-TURP as compared to 0.7(2.1) mEq/lit for B-TURP (p < 0.0001), which was statistically significant. None of patient in either group developed TUR syndrome. Monopolar & bipolar techniques of performing TURP reduces IPSS scores, PVRU, and improve urinary flow rate. In between groups, there were no statistically significant difference found in terms of IPSS score(p=0.5523), QoL score(p=0.4327), Qmax(p=0.81), PVRU(p=0.8718). Conclusion: Bipolar TURP has minimal effects on serum Sodium. Bipolar TURP has similar improvement in urinary symptoms during 6 months of follow up when compared with conventional Monopolar TURP. Key words: Transurethral resection of prostate (TURP), Monopolar, Bipolar

   MP5-09: Single stage reconstruction of an adult female exstrophy (reared as a male) Top

Sandhu A, Arya MC, Tiwari R, Kumar L, Swami JP, Yogendra

SP Medical College, Bikaner

Introduction Bladder exstrophy is one of the most challenging and rare congenital anomaly. We are presenting an adult with classical female exstrophy (but reared as a male) who underwent total reconstruction in a single stage. Material and method A 19 year old male presented to us in November 2016 with urinary incontinence. On examination it was classical female exstrophy with well developed bladder plate and vagina. Routine blood investigations were normal. X ray KUB revealed pubic diastasis. IVU showed bilateral normal kidneys. MRI showed internal genitalia to be uterus and ovary. Karyotype was XX. Patient and his parents agreed to rear him as female. Under general anaesthesia bilateral cross trigonal ureteric reimplantation, bladder neck reconstruction (Young Dees), bladder closure and genitoplasty were done in one stage. Post operative period was uneventful. Results In follow up patient had dry period of one and half hour with urge incontinence. We are planning bladder augmentation if she continues to have incontinence. Multiple bladder biopsies were taken which did not reveal any malignancy. Conclusion Female exstrophy presenting at adult age (being reared as a male) is extremely rare. We have done total reconstruction in one stage

   MP5-10: Protocol based perioperative surgical prophylaxis in an Indian tertiary care centre: A feasibility study Top

Sharma AP, Devana SK, Mandal AK, Mavuduru RM, Bora GS

Postgraduate Institute of Medical Education and Research, Chandigarh

Introduction and Objective Rational use of antibiotics and strict adherence to practice guidelines is essential for preventing emergence of antibiotic resistance. Best surgical prophylaxis practices require tailoring of guidelines based upon local bacterial flora. We designed a protocol for surgical prophylaxis to check emerging drug resistance and rampant use of antibiotics at our centre and studied its feasibility. Methods Patients admitted for elective major surgeries in a single unit of our department, from 01/03/2017 to 07/08/2017 were included in the study. A protocol for antibiotic prophylaxis was designed inspired from European association of urology guidelines and local hospital antibiogram. Single dose intravenous cefuroxime was administered for clean and clean contaminated surgeries. Extended protocols were formulated for contaminated surgeries. Post-operative complications and protocol breach was duly noted. Prospectively maintained data was analysed using descriptive statistics. Success was defined as adherence to the protocol with no additional use or change of antibiotic and uneventful postoperative course. Results Data of 277 patients was analysed. Mean age was 48.37ą17.39 years. Incidence of comorbidities was 27.1%. Majority of surgeries were clean contaminated (81%), with endoscopic surgeries comprising (60.3%) of total. Protocol was followed successfully in 89.5% patients (248/277). Protocol failure rate was high in contaminated procedures (41.7%) (OR-6.43; CI=1.51-27.2, p<0.001). Septic shock occurred only in endourologic procedures and comprised 24.1% of all failure cases. Conclusions Protocol based antibiotic prophylaxis is feasible in Indian scenario in tertiary care centre. Similar protocols should be developed and validated at major centres to prevent emergence of antibiotic resistance.

   MP5-11: Infected Giant Prostatic Utricle Cyst –Diagnostic Dilemma Top

Shriram Joshi, Joshi SS, Hedayatullah M, Ajay K, Patel F, Mistry S, Jain A

Jaslok Hospital and Research Centre, Mumbai

Introduction Prostatic utricle cyst is a rare midline cystic lesion between the urinary bladder and the rectum, commonly associated with hypospadias. Rarely it may enlarge and present as a pelvic mass or during pelvic, trans-rectal ultrasonography as a fluid filled cavity in retrovesical region. We are presenting a infected giant prostatic utricle cyst, a very very rare presentation. Case Summary Operated case of proximal hypospadias as double island flap hypospadias at 3 yr of age. Presented at 6 year, with significant, irritable lower urinary tracts symptoms and foul smelling urine for 6 months. On physical examination, neomeatus was normal in position and caliber and a suprapubic lump was palpated which on pressing pus came out from urethra. Under coverage of antibiotic, cystourethroscopy was done. Recontructed urethra was normal and posterior urethra and bladder full of pus. A small opening seen at veru which was connecting with a large pus filled sac posteriorly. All pus drained and cyst opening enlarged. Postoperatively patient was given antibiotic on the basis of urine culture. Laparoscopic cyst excision done after infection came under control. Cyst was densely adherent to bladder neck, seminal vesicle. After removal of catheter patient was passing urine with good stream. MCU showed a small residual cyst which emptied at 30 min post void image Conclusion High degree of suspicion and staged treatments can be considered for infected giant prostatic utricle cyst. Laparoscopic excision is the preffered method of treatment for prostatic utricle.

   MP5-12: Intra-sphincteric Botulinum A Toxin for Refractory Voiding Dysfunction in neurologically normal Children: A New Ray of Hope Top

Soni Rahul, Dharmveer Singh, S Rustagi, S K Sureka, A Srivastava, MS Ansari

SGPGIMS, Lucknow

Introduction and Objectives Botulinum toxin injection into the external urinary sphincter in spinal cord injury with detrusor-sphincter dyssynergia (DESD)has been reported. We expand the clinical use of intrasphicteric botulinum toxin A (Botox) in neurologically normal children with voiding dysfunction resistant to conservative therapies. This study aimed to evaluate the efficacy and durability of Botox injection into the external urethral sphincter (EUS) in such scenario. Material & Methods This is a prospective study conducted between April 2011 to June 2017. Children between age- 4 to 19 years with refractory voiding dysfunction included in the study. Preoperative assesment was done with voiding Diary, Ultrasound KUB, Uroflowmetry & PVR volume, Electromyography, voiding cystourethrogram while Postoperative assesment by voiding symptoms and UFM PVR. Injection BOTOX was given with rigid paediatric cystoscope with 22 fr needle. 100 IU of BOTOX was injected in external urinary sphinter under direct vision at 3, 6, 9, 12 o clock position. Behavioural and biofeedback re-education was given after 2-4 weeks. Results Total 24 children were included in study with 14 girls and 10 boys. Median follow up was 33 months with range of 8 to 59 months. Most common preoperative symptom was recurrent UTIs in 18 out of 24 children. Sixteen out of 24 (67 %) have successful outcome after BOTOX injection while 8 (33%) had failed to resolve symptoms. Mean PVR value was improved from 115 ± 83 mL in preoperative to 57 ± 61 mL (p=0.016) postoperatively. Mean Qavg preoperatively was 4.5 ± 1.8 mL/sec which improved postoperatively to 10.8 ± 6 mL/sec with p value of 0.02, similarly Mean Qmax was 11.5 ± 9.4 mL/sec and 21.2 ± 8.8 mL/sec (p=0.04) pre and postoperative respectively. Conclusion Our intermediate-term results demonstrate reasonable efficacy and durability for EUS Botox injection. Efficacy seems to be associated with the ability of patients to participate in bladder rehabilitation once the cycle of DESD has been attenuated by transurethral Botox.

   Moderated Video Session - 1  Top

   MV1-01: Inaccessible ureteric calculi in unilateral complete duplication of ureter: our experience Top

Ghule Rahul, Date Jaydeep, Bhave Shirish, Shivde Subodh

Deenanath Mangeshkar Superspeciality hospital, Pune

Introduction and Objective: Complete duplex ureters opening separately into the urinary bladder are extremely rare; they can be embryologically explained as a development of two ureteral buds separately from a single mesonephric duct. Methods: 65yr male presented to with Left flank pain intermittent colicky, c/o fever intermittent low grade, lower urinary tract symptoms. Clinical examination and Blood investigations were normal. Ultrasonography KUB- left hydronephrosis and hydroureter with 8.7 mm calculi in mid ureter. CT Urography- complete duplication of ureter on left side with calculi in mid ureter draining the upper moiety with delayed excretion of contrast. Cystoscopy- upper moiety ureteric orifice could not be identified. Hence retrograde access was not possible. Ureteric catheter in lower moiety ureter kept in place for differentiation. Upper moiety calyceal system was accessed antegrade under ultrasound guidance. Guide wire deployed, there was complete duplication of ureter with wire entering in the bladder medial and lower to lower moiety ureter. Tract dilated till 16 fr. 7.5 fr flexible ureteroscope was used. Stone was present in midureter, fragmented with Holmium laser and retrieved with basket. Follow up stent removal cystoscopy showed upper moiety ureteric orifice was too medial and directed upward. Result: Stone was inaccessible in retrograde manner as ureteric orifice could not be identified. Stone was accessed in antegrade manner with flexible ureteroscope and complete stone clearance achieved Conclusion: There could be variety of options to tackle the inaccessible ureteric stone and that depends on armamentarium (Ultrasound, flexible ureteroscope, Laser) available.

   MV1-02: Accept the challenge: A staged approach for impacted upper ureteric calculi making task difficult to Easy ! Top

Haresh Thummar, Shivang D, Jigish V, Keya T, Nisha T, Nelson Z


Introduction & Objective it's a challenging task to manage large burden upper ureteric stone because it can be associated with severe hydronephrosis, compromised renal function, and infection or pyonephrosis. It makes all modality difficult whether performed antegrade or retrograde, because the large volume in the narrow confines of the ureter does not lend itself to bulk extraction, as can be done for renal stones. We present the results of our technique of retrograde ureteroscopy combined with antegrade irrigation after staging the procedure. Methods We identified 65 patients from 2009 to 2016 who presented with hydronephrosis due to high volume ureteral stones without renal stones and underwent percutaneous nephrostomy (PCN) for decompression. The patients then underwent retrograde ureteroscopy, lithotripsy, and stone extraction (URSL) with our novel technique at a separate session. Irrigation was performed with normal saline using a low-pressure system (gravity at 10 cm H2O) through the PCN. Data regarding stone size/location, degree of hydronephrosis, presence of infection, OR time, EBL, stone-free rate (SFR) and efficiency quotients (EQ), complications, and need for ancillary procedures were analyzed. Results We identified 65 patients from 2009 to 2016 who presented with hydronephrosis due to high volume ureteral stones without renal stones and underwent percutaneous nephrostomy (PCN) for decompression. The patients then underwent retrograde ureteroscopy, lithotripsy, and stone extraction (URSL) with our novel technique at a separate session. Irrigation was performed with normal saline using a low-pressure system (gravity at 10 cm H2O) through the PCN. Data regarding stone size/location, degree of hydronephrosis, presence of infection, OR time, EBL, stone-free rate (SFR) and efficiency quotients (EQ), complications, and need for ancillary procedures were analyzed. Conclusions Staged treatment of large volume ureteral stones with PCN placement followed by retrograde URSL with continuous antegrade irrigation is a safe, effective technique with high success and low morbidity.

   MV1-03: Miniperc for caliceal diverticular calculi removal: a single stage approach Top

Kishore Wani

Kidney Care Hospital & Research Centre, Nashik

PURPOSE: Current percutaneous treatment of symptomatic caliceal diverticular calculi involves renal access, stone removal, dilation of the diverticular communication, fulguration of the cavity and placement of a nephrostomy tube. We reviewed the outcomes of patients undergoing Miniperc technique for radiopaque caliceal diverticular stones. Eliminating access to pelvicalycal system. MATERIALS AND METHODS: A total of 12 patients (7 male and 5female) with a mean age of 42.4 years underwent Miniperc for caliceal diverticular stones from February 2015 to August 2017. Of the diverticula 3 were upper pole, 7 were interpolar and 2 were lower pole. Access was established directly onto the radiopaque stones. Tract was dilated with miniperc dilator &15Fr miniperc sheath was placed.12 Fr Storz miniperc scope used. Stones in the diverticulum were fragmented with 600micron holmium laser fibre. Following stone removal the diverticulum was fulgurated. The infundibulum was neither cannulated nor dilated. All procedures were tubeless. RESULTS: All were discharged home tubeless on POD2. stone- free status was confirmed on follow up by Digital X ray KUB & in 2 patients by noncontrast computerized tomography. Mean operative time was 58.5 minutes and mean stone burden was 138.9 mm. Mean stone diameter was 11.6 mm and mean diverticular diameter was 15.3 mm. CONCLUSIONS: In patients with symptomatic radiopaque caliceal diverticular stones, a single stage with direct diverticular puncture allows for a rapid procedure with little morbidity.

   Moderated Video Session - 2  Top

   MV2-01: Novel technique in management of level 2 venacaval thrombosis (1.5cm into venacava) without caval control – point of technique Top

Dusi VSLNS, Vallivai R, Tiwari A, Lakhani D, Singh V

Apollo hospital, Hyderabad

Introduction: Renal cell carcinoma with tumour thrombus extending from renal vein into the vena cava has been reported to occur in 4 -10% of patients. Caval and opposite renal vein control followed by cavotomy, extraction of thrombus and suture closure of cavotomy, followed by nephrectomy is the standard of care. Objective: In this video, we present our novel technique of excision of venacaval thrombus protruding 1.5 cm into cava without caval control. Method: 59 year male patient, Diabetic, Hypertensive with Body mass index – 29 kg/m2, presented with hematuria, clot retension, evaluated, found to have RCC with solid thrombus extending 1.5 cm into IVC with renal vein width 3 cm. Angioembolization was done. Taken up for Robotic nephrectomy with thrombectomy through standard ports. Renal pedicle exposed and cava skeletonized to 2.5 cm above and below the renal vein. Vessel loop was placed around renal vein and with the help of satinsky, tumour thrombus was pushed back into renal vein and a dry run was conducted by placing a GI Stapler across the cava to see GI stapler jaws were opposing and no tumour thrombus was caught in between jaws. Subsequently GI stapler was fired to excise the part of vena caval wall and Radical Nephrectomy was performed by standard technique. Result: Pathology 14 cms RCC(Clear cell) and margin of cava is free of tumour thrombus. Conclusion: Renal cell carcinoma with level 2 venacaval thrombus can be managed without caval control in selected cases without compromising the oncology principles.

   MV2-02: Robotic Assisted excision of extra adrenal Paraganglioma presenting as Left seminal vesicle mass Top

Mohammed Shahid Ali, Deepak Dubey, Mohammed Shahid Ali, Brendan Dias

Manipal hospital Bangalore

Introduction Seminal vesicle cysts are a rarely diagnosed disease, seen in only 1 in 20,000 men.1Zinner syndrome is characterized by the coexistence of vas deferens stenosis, renal agenesis, and an ectopic ureteral orifice in the prostatic part of the urethra or seminal vesicle. 2 To date, only 100 cases of Zinner syndrome have been described in the literature. 3 Paraganglioma of genitourinary tract is rare. They may cause symptoms such as perineal pain, painful ejaculation, hematospermia, 4, 5 abnormal micturition, 6 lower urinary tract symptoms (LUTS), or dysuria. 5 There are some reports in the urology literature about paragangliomas located in the prostate, bladder and even the paratesticular region (six cases). 7 The treatment of choice for symptomatic seminal vesicle cysts is surgical resection. Case description We operated a 67 year male patient presenting to urology OPD with LUTS and painful ejaculation. On evaluation with TRUSG -a spherical mass lesion of size 3.6cms - 2.5cms noted at left lateral part of left seminal vesical. mass shows homogenous soft tissue, no cystic components or calcifications. MRI revealed Well-defined retro vesicular T1 hypointense, T2 heterogeneously hyperintense soft tissue mass is seen arising from lateral aspect of left seminal vesicle. It measures 33x35x28 mrn. We performed a robotic assisted excision of the mass Using the Da vinci Surgical system CA, USA. Robotic approach offers great help intraoperatively owing to the deep seated anatomy of the mass and challenges met during reching & mobilisation of veico rectal recess. Port placement was standard as for the robotic prostatectomy with a 12 mm supraumbilical port and two 8 mm ports in RIF and one 8 mm working port in the LIF. The procedure lasted 150 minutes, with minimal blood loss. The patient was discharged home on the second postoperative day. His preoperative symptoms completely resolved after surgery. Histopathologic examination revealed a Extra Adrenal- Paraganglioma and an Unremarkable seminal vesicIe. On immunohistochemistry Tumour ceIls are positive for Synaptophysin, Chromogranin and S-l00 stains with a KI-67 proliferative index is less than 2% Conclusion A symptomatic seminal vesicle mass is a good indication for using a robotic technique. Compared with the open technique robotic surgery is safe and, in our opinion, provides a better view of the operated area and faster recovery.

   MV2-03: Robot assisted laparoscopic radical cystectomy(RALRC) with intracorporeal conduit : Our experience of 15 cases Top

Nischith D Souza, Mujeeburahiman, Altaf Khan, Rahul Bhargava, Vinit

Yenepoya medical College Mangalore

Robotic surgery, or robot-assisted surgery, allows to perform many complex procedures with more precision, flexibility and control than is possible with conventional techniques. The surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification helps resulting in improved ergonomics. Due to this there is a reduced duration of hospital stay, blood loss, transfusions and use of pain medication. Robot assisted laparoscopic radical cystectomy (RALRC)is a complex procedure done in open fashion conventionally. In most of these series, the urinary diversion has been performed in an extracorporeal fashion. There have been few case reports of an intracorporeal diversion and little description of the technique of such a procedure. We report our initial experience with robotic-assisted laparoscopic intracorporeal urinary diversion, describing procedure and evaluating perioperative and pathologic outcomes of this novel procedure in 15 cases.

   MV2-04: Robot assisted radical nephrectomy with IVC thrombectomy in patient of renal secondaries with IVC thrombus Top

Sengar APS, Sudarshan SB, Singh A, Ganpule A, SabnisR, Desai M

Mulijibhai Patel Urological Institute Nadiad

Introduction & Objective: Renal metastasis with IVC thrombus in primary bone malignancy is a rare finding. Most diagnosis are made at autopsy. Early diagnosis either due to symptoms or on imaging in follow up can diagnose early and affect the outcome. These patients can be managed with radical nephrectomy with postoperative multimodality therapy. Robotic platform in addition to features of laparoscopy has level of precision, three dimensional vision, good control of movements and cross clamping of IVC can be easily performed for IVC thrombectomy. Methods 37 years male with history of operated osteosarcoma in Right Humerus in 2010 followed by 1st line chemotherapy(cisplatin with adriamycin). IN 2015 Isolated left lung metastatectomy was done.2nd line chemotherapy(Ifosfamide + methotrexate + adriyamycin+mesna) given. Follow up PET CTwas suggestive of Right kidney lower pole mass extending up to IVC. Surgical steps: Intraoperatively IVC was slinged doubly inferior followed by superior to renal vein after dissection, IVC clamped above and below to thrombus, renal vein was opened at junction of IVC. Thrombus was removed en masse and covered with gloves finger.IVC was closed with gortex 6-0 in water tight fashion.specimen was retrieved from right iliac fossa incision. Results Patient recovered well with Hemoglobin drop of 2 gm%. peruretheral catheter was removed on postoperative day 2(POD 2). Histopathology confirmed metastatic chondroblastic osteosarcoma. Patient voided well after PUC removal. Conclusions In case of inferior vena cava tumor thrombus, robotic nephrectomy is safe and feasible. Although these procedures are complex, the results are encouraging among surgeons with good robotic expertise.

   MV2-05: Safety, feasibility and concerns of Simultaneous robot assisted bilateral partial nephrectomy Top

Shahid Ali, Brendan Dias, Srinivas AK, Amrith Raj Rao, Shivashankar R, Deepak Dubey

Manipal Hospital, Bangalore

We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Very few papers have been reported con- cerning simultaneous bilateral robot assisted partial nephrectomy. We think that our technique was note-worthy for some important aspects: single side clamping of vessels for better renal function outcome, lesser cost as it was a single sitting, less morbid, lesser hospital stay with good cosmesis. Single-setting bilateral robotic partial nephrectomies can be safely and effectively performed on patients with bilateral small exophytic kidney tumors. A 54-year-old male patient visited our department after incidentally being diagnosed to have bilateral small renal masses. He had no history of hematuria or flank pain. The procedure was performed using a three-arm Da Vinci Robot, standard version, starting from the left side. We employed a no clamp technique on the left side while we had a warm ishchemia time of 12 mins for the right side. The total operation time was 285 min and total console time was 160 min. The estimated blood loss was 265 cc. The postoperative period was uneventful. The patient was mobilized on day 1. The urethral catheter was removed on day 1. The right and left drains were removed on days 2 and 3, respectively. The patient was discharged on day 3. The pathological examination reported bilateral renal cell carcinoma, Fuhrman grade 1, with negative surgical margins. Six months after surgery, computed tomography scan did not show tumor local recurrences. In conclusion, our technique was safe, feasible, time and cost effective with a cosmetic benefit for the patient.

   MV2-06: 'Beyond traditional frontiers: Robotic Total Pelvic Exenteration' Top

Tamhankar A S, Ojha S, Ahluwalia P, Gautam G

Max Institute of Cancer Care, Max Superspeciality Hospital, Saket, New Delhi

Introduction Total pelvic exenteration is the procedure carried out most often by gynaecologists for advanced cervical malignancies. In Urology, it is indicated for few rare masses arising from soft tissue of pelvis which generally have sarcomatous origin. Methods 49 year old gentleman was diagnosed with pelvic mass from one year, biopsy of which was suggestive of sarcomatous histology. Patient was advised for exenteration that time but he did not follow up. He received ADT and m-TOR inhibitors outside, but landed up with disease progression to 13.1 cm sized FDG avid mass in pelvis. He was operated for Robotic Total Pelvic Exenteration with da Vinci Xi system. Results Console time was 6 hours 50 minutes with blood loss of 400cc and length of stay of 9 days. He had a Clavien grade 3a complication in the form of lymphorrhea from perineal wound for which CT imaging and Foley drain placement was considered. Histopathology was suggestive of epithelioid leiomyosarcoma grade 2 invading into full thickness of muscle layer of bladder and rectum with R0 resection. All 32 lymph nodes were negative. Conclusion Total Robotic Pelvic Exenteration is a safe and feasible procedure with potential of speedy recovery and good lymph node yield. It replicates the open surgery in closer manner. Preoperative treatment planning and the multidisciplinary team approach are the crucial steps. In order to achieve R0 resection the plane between bladder and rectum should not be violated in total pelvic exenteration for such an atypical soft tissue tumor.

   Moderated Video Session - 3 Top

   MV3-01: Laparoscopic Ureterolysis in retroperitoneal fibrosis Top

Anil Gulia, Kumar Anant

Max Hospital, Delhi

Objective To demonstrate our technique of laparoscopic ureterolysis in retroperitoneal fibrosis. Methods From January 2010 to January 2017, there were 15 renal units with obstructed ureters due to retroperitoneal fibrosis. All patients have failed medical management and ureteral stenting. Here we present our technique of laparoscopic ureterolysis in two patients with solitary functioning kidneys with ureteral obstruction due to retroperitoneal fibrosis. Results In all patients renal function improved and ureteral obstruction resolved. There were no complications, no conversions to open surgery. No recurrence of ureteral obstruction at mean follow up of 40 months Conclusions With adequate experience, laparoscopic ureterolysis can be accomplished in a safe manner with good outcomes.

   MV3-02: Feasibility and technical nuances of Robotic Kidney Transplant (RKT) with graft placement in the left iliac fosas Top

Feroz Amir Zafar, Tarun Jindal, Indraneel Banerjee, Ashwin Mallya, Sachin Arakere, Anil Mandhani, Rajesh Ahlawat

Fortis Escorts Kidney and Urology Institute, New Delhi

Introduction: Robotic Kidney Transplant (RKT) has been found to achieve comparable functional outcomes with open kidney transplant (OKT) with the added minimally invasive benefits and lower vascular and wound related complications. The video demonstrates the feasibility and technical nuances of doing kidney transplant robotically with placement of graft in the left iliac fossa. Material and Methods:A retrospective analysis of patients who underwent RKT at our institution from June 2016-August 2017 was performed. The patients who had a left sided transplant were identified from this cohort. The time taken for bed preparation, venous anastomosis, arterial anastomosis, total ischemia time, total console time, and mean creatinine values at discharge were compared with those who had a right sided RKT. Results: Forty-two patients underwent RKT between June 2016 and August 2017 out of which 5 patients had the graft kidney placed in the left iliac fossa. The parameters evaluated were comparable between both the groups. The bed preparation time(mins) in the right and left iliac fossa group were 18.72 (+/-5.9) and 17.8(+/-1.92), Venous anastomosis time(mins) were 12.9(+/-2.48) and 13.4(+/-2.07), Arterial anastomosis time(mins) were 12.07 (+/-2.78) and 13.6+/-2.19, console time(mins) was 149.45+/-15.71 and 156.2+/-16.39, total ischemia time (mins) was 74.35 (+/-14.93) and 78.65 (+/-16.68) respectively. The mean creatinine (mg/dl) at discharge was 1.29(+/-0.61) in right iliac fossa group compared to 1.37(+/-0.65) in the left iliac fossa group. However, the technique of retroperitonealization differed on the two sides. Conclusions: RKT in the left iliac fossa is technically feasible and the outcomes are similar to those undergoing a conventional right iliac fossa RKT.

   MV3-03: Completely Intracorporeal Robotic Renal Autotransplantation for Nutcraker Syndrome Top

Goyal K, Modi PR, Pal BC, Rizvi SJ, Kumar S, Chouhan R, Pilli VP

Institute of kidney diseases & reseach centre, and institute of transplantation sciences, Ahmedabad

Introduction- Renal auto-transplantation (RATx) is a suitable option for treatment of patients with pan-ureteric strictures and nutcracker syndrome [left renal vein entrapment between aorta and superior mesenteric artery (SMA)]. The current gold standard approach is a laparoscopic nephrectomy followed by open auto-transplantation. With the advent of robotic-assisted laparoscopic surgery, complex surgical procedures can be managed successfully with minimal invasive techniques. Materials and methods We present the case of a 21-year-old lady referred to our institution for persistent gross haematuria with clots, flank pain and anemia. On evaluation she was found to have a single preaortic left renal vein with moderate luminal narrowing between SMA and aorta and no evidence of an upper tract malignancy or hydronephrosis. Medical causes of hematuria were rules out. Left nephrectomy, intracorporeal perfusion with cold HTK solution & auto-transplant in left iliac fossa was performed using four arms of robot without any incision for procurement or for transplant. Results Total operative time was 4.5 hours, with total ischemia time of only 68 minutes (3 minutes warm ischemia, 17 min perfusion time, 48 minutes re-warming time including 39 min anastomotic time). Hospital stay was 5 days and blood loss was minimal. At follow up of 8 months, she had no flank pain, or haematuria (gross/microscopic) with normal graft doppler and serum creatinine. Conclusion To our knowledge, this is the first reported case of a completely intracorporeal robotic auto-transplant in India. It is effective for symptomatic Nutcracker syndrome with good cosmetic outcome, short post-operative stay.

   MV3-04: Technical Tips in Laparoscopic Augmentation of Tuberculous contracted bladder Top

M Ramalingam, Sivasankaran N, Senthil K

Ganga Medical Centre & Hospitals, Coimbatore

The stomach is the preferred augmentation option for a contracted bladder in a patient with renal failure. A 70 year-old male presented with irritative LUTS for six months duration, on evaluation was diagnosed with Genitourinary tuberculosis and contracted small capacity bladder. He had creatinine of 2.7 mg%. By laparoscopic approach, right gastroepiploic artery based gastric flap was isolated using staplers and used for bladder augmentation. Laparoscopic gastrocystoplasty is feasible and effective augmentation option in those with renal failure, giving the benefits of minimally invasive approach.

   MV3-05: Management of complex penile urethral strictures with optimal use of buccal graft augmentation Top

Pankaj Joshi, Sandesh Surana, Omkar Joglekar, Mohammad Alkandri, Jyotsna Kulkarni, Sanjay B Kulkarni

Kulkarni School of Urethral Surgery

Introduction: Complex penile strictures are usually repaired using one or two two-stage urethroplasty. This decision is based on the width of urethral plate. Buccal mucosal graft (BMG) placed in the first stage can have a significant contraction rate, which may require a subsequent revision surgery. We describe our technique of penile augmentation with tubularisation of urethra using dorsal inlay BMG either in one stage or two stage. Methods: Within a multi-institutional cohort, 59 patients underwent urethroplasty for complex penile stricture. We follow the principle of tubularisation immediately at the time of graft placement. 11 Patients had wide urethral plate more than 8 mm, where in urethra was opened ventrally, BMG inserted as dorsal inlay and Urethra tubularised in one stage. 48 patients, the urethral plate was narrow, underwent our composite two-stage penile urethroplasty with Johanson I and Dorsal inlay augmentation with tubularisation after 6 months. Thus BMG was used in stage 2. In no patient was the urethral plate excised and BMG implanted in first stage for staged repair later. The primary outcome of the study was to evaluate stricture-free success rate. Results: Of total 59, 5 patients were lost to follow-up. 54% of stricture etiology was failed hypospadias repair. Mean stricture length was 4.5 cm (range 3–8 cm). At a median follow-up of 56 months, 89.5% were successful. Conclusions: Patients with complex penile stricture should be treated with buccal graft augmentation with tubularisation. If urethral plate is wide, single stage dorsal inlay augmentation is performed. If urethral plate is narrow, urethra is laid open like Johansson's technique. Buccal graft is inserted in stage 2 as dorsal inlay and urethra tubularised immediately.

   MV3-06: Our experience with laparoscopic reconstruction of lower ureter Top

Vaddi Chandra Mohan, Paidakula Ramakrishna, Siddalinga Swamy PM

Preeti Urology and Kidney Hospital, KPHB, Hyderabad

INTRODUCTION: Laparoscopic technique has been there for many decades. Lower ureteric reconstruction includes neocystostomy, posas hitch, boari flap, ileal replacement ect. These procedures require advanced training in laparoscopy including suturing. OBJECTIVE: We present a video of our experience with laparoscopic reconstruction of lower ureter done at our hospital. METHOD: We have done and one boari flap, one psoas hitch and one tunneled neocystostomy. Case 1: young boy had refluxing left ureter with recurrent UTI. He under went left tunneled ureteric reimplantation procedure. Case 2: young female had lower ureteric stricture due to hysterectomy. She underwent bladder mobilization with psoas hitch ureteric reimplantation. Case 3: young female had mid lower ureteric stricture due to caesarian section. Intraoperatively there was a long segment of stricture which was managed with boari flap reconstruction. All cases were followed at 1 week for Foleys removal followed with DJ stent removal at 6 weeks. All patients were followed for 1 yr for any recurrence with dtpa scan or IVP. RESULTS: 3 patients had ureteric reimplantation. One patient had fever post operatively which was managed with higher antibiotics. No complications were seen. No recurrence was seen during follow up of 2 yrs. CONSCLUSION: Laparoscopic reimplantation with good suturing skills, has good results and can be an alternative for open procedure

   Moderated Video Session - 4 Top

   MV4-01: A case of laparoscopic heminephrectomy in a two month old baby with double moiety system Top

Arup Kumar Nath, Nitin Gupta, Debajit Baishya


Introduction and Objective: Heminephrectomy for polar non functioning unit is a standard procedure for years. With the revolution of minimally invasive technique, there are reports of successful laparoscopic heminephrectomy for the same. Nordmark first described heminephrectomy in 1948. Incidence is about 1 in 125 patients (0.8%) Often, these remain asymptomatic or may present with pain or recurrent UTI. Methods: Here we present the video of laparoscopic heminephrectomy in a 2 months old female child who presented to us with h/o recurrent fever, poor feeding, not gaining weight. On examination cystic right flank lump was there. CT Urography revealed duplex collecting system on right side with ectopic opening of right upper moiety ureter with gross upstream dilatation of ureter. MCU showed no vesicoureteric reflux. Results: The operative time was approximately 1.36 Hrs, and there were no complications during the procedure. The estimated blood loss was approximately 35cc. Post operative period was uneventful. Baby was discharged satisfactorily on day 4. On follow up patient was asymptomatic, good weight gain and milestones development was normal. Conclusions: In pediatric age group laparoscopic partial nephrectomy remains a technically challenging procedure, being performed only in pediatric centers with high experience in minimally invasive surgery. Though technically challenging, laparoscopic urological procedure in the presence of good pediatric and anaesthesia cover is a safe procedure even in very young infants.

   MV4-02: Posterior Urethral POLYP: A rare cause of bladder outlet obstruction in infant Top

Ghule Rahul, Shivde Subodh, Kashyapi Bhalchandra

Deenanath Mangeshkar Superspeciality hospital, Pune

Introduction and objective: Posterior urethral polyp is a rare entity leading to bladder outlet obstruction in children. It is usually presented with acute retention of urine, intermittent urinary obstruction, hematuria and urinary tract infection. Method: One year old male baby presented with intermittent urinary obstruction, poor stream, cry while micturition. Ultrasonography revealed polypoidal lesion at the bladder base while CT Urography suggested posterior urethral polyp projecting into the urinary bladder. Urethro-cystoscopy with 8fr cystoscope done suggestive of pedunculated polyp arising from posterior urethra with intravesical projection. Excision of polyp done with holmium laser. Histological analysis suggested benign fibroepithelial polyp. Results: Laser excision of posterior urethral polyp is only treatment option. Presentation of posterior urethral polyp ranges from lower urinary tract symptoms to even upper tract changes like obstructive uropahy. Conclusion: Posterior urethral polyp is a rare cause of urinary retention in children. It usually presents with intermittent urinary obstructions, hematuria, and urinary tract infection. Diagnosis is usually settled by ultrasonography and voiding cystourethrography. CT scan can be done for good anatomical delineation and when the diagnosis on earlier imaging is doubtful. Cystourethroscopy always proves the diagnosis and has a therapeutic value.

   MV4-03: Combined Lapro Endoscopic approach for high volume renal calculi Top

Muneer Khan, Naveed Khan, Sajjad Nazir, Sheela ran

Kidney Hospital Srinagar

For all large Renal stones PCNL is the procedure of choice. It has stood the test of time since its conception in the year 1976Laparoscopic Retro Peritoneal Pyelolithotomy when feasible is an excellent procedure. It can be performed in the Preferable Hospital where a laparoscopic set is usually available. No C-ARM or X RAY facilities in the OT are needed. None of the hemorrhagic complications seen in PCNL are associated with Laparoscopic pyelolithotomy as the access to the stone is through the Renal pelvis of the Kidney and not through the Renal cortex. All cases with extra renal pelvis having the bulk of stone burden in the renal pelvis should be taken up for laparoscopic pyelolithotomy. Calyceal stones can be removed by a rigid or flexible nephroscope using the pneumatic lithotripsy or holmium laser through the flexible nephroscope. The common indications for lap pyelolithotomy are ectopic kidney, horse shoe kidney, Renal Stone with PUJ obstruction, high risk patients and kidney with a solitary pelvis calculus. In most of the centers lap pyelolithotomy is infrequently performed as it is technically more demanding and most of surgeons are not familiar with a retroperitoneal access. A video depicting the same is presented.

   MV4-04: Technical Modification Of Standard TVT-O For Better Clinical Outcome Top

Odugoudar AR, Chawla A, Hegde P, Hameed ZBM, Thomas J

Kasturba Medical College, Manipal

Introduction: Standard TVT-O inside out technique is done by placing the suburethral mesh after paraurethral dissection and piercing obturator membrane by helical needle with the help of tunnler and bringing the the mesh 2cm lateral to the groin crease at the level of clitoris. Our Idea (modified TVT-O) a. No piercing the obturator membrane b. No tunneling c. Direct insertion of the trocar at the groin crease at the level of clitoris Aims We aim to study the pain score, analgesic requirement, QoL and subjective cure of SUI between the patients treated by standard TVT-O and the modifications for standard TVT-O Results n= 71 were the number of patients treated for SUI. They were further divided into 2 groups. Group1 (n=36) treated by standard TVT-O, Group2 (n=35) treated by modification for standard TVT-O. No intraoperative complications (like hemorrhage, operative difficulties) were recorded. The SUI cure rate was similar among both the groups 98.7% versus 97.7% (original versus Modified, respectively; p=0.431). Incidence and intensity of groin pain was higher in the standard TVT-O group on day 1 and at 1 week requiring more analgesics but not thereafter. Similarly there was improved QoL noted at Day1 and 7days in patients undergoing modified TVT-O. However there no was no statistical significance noted Conclusion Modification in the standard TVT-O technique is associated with similar resolution of SUI at 1 year with reduced pain and improved QoL noted in the immediate postoperative period and 1 week.

   MV4-05: Say Hi to Zinner - Laparoscopic Seminal Vescial Cyst Excesion Top

Sudhir Jatal

Jatal Hospital Latur

Zinner's syndrome is a triad of mullerian duct abnormality comprising of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. 100 cases of seminal vesicle cysts associated with ipsilateral renal agenesis have been reported in the literature. Most patients with this group of mesonephric duct anomalies are asymptomatic until the third or fourth decade of life and often manifest during the period of high sexual or reproductive activity. Cysts larger than 12 mm are termed as “giant cysts” as they are also likely to cause bladder and colonic obstruction Case report 28-year-old male presented with complaints of increased frequency of micturition, urinary urgency and pain during defecation. he was treated before with multiple lines of antibiotic in consideration of UTI. We performed USG abdomen pelvis s/o unilateral renal agenesis with cystic swelling below bladder. As diagnosis was not confirmed we performed MRI abdomen s/o unilateral renal agenesis and large9 x 3.7 x 2.6 cm seminal vesicle cyst on left side of abdomen differential diagnosis of zinner's syndrome. Patient underwent laparoscopic excision of seminal vesical cyst with minimal blood loss. Pt was discharged on day 3 and asymptomatic after surgery. Histopathology confirmed diagnosis. Zinner syndrome, therefore, constitutes an uncommon but important diagnostic consideration in young age when the patient presents with recurrent urinary symptoms. MRI is the ideal imaging study to evaluate malformations of the mesonephric duct. Minimal invasive surgery is very useful in these patients.

   MV4-06: Laparoscopic selective renal artery clamping for partial nephrectomy Top

Vaddi Chandra Mohan, Paidakula Ramakrishna, Siddalinga Swamy PM

Preeti Urology and Kidney Hospital

Introduction: Laparoscopic partial nephrectomy is not a new method but its technically challenging. Selective renal artery clamping can reduce warm ischemia time, which decreases reperfusion injury. Very few studies have been done by laparoscopic method. Objective: We present a video of technique of laparoscopic partial nephrectomy done by selective renal artery clamping in 2 cases. Method: Case 1: 72 yr old male diagnosed with a right lower pole mass supplied by a separate vessel from the renal artery. Dissection and clamping of only lower pole vessel at hilum was done. Case 2: 65 yr old female was diagnosed with right upper pole renal tumor of size 3 cm. she underwent laparoscopic left partial nephrectomy with hilar dissection and selective upper pole renal artery clamping. Bulldog clamp was used. Both cases were done with zero warm ischemia time. Postoperative period was uneventful. Patient was discharge on 5 th POD. Results: Both cases HPE report was clear cell carcinoma with negative margins. Patient was followed up at 1 week, 1 month and at 3 months with relevant investigations. Patient is doing well at 6 months. Conclusion: Selective renal artery clamping is a good method of reducing the warm ischemia time and it can be done by laparoscopy with advance training.

   Unmoderated posters Top

   UP-01: Double Faced (Inlay And Onlay) Buccal Mucosa Urethroplasty Offers Better Long Term Results For Complex Urethral Strictures Top

Ashish Pardeshi, Vijay Raghoji, Navnath Fulari, Pratikshit Mahajan, Narendra Wankhede

Kidney & Urology Super-Speciality Clinic Pune

   UP-02: Importance of penile suspensory ligament repair in severe proximal hypospadias Top

Ashish Pardeshi, Vijay Raghoji, Navnath Fulari, Pratikshit Mahajan

Kidney & Urology Super-Speciality Clinic Pune

   UP-03: The outcome of an opportunistic screening of men with lower urinary tract symptoms in India Top

Banerjee I, Agnihotri S, Srivastav A, Kapoor R, Mandhani A

Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow

   UP-04: A novel scoring system based on histopathological features in anterior urethral strictures secondary to lichen sclerosus. Does it correlate with disease severity? Top

Chaudhary K, Devasia A, Mukherjee Partho, J Chandrasingh, Kumar S, Mukha R, Kekre N

Christian Medical College, Vellore

   UP-05: Opportunistic screening in prostate cancer: Result of a retrospective pilot cohort study Top

Jaimin Shah, A Ganpule, Abhishek Singh, RB Sabnis, MR Desai, V Mohankumar, SB Sudharsan

Muljibhai Patel Urological Hospital, Nadiad

   UP-06: Emphysematous Pyelonephritis – Is the final frontier conquered? Top

Lawande PR, Prabhudesai MR, Chari PD, Talwadker NB, Halarnakar RG, Oza UG

Goa Medical College

   UP-07: Xanthogranulomatous cystitis masquerading as genitourinary tuberculosis Top

Mahakshit Bhat, Amilal Bhat, Bilal Ahmad Dar, M.K. Chhabra, Gordhan Choudhary

Dr SN Medical 'College, Jodhpur

   UP-08: Complex pelvic-ureteric junction obstruction (PUJO) of kidneys: successful management with robotic assistance Top

Narain Tushar Aditya, Bora GS, Mavuduru RM, Singh SK, Mandal AK

PGIMER, Chandigarh

   UP-09: “Stenting Antegrade Via Vere's needle during laparoscopic pyleoplastY' - “SAVVY” technique Top

Niranjan Raj, Ramesh Babu, Venkatramanan

Sri Ramachandra University

   UP-10: Renal allograft compartment or compression syndrome (RACS) as etiology of early graft dysfunction: underappreciated because of poor sonography Top

S K Sureka, Sanchit Rustagi, Anil Mani, U P SIngh, M S Ansari, A Srivastava


   UP-11: Relation of volume loss with functional change in robot assisted nephron sparing surgery: a short term prospective study Top

Sadasukhi N, Mandal AK, Singh SK, Bora GS, Mittal BR, Kakkar N, Lal A

PGIMER, Chandigarh

   UP-12: Re-exploration AVF: “Should We Do It” Top

Shabbir Husain, Nafisa Husain

Global Hospital and Urology Research Center, Jabalpur

   UP-13: Outcome of open pyeloplasty in ectopic anomalous kidney with uretero-pelvic junction obstruction: a single centre experience Top

Sunny Goel, Kumar V, Singh V, Sinha RJ, Sankhwar SN, Kumar M

KGMU, Lucknow

   UP-14: To study the role of LISWT in peyronie's disease amongst indian patients Top

Venkatesh Kumar, Terefe Tadesse, Ajit Saxena

Indraprastha Apollo Hospitals, New Delhi

   UP-15: Assessment of the efficacy of reduced-radiation non-contrast ct scan in urolithiasis: a prospective observational study Top

Aggarwal G

Apollo Hospital, Bhubaneswar

   UP-16: Role of Sonourethroram in evaluation of short segment anterior urethral stricture and its comparison with RGU and Urethroscopy Top

Anuj Kumar, Hemant Goel, Umesh Sharma, Swatantra Nagendra Rao, Harsh Jain, Rajeev Sood

PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi

   UP-17: Role of plasma sterilisation for infection control in Endourology Top

Anup Krishnan

Amrita Institute of Medical Sciences, Kochi

   UP-18: The Learning Curve of Robot Assisted Partial Nephrectomy: An Indian Experience Top

Brendan Dias, Shahid Ali, Srinivas AK, Shivashankar R, Amrith Raj Rao, Deepak Dubey

Manipal Hospital, Bangalore

   UP-19: Comparison of perioperative outcomes following Robot assisted Partial Nephrectomy in Tumours with PADUA score ≥ 8: A single institutional experience Top

Brendan Dias, Shahid Ali, Srinivas AK, Amrith Raj Rao, Shivashankar R, Deepak Dubey

Manipal Hospital, Bangalore

   UP-20: Deceased Donor Renal Transplantation- An Institutional Experience of 24 years Top

C Danny Darlington, Balaji AR, Prakash JVS, Arun Kumar Paranjothi

Stanley Medical College Chennai

   UP-21: Microscopic varicocelectomy as treatment option for patients with severe oligospermia Top

Chirag Gupta, Arun Chinchole, Rupin Shah, Hemant Pathak

Lilavati Hospital

   UP-22: PCNL in paediatric urolithiasis: a single centre experience Top

Dar B A, Bhat A, Bhat M, Saran R K, Tomar VS, Burman A, Chhabra MK

Dr S N Medical College Jodhpur

   UP-23: Prospective comparative study of RIRS with Miniperc in lower calyceal stones of 1 to 2 cm size Top

Dassi Vimal, Kumar A, Chauhan U, Anurag K

Max Healthcare Delhi NCR

   UP-24: Laparoscopic and Robotic specimen retrieval system (Modified Nadiad Bag): Validation and cost-effectiveness study model Top

Deshmukh C S, Ganpule A, Sudharsan S B, Singh A, Sabnis R B, Desai M R

Muljibhai Patel Urological Hospital, Nadiad

   UP-25: Diagnostic value of pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio for invasive bladder carcinoma Top

Edikkula Varghese, M Manikandan, KV Shanmughadas, N Madhavan, AT Rajeevan, AV Venugopal, Felix Cardoza

Govt Medical College, Calicut

   UP-26: Association of Vitamin D deficiency with carcinoma prostate – a single institutional observational study Top

Gotam Pipara, Surya Kant Choubey, Saurabh Mittal

St Johns Medical College, Bangalore

   UP-27: Evolution of bladder dysfunction in renal transplant recipient with no pre-existing bladder abnormality: A critical appraisal Top

Gupta Shashikant, Gaur Pankaj, Singh UP, Sureka SK, Kapoor R, Shrivastava A, Ansari MS


   UP-28: Stentless Ureteroscopy for Uncomplicated Distal Ureteral Stones: A Prospective study Top

Jagatheswaran C, Balaji AR, Prakash JVS, Vetrichandar S, Arasi

Govt Stanley Medical College, Chennai

   UP-29: Serum cystatin vs creatinine based estimation of glomerular filtration rate in healthy people: which one to choose? Top

Jain Abhinav

Institute of Liver and Biliary Sciences (ILBS), Delhi

   UP-30: Serum high sensitivity C- reactive protein (hs-CRP) levels in patient with erectile dysfunction Top

Jamaluddin, Gupta NP

Medanta the Medicity, Gurgaon

   UP-31: Comparitive study between PCNL and Anatropic Pyelolithotomy for staghorn calculus Top

Khizar Raoof, MA Raoof, K Eashwer Goud, MA Majid Adil, Kalyan Kumar, Bhagwan Reddy

Deccan College of Medical Sciences, Hyderabad

   UP-32: Surgical stress response following percutaneous nephrolithotomy Top

Khwairakpam Amitkumar Singh, Ravi Mohan SM, Sudheer Kumar Devana, Sanjay Bhadada, Ranjana Walker Minz

PGIMER, Chandigarh

   UP-33: Modified Brickers urinary diversion- A recourse to standard Brickers technique Top

Kulthe Ramesh Seetharam Bhat, Kunal Dholakia, Priyank Shah, Gyvi Gaurav, Nilay Jain, Narasimhan Ragavan

Apollo Hospitals Chennai

   UP-34: Urethral stricture after bipolar transurethral resection in saline of prostate - truth vs hype Top

Kumar BN, Srivastava A, Sinha T

Army Hospital (Research & Referral), New Delhi

   UP-35: A prospective randomized double blind parallel group single centre based study to evaluate the efficacy of tadalafil with dutasteride combination therapy versus tamsulocin with dutasteride therapy in patients with lower urinary tract symptoms Top

Malpani A, Suryaprakash V, Singh A, Ganpule A, Sabnis RB, Desai M

Muljibhai Patel Urological Hospital, Nadiad

   UP-36: Female urethral stricture: A prospective study to find “true” strictures in women on urethral dilatations and early results of dorsal vaginal graft urethroplasty Top

Manasa T, Nikhil khattar, Mahesh Chandra Tripathi, Hemant Goel, Ritesh Kumar Singh, Rajeev Sood

PGMER & Dr RML Hospital, New Delhi

   UP-37: Analysis of anastomotic urethroplasty for pelvic fracture urethral distraction defect: decadal experience from a high volume tertiary care centre Top

Manav Agarwal, Saini D, Singh V, Sinha RJ, Sankhwar SN, Kumar M

King George Medical University, Lucknow

   UP-38: Pre-operative urinary microalbumin and renal volume as predictor of renal functional recovery in live donor nephrectomy Top

Mittal PK, Mukha RP, Chandrasingh J, Kumar S, Devasia A, Kekre N

CMC, Vellore

   UP-39: Endoscopic Classification of Urethral Strictures and Role of Intra-operative Endoscopy in Decision Making: A Prospective Study Top

Omkar Joglekar, Sandesh Surana, Pankaj Joshi, A Alkandari Mohammad, Jyotsna Kulkarni, Sanjay Kulkarni

Kulkarni Endo-surgery Institute and Reconstructive Urology Center

   UP-40: Management of complex vesicovaginal fistula: a single centre experience Top

Pamecha Yash, Patwardhan Sujata, Patil Bhushan, Shelke Umesh

Seth GS Medical College and KEM Hospital, Mumbai

   UP-41: Percutaneous Nephrolithomy (PCNL) in paediatric age group: our experience Top

Guarav Goyal, Hemant Pathak, Mukund Andankar

TN Medical College & BYL Nair Ch Hospital, Mumbai

   UP-42: Our initial experience with Mini-PERC in renal and ureteric stones Top

Dar B A, Bhat A, Chhabra M K, Bhat M, Singh T, Tomar V S, Choudhary G

Dr S N Medical College Jodhpur

   UP-43: Blood pressure and sugar trends and quality of life in patients undergoing pheochromocytoma surgery Top

Pradeep Prakash, Rashmi Ramachandran, Nikhil Tandon, Rajeev Kumar

AIIMS, New Delhi

   UP-44: Percutaneous Nephrolithotomy: Are tubes really required?? Top

Priyadarshi N, Paul F, Bhat S.

Government Medical College Kottayam

   UP-45: Forgoten DJ Stents – Difficult situation Top

Raghuvanshi Kshitij, Jain Devendra Kumar, Vartak Ketan, Iqbal Shams, Deshmukh Hrishikesh, Patil Sachin, Shaikh Irfan

Bharati Vidyapeeth Medical College And Hospital, Katraj, Pune

   UP-46: ABO incompatible renal transplants - our experience Top

Sanna Adappa, Tyagi V, Pahwa M, Chadha S, Singh S, Agarwal R, Jain S

Sir Ganga Ram Hospital, New Delhi

   UP-47: Setting up a deceased donor transplant programme in North India: our experience Top

Sunny Goel, Singh M, Sankhwar SN, Goel A, Kumar M

King George Medical University, Lucknow

   UP-48: An audit of hypospadias repair in a tertiary care centre Top

Vikas Singh Tomar, Bhat A, Bhat M, Dar BA, Chhabra MK, Singh TP

Dr S N Medical College, Jodhpur

   UP-49: Auto-transplantation of kidney in a case of Renal Artery Stenosis Top

Patel F, Agarwal R, Raina S, Bahadur M, Shah R

Jaslok Hospital and Research Centre, Mumbai

   UP-50: Primary vesical adenocarcinoma mimicking as urachal adenocarcinoma Top

Samanta K, Chatterjee S, Aashu A, Singh SK, Sharma PK, Singha Mahapatra RK, Karmakar D, Mandal SN

Calcutta National Medical College and Hospital, Kolkata

   UP-51: Robot Assisted Partial Nephrectomy For Small Renal Mass. Top

Vinit Singh, Altaf Khan, Mujeebu Rahiman, Nischith D'souza, Rahul Bhargava, Ashish Verma

Yenepoya Medical College Mangalore

   UP-52: Post Cystectomy Urinary Diversion: SKIMS experience Top

Aashaq Hussain, Magray Javed, Iqbal Muzzain, Khawaja A Rouf, Hamid Arif, Wani M Saleem

Sher-i-Kashmir Institute Of Medical Sciences (SKIMS) Srinagar

   UP-53: Primary perineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD): a case series from SKIMS Top

Aashaq Hussain, Iqbal Muzzain, Magray Javed, Khawaja A Rouf, Hamid Arif, Wani M Saleem

Sher-i-Kashmir Institute Of Medical Sciences (SKIMS) Srinagar

   UP-54: Priapism due to essential thrombocythemia-a rare causation Top

Ajay Aggarwal, Sunny Goel, Ashok Kumar Sokhal, Bhupendra Pal Singh

King George's Medical University

   UP-55: Penile cutaneous horn in a 22 month child – a rare case report Top

Akshita Bhat, Nikhil Khandelwal, Girish Prabhakar, Amilal Bhat

Sardar Patel Medical College, Bikaner

   UP-56: Extrarenal retroperitoneal angiomyolipoma with oncocytoma Top

Ali Amir, Rizvi J, Nigam L, Modi P, Khemchandani S, Ramya, Raghuveer

IKDRC - ITS, Ahmedabad

   UP-57: De Novo Muconephrosis Of Renal Moiety Top

Anupam Choudhary, Chawla A

KMC, Manipal

   UP-58: Giant calyceal diverticulum masquerading as renal cyst Top

Arya Ankur, Bhatyal Hardev, Narang Vineet

BLK Superspeciality Hospital, New Delhi

   UP-59: Isolated Renal Liposarcoma: a rare entity Top

Ashish Sharma, Kumar M, Sankhwar SN, Goel A, Singh V, Singh BP, Sinha RJ

King George Medical University, Lucknow

   UP-60: Megalourethra of bulbar, membraous and prostatic urethra rare case Top

Ashvin Gami, Deepak Rajyaguru

Palanpur, Gujrat

   UP-61: Augmentation Cystoplasty in tubercular bladder Top

Ayush Khetarpal, Puneet Singh, Lokesh Sharma, Nisar Ahmed, RG Yadav, Rajeev Mathur, Devendra Choudhary

National Institute Of Medical Sciences, Jaipur

   UP-62: Laparoscopic Transperitoneal Pyelolithotomy in Pelvic Kidney – Our experience of 2 cases Top

Ayush Khetarpal, Puneet Singh, Lokesh Sharma, Nisar Ahmed, RG Yadav, Rajeev Mathur, Devendra Choudhary

National Institute Of Medical Sciences, Jaipur

   UP-63: Primary mucormycosis of the kidney in immunocompetent young host: rare presentation Top

Bafna Sandeep, Aarthy G, Dholakia K, Nitesh Jain

Apollo Hospitals, Chennai

   UP-64: Buccal mucosal graft urethroplasty: our experience and review of literature Top

Chandrakant Pancholi, HM Punjani, Umesh Oza, SW Thatte, MuKund Andankar, RK Garg, DD Gaur

Bombay Hospital Institute of Medical Sciences, Mumbai

   UP-65: Bedside interventional ultrasound unit- An extended arm of urologist Top

Chari PD, Prabhudesai MR, Gaude VA, Mandrekar PTN, Talwadker NB, Punjani HM

Goa Medical College

   UP-66: Organized urachal abscess masquerading urachal carcinoma Top

Chatterjee Souvik, Samanta K, Singha Mahapatra RK, Sharma PK, Mandal SN, Karmakar Dilip

Calcutta National Medical College and Hospital, Kolkata

   UP-67: A rare case of bilateral synchronous renal tumors with different histology treated with bilateral partial nephrectomy Top

Dhanuka S, Mandal TK, Mondal M, Mukhopadhyay BC, Kayal A

Nil Ratan Sircar Medical College & Hospital, Kolkata

   UP-68: Multiple punctures for PCNL to achieve complete stone clearance is efficacious and doesn't lead to additional complications Top

Gaurang Shah, Nishant Kathale, Charalampos Mamoulakis

Saifee hospital, Mumbai

   UP-69: Giant prostatic urethral calculus and orthopedic intervention: pointers to rare disorder Top

Gautam Chopra, Sabapathi MK, Viswaroop SB, Arul M, Gopalakrishnan G, Kandasami SV

Vedanayagam Hospital

   UP-70: Urinary bladder schistosomiasis- a rare case report Top

Hardik Yadav, Shah Shrenik, Prashant Patel, Patel Krunal, Tanay Singh

Civil Hospital Ahmedabad

   UP-71: Traumatic angiomyolipoma rupture in a septuagenarian Top

Hegde Suraj P, TP Rajeev, Menon Arun R, Kumar Amit

K S Hegde Medical Academy

   UP-72: Dual Components in Penile Malignancy - A very rare case report Top

Jagadish Kaushik B, R Neelakandan, CN Sai Shalini, T Chandru, K Natarajan, S Venkat Ramanan

Sri Ramachandra Medical College, Chennai

   UP-73: A rare case report of adrenal maliganancy Top

Jampana Siva S Raju, D Senthil, T Senthil Kumar, J Saravanan, RM Meyyappan

SRM Medical College and Hospital, Chennai

   UP-74: Splenic injury during retroperitoneal nephrectomy. A case report Top

Jariwala S K, Dholaria P, Joshi V, Karia S, Amlani J

B T Savani Kidney Hospital

   UP-75: Prostate biopsy in a rural hospital. Our experience Top

Jariwala S K

Rajah Muthiah Medical College Hospital

   UP-76: Effect of testicular vein ligation and clomiphene citrate in patients presenting with infertility having varicocele Top

Jatin Soni, Vivek Sharma, Haris CH

Govt Medical College Trivandrum

   UP-77: A rare association of clear cell renal cell carcinoma with staghorn calculus Top

Jaynil A Bagawade, Rohan S Batra, Sanjoy L Paul, Sujit Saikia, SK Singhania, PM Deka

Dispur Hospitals Pvt Ltd

   UP-78: Urethral Diverticulum with a Giant Urethral Calculus – A case report Top

Kalimuthu K, Saraswathi S, Anton Uresh Kumar T, Harry Santhaseelan W, Balasubramanian R, Govindharajan P, Ilamparuthi C

Madras Medical College

   UP-79: Renal Hydatid Cystic Disease masquerading as Renal Tumor- A case report Top

Karthik M, Kalyanram K, Vasudevan T, Joseph Philipraj, Mossadeq A

Mahatma Gandhi Medical College & Research Institute, Pondicherry

   UP-80: Inflammatory myofibroblastic tumor of the perirenal soft tissue : A case report Top

Krunalbhai Kundaida, Sabapathi MK, Viswaroop SB, Arul M, Gopalakrishnan G, Kandasami SV

Vedanayagam Hospital

   UP-81: Urethral Diverticulum- An Unusual Complication Following Ventral Split Thickness Skin Onlay Graft Urethroplasty Top

Krutik Raval, Shimpi RK, Darshan Patel, Ulhas Nikam

Ruby Hall Clinic, Pune

   UP-82: Robotic NSS is feasible in pregnancy : A case report Top

Lanka PK, Mandal AK, Ravimohan SM, Bora GS, Bansal A

PGIMER, Chandigarh

   UP-83: Management of hematuria due to pseudoaneurysm in a case of Tuberous Sclerosis Top

Maharaj Mondal, TK Majhi, S Dhanuka, A Kayal, T K Mondal, S Chowdhury

Nilratan Sircar Medical College & Hospital

   UP-84: Zinner Syndrome A Rare Entity Top

Mohan Amaresh, Chawla A

KMC Manipal

   UP-85: A sheep in wolf's clothing: tubulovillous adenoma of urinary bladder Top

Nagesh Kamat, Saurabh K Jambu, Rakesh Vaidya

Kamat Kidney and Eye Hospital Pvt Ltd

   UP-86: Rare case of Prostatic Leiomyoma Top

Niraj C Chaudhari, VP Sabale, SP Kankalia, V Satav, D Mane, A Mulay, S Mhaske

Dr DY Patil Medical College and Hospital Pimpri, Pune

   UP-87: Sonourethrography is the future of urethral stricture assessment Top

Paik Chayan, Dorairajan LN, Ramkumar G, Manikandan R, KS Sreerag, Nagarag

JIPMER, Pondicherry

   UP-88: Association of preputial stone with penile cancer: a case report Top

Panda Rakesh, Mohanty NK Panda S, Singh GP, Hota D

SCB Medical College Cuttack

   UP-89: Cystoscopic removal of a long crochet metallic needle that had ruptured through prostatic urethra Top

Pankaj N Maheshwari

Fortis Hospital Mulund, Mumbai

   UP-90: Pattern of microbial infection in clinically symptomatic benign prostatic hyperplasia patient – a prospective study Top

Pranab Kr Kaman, TP Rajeev, Barua SK, Baruah SJ, Sarma D, Bagchi PK, Phukan M

Gauhati Medical College, Guwahati

   UP-91: Unusual renal mass - a retrospective review of management and follow up Top

Pranab Kr Kaman, TP Rajeev, Barua SK, Baruah SJ, Sarma D, Bagchi PK, Phukan M

Gauhati Medical College, Guwahati

   UP-92: Carcinoma Prostate masquerading as carcinoma rectum Top

Prashant Kumar, Amlesh Seth

AIIMS, New Delhi

   UP-93: Neovaginal reconstruction in vaginal atresia with incontinence Top

Puneet Singh, Ayush Khetarpal, Nisar Ahmed, Lokesh Sharma, RG Yadav, Rajeev Mathur, Devendra Choudhary

National Institute of Medical Sciences, Jaipur

   UP-94: Forgotten Double J Stent with massive lumbar incisional hernia Top

Puneet Singh, Ayush Khetarpal, Nisar Ahmed, Lokesh Sharma, RG Yadav, Rajeev Mathur, Devendra Choudhary

National Institute of Medical Sciences, Jaipur

   UP-95: A rare encounter-cancer prostate metastasis to testis Top

Raghuvanshi Kshitij, Jain Devendra Kumar, Vartak Ketan, Iqbal Shams, Deshmukh Hrishikesh, Patil Sachin, Shaikh Irfan

Bharati Vidyapeeth Medical College and Hospital, Katraj, Pune

   UP-96: Acute presentation of GUTB Top

Ratkal C S, Ratkal V C

ReSCUE The Urology Centre, Bangalore

   UP-97: A case of incomplete duplication of ureter with obstruction Top

Raval Abid, Jain DK, Vartak K, Iqbal S, Deshmukh H, Patil S, Shaikh I

Bharati Vidyapeeth University Medical College Hospital

   UP-98: Melioidosis in a case of adpkd post renal transplant Top

Rawoot Suhaib, Singh Vijay, Anand Apurv, Joshi Vinod, Kothari Jatin

PD Hinduja National Hospital and Medical Research Centre

   UP-99: Inferior vena cava leiomyosarcoma with retroperitoneal lymph node tuberculosis in a young female patient: an unusual presentation Top

Rawoot Suhaib, Singh Vijay, Shah Bhargav, Joshi Vinod, Sagade Sharad

PD Hinduja National Hospital and Medical Research Centre

   UP-100: Cystic mature Adrenal Teratoma: a case report Top

Sajad Ahmad Para, Debansu Sarkar, Dilipkumar Pal

Institute of Postgraduate Medical Education & Research Kolkata

   UP-101: Adrenal Ganglioneuroma Top

Samarth Agarwal


   UP-102: Vascular anomalies in live donor nephrectomy : our experience Top

Sandeep Pradhan, Mishra GK, Panda PK, SamalS, Panda SS, Swain S, Singh GP, Hota D

SCB Medical College, Cuttack

   UP-103: Metastatic carcinoma prostate masquerading as retroperitoneal lymphoma Top

Saurabh Kale, Bhavish N, Surender Singh, Rajeevan AT, Felix Cardoza

Government Medical College, Calicut

   UP-104: A rare case of epithelial varient of angiomyolipooma ; a case report Top

Shah CG, Shah PJ, DholariaPD, Joshi VD, Amlani JC, Panwar GB

BT Savani Kidney Hospital, Rajkot

   UP-105: An unusual case of horse shoe kidney with high grade long segment left lower ureter transitional cell carcinoma Top

Shamsukha Dheeraj, Sathe Saket, Joshi Nitin, Patil Ajinkya, Nathwani Parth

Mahatma Gandhi Mission Medical College and Hospital, Navi Mumbai

   UP-106: Holmium laser enucleation of the prostate for super large prostates (volume > 150 cc ) : a study of 25 cases Top

Singh Amrinder, Sood Swapan, Agarwal Suresh

Patel Hospital, Jalandhar

   UP-107: Lap assisted PCNL in pelvic ectopic kidney- a preferred approach Top

Sonu Sharma, V Satav, V Sabale, SP Kanklia, A Mulay, D Mane, S Mhaske

Dr D Y Patil Medical College

   UP-108: Traumatic Angiomylipoma rupture in a septuagenarian Top

Suraj Hegde P, Arun Menon, Rajeev T P, Amit Kumar

K S Hegde Medical Academy

   UP-109: A rare case of mixed gonadal dysgenesis with persistent Mullerian syndrome in a phenotypic male Top

Surajit Das, Ranjit Kumar Das, Supriya Basu, Ranjan Kumar Dey

R G Kar Medical College, Kolkata

   UP-110: An unusual presentation of infected urachal cyst in an adult Top

T Sai Venkat Manoj, Gowdhaman S, Senthil D, Senthil Kumar T, Muthu V, Vairavel P, RM Meyyappan

SRM Medical College and Hospital, Chennai

   UP-111: Female Epispadias (A report of 2 cases) Top

Tiwari R, Arya MC, Sandhu A, Hariyawat BS, Yogendra

SP Medical College, Bikaner

   UP-112: Pseudoepitheliomatous, keratotic and micaceous balanitis (PKMB): A rare case report Top

Vidyasagar Hansraj Baheti, Gaurav Somani, Rupesh Gundawar

Latur, Maharashtra

   UP-113: An unusual combination - transitional cell carcinoma of the renal pelvis and giant hydronephrosis Top

Vishal, Vasudevan T, Kalyanram K, Joseph Philipraj, Mossadeq A

Mahatma Gandhi Medical College & Research Institute, Pondicherry

   UP-114: Alveolar rhabdomyosarcoma of the prostate in an young adult presenting with acute retention of urine Top

Vishal Kadeli, RB Nerli, Shridhar C Ghagane

KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-115: Renal transplantation in sickle cell nephropathy (SCN) Top

Y P Singh Rana, Aditya Pradhan, Ashish Kumar, Harish Sinha

BLK Super speciality Hospital, New Delhi

   UP-116: Role of unilateral nephrectomy in the treatment of refractory nephrogenic hypertension secondary to reflux nephropathy in child bearing age: a case report Top

Yaser Ahmad, Sajjad Malik, Rouf Khawaja, Arif Hamid, Saleem Wani

SKIMS, Srinagar

   UP-117: A comparative study of bipolar turp versus monopolar TURP Top

A Jai Babu

Sri Venkateswara Institute of Medical Sciences

   UP-118: Anastomotic urethroplasty in children with PFUDD Top

Abhijit Musale, Nerli RB

KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-119: Expanded criteria deceased kidney donor outcome : our experience Top

Aditya Pradhan, Y P Singh Rana, Ashish Kumar, Harish Sinha

BLK Super speciality Hospital, New Delhi

   UP-120: A retrospective analysis of transrectal ultrasonography guided prostate biopsy in prostate cancer detection Top

Akshay V Patil, Ajit Somaji Sawant, Prakash Wamanrao Pawar, Sunil Raghunath Patil, Gavrav Kasat, Abhishek Savalia

Lokmanya Tilak Muncipalmedical College, Sion, Mumbai

   UP-121: To the Moon and back: Our journey with Memokath in management of urinary strictures Top

Aman Gupta, Col Rajeev Sood, Niren Rao

Flt Lt Rajan Dhall Fortis Hospital, Vasant Kunj, New Delhi

   UP-122: Challenges in Managing atherosclerosed/thrombosed recepient vessels in renal transplantation Top

Aman Gupta, Col Rajeev Sood, Niren Rao

Flt Lt Rajan Dhall Fortis Hospital, Vasant Kunj, New Delhi

   UP-123: Renal salvage in patients with urinary tuberculosis in the era of modern chemotherapy and surgical armamentarium Top

Amar Kumar, Anuj Deep Dangi, Rajiv Paul Mukha, Chandrasingh J, Santosh Kumar, Nitin S Kekre, Antony Devasia

Christian Medical College, Vellore

   UP-124: Comparison of IM Diclofenac and Local analgesic agent as an alternative to Monitored IV Anesthesia for ESWL at KLESKF Top

Amey Patil, SI Neeli, Srikanth P

KLES Kideny Foundation, JNMC Belgaum

   UP-125: Use of K-Y Jelly as buffer to prevent migration of stone during Ureterorenoscopy Top

Amey Patil, SI Neeli, Srikanth P

KLES Kideny Foundation, JNMC Belgaum

   UP-126: Are armed forces peronnel more “stoned” than others? Top

Amit Agrawal, S Tripathy, Deepak Kumar

Command Hospital, Pune

   UP-127: Supine PCNL in children – early experience Top

Amit Mungarwadi, Vishal Kadeli, Nerli R

KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-128: Surgical and oncological safety of nephron sparing surgery in T1b renal cell carcinoma Top

Amitabh Singh, Paul Rajeev, Raghuveer, Baidya Saroj, Jaipuria Jiten, Jain Jalaj, Rawal Sudhir

Rajiv Gandhi Cancer Institute and Research Centre

   UP-129: Robot assisted radical prostatectomy with Retzius sparing technique: Initial experience in a tertiary care centre Top

Amitabh Singh, Rawal Sudhir, Raghuveer, Baidya Saroj, Jaipuria Jiten, Jain Jalaj

Rajiv Gandhi Cancer Institute and Research Centre

   UP-130: Role of Reno protective measures in Emphysematous Pyelonephritis Top

Anand Ravindra Baid, Reddy Rajesh, Laxman Prabhu, Shetty Ranjit, Prajwal Ravinder, Sanman KN

KMC Hospital, Mangalore

   UP-131: Laparoscopic donor nephrectomy: Right versus left Top

Anil Gulia, Kumar Anant

Max Hospital, Delhi

   UP-132: Renal Tuberculosis presenting as pseudotumour mimicking Renal cell carcinoma -Rare Case Report Top

Anoop Krishnan K K, Rajeevan A

Government General Hospital Kochi

   UP-133: A study of quantitative analysis of serum tissue inhibitor of metalloprotease level in patients with carcinoma prostate Top

Anshuman Aashu, Pramod K Sharma, Sudipta K Singh, Souvik Chatterjee, Kanishka Samanta, S N Mandal, Dilip Karmakar

Calcutta National Medical College, Kolkata

   UP-134: Effect of silodosin, darifenacin and combination therapy for treatment of ureteral stent related discomforts Top

Aquinas B, Saraswathi S, Hemalatha R, Vezhavendhan, Govindarajan P, Ilamparuthi C

Madras Medical College

   UP-135: Surgical sperm retrieval in Non-Obstructive Azoospermia(NOA) - How do we predict success? Top

Arun Karthik P, Vasan SS, Karthik KN, Madhumitha M

Manipal Fertility Centre, Kurinji Hospital

   UP-136: Say no to morcellation in laser prostatectomy: Thulium LASER vapoenucleation technique – a novel approach Top

Arup Kumar Nath, Nitin Gupta, Debajit Baishya


   UP-137: Simultaneous bilateral ureteroscopy for bilateral ureteric calculi Top

Arvind Kumar Tiwari, Pai Narendra, Ali Imdad N, THS Ravishankar, G Jayaprakasha, Gomes Keith, Urs Devaraj

Vijayanagara Institute of Medical sciences, Bellary

   UP-138: Fracture Penis – Our Experience Top

Arya MC, Tiwari R, Sandhu A, Yogendra, Hariyawat BS

SP Medical College, Bikaner

   UP-139: Traumatic bulbar urethral stricture- modified urethroplasty, our experience Top

Arya MC, Sandhu A, Yogendra, Hariyawat BS, Tiwari R, Saxena G

SP Medical College, Bikaner

   UP-140: “PCNL Simplified” - One step tract dilatation for 24 Fr PCNL Vs SERIAL alken dilatation - results of a prospective comparative study Top

Ashish Chhajed,

Apollo Hospitals, Indore

   UP-141: Do preoperative alpha blockers facilitate ureteroscope insertion at vesico ureteric junction? An answer from a prospective case-controlled study Top

Ashish Sharma, Sankhwar SN, Singh V, Sinha R.J, Kumar M, Sokhal AK

King George Medical University, Lucknow

   UP-142: Management and Evaluation of Staghorn Calculus on Basis of Stone volume analysis Top

Ashwani Kandari, VP Satav, VP Sabale, A Mulay, D Mane, S Mhaskey, SP Kanklia

Dr D Y Patil Medical College, Pimpri, Pune

   UP-143: Scrotal Dartos Flap in failed hypospadias repair : A rescue Option Top

Ashwani Kandari, VP Sabale, VP Satav, A Mulay, D Mane, S Mhaskey, SP Kanklia

Dr D Y Patil Medical College, Pimpri, Pune

   UP-144: Duration for which Double J Stent to be kept in ureteroscopic lithotripsy- a prospective study Top

Baghel Pushpendra, Yadav SS, Tomar Vinay, Priyadarshi Shivam, Vyas Nachiket, Agarwal Neeraj

SMS Medical College and Associated Hospital, Jaipur

   UP-145: Prospective study to evaluate factors influencing success of semi-rigid ureteroscopy for ureteral stones Top

Bali D, Gomes K, Ali Imdad N, M Shivashankarappa, THS Ravishankar, G Jayaprakasha, Reddy G

Vijayanagar Institute of Medical Sciences, Bellary

   UP-146: Prostatic artery embolization in treatment of BPH- Our Expirence Top

Bhadrabavar S K, Prabha V, Nerli R B, Mulimani N, Kadeli V

KLES Kidney Foundation, Belagavi

   UP-147: Repair of recto-urethral fistula with urethral augmentation by buccal mucosal graft and gracilis muscle flap interposition- our experience Top

Bhadranavar S K, Prabha V, Nerli R B, Mulimani N, Kadeli V

KLES Kidney Foundation, Belagavi

   UP-148: An Observational study comparing Renal Function in Renal Donors Top

Bharat Khadav, TC Sadasukhi, Manish Gupta, HL Gupta, Govind Sharma

Mahatma Gandhi Medical College and Hospital

   UP-149: Horseshoe Kidney and Renal Cell Carcinoma: A Rare Entity; Case Report and Review of Literature Top

Bharat Khadav, TC Sadasukhi, Manish Gupta, HL Gupta, Govind Sharma

Mahatma Gandhi Medical College and Hospital, Jaipur

   UP-150: Role of alpha blockers in reducing urine leak following nephrostomy tube removal, after percutaneous nephrolithotomy, in patients with Indwelling Double-J Stent Top

Bhatnagar Ankur, Tomar Vinay, Yadav Shersingh, Priyadarshi Shivam, Vyas Nachiket, Agarwal Neeraj

SMSMC Jaipur

   UP-151: Discrepancy in radiological and pathological tumour size in renal cell carcinoma-initial experience from tertiary care centre Top

Bhattarai Neeraj, Keshavamurthy R, Manohar CS

Institute of Nephrourology, Victoria Hospital Campus, Bangalore

   UP-152: Factors predicting the outcome of arterio-venous fistula Top

Byram Ranadheer, Harikrishna M, Sudeep B, Vedamurthy Reddy P, Vijayabhaskar Reddy G

Narayana Medical College and Hospital, Nellore

   UP-153: Observational study of predictive factors and outcome in sperm retrieval of azoospermic males Top

Chandankhede Uday, Shah Rupin, Pathak Hemant, Rahangdale Pawan

Lilavati Hospital & Research Centre, Mumbai

   UP-154: Correlation of Prostate Gland Size and Uroflowmetry in Patients with Lower Urinary Tract Symptoms Top

Chellapandian, AR Balaji, JVS Prakash, Arunkumar, Natarajan

Government Stanley Medical College, Chennai

   UP-155: Comparison of ESWL and Ureteroscopic Techniques in the management of 8 - 15 mm proximal ureteric calculi : A Prospective analysis Top

Damanbir Singh Chahal, Shivakumar V, Navriya S, Keshavamurty R

Institute of Nephro-Urology, Bangalore

   UP-156: Comparison of holmium laser and pneumatic lithotripsy using semirigid scope in managing ureteric calculus Top

Dani Tushar, Sanman KN, Laxman Prabhu GG, Shetty Ranjit, Ravinder Prajwal, BH Rakesh, Reddy Rajesh

KMC Hospital, Mangalore

   UP-157: Effect of preoperative DJ Stent placement in ureteric stone management on stone free rates and complications Top

Das Priyabrata, G Venugopal, LR Rakhul, R Vashantharaja, S Darhan

Government Medical College, Trivandrum

   UP-158: Outcomes and complications of Nephron sparing surgery in Renal Tumors - A single institution experience Top

Dhananjaya kumar B R, Manohar CS, Shivakumar V, Sreenivas J, Shivalingaiah M, Nagabhusahn M, Keshavamurthy R

Institute of Nephro-Urology, Bengaluru

   UP-159: Mini-percutaneous cystolithotripsy (PCCL) in pre-school children Top

Dilip k Mishra, Madhu S Agrawal

Global Rainbow Healthcare, Agra

   UP-160: To study the role of lingual mucosal graft in surgical treatment of Peyronie's disease Top

Faiz Ahmed khan, Pushpendra Kumar Shukla, Aditya Kumar Singh, Yashpal Ramole, U.S. Dwivedi, Sameer Trivedi

IMS, BHU, Varanasi

   UP-161: Management of ruptured Brachio-cephalic Arterio-venous fistula, a rare but serious complication: Case series Top

Fusakele Ankit, Wadhera Vishal, Khandelwal Shradha

City Hospital & Research Centre Jabalpur

   UP-162: Initiating a deceased donor programme in a state like Madhya Pradesh which has not yet enacted Transplant of Human Organ & Tissue Act (THOTA) : Legal and administrative Challenges Top

Fusakele Ankit, Wadhera Vishal, Solanki Fanindra

City Hospital & Research Centre Jabalpur

   UP-163: Comparison of surgical and functional outcome of laparoscopic and robot assisted pyeloplasty for treatment of congenital uretero-pelvic junction obstruction Top

Gagandeep Singh, Aditya Jha, Raghav Talwar, SC Dash, A Datta

Army Hospital (R & R), Delhi Cantt

   UP-164: Primary squamous cell carcinoma of the male urethra : results of surgery with chemoradiation therapy Top

Garg A, T P Rajeev, Barua S K, Sarma D, Baruah S J, Bagchi P K, Phukan M

Gauhati Medical College

   UP-165: Role of DJ Stent Exchanges in Urological Practice Top

Gaude VA, Prabhudessai MR, Cardoso AL, Rajendra P, Halarnakar RG, Thatte SW

Goa Medical College

   UP-166: Role of urodynamic evaluation in parkinson's disorder with urinary complaints Top

Gaurav Agrawal, Vinod Joshi, Chirag Punatar, Ravish Rathee, Suhaib, Vijay Singh

PD Hinduja National Hospital & MRC, Mumbai

   UP-167: Tanagho procedure for reconstruction of female urethra revisted : single center experience Top

Gautam Chopra, Sabapathi MK, Viswaroop SB, Arul M, Gopalakrishnan G, Kandasami SV

Vedanayagam Hospital

   UP-168: Percutaneous Nephrolithotomy (PCNL) related urosepsis: can we predict it? Top

Gomes K, Pai N, Ali I, Shivashankarappa MG, Ravishankar THS, Jayaprakasha G, Reddy G

Vijaynagara Institute of Medical Sciences, Bellary

   UP-169: Impact of TOT Treatment in Patients With Mixed Urinary Incontinence Top

Goutham Reddy Sathi, Neelakandan, Chandru, Natarajan

Sri Ramachandra University, Chennai

   UP-170: Comparison of Stone Scoring Systems for the prediction of Stone-Free Rate(SFR) and complication rates following Percutaneous Nephrolithotomy(PCNL) Top

Goyal K, Pal BC, Modi PR, Rizvi SJ, Nagarajan R

Institute of kidney diseases & reseach centre, and institute of transplantation sciences, Ahmedabad

   UP-171: Factors predicting the outcome of native arteriovenous fistula for haemodialysis : prospective study Top

H Ramesh, M Shivalingaiah, R Keshavamurthy, C S Manohar

Institute Of Nephrourology

   UP-172: Intrinsic host factors in causation of recurrent urinary tract infections in perimenopausal and postmenopausal women Top

H Krishna Moorthy, Manas Babu, Praveen B, Devesh Bansal, Sony Mehta, Biju S Pillai, Mohan P Sam

Department of Urology, Lourdes Hospital, Kochi

   UP-173: Laparoscopic radical prostatectomy in oligometastatic prostate cancer – is it worth doing? Top

Hardik Yadav, Shah Shrenik, Patel Prashant, Patel Krunal, Singh Tanay, Sahare Pranal, Pawar Dushyant

Department of Urology, Civil Hospital, Ahmedabad

   UP-174: Comparative study of straight-line onlay technique versus end-side anastomosis in arteriovenous fistula Top

Harsha HS, Krishnaprasad T, Maneesh Sinha, Venkatesh Krishnamoorthy

NU Hospital, Bengaluru

   UP-175: Transperitoneal versus retroperitoneal laparoscopic nephrectomy-does the approach make a difference Top

Jadhao Vivek G, Gaur DD, Andankar M, Agarwal Himanshu, Mahatme Prajwal, Pancholi Chandrakant

Bombay Hospital Institute of Medical Sciences, Mumbai

   UP-176: Approach to emphysematous pyelonephritis and associated prognostic factors for mortality Top

Jain Amit, Manikandan Ramanitharan, Dorairajan LN, KS Sreerag, Kataria Gaurav, Mehra Ketan, Khelge Vinod

JIPMER Pondicherry

   UP-177: Combined laparo-endourological techniques in management of secondary calculus associated with anatomical upper and lower urinary tract obstruction Top

Jain Amit, Ramanitharan Manikandan, Dorairajan LN, KS Sreerag, Zaphu Tepukiel, Kumar Vijay, Kumar Rajiv

Jawaharlal Institute of Postgraduate Medical Education & Research Pondicherry

   UP-178: Human papilloma virus infection and chronic prostatitis: an association study Top

Jain Pritesh, Pal Dilip Kumar, Ghosh Amlan

IPGMER and SSKM Hospital, Kolkata

   UP-179: Feasibility of Percutaneous Nephrolithotomy (PCNL) under Spinal Anaesthesia for Staghorn Kidney Stones: Safety and Efficacy Top

Jaisukh Kalathia, Baldaniya P, Agrawal S, Chipde S

Sri Aurobindo Institute of Medical Science, Sadbhavna Trust Hospital

   UP-180: Prospective comparative study of Laser lithotripsy versus pneumatic lithotripsy in percutaneous renal stone management- A single center experience Top

Jampana Siva S Raju, D Senthil, T Senthil Kumar, J Saravanan, V Muthu, P Vairavel, RM Meyyappan

SRM Medical College and Hospital, Chennai

   UP-181: Management of lower renal calyceal stones of 1 to 2 cm: A comparative study of shock wave lithotripsy, percutaneous nephrolithotomy and retrograde intra renal surgery Top

Jaynil A Bagawade, Rohan S Batra, Sanjoy L Paul, Sujit Saikia, SK Singhania, PM Deka

Dispur Hospitals Pvt Ltd

   UP-182: Evaluation of outcome of tubularized incised plate for hypospadias repair : Study of 142 cases Top

Jimmy Shad

Apollo Children's Hospital, Chennai

   UP-183: Uroflowmetry nomogram in the healthy indian population Top

Jitendra Chouhan, Tony Thomas, Nazar M, Dineshan KM

TD Medical College

   UP-184: Open Renal Stone Surgery (ORSS) combined with nephroscopic clearence in the present era of MIS Top

Joy Narayan Chakraborty

Apollo Hospitals, Guwahati

   UP-185: Laparoscopic burch Colposuspension– Our experience Top

K Priyatham, Tarun Dilip Javali, HK Nagaraj, SML Prakash Babu

MS Ramaiah Medical College, Bengaluru

   UP-186: Predicting ureteric stone free rates in ureteroscopy from pre operative S.T.O.N.E score Top

Kadam Swapnil, Guru N, Patil BS, Kundargi VS, Patil SB

Shri B M Patil Medical College Vijayapur

   UP-187: Extracorporeal Shock Wave Lithotripsy for Management of Residual Stones after Ureterolithotripsy versus Mini-Percutaneous Nephrolithotomy: A Retrospective Study Top

Kalimuthu K, Saraswathi S, Anton Uresh Kumar T, Harry Santhaseelan W, Balasubramanian R, Govindharajan P, Ilamparuthi C

Madras Medical College

   UP-188: Evaluating predictors of mortality and highlighting differences between diabetic and non-diabeticpatients with emphysematous pyelonephritis Top

Kamath S, Patwardhan S, Patil B, Shelke U

KEM Mumbai

   UP-189: To study the prevalance and factors asociated with acute kidney injury in patients diagnosed with ureteric calculi Top

Kamath S, Patwardhan S, Patil B, Shelke U

KEM Mumbai

   UP-190: Uroflowmetry in healthy women, normal pattern and development of flow volume and flow age nomogram Top

Kamlesh Gunjan, Ahmad Ahsan, Tiwari Kumar Rajesh, Mahmood Khalid, Kumar Sanjay

Indira Gandhi Institute of medical sciences, Patna

   UP-191: Role Low Intensity Shock Wave Therapy (LI-ESWT) in Intractable ED- Growing Evidence Top

Kammela Sreedhar, Srinivas, Ramachandra Murthy, Siddique Ahmed Khan, Deva Prasad


   UP-192: A retrospective study on the association of diabetes, hypertension and lifestyle factors in common urological malignancies Top

Karthik M, Joseph Philipraj, Vasudevan T, Kalyanram K, Mossadeq A

Mahatma Gandhi Medical College & Research Institute, Pondicherry

   UP-193: Clinical profile of younger patients with erectile dysfunction Top

Kewlani N, Vasudevan S

Government Medical College, Thiruvananthapuram

   UP-194: R.E.N.A.L Nephrometry Score: Predicting perioperative outcomes in partial nephrectomy Top

Khan I A, Basu S, Das R K, Dey R K

RG Kar Medical College and Hospital, Kolkata

   UP-195: Penile Fasciocutaneous Mc Aninch Flap Urethroplasty – Our Centre Experience Top

Krunalbhai Kundaida, Sabapathi MK, Viswaroop SB, Arul M, Gopalakrishnan G, Kandasami SV

Vedanayagam Hospital

   UP-196: Modification of microsurgical longitudinal intussusception technique of vasoepididymal anastomosis - Our experience and an analysis of outcomes in an Indian scenerio Top

Krutik Raval, Shimpi R K, Darshan Patel, Ulhas Nikam

Ruby Hall Clinic, Pune

   UP-197: Pattern of iatrogenic ureteric injuries in a tertiary care centre Top

Kumar Prabhat, Kumar Rohit, Upadhyay Rohit, Mahmood Khalid, Kumar Vijoy

IGIMS, Patna

   UP-198: Prospective study to analyse pattern of semen fluid abnormalities in male partners of infertile couples Top

Kumar Rohit, Mishra P, Mishra G, Upadhyay R, Mahmood K, Kumar V

Indira Gandhi Institute of Medical Science

   UP-199: Intravesical Prostatic Protrusion – Does it effect the outcomes of TURP ? Top

Mahadik Rajat, Sanjeevan KV, Mathew Georgie, Thomas Appu

Amrita Institute of Medical Sciences, Kochi

   UP-200: Ureteric stricture in GUTB - Management, our institutional experience Top

Manikandan M, Anton Uresh Kumar T, Balasubramaniam R, Harry santhaseelan W, Chengalvarayan G, Govindharajan P

Madras Medical College

   UP-201: Early imaging after partial nephrectomy, can be misleading Top

Manish Pandey, Shrivastava V, Ramole Y, Khan FA, Trivedi S, Dwivedi US

IMS BHU Varanasi

   UP-202: The Prospective Study of Mini PCNL by 11Fr Sheath for safety and efficacy in Renal calculi upto 2 cm Top

Manjunath Venkatachalaiah, Arun Chawla, BM Zeeshan Hameed, P Hegde

Kasturba Hospital, Manipal

   UP-203: Immunohistochemical analysis of von hippel-lindau, hypoxia-inducible factor 1 α and lim domains containing-1 gene in different stages of renal cell carcinoma and its clinicopathological implication Top

Maurya Arun Kumar, Pal Dilip Kumar, Panda Chinmay Kumar, Dutta Chhanda

IPGMER and SSKM Hospital, Kolkata

   UP-204: A comparative study of quality of life between ileal conduit urinary diversion and orthotopic neobladder reconstruction after radical cystectomy Top

Md Dawood Khan, Ranjan Dey, Supriyo Basu, Ranjit Das

R G Kar Medical College, Kolkata

   UP-205: Conventional PCNL for small renal stones – do we really need to go mini always? Top

Mehta Amish, Pratik Shah, Parth Jadeja, Chirag Shah

B T Savani Kidney Hospital, Rajkot

   UP-206: Radical cystectomy and urinary diversion : a single center experience Top

Mishra G K, Pradhan S, Samal S, Panda S, Mohanty P K, Singh GP, Hota D

SCB Medical College & Hospital, Cuttack

   UP-207: TURP in patients with bladder outflow obstruction and underactive detrusor Top

Mohammad Ismail, Sanjay Pandey, Bejoy Abraham

Kokilaben Dhirubhai Ambani Hospital

   UP-208: Risk of metabolic syndrome among patient receiving primary androgen deprivation therapy for prostate cancer: prospective observational study Top

More Sumit, Manikandan M, Madhavan N, Rajeevan AT, Shanmugadas KV, Venugopalan A V, Felix Cardoza

Government Medical College, Calicut

   UP-209: Basilic Vein Transposition for Dialysis Access Top

Mukut Debnath, P Mukherjee, Chandra Singh, R P Mukha, S Kumar, N Kekre, A Debasia

Christian Medical College, Vellore

   UP-210: Management of renal trauma and its outcome at tertiary referal center Top

N.G. Thakappa, R Keshavamurthy, Kamath A J, C S Manohar, V Shivakumar

Institute of Nephro-Urology

   UP-211: Robot assisted reconstructive urology: Initial experience of 1 year Top

Nischith D Souza, Mujeeburahiman, Altaf Khan, Rahul Bhargava, Vinit

Yenepoya Medical College Mangalore

   UP-212: Bladder mucosal changes in patients on long term indwelling Catheters Top

Nithyanand HA, M Nazar, Dineshan, Tony, Jitendra Chouhan, Shankar S Ram, Rahul Raveendran

Govt TD Medical College Vandanam Alappuzha

   UP-213: Safety and effectiveness of TOT with customised mesh and customised needles Top

Odugoudar AR, Chawla A, Hegde P, Hameed ZBM

Kasturba Medical College Manipal

   UP-214: Radical nephrectomy with inferior venacava thrombectomy - single centre experience in 5 years (2013-2017) Top

P Aarthy, V Murali, Ganesan T, Arun Kumar, Sivaraman Ananth, Jain Nitesh, N Raghavan

Apollo Hospitals Chennai

   UP-215: Retrospective analysis of surgical complications following cadaveric kidney transplantation Top

P Gunaseelan, AR Balaji, JVS Prakash, Vetrichander, Arasi

Stanley Medical College, Chennai

   UP-216: 1 Year follow-up of adult pyeloplasty with DTPA renal scan- Prospective study Top

PM Rubaganesh, Antan Uresh Kumar T, Chengalvarayan G, Ilamparuthi C, Govindarajan P

Madras Medical College

   UP-217: Diode laser enucleation of the prostate vs monopolar turp a prospective study Top

Padmakar, LN Raju, Sridhar Reddy, Deepak Bolbandi, Prithvi Shetty, Fahim Rajwate

Rajarajeswari Medical College

   UP-218: Complications of not stenting after uncomplicated ureteroscopic lithotripsy -a prospective study Top

Pai Narendra, Tiwari Arvind K, Ali Imdad N, Shivashankarappa M, THS Ravishankar, G Jayaprakasha, Gomes K

Vijayanagar Institute of Medical Sciences, Bellary

   UP-219: Our experience with buccal mucosal graft urethroplasty Top

Paidakula Ramakrishna, Chandramohan V, Siddalinga Swamy PM

Preeti urology and Kidney Hospital, KPHB, Hyderabad

   UP-220: Testicular Tumor Presenting with Inguinal Lymphadenopathy: An Odd Scenario Top

Pamecha Yash, Patwardhan Sujata, Patil Bhushan, Shelke Umesh

Seth GSMedical College and KEM Hospital, Mumbai

   UP-221: Holmium laser enucleation of prostate (HOLEP) in patients taking antiplatelet or anticoagulation medications Top

Pankaj E Bhirud, Kishnamohan Ramaswamy, Khurshid Ahmed, Mohammed Salim, Harigovind Pothiyedath

Metromed institute of advanced Urology and renal transplant (MIART), Calicut

   UP-222: Robotic Urologic Surgery – Application in various urological procedures and its outcomes Top

Patel F, Raina S, Chibber PJ

Jaslok Hospital and Research Centre

   UP-223: Laparoscopic ureteroureterostomy in children Top

Pathade Amey, Prasanna Ram, Mallikarjun Reddy, Nerli R B

KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-224: A comparison of tamsulosin, naftopidil and tadalafil as medical expulsive therapy for lower ureteric calculus: an observational study Top

Patil Santosh, Sanman K N, Laxman Prabhu GG, Shetty Ranjit, Prajwal Ravinder, B H Rakesh, Reddy Rajesh

KMC Mangalore

   UP-225: Urinary Tract Endometriosis-A Single Centre Experience Top

Praneeth Pasam, Sanjay Parachuri, Venkatesh Rao, Siddalingeshwar, Sai Sri Harsha, Bivek, Dileep

Vydehi Institute of Medical Sciences, Bangalore

   UP-226: Analyzing functional outcome after partial nephrectomy using R.E.N.A.L. nephrometry, PADUA classification, and Centrality index score Top

Prarthan Joshi

Ramaiah Medical College

   UP-227: Verrucous Carcinoma of the penis – our experience Top

Prasanna Ram, R. B. Nerli, Shridhar Ghagane

KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-228: Low grade, multiple, ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression Top

Prasanna Ram, RB Nerli, Shridhar Ghagane, MB Hiremath

KLE University's JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-229: Laparoscopic Adrenalectomy – Does size of tumor matters Top

Prashant Patel, Shrenik J Shah, Krunal, Tanay Singh, Dushyant Pawar

B J Medical College Ahmedabad

   UP-230: Comparative study of miniature nephroscopes, MINIPERC-M VS MINIPERC XS in treatment of stone disease Top

Prasun Pramanik, Vils Sabale, SP Kanklia, V Satav, D Mane, A Mulay, S Mhaske

Dr DY Patil Medical College, Pimpri, Pune

   UP-231: Prospective comparative study between Standard tubeless PCNL versus Miniperc tubeless PCNL for less than 2cm size renal stones Top

Pratikkumar J Shah, Dholaria PD, Mehta AK, Joshi VD, Amlani JC, Moteria SB, Panwar GB

BT Savani Kidney Hospital, Rajkot

   UP-232: FGFR3 mutation detection and correlation between tissue and urine samples in cases of bladder cancer Top

Praveen Sundar B, Appu Thomas, Lalitha Biswas, Ginil Kumar P

Amrita Institute of Medical Sciences, Cochin

   UP-233: Single step dilatation in PCNL: Feasible or dangerous??? Top

Preetham Dev, Girish TD, Vijaykumar R, Dhayanand GS, Sachin Dharwadkar, KM Madappa

JSS Medical College, Mysore

   UP-234: Foreign bodies in the urinary bladder and their endoscopic management Top

Prodyut Kumar Saha, Hossain AKMS, Belal MT, Alam SM, Hussain MF, Hasan ANML

Dhaka Medical College Hospital, Dhaka, Bangladesh

   UP-235: Complications following nephrectomy for emphysematous pyelonephritis Top

Purohit SP, Kurne C, Kulkarni AV

Bharti Vidyapeeth Deemed University Medical College Hospital, Sangli

   UP-236: Carcinoma penis: RAIL Vs VEIL Top

Rahul Bhargava, Altaf Khan, Mujeeburahiman, Nischith Dsouza, Vinit Singh

Yenepoya Medical College Mangalore

   UP-237: Evaluation of Renal Function Pre and Post Percutaneus Nephrolithotomy (PCNL) in Renal Stone Patients using Renal Scan Top

Ram Niwas Yadav, Sankhwar SN, Goel A, Singh V, Singh BP, Sinha RJ, Kumar M

KGMU, Lucknow

   UP-238: To assess the quality of life in patients with urethral strictures on clean intermittent catheterization (CIC) following direct vision internal urethrotomy Top

Ram Niwas Yadav, Sankhwar SN, Goel A, Singh V, Singh BP, Sinha RJ, Kumar M

KGMU Lucknow

   UP-239: Robotised Laparoscopic Urology – An Asian Experience Top

Ramaswami Krishnamohan, Bhirud Pankaj, Ahmed Khurshid, Saleem Mohammad, Podiyedath Harigovind

Metromed Institute of Advanced Urology and Renal Transplant (MIART)

   UP-240: Perioperative Morbidities in the patients undergoing Open Nephron Sparing Surgery (ONSS) And Robotic Assisted Laparoscopic Nephron Sparing Surgery (RALNSS) for Renal Cell Carcinoma (RCC): A Multi Institutional Study Top

Ratnesh Mahajan, Vidur Bhalla, AK Attri, AK Mandal, Anshu Palta

Government Medical College and Hospital, Chandigarh

   UP-241: Outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease- single tertiary centre study Top

Rohan Patel, Sankhwar SN, Goel A, Singh BP, Singh V, Sinha RJ, Kumar M

King Georges Medical University Lucknow

   UP-242: Evaluation Of Factors Causing Prolonged Urine Leak Following Nephrostomy Tube Removal After Percutaneous Nephrolithotomy And Its Management Top

Rohan Patel, Singh V, Sinha RJ, Kumar V, Sankhwar SN, Goel A, Kumar M, Singh BP

KGMU, Lucknow

   UP-243: A prospective observational study to assess the impact of anterior urethral stricture on the urethral length Top

Ruchir Aeron, Goel A, Sankhwar SN, Singh V, Singh BP, Sinha RJ, Kumar M

King George's Medical University, Lucknow

   UP-244: Analysis of polymorphisms in dna repair genes and xenobiotic metabolising genes in their association with bladder cancer: a single centre prospective observational study Top

Ruchir Aeron, Sankhwar M, Sankhwar SN, Goel A, Singh V, Singh BP, Kumar M

King George's Medical University, Lucknow

   UP-245: Comparison between outcomes of paraurethral injection of triamcionolone versus paraurethral injection of triamcinolone and mitomycin-C mixture following OIU Top

Ruchir Dhakad, Sudheer Rathi, Abhishek Jain, Vishal Aggrawal, Yasmeen Usmani

LLRM Medical College and SVBP Hospital, Meerut

   UP-246: Comparison of outcome of marginal renal graft to standard renal graft in terms of estimated graft glomerular filtration rate: - a single center observational prospective study Top

Rupala Ketankumar, Sharma Anil, Khera Rakesh, Ahlawat Rajesh, Ghosh Prasun

Medanta-The Medicity

   UP-247: Apache II score with serum procalcitonin utility in prognosticating urosepsis Top

Saini A K, Sreenivas J, Vijay G, Keshavamurthy R, Kamath A J

Institute of Nephrourology, Victoria Hospital Campus, Bangalore

   UP-248: Prostate MRI for Patients and Curious Doctors Top

Samuel Aronson

McGill University Montreal

   UP-249: Total Tubeless Ultra-mini Supine Percutaneous Nephrolithotomy: Our Initial Experience Top

Sandeep Gupta, Susanta Kumar Das, Dilip Kumar Pal

IPGMER, Kolkata

   UP-250: Sarcomatoid renal cell carcinoma: a decade with multi-modality treatment Top

Sandeep Kondisetty, Ginil Kumar, KV Sanjeevan, Appu Thomas

Amrita Institute of Medical Sciences

   UP-251: Post TURP anterior urethral strictures: uniform problem, non uniform answers Top

Sandesh Surana, Pankaj M Joshi, Omkar Joglekar, Mohammad Alkandari, Jyotsna Kulkarni, Sanjay Kulkarni

Kulkarni Reconstructive Urology Center, Pune

   UP-252: Anomalies and renal transplantation - a case series of our institutional experience Top

Santhosh Kumar, Ezhilsundar, Sivabalan, Subramaniyan, Saravanan, Govindarajan, Ilamparuthi

Institute Of Urology, MMC, Chennai

   UP-253: A case series on rare presentations of XGPN and their management – our institutional experience Top

Sathyanarayanan, Ilamparuthi, P Govindarajan, PR Saravanan, Subramanian, Sivabalan, Ezhil

Madras Medical College & RGGH

   UP-254: A randomized comparative study of tubeless versus totally tubeless percutaneous nephrolithotomy Top

Shah I, Yakaiah R, Panduranga Rao K

Venkateshwara Kidney Centre, Karimnagar

   UP-255: Anogenital distance in males attending assisted reproduction center Top

Shankar K, Nerli R B, Vishal Kadeli, Shridhar Ghagane

KLE University, JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-256: Bladder invasion in patients with advanced colorectal carcinoma Top

Shankar K, R. B. Nerli, Prasanna Ram, Shridhar Ghagane

KLE University, JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-257: Donor nephrectomy 1 year data Top

Sharma Anil, Ghosh Prasun, Khera Rakesh

Medanta, the Medicity, Gurgaon

   UP-258: Management of upper tract urolithiasis in anomalous kidney : single center experience Top

Shiv Charan Navriya, Manohar C S, Sanjay R P, Srinivas J, Nagabhushan M, Keshavamurthy R

Institute of Nephro-Urology, Bangalore

   UP-259: Comparison of MRI staging with that of histopathological staging in patients undergoing radical prostatectomy: our experience from a tertiary center in South India Top

Shree Vishnu Siddarth R, Priyank Bijalwan, Ginil Kumar, Appu Thomas

Amrita Institute of Medical Sciences, Kochi

   UP-260: Prospective study of modified laser settings in retrograde intrarenal surgery for better stone free rate Top

Siddalinga swamy P M, Dr Chandramohan V, Dr Ramakrishna

Preeti Urology and Kidney Hospital, KPHB, Hyderabad

   UP-261: Robotic repair of urogynaecological fistula: our experience of 17 patients Top

Singh Sujan, Tyagi Vipin Kumar, Chadha Sudhir, Pahwa Mrinal, Adappa Sana, Agarwal Rohit

Sir Ganga Ram Hospital, New Delhi

   UP-262: Reconstructive Surgery for Penoscrotal Filarial Lymphedema: A Decade of Experience and Follow-up with special emphasis on sexual Function Top

Singh V, Patel R, Sinha RJ, Sankhwar SN, Kumar M

King Georges Medical University Lucknow

   UP-263: Conversion of robotic partial nephrectomy to radical nephrectomy: a prospective multi-institutional study Top

Sohrab Arora, Brian Chun, Mahendra Bhandari, Rajesh Ahlawat, TB Yuvaraja, Craig G. Rogers

Multi-institutional (VCQI collaboration)

   UP-264: Urologic complications post cadaveric renal transplant - a single institutional experience Top

Soundarya G, Vezhaventhan G, Chengalvarayan G, Govindarajan P, Ilamparuthi C

Madras Medical College And Rajiv Gandhi Government General Hospital, Chennai

   UP-265: Testicular volume in fertile adults & correlation between testicular volume, seminal parameters and body mass index: a prospective observational study Top

Srikanth K, Anton Uresh Kumar T, Balasubramaniam R, Harry santhaseelan W, Chengalvarayan G, Govindharajan P

Madras Medical College

   UP-266: Familial Aggregation of Hypospadias Top

Srikanth P, Nerli RB, Shridhar G

KLE University, JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-267: Persistence and appearance of VUR/Obstruction following open reimplantation for VUR Top

Srikanth P, Nerli RB, Shridhar G

KLE University, JN Medical College, KLES Dr Prabhakar Kore Hospital & MRC

   UP-268: Primary bladder diverticulum in adults: report of 4 cases Top

Sudeep Bodduluri, Ranadheer B, Harikrishna M, Vedamurthy P, Vijay Bhaskar G

Narayana Medical College, Nellore

   UP-269: Association of MMP 2 gene polymorphism with prostate cancer suceptibility in an urban area Top

Sudipta Kumar Singh, Dilip Karmakar, S N Mandal, P K Sharma, Rajkumar Singha Mahapatra, Souvik Chatterjee, Kaniska Samanta

Calcutta National Medical College And Hospital

   UP-270: Prospective observational study of adverse reactions following intravesical BCG in bladder cancer patients in tertiary hospital in Kerala Top

Sunil Ravindran, Vivek Sharma, Abhinav Kumar, Praveen G, Rustam Singh, Vasudevan S

Government Medical College, Trivandrum

   UP-271: Clinical value of Intravesical prostatic protrusion in the evaluation and management of BPH Top

Suryakant Choubey

St Johns Medical College, Bangalore

   UP-272: Distraction During Cystoscopy To Reduce Pain And Increase Satisfaction: Randomized Control Study Between Real Time Visualization Vs Listening To Music Vs Combined Music And Real Time Visualization Top

Susanta Kumar Das, Sandeep Gupta, Dilip Kumar Pal

IPGME R, Kolkata

   UP-273: Clinical spectrum of acute pyelonephritis in a tertiary care centre- a retrospective study Top

T Sai Venkat Manoj, Gowdhaman S, Senthil D, Senthil Kumar T, Muthu V, Vairavel P, R M Meyyappan

SRM Medical College and Hospital, Chennai

   UP-274: The Evalauation of Results of PCNL in a Tertiary Care Centre Top

Tejinder Pal Singh, Bhat Amilal, Burman Alakesh, Bhat Mahakshit, Chhabra M K, Tomar V S

Dr SN Medical College Jodhpur

   UP-275: Outcome of dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: an institutional study Top

Tillu Neerja, Patwardhan Sujata, Patil Bhushan, Shelke Umesh

Seth GS Medical College and KEM Hospital

   UP-276: Retained DJ Stents: A study to assess its complications and factors promoting super-added calculi over retained DJ Stents Top

Tillu Neerja, Patwardhan Sujata, Patil Bhushan, Shelke Umesh

Seth GS Medical College and KEM Hospital

   UP-277: A review of complications following open radical / partial nephrectomy using modified clavien dindo classification Top

Tiwari R, Arya MC, Swami JP, Sandhu A, Hariyawat BS, Yogendra.

SP Medical College, Bikaner

   UP-278: Treatment of pelvic malignancies using radiotherapy- do we need to keep these patients on long term follow up? Top

Umesh Ravikant Shelke, Sujata K Patwardhan, Bhushan Patil, Yash Pamecha, Neeraja Tillu, Shashank Kamat

Seth GSMC & KEM Hospital, Mumbai

   UP-279: Does ESWL cause more injury to the kidneys than PNL for moderate size (1.5 – 2 cm) stones? Top

Uttam Mete, Mittal Ankur, Mittal B R

PGIMER, Chandigarh

   UP-280: The role of De Ritis ratio as a prognostic factor in RCC Top

V S Bhavish, Manikandan M, Madhavan N, Rajeevan AT, Shanmugadas KV, Venugopalan AV, Felix Cardoza

Department of Urology, GMC Calicut

   UP-281: Fibrinogen and D-dimer levels as marker for prostate cancer: A prospective cohort study Top

V Arul, C Ilamparuthi, Govindarajan, Vezhavendhan

Madras Medical College

   UP-282: Fibrinogen and D-dimer levels as marker for prostate cancer: A prospective cohort study Top

V Arul, C Ilamparuthi, Govindarajan, Vezhavendhan

Madras Medical College

   UP-283: Applicability of Clavien- Dindo classification system for grading of complications of transurethral resection of bladder tumor and predicting the factors Top

Varinder Singh, Jayaram Sreenivas, Manohar CS, Shivakumar V, Keshavamurthy R

Institute of Nephrourology, (INU) Bangalore

   UP-284: Predictors of urinary incontinence after holmium laser enucleation of prostate- quality of life, recovery and long term follow up Top

Vikas Kumar, Singh BP, Sankhwar SN, Goel A, Kumar M, Sokhal Ashok

KGMU, Lucknow

   UP-285: Laparoscopic Pyeloplasty for Ureteropelvic Junctions Obstruction in Adults: 5 Years' Experience in a single tertiary care Center Top

Vikas Kumar, Patel Rohan, Singh BP, Sankhwar SN, Goel Apul, Kumar M, Goel S

KGMU, Lucknow

   UP-286: Pulsed versus continuous mode fluoroscopy during percutaneous nephrolithotomy: radiation exposure, safety and effectiveness comparison Top

Vikas Singh, Vinay Tomar, SS Yadav, Shivam Priyadarshi, Nachiket Vyas, Neeraj Agarwal


   UP-287: Change in renal function of donor after live donor nephrectomy for renal transplant Top

Vikas V, Singh S, Soni J, Haris C H, Kumar G S

Government Medical College, Thiruvananthapuram

   UP-288: Effect of Post Radical Cystectomy Urinary Diversion on Renal Function and Quality of Life Top

Vikas Vaibhav, Singh Singh, Soni Jatin, Haris C H, Kumar G Sathish

Government Medical College, Thiruvananthapuram

   UP-289: A prospective randomised study assessing the outcomes of monopolar vs bipolar transurethral resection of prostate in benign prostatic hyperplasia of volume more than 50cc Top

Vishal, Vasudevan T, Kalyanram K, Joseph Philipraj, Mossadeq A

Mahatma Gandhi Medical College & Research Institute, Pondicherry

   UP-290: A comparative study of traditional posterior percutaneous nephrostomy with anterior tunnelled percutaneous nephrostomy in patients of malignant ureteric stricture Top

Vishal Kirti Jain, Yadav Sher Singh, Tomar Vinay, Priyadarshi Shivam, Vyas Nachiket, Agarwal Neeraj

SMS Medical College, Jaipur

   UP-291: Study on effect of neoadjuvant chemotherapy on peri-operative complications in patients under-going radical cystectomy Top

Vishnu Agrawal, Das RK, Dey RK, Basu S

R G Kar Medical College, Kolkata

   UP-292: Genito-urinary tuberculosis revisited- 10 years' experience of a single centre Top

Vivek K Gowda, Sandeep Puvvada

M S Ramaiah medical college, Bangalore

   UP-293: Extracorporeal shock wave lithotripsy vs ureteroscopic lithotripsy as first line of treatment for patients with solitary distal ureteric calculus: a prospective randomized study Top

Vivek K Gowda, Sandeep Puvvada

M S Ramaiah medical college, Bangalore

   UP-294: Role of oral thiocolchicoside and etoricoxib in lower ureter negotiation by ureteroscope prior to intracorporeal lithotripsy Top

Vyas Sameer, Vyas Nachiket, Tomar Vinay, Yadav SS, Priyadarshi Shivam, Aggarwal Neeraj

SMS Medical College and Hospital, Jaipur

   UP-295: Transperineal anastomotic urethroplasty and role of endoscopic assessment in Pelvic fracture urethral distraction defect (PFUDD): a case series Top

Yaser Ahmad, Muzayen, Rouf Khawaja, Arif Hamid, Saleem Wani

SKIMS, Srinagar

   UP-296: Complications of Ultrasound Guided Percutaneous Nephrostomy for upper tract obstruction using Clavien classification system Top

Yashal Ramole, Faiz Ahmed Khan, Manish Pandey, Vaibhav Srivastava, U S Dwivedi, S Trivedi

IMS BHU, Varanasi

   UP-297: Emphysematous Pyelonephritis: A correlation of clinical characteristics with serum parameters and its contribution in determination of prognostic factors Top

Yashasvi Singh, TP Rajeev, Barua SK, Sarma D, Baruah SJ, Bagchi PK, Phukan MP

Gauhati Medical College Hospital, Guwahati

   UP-298: Correlative analysis between severity of urolithiasis and laboratory parameters and its implication in evaluation of the probable risk profile Top

Yashasvi Singh, TP Rajeev, Barua SK, Sarma D, Baruah SJ, Bagchi PK, Phukan MP

Gauhati Medical College Hospital, Guwahati

   UP-299: Ureteric Endometriosis: An uncommon cause of ureteric stricture Top

Sumeet G Agrawal, Hemant R Pathak

Lilavati Hospital and Research Centre, Mumbai

   UP-300: Mixed epithelial and stromal tumor of the kidney- case report of rare benign kidney tumor Top

A Jai Babu

Sri Venkateswara Institute of Medical Sciences

   UP-301: Lynch syndrome - a case series & our institutional experince Top

Anbalagan M, Hemalatha K, Sivabalan J, Subramaniyan K, Saravanan PR, Govindharajan P, Ilamparuthi C

Institute of Urology, Madras Medical college

   UP-302: Evaluation of PTH hormone in urolithiasis Top

Ashish Gupta, Neeraj Aggarwal, Vinay Tomar, SS Yadav, Shivam Priyadarshi, Nachiket Vyas

SMS Hospital Jaipur

   UP-303: Rare case of metastatic Seminoma involving urinary tract Top

Dileep M, Sanjay P, Venkateshwara Rao, Siddalingeshwar, Sai Sri Harsha

Vydehi Institute of Medical Sciences

   UP-304: Abdominoscrotal hydrocele causing hydroureteronephrosis: a rare complication Top

Faiz Ahmed Khan, Pushpendra Kumar Shukla, Aditya Kumar Singh, Yashpal Ramole, US Dwivedi, Sameer Trivedi

IMS, BHU, Varanasi

   UP-305: Penile incarceration with metallic ring- difficult case scenario Top

Farzana TC, Manikandan M, Shanmugha Das KV, Madhavan N, AT Rajeevan, AV Venugopalan, Felix Cardoza

Govt Medical College, Calicut

   UP-306: Primary repair of complete vesicourethral transection in a female child Top

Hari Krishna M, Sudeep B, Ranadheer B, Vijay Bhaskar G, Vedamurthy Reddy P

Narayana Medical College, Nellore

   UP-307: Laparoscopic nephrectomy as a management of non-functioning kidney in unilateral renal artery stenosis Top

Hemnath U A, Antan Uresh Kumar T, Chengalvarayan G, Govindarajan P, Ilamparuthi C

Madras Medical College And Rajiv Gandhi Government General Hospital, Chennai

   UP-308: A rare case of renal malignancy in crossed fused ectopic kidney treated with nephron sparing surgery Top

Himanshu Agarwal, Sadanand W Thatte, Jagdeesh N Kulkarni, Umesh Oza, Vivek Jadhao, Prajwal Mahatme

Bombay Hospital Institute of Medical Sciences, Mumbai

   UP-309: Bilateral adrenocortical carcinoma presenting as large palpable lump: a case report Top

Kaurav Rustam Singh, S Vasudevan, Gopi Praveen, Rakesh, Narayan, Sunil

Government Medical College, Trivandrum

   UP-310: Incidentally Detected Squamous Cell Carcinoma of Renal Pelvis in a Patient with Staghorn Calculus Top

Krishna Sumanth Thota, B Prakasa Rao, Prabhakar, Aslam

Guntur Medical College, Guntur

   UP-311: DJ stenting : An innocent procedure – A unique case of large para renal hematoma post DJ stenting in a mildly hydronephrotic kidney Top

Mahadik Rajat, Rajendran Rohan, Bijalwan Priyank, Kumar Ginil, Thomas Appu

Amrita Institute of Medical Sciences, Kochi

   UP-312: Left ureterorectovesical fistula management in a post abdominal hysterectomy with left salphingo oophorectomy patient : case report Top

Mahatme PV, Thatte SW, Jaju R, Agarwal H

Bombay Hospital Institute of Medical Sciences

   UP-313: Unusual presentation of urethral caruncle Top

Manish Pandey, Pandey M, Shrivastava V, Ramole Y, Khan FA, Trivedi S, Dwivedi US

Deptt of Urology, IMS BHU, Varanasi

   UP-314: Isolated renal hydatidosis presenting as renal mass Top

Panda PK, Mishra GK, Majhi PC, Mohanty PK, Panda S, Swain S, Singh GP, Hota D

SCB Medical College Cuttack

   UP-315: Spermatic cord Lymphoma : An unusual presentation Top

Prashant Patel, Shrenik J Shah, Pranal Sahare

B J Medical College Ahmedabad

   UP-316: A very unusual case of renal hydatid cyst presented as post labour hydatiduria managed with Laparoscopic Cyst Deroofing Top

Pratikkumar J Shah, Moteria SB, Dholaria PD, Mehta AK, Joshi VD, Amlani JC, Panwar GB

BT Savani Kidney Hospital, Rajkot

   UP-317: Penile secondaries an unusual cause of priapsm Top

Puvai Murugan P, Bhalaguru Iyyan A, Vaishnavi J

PSG Institutue of Medical Sciences and Research, Coimbatore

   UP-318: Ureteric stenting: A 'friendly' procedure with an 'unfriendly' morbidity Top

Rahul Bhargava, Mujeeburahiman, Altaf Khan, Nischith Dsouza

Yenepoya medical College Mangalore

   UP-319: Diagnostic dilemma in urinary bladder tumor Top

Rahul Eknath Patil, Paul Vinsant, K Venugopal, R Ravichandran

Meenakshi Mission Hospital & Reserch Centre, Madurai

   UP-320: Giant inflammatory myofibroblastic tumor of paratesticular origin - a rare entity Top

Rakhul L R, Darsan S, Priyabrata Das, Vasanth, Venugopal G

Government medical college, Thiruvananthapuram

   UP-321: Neuro-endocrine carcinoma of retroperitoneum - an unusual cause of ureteric obstruction Top

Rakhul L R, Darsan S, Priyabrata Das, Venugopal G

Government Medical College, Thiruvananthapuram

   UP-322: Primary leiomyosarcoma of kidney: an infrequent conclusion Top

Rasheed Rayeez, Manikandan M, Madhavan N, Rajeevan AT, Shanmugha Das KV, Venugopal A V, Felix Cardoza

Government Medical College, Calicut

   UP-323: An interesting case of penile fracture Top

Sadagopan M, Saraswathy, P R Saravanan, P Govindarajan, C Ilamparuthi

Madras Medical College

   UP-324: Young male with obstructive lower urinary tract symptoms Top

Saini A K, Vijay G, Keshavamurthy R, Ali Poonawala, Manohar CS, Kamath A J

Institute of Nephrourology, Victoria Hospital Campus, Bangalore

   UP-325: Case Report of Congenital Anterior Urethral Diverticulum in an adult Top

Sandeep Maheswara Reddy Kallam, B Prakasa Rao, M Prabhakara Rao

Government General Hospital, Guntur

   UP-326: Testicular torsion in adult and geriatric patients Top

Sandhu A, Arya MC, Yogendra, Hariyawat BS, Tiwari R, Swami JP

SP Medical College, Bikaner

   UP-327: Outcome of primary AV Fistula for hemodoalysis access and factors affecting its patency and complications Top

Sanjay Parashar, Saurabh Chipde, Jaisukh Kalathia, Anurag Tyagi, Udit Mishra, Santosh Agrawal

SAIMS Campus Bhorasla Indore

   UP-328: An interesting case of para-urethral swelling Top

Saravanan T, Saraswathi S, Ilamparuthi C, Govindarajan P

Madras Medical College

   UP-329: Recurrent lower urinary tract foreign bodies in a mentally retarded patient; a case report Top

Shah CS, Shah PS, Moteria SB, DholariaPD, Joshi VD, Amlani JC

BT Savani Kidney Hospital, Rajkot

   UP-330: Peripheral neuro-ectodermal tumour of kidney; a case report Top

Shah PJ, Panwar GB, Shah CG, Dholaria PD, Joshi VD, Amlani JC

BT Savani Kidney Hospital, Rajkot

   UP-331: Evaluation of the Safety and Efficacy of Spinal Anesthesia vs. General Anesthesia for Percutaneous Nephrolithotomy (PCNL) Top

Shamsukha Dheeraj, Sahu Suman, Parmar Chirag, Sathe Saket

Mahatma Gandhi Mission Medical College & Hospital, Navi Mumbai

   UP-332: Case report of rare primitive neurectodermal tumour of kidney Top

Sunil Ravindran, Praveen Gopi, Rustam Singh, Narain Kewlani, Rakesh Ranjan, Vasudevan S

Govt Medical College, Thiruvananthapuram

   UP-333: Adult Male Epispadias Reconstruction Top

Swami JP, Arya MC, Sandhu A, Rahul T, Hariyawat BS, Yogendra

SP Medical College, Bikaner

   UP-334: Giant urethral stone mimicking as scrotal mass Top

Tanay Singh, Shrenik J Shah, Pranal Sahare, Dushyant Pawar

Civil Hospital Ahmedabad

   UP-335: Coexisting renal tuberculosis and renal cell carcinoma: A rare case report Top

Thaha Rashid P T, Manikandan M, Shanmughadas K V, Madhavan N, Rajeevan A T, A V Venugopalan, Felix Cardoza

Dept of Urology, Govt Medical College, Calicut

   UP-336: Ovarian vein syndrome: A rare etiology for ureteric stricture formation Top

Tushit Kumar Rai, Ravimohan SM, Sudheer K Devana, Giridhar S Bora

PGIMER, Chandigarh

   UP-337: Open Bladder Diverticulectomy with TURP Top

Vaibhav Shrivastava, Shrivastava V, Pandey M, Ramole Yashpal, Khan FA, Dwivedi US, Trivedi S

IMS, BHU Varanasi

   UP-338: A case of obesity tumor of adrenal – surgical cure by laparoscopic adrenalectomy Top

Vasantharaja R, Darsan S, Priyabrata D, Rakhul L R, Venugopal G

Government Medical College, Trivandrum

   UP-339: A rare case of retrocaval ureter with concomitant stone disease Top

Veerappan R, Saraswathi S, Hemalatha R, Balasubramaniam R, Vezhaventhan G, Govindarajan P, Ilamparuthi C

Institute of Urology, Madras Medical College, Chennai

   UP-340: Adult WILMS Tumour – A case report Top

Veerappan R, Saraswathi S, Hemalatha R, Balasubramaniam R, Vezhaventhan G, Govindarajan P, Ilamparuthi C

Institute Of Urology, Madras Medical College, Chennai

   UP-341: Pentafecta in Robotic partial nephrectomy for T1b renal masses: Single institute-single surgeon retrospective analysis Top

Waigankar Santosh, Pednekar Abhinav, Wagaskar Vinayak, Yuvaraja TB

Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute

   UP-342: Uretero-Iliac Artery Fistula : A rare complication of ureteroscopic stone removal Top

Yashpal Ramole, Faiz Ahmed Khan, Manish Pandey, Vaibhav Srivastava, U S Dwivedi, S Trivedi

IMS BHU, Varanasi

   UP-343: Inflammatory Pseudotumor of the ureter mimicking a urothelial carcinoma Top

Aggarwal G, Adhikary SD, Mohapatra N, Satapathy KP

Apollo Hospital, Bhubaneswar

   UP-344: Preemptive Renal Transplant for intractable hyperuricemic gout Top

Arora R, Chhabra Y, Mathur RP, Zaman W

Max Superspeciality Hospital, Shalimar Bagh, New Delhi

   UP-345: Ileal replacement for ureteral stricture following vvf repair: a case report Top

Burman Alakesh, Bhat A, Bhat M, Singh T, Chhabra M K, Dar B A

Dr SN Medical College, Jodhpur

   UP-346: Debulking a large metastatic Adult Nephroblastoma (Wilms' Tumor): A better prognostic alternative Top

Jaisukh Kalathia, Agrawal S, Chipde S, Mishra U, Tyagi A, Parashar S

Sri Aurobindo Institute of Medical Science

   UP-347: Arteriovenous malformation of pelvis -a rare cause of haematuria Top

Kamlesh Gunjan, Kumar Pawan, Mishra Gaurav, Kumar Shushil, Ahmad Ahsan, Tiwari Kumar Rajesh

Indira Gandhi Institute of medical sciences, Patna

   UP-348: Recurrent Bacterial UTI – Are we missing genitourinary tuberculosis? Top

Lawande PR, Prabhudessai MR, Cardoso AL, Halarnakar RG, Talwadker NB, Punjani HM

Goa Medical College

   UP-349: Anatropic Nephrotomy Re Visited – Nephron Sparing Surgery Top

Mahendra Pal, GaganPrakash, Ganesh Bakshi

Tata Memorial hospital

   UP-350: Solitary Penile Nodule: Diagnostic Pitfall Top

Narang Vineet, Bhatyal Hardev, Arya Ankur

BLK Super Speciality Hospital, New Delhi

   UP-351: Renal artery dissection following angioembolisation for post percutaneous nephrolithotomy (PCNL) bleed Top

Nath SR, Bhat HS, Nair B

Rajagiri Hospital Cochin

   UP-352: A unique case of ectopic rudimentary left ureter emptying in the seminal vesicle cyst with left renal agenesis diagnosed during an investigation of urinary incontinence Top

Patel Mikir, Vasudewa Pawan, Kumar Anup, Kumar Niraj, Kumar Gaurav, Yadav Siddharth, Gupta Pankaj

Safdarjung hospital, Vardhman Mahavir Medical College, New Delhi

   UP-353: A case of acquired retrorenal colon and its implications during percutaneous nephrolithotomy Top

Patil Santosh, Shetty Ranjit, Reddy Rajesh, KN Sanman, Laxman Prabhu GG, Ravinder Prajwal, Dani Tushar

KMC Mangalore

   UP-354: Role of nephrectomy for tubercular non-functioning kidneys: Current status Top

Pradeep Prakash, Prabhjot Singh, P N Dogra

AIIMS, New Delhi

   UP-355: Management of a large extra-renal angiomyolipoma in the first trimester of pregnancy Top

Praveen Sundar B, Appu Thomas, Priyank Bijalwan

Amrita Institute of Medical Sciences, Cochin

   UP-356: Collision tumor of the kidney composed of papillary & collecting duct carcinoma: a rare occasion Top

Sanchit Rustagi, Dharmveer Singh, Rahul Jena, S K Sureka, A Srivastava


   UP-357: Triplicate ureter with contralateral duplication along with mullerian duct abnormalities in a congenitally incontinent girl Top

Saurabh Gupta, Sandhu Gagandeep, Gill Gurpreet, Gupta Anshul

Adesh Institute of Medical Sciences and Research, Bathinda

   UP-358: A rare case of bladder endometriosis with non functioning kidney Top

Shailesh Chandra Sahay, Pawan Kesarwani, Umar Farouqui

MAX Superspeciality Hospital, Patparganj, Delhi

   UP-359: Inguinal hernia containing bladder with ureteroneocystostomy: A rare cause of obstructive uropathy in transplanted kidney Top

Shailesh Chandra Sahay, Pawan Kesarwani, Umar Farouqui

Max Superspeciality Hospital, Patparganj, Delhi

   UP-360: Robotic–assisted completely intracorporeal ileal ureter: description of our technique Top

Singh Sujan, Tyagi Vipin Kumar, Kumar Mahendra, Agarwal Rohit, Adappa Sana

Sir Ganga Ram Hospital, New Delhi

   UP-361: Genital hemangioma: A rare urological entity Top

Tomar Vikas Singh, Bhat A, Bhat M, Dar BA, Chhabra MK, BurmanA.

Dr SN Medical College, Jodhpur

   UP-362: Granular cell tumour of penis Top

Tripathy S, Adhikary SD, Baisakh MR, Satapathy KP

Apollo Hospital, Bhubaneswar

   UP-363: “Puncture and flush technique”- A simple and safe adjunct to percutaneous nephrolithotomy Top

Vignesh M, Sudheer K Devana, Santosh Kumar, Giridhar S Bora, Ravimohan SM, SK Singh, AK Mandal

PGIMER, Chandigarh

   UP-364: Transplant is teamwork: management of a difficult case by “we” and not “me” Top

Vikas Jain, Saurabh Jain, Suman Lata Nayak

Institute of Liver and Biliary Sciences, New Delhi

   UP-365: Comparative evaluation of the effects of Beta-agonist Isoprenaline and Tadalafil on human ureter motility in an ex vivo setting Top

Abhimanyu Anat, Sher Singh yadav, Vinay Tomar, Shivam Priyadarshi, Nachiket Vyas, Neeraj Agarwal

SMS Medical College, Jaipur

   UP-366: A qualitative analysis of the impact of Carboplatin AUC 10 on physical, work functioning and bone marrow toxicity among Seminoma patients- A single centre experience Top

Kamble S, Vasdev N, Dadhania S, Hawkins A, Hall M, Gogbashian A, Rustin G, Sharma A

Mount Vernon Cancer Centre, Northwood, UK

   UP-367: Single center experience of use of Radium 223 with clinical outcomes based on number of cycles and bone marrow toxicity Top

Kamble S, Vasdev N, Dadhania S, Alonzi R, Douglas S, Gogbashian A, Hughes R, Danube Z, Adshead J, Lane T, Westbury C, Anyamene N, Ostler P, Hoskin P, Sharma A

Mount Vernon Cancer Centre, Northwood, UK

   UP-368: Outcome analysis of urethroplasty for anterior urethral stricture among men at a tertiary centre Top

Sandesh Parab, Hemant Pathak, Mukund Andankar

TN Medical College & BYL Nair Ch. Hospital, Mumbai

   UP-369: Urinary bladder perforation in genitourinary tuberculosis Top

Sudarshan Jadhav, Hemant Pathak, Mukund Andankar

TN Medical College & BYL Nair Ch. Hospital, Mumbai

   UP-370: Use OF PHOSPHODIESTERASE 5 inhibitors in supra sacral spinal cord injury pateints. Does it have a role ? Top

Muzzain Khateeb

SKIMS, Sri Nagar

   UP-371: Surgical outcome of beating heart surgery in level 4 thrombus and other reno caval thrombus secondary to Renal Cell Carcinoma : a case series from SKIMS Top

SKIMS, Sri Nagar

   Unmoderated Videos Top

   UV-01: Robot assisted Partial nephrectomy with renal vein repair for hilar tumour Top

Anandan M, Ramesh C, Baranikumar, Kuppurajan, Devdas Madhavan

Kovai Medical Center and Hospital, Coimbatore

   UV-02: Laparoscopic renal folding as an auxiliary technique in giant hydronephrosis due to pelvi-ureteric junction obstruction Top

Amlani P, Abhilash S, Sravan B, Patil V, Chally P, Azeez A, Chally R

Baby Memorial Hospital, Kozhikode

   UV-03: Tips and tricks to improve continence outcomes in 3-D laparoscopic radical prostatectomy Top

Anup Kumar, Neeraj Kumar, Siddharth Yadav, Gaurav Kumar, Mikir Patel, Pankaj Gupta

VMMC & SJH, New Delhi

   UV-04: 3-D Laparoscopic transperitoneal partial nephrectomy for clinical T1b renal tumors: A prospective evaluation Top

Anup Kumar, Neeraj Kumar, Siddharth Yadav, Gaurav Kumar, Mikir Patel, Pankaj Gupta

VMMC & SJH, New Delhi

   UV-05: Laparoscopic donor nephrectomy with circumaortic renal vein and early bifurcation Top

Arora R, Chhabra Y, Mathur RP, Zaman W

Max Superspeciality Hospital, New Delhi

   UV-06: Our technique of Bladder Neck Dissection and management of Median Lobe during Robotic Assisted Radical Prostatectomy Top

Ashish Sabharwal, Shantanu Gore, Ajit Saxena

Indraprastha Apollo Hospital, New Delhi

   UV-07: Expanding the Spectrum of Robot assisted Pyeloplasty: Bilateral Pelvi-ureteric junction obstruction with stones Top

Ashwin Mallya, I Banerjee, Sachin AN, Tarun Jindal, Feroz zafar, Mandhani A, Ahlawat R

Fortis Escorts Kidney and Urology Institute, Delhi

   UV-08: Robot assisted laprascopic extraperitoneal right lower ureterectomy with cuff of bladder excision with ureteric reimplant Top

Bafna Sandeep, G Aarthy, Dholakia K, Bhat Seetharam, Ragavan N

Apollo Hospitals, Chennai

   UV-09: Our modified technique of robot assisted robotic radical prostatectomy: initial results Top

Banerjee I, Mallya A, AN Sachin, Jindal T, Zafar FA, Mandhani A, Ahlawat R

Fortis Escorts Kidney and Urology Institute, New Delhi

   UV-10: A modified technique of laparoscopic trans-peritoneal donor nephrectomy Top

Chaturvedi S, Desai P, Danda M K, Sabharwal K V, Maheshwari R, Gulia A K, Kumar A

Max Super Speciality Hospital, New Delhi

   UV-11: A modified technique of laparoscopic trans-peritoneal donor nephrectomy Top

Chaturvedi S, Desai P, Danda M K, Sabharwal K V, Maheshwari R, Gulia A K, Kumar A

Max Superspeciality Hospital, New Delhi

   UV-12: Combined use of incision and grafting together with plication in correction of complex peyronie's disease Top

Chirag Gupta, Rupin Shah

Lilavati Hospital

   UV-13: Robotic graft uretero-neocystostomy in a case of open kidney transplant with stricture of lower ureter Top

Feroz Amir Zafar, Tarun Jindal, Indraneel Banerjee, Ashwin Mallya, Sachin Arakere, Anil Mandhani, Rajesh Ahlawat

Fortis Escorts Kidney and Urology Institute, New Delhi

   UV-14: Complete laparoscopic distal ureterectomy with ipsilateral pelvic lymph node dissection and ureteroneocystostomy for distal ureteric urothelial carcinoma Top

Gaur Pankaj, Gupta SK, Sureka SK, Singh UP, Kapoor Rakesh, Ansari MS, Srivastava Aneesh

SGPGIMS, Lucknow

   UV-15: Robotic Retroperitoneoscopic surgery for retrocaval mass Top

Ginil Kumar Pooleri, Priyank Bijalwan

Amrita Institute of Medical Sciences, Kochi

   UV-16: Robot assisted Buccal mucosal inlay-onlay graft repair of Ureteric stricture: A point of technique Top

Jaimin Shah, A Ganpule, Abhishek Singh, RB Sabnis, MR Desai

Muljibhai Patel Urological Hospital, Nadiad

   UV-17: Robot assisted radical prostatectomy in a post transplant setting- tips and tricks Top

KR Seetharam Bhat, Nitesh Jain, Priyank Shah, Kunal Dholakia, Sandeep Bafna, Neelay Jain, Anathakrishnan Sivaraman

Apollo Hospitals Chennai

   UV-18: Retrograde flexible ureteroscopic stone removal in a ureteric stone – in a patient with ileal conduit and wallace-type ureteroileal anastomosis Top

Karamveer Sabharwal, Anil Gulia, Samit Chaturvedi, Ruchir Maheshwari, Mandeep Dhanda, Anant Kumar

Max Superspeciality Hospital, New Delhi

   UV-19: Bilateral simultaneous robot assissted tubularized flap pyelovesicostomy for bilateral giant hydronephrosis Top

Khanna Ashish, Kumar Santosh, Panwar Vikas, Bishnoi Kshitij, arain Tushar Aditya

PGIMER, Chandigarh

   UV-20: Lap Assisted Orthotopic Neobladder - Technical Tips Top

M Ramalingam, Sivasankaran N, Senthil K

Ganga Medical Centre & Hospitals, Coimbatore

   UV-21: Laparoscopic nephrectomy in giant hydronephrosis Top

Malik Abdul Rouf, Anshuman Agarwal, enkatesh Kumar, Mahender Sharma, hrawan Kumar, aibhaw Sood

Indraprastha Apollo Hospital Sarita Vihar New Delhi

   UV-22: “High” VVF can be managed vaginally; A call for resurgence of Latzko technique Top

Manasa T, Sumit Gehlawat, Nikhil Khattar, Ritesh Singh, Hemant Goel, Rajeev Sood

PGIMER & Dr RML Hospital, New Delhi

   UV-23: Limited dissection surgical technique: for repair of vesico-vaginal fistula using Da Vinci XI robotic platform Top

Mandeep Kumar Dhanda, Kumar Anant, Gulia A, Maheshwari R, Chaturvedi S, Sabharwal K, Desai P

Max Superspeciality Hospital, New Delhi

   UV-24: Robotic assisted bladder diverticulectomy-technique Top

Md Hedayatullah, Shailesh R, Mistry S, Roohi F

Jaslok Hospital and Research Centre, Mumbai

   UV-25: Laparoscopic management of concomitant renal tumor and nephrolithiasis Top

Mohammed Taif Bendigeri, Chiruvella M, Purnachandra RK, Ragoori DR, Ghouse SM, Enganti B

Asian Institute of Nephrology & Urology, Hyderabad

   UV-26: Urethroscopic view of the most proximal bulbar urethral mucosa urethroplasty – preoperative, intraoperative, and postoperative Top

Nagesh Kamat, Saurabh Jambu, Arnav Kamat

Kamat Kidney and Eye Hospital, Vadodara

   UV-27: Simultaneous robot assissted foleys Y-V pyeloplasty and ureteric reimplantation for ipsilateral pelviureteric junction obstruction and vesicoureteric junction obstruction in a duplex hydronephrotic kidney Top

Narain Tushar Aditya, Kumar Santosh, Khanna Ashish

PGIMER, Chandigarh

   UV-28: The Deceptive Superior Mesentric artery. SMA injury during Robotic, Left Radical Nephrectomy Top

Nishant R Kathale, Gaurang Shah, Imran Hamzawala

Saifee Hospital, Mumbai

   UV-29: ABO incompatible Renal Transplantation with Venous Drainage through gonadal vein in a patient with infrarenal thrombosed/ anomolous IVC Top

PP Singh, Amit Singh Malhotra

Batra Hospital & Medical Research Centre New Delhi

   UV-30: Anderson hynes pyeloplasty in a child with pelviureteric junction obstruction using robotized laparoscopy – a new armamentarium Top

Pankaj E Bhirud, Kishnamohan Ramaswamy, Khurshid Ahmed, Mohammed Salim, Harigovind Pothiyedath

Metromed institute of advanced Urology and renal transplant (MIART), Calicut

   UV-31: Oncology outcome of Anterior Exenteration with Ileal Conduit in a 30 years old Unmarried female Top

Pednekar A, Yuvaraja TB, Waingankar S, Wagaskar V

Kokilaben Dhirubhai Ambani Hospital, Mumbai

   UV-32: Modified technique of urethrovesical anastomosis in robot assisted radical prostatectomy for organ confined prostate cancer by combining Rocco's stitch along with posterior layer Top

Pragnesh Desai, Mandeep Kumar Dhanda, Karamveer Sabharwal, Samit Chaturvedi, Ruchir Maheshwari, Anil Kumar Gulia, Anant Kumar

Max Super speciality Hospital, Saket, New Delhi

   UV-33: Management of large intravesical median lobe during robot assisted radical prostatectomy Top

Pragnesh Desai, Mandeep Kumar Dhanda, Karamveer Sabharwal, Samit Chaturvedi, Ruchir Maheshwari, Anil Kumar Gulia, Anant Kumar

Max Super speciality Hospital, New Delhi

   UV-34: Laparoscopic Right Radical Nephrectomy for Wilm's Tumor in Paediatric patient Top

Rakesh M Sharma, Ashwin Giridhar, Yugandhar Reddy, T. Subramanyeshwar Rao

Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad

   UV-35: Robotised laparoscopic ureteric reimplanation of obstructed mega ureter solitary kidney – new possibilities in key hole surgery Top

Ramaswami Krishnamohan, Bhirud Pankaj, Ahmed Khurshid, Saleem Mohammad, Podiyedath Harigovind

Metromed Institute Of Advanced Urology And Renal Transplant (MIART)

   UV-36: Everted saphenous vein graft urethroplasty: it's operative technique and outcome in anterior urethral stricture Top

Rao Swatantra Nagendra, Khattar Nikhil, Goel Hemantl, Sharma Umesh, Akhtar Arif, Sood Rajeev

PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi

   UV-37: Renal mass with large level 1 tumor thrombus in an obese patient necessitating frequent change in flank position, managed laparoscopically: a novel approach Top

Rohit Kaushal, Anil Gulia, Samit Chaturvedi, Pragnesh Desai, Anant Kumar

Max Superspeciality Hospital Saket, New Delhi

   UV-38: Results of modified blandy's technique of bipolar turp in large prostate more than 100 gms Top

Rupala Ketankumar, Gupta Narmada, Rupala Ketankumar, Rathi Deepak

Medanta-The Medicity

   UV-39: Ectopic pelvic pancake kidney stone: a surgical challenge overcome by robotic surgery Top

S Kumar, Kumar M, Sadasukhi N, Narayan TA, Bisnoi K, Singhal P

PGIMER, Chandigarh

   UV-40: Robot-assisted Level II Inferior Vena Cava tumor thrombectomy with Metastasectomy for left sided renal tumor: Step-by-Step Technique Top

Sachin AN, Ashwin Mallya, Indraneel Banerjee, Firoz, Tarun Jindal, Anil Mandhani, Rajesh Ahlawat

Fortis Escorts kidney and Urology Institute, New Delhi

   UV-41: Non Transection Bulbar Urethroplasty Top

Sandesh Surana, Pankaj M Joshi, Omkar Joglekar, Mohammad Alkandari, Jyotsna Kulkarni, Sanjay Kulkarni

Kulkarni School of Urethroplasty

   UV-42: Intraluminal buccal graft urethroplasty for female urethral strictures Top

Sanjay Kulkarni, Pankaj Joshi, andesh Surana, yotsna Kulkarni, mkar Joglekar, ohammad Alkandri

Kulkarni School of Urethral Surgery

   UV-43: Ectopic pelvic pancake kidney stone: a surgical challenge overcome by robotic surgery Top

Santosh Kumar, Manjeet Kumar, Nripesh Sadasukhi, Tushar aditya narayan, Kshitij Bisnoi, Paras singhal

PGIMER, Chandigarh

   UV-44: Complex Renal Mass : Robotic Partial Nephrectomy Top

Shrikant Jai, A Malpani, A Singh, A Ganpule, RB Sabnis, MR Desai

MPUH Nadiad

   UV-45: Lap assisted Ileal Ureter in post radiation long segment ureteric stricture Top

Sivasankaran Nachimuthu, Ramalingam M, Senthil K

Ganga Medical Centre & Hospitals, Coimbatore

   UV-46: Double Whammy : Laparoscopic Nephrolithotomy with Partial Nephrectomy in a complex lower pole renal cyst and lower calyceal calculus Top

Sivasankaran Nachimuthu, Dr. Ramalingam M, Dr. Senthil K

Ganga Medical Centre & Hospitals, Coimbatore

   UV-47: Robotic Ureterolysis for management of Retroperitoneal fibrosis Top

Syed Mohammed Ghouse, Chiruvella Mallikarjuna, Bendigeri MT, Purnachandra RK, Ragoori DR, Enganti B

Asian Institute of Nephrology & Urology, Hyderabad

   UV-48: Robot assisted laparoscopic management of ectopic ureter and ureterocele in children with duplex renal anomaly Top

Wagholikar HD, Modi PR, Pal BC, Rizvi SJ

Institute of Kidney Diseases and Research Centre, Ahmedabad

   UV-49: Laparoscopic (Robot-assisted) excision of large adrenal tumour: Video demonstration & Perioperative outcomes Top

Yuvaraja TB, Waigankar Santosh, Wagaskar Vinayak, Pednekar Abhinav

Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute

   UV-50: Implantation of 3 piece AMS800 artificial urinary sphincter in an operated case of robotic radical prostatectomy with postoperative total incontinence Top

Amit Gala, Shailesh Raina

Jaslok Hospital and Research Centre, Mumbai

   UV-51: My method of inner prepucial ventral onlay pedicle graft for hypospadias surgery Top

Ashvin Gami, Deepak Rajyaguru

Palanpur, Gujrat

   UV-52: Laparoscopic scardino prince vertical flap pyeloplasty in an ectopic and reversely malrotated kidney: video presentation Top

Das Nabajeet, Sarma D, T P Rajeev, Baruah S J, Barua S K, Bagchi P K, Phukan M P

Gauhati Medical College Hospital, Guwahati

   UV-53: Novel technique in management of lower ureter for upper tract urothelial carcinoma by pure robotic nephroureterectomy Top

Dusi VSLNS, Vallivai R, Tiwari A, Lakhani D, Singh V

Apollo hospital, Hyderabad

   UV-54: Laparoscopic pyelollithotomy in ectopic pelvic kidney Top

Muneer Khan, Naveed Khan, Sajjad Nazir, Sheela ran,

Kidney Hospital Srinagar

   UV-55: Laparoscopic management of secondary calculi in a case of pelvi-ureteral junction obstruction Top

Nath SR, Bhat HS, Nair B

Rajagiri hospital Cochin

   UV-56: Ectopic pelvic pancake kidney stone: a surgical challenge overcome by robotic surgery Top

S Kumar, Kumar M, Sadasukhi N, Narayan TA, Bisnoi K, Singhal P

PGIMER, Chandigarh

   UV-57: Transperitoneal laparoscopic excision of retrocaval part of ureter and ureterouretostomy Top

Sandeep Pradhan, Mishra G, Panda PK, anda S, Swain S, Mohanty PK, Singh GP, Hota D

SCB Medical College, Cuttack

   UV-58: Hydatid cyst removal by laparoscopy with help HTCS Top

Sanjay Parashar, Saurabh Chipde, Jaisukh Kalathia, Anurag Tyagi, Udit Mishra, Santosh Agrawal


   UV-59: Initial Experience with Laparoscopic Living Donor Nephrectomy Top

Satyajit Samal, Panda S, Swain S, Panda S, Hota D

SCB Medical College, Cuttack

   UV-60: Female urethroplasty video Top

Shabbir Husain, Solanki F, Sharma DB, Sharma D

NSCB Medical College Jabalpur

   UV-61: Revisiting reverse cut conventional vea in era of ductular anastomosis Top

Sumeet G Agrawal, Rupin Shah

Lilavati Hospital And Research Centre, Mumbai

   UV-62: Laparoscopic Adrenalectomy Top

Tanay Singh, Shrenik J Shah, Prashant Patel, Dushyant Pawar, Pranal Sahare

Civil Hospital Ahmedabad

   UV-63: Robot assisted organ preserving approach for treatment of bladder haemangioma Top

Uttam Mete, Singhal P, Bansal A, Kakkar N

PGIMER, Chandigarh

   UV-64: Laparoscopic (Robot-assisted) excision of large pelvic mass tumor: Video demonstration Top

Waigankar Santosh, Pednekar Abhinav, Wagaskar Vinayak, Yuvaraja TB

Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute

   UV-65: Management of Intraoperative Complications: the Robotic Way Top

Maheshwari R, Chaturvedi R, Gulia A, Sabharwal KS, Desai PN, Dhanda M, Kumar A

Max Super Specialty Hospital, New Delhi


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   UP-214: Radical ...
   UP-215: Retrospe...
   UP-216: 1 Year f...
   UP-217: Diode la...
   UP-218: Complica...
   UP-219: Our expe...
   UP-220: Testicul...
   UP-221: Holmium ...
   UP-222: Robotic ...
   UP-223: Laparosc...
   UP-224: A compar...
   UP-225: Urinary ...
   UP-226: Analyzin...
   UP-227: Verrucou...
   UP-228: Low grad...
   UP-229: Laparosc...
   UP-230: Comparat...
   UP-231: Prospect...
   UP-232: FGFR3 mu...
   UP-233: Single s...
   UP-234: Foreign ...
   UP-235: Complica...
   UP-236: Carcinom...
   UP-237: Evaluati...
   UP-238: To asses...
   UP-239: Robotise...
   UP-240: Perioper...
   UP-241: Outcomes...
   UP-242: Evaluati...
   UP-243: A prospe...
   UP-244: Analysis...
   UP-245: Comparis...
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   UP-251: Post TUR...
   UP-252: Anomalie...
   UP-253: A case s...
   UP-254: A random...
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   UP-256: Bladder ...
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   UP-258: Manageme...
   UP-259: Comparis...
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   UP-262: Reconstr...
   UP-263: Conversi...
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   UP-266: Familial...
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   UP-268: Primary ...
   UP-269: Associat...
   UP-270: Prospect...
   UP-271: Clinical...
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   UP-273: Clinical...
   UP-274: The Eval...
   UP-275: Outcome ...
   UP-276: Retained...
   UP-277: A review...
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   UP-279: Does ESW...
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   UP-287: Change i...
   UP-288: Effect o...
   UP-289: A prospe...
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   UP-291: Study on...
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   UP-294: Role of ...
   UP-295: Transper...
   UP-296: Complica...
   UP-297: Emphysem...
   UP-298: Correlat...
   UP-299: Ureteric...
   UP-300: Mixed ep...
   UP-301: Lynch sy...
   UP-302: Evaluati...
   UP-303: Rare cas...
   UP-304: Abdomino...
   UP-305: Penile i...
   UP-306: Primary ...
   UP-307: Laparosc...
   UP-308: A rare c...
   UP-309: Bilatera...
   UP-310: Incident...
   UP-311: DJ stent...
   UP-312: Left ure...
   UP-313: Unusual ...
   UP-314: Isolated...
   UP-315: Spermati...
   UP-316: A very u...
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   UP-318: Ureteric...
   UP-319: Diagnost...
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   UP-321: Neuro-en...
   UP-322: Primary ...
   UP-323: An inter...
   UP-324: Young ma...
   UP-325: Case Rep...
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   UP-327: Outcome ...
   UP-328: An inter...
   UP-329: Recurren...
   UP-330: Peripher...
   UP-331: Evaluati...
   UP-332: Case rep...
   UP-333: Adult Ma...
   UP-334: Giant ur...
   UP-335: Coexisti...
   UP-336: Ovarian ...
   UP-337: Open Bla...
   UP-338: A case o...
   UP-339: A rare c...
   UP-340: Adult WI...
   UP-341: Pentafec...
   UP-342: Uretero-...
   UP-343: Inflamma...
   UP-344: Preempti...
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   UP-347: Arteriov...
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   UP-349: Anatropi...
   UP-350: Solitary...
   UP-351: Renal ar...
   UP-352: A unique...
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   UP-354: Role of ...
   UP-355: Manageme...
   UP-356: Collisio...
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   UP-361: Genital ...
   UP-362: Granular...
   UP-363: “P...
   UP-364: Transpla...
   UP-365: Comparat...
   UP-366: A qualit...
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   UP-368: Outcome ...
   UP-369: Urinary ...
   UP-370: Use OF P...
   UP-371: Surgical...
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