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EDITORIAL |
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| Year : 2019 | Volume
: 35
| Issue : 4 | Page : 248-249 |
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What's inside?
Apul Goel
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 1-Oct-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/iju.IJU_276_19
How to cite this article:
Goel A. What's inside?. Indian J Urol 2019;35:248-9 |
 Female Urethral Stricture | |  |
Female urethral stricture still remains an enigma. Evidence regarding management is scarce with most data coming from case series comprising a small number of patients. Surgeons treat this disease in women, applying principles learned from treating urethral stricture in men, where this condition is common. Nayak et al. shared their experience in treating 12 women with urethral stricture using the ventral inlay buccal mucosal graft urethroplasty.[1] Their technique is different from the ventral onlay technique that is more commonly described in the literature. In the inlay method, they have performed the entire procedure intraurethrally. While the authors discussed the advantages of their approach, they have not mentioned the width of graft that they were able to place transurethrally.
In another study on this condition, Manasa et al. have evaluated the sexual function in 13 women who had undergone dorsal graft urethroplasty using the vaginal mucosal graft.[2] Female urethral stricture is often treated by placing grafts (either dorsally or ventrally). There are advantages and disadvantages of both the approaches. One potential drawback of dorsal approach is injury to clitoral neurovascular bundle with subsequent sexual dysfunction. The authors evaluated the sexual function using the female sexual function inventory (FSFI) score both preoperatively and at 3 months following surgery. Of 13 women who underwent urethroplasty, even at a short mean follow-up duration of 8.5 months, three failed (stricture recurred) and needed further therapy. The authors evaluated 12 sexually active women and found that the mean improvement in FSFI score was 6.42. No woman had reported sexual dysfunction before surgery, but sexual function improved after urethroplasty. While reporting their results, the authors have not explained the reasons for improvement in sexual function after urethroplasty.
| Penile Carcinoma | | |
In a large series involving 89 men with invasive penile squamous cell carcinoma (SCC) without palpable inguinal disease, Ramos et al. have reported the diagnostic precision of sentinel lymph node biopsy (SLNB).[3] The decision to perform lymphadenectomy and its extent has always been controversial. For the entire cohort, the authors have reported that dynamic SLNB had a sensitivity of 84%, a specificity of 89%, and a false-negative rate of 6.6%, with a similarity ratio (LR+) of 7.80 (3.80–16.03) and a likelihood ratio (LR−) of 0.18 (0.07–0.44). However, when the authors have calculated the sensitivity and specificity only for high-risk T1 patients, who required superficial inguinal lymphadenectomy according to the current NCCN guidelines, the sensitivity was 33% and the specificity 100% for such subgroup of patients, along with a positive predictive value of 100%, a negative predictive value of 93%, and a diagnostic accuracy of 93.9%. Based on their observations, the authors have considered that SLNB is a useful diagnostic tool in men with infiltrative penile SCC with nonpalpable lymph nodes.
| Voiding Dysfunction Assessment | | |
It is always difficult to ask patient to prepare frequency–volume charts (FVCs) and to explain to them the process of making one. This difficulty increases further with illiterate patients. Very little effort has been made to devise methods to get reliable FVCs from this group of individuals. Vasudeva et al. have devised a novel way to solve this issue.[4] The patients were provided (a) two measuring jars (one smaller [1 L] and one larger [5 L]), (b) a box of pebbles, (c) two small cloth pouches (one yellow colored and the other black colored), and (d) a black marking pen. The patients were taught how to use them. The authors have demonstrated that their method was effective and produced reliable FVCs.
| Muscle Invasive Bladder Cancer | | |
Grant et al. have analyzed the United States National Cancer Database to report the trends in the use of neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer with nonurothelial and variant histology between 2006 and 2014.[5] They reviewed data of 22,320 patients of whom 22.6% received NAC. The authors noticed that the proportion of patients receiving NAC increased significantly over time in the neuroendocrine and urothelial cell categories, while this increase was not noticed with other variant histologies. Patients receiving NAC were more likely to have downstaging to pT0 (13.4% versus 2.7%), negative surgical margin (89.1% versus 86%), and pN0 (63.2% versus 60.5%) and were less likely to have 30-day or 90-day mortality. The rates of downstaging to pT0 after NAC were similar among histologies.
| Percutaneous Nephrolithotripsy in Solitary Functioning Kidneys | | |
Singh et al. have reported their experience with percutaneous nephrolithotripsy (PCNL) in patients with a solitary functioning kidney (SFK).[6] Of 128 patients, 44 patients were in chronic kidney disease (CKD) category 3B, 4, and 5. These patients had lower stone clearance in a single session, prolonged postoperative hospital stay, and increased incidence of higher Clavien grade complications and dialysis. Even after a second procedure (n = 12 patients), a clearance rate of only 77.2% could be achieved as compared to 95.2% in patients without or with lesser degree of CKD. The authors concluded that PCNL in SFK is safe, with acceptable stone clearance and adverse events. However, with increasing stage of CKD, the rate of stone clearance decreases and complications increases.
| Vesicovaginal Fistula | | |
Rajaian et al. have written a comprehensive review on vesicovaginal fistula covering the epidemiology and etiology, its classification, and management, including conservative, minimally invasive, and standard procedures.[7] The authors have discussed the latest consensus on issues such as early or delayed repair, abdominal or vaginal approach, positioning of the patient during repair, role of colpocleisis, role of tissue interposition, tract excision, and urinary diversion for inoperable fistula. The authors have also discussed the issues such as stress incontinence and overactive bladder that may be encountered with this condition. The authors have also reviewed literature on sexual function after vesicovaginal fistula repair.
| Cases | | |
In an interesting report, Sonawane et al. have reported harvesting kidney for live renal transplantation from a boy with complete situs inversus.[8] Complete situs inversus is considered a contraindication for liver and heart transplantation.
Pandya et al. have described an unusual scenario where an 80-year old man was diagnosed with synchronous metastatic cancer prostate and urinary bladder tumor.[9] What made the management challenging was the fact that the patient had Shah® malleable penile implant for the last 11 years. Cystoscopy using rigid endoscopes failed, and the authors have resorted to the formation of temporary perineal urethrostomy for performing transurethral resection of bladder tumor.
Hisamatsu et al. have described the management of 5-year-old boy with ectopic scrotum and penile torsion.[10] In this child, the right hemiscrotum was located in the right infrainguinal region and contained the right testis.
Financial support and sponsorship: Nil.
Conflicts of interest: There are no conflicts of interest.
| References | | |
| 1. | Nayak P, Mandal S, Das M. Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture. Indian J Urol 2019;35: 273-7.  [Full text] |
| 2. | Manasa T, Khattar N, Tripathi M, Varshney A, Goel H, Sood R. Dorsal onlay graft urethroplasty for female urethral stricture improves sexual function: Short-term results of a prospective study using vaginal graft. Indian J Urol 2019;35:267-72. [Full text] |
| 3. | Ramos JG, Jaramillo DC, Sandoval D, Gallego LJ, Riveros C, Sierra JA, et al. Diagnostic precision of sentinel lymph node biopsy in penile cancer. Indian J Urol 2019;35:282-6. [Full text] |
| 4. | Vasudeva P, Kumar N, Madersbacher H, Yadav S, Prasad V, Saurav K. Frequency volume chart for the illiterate population: A simple solution. Indian J Urol 2019;35:278-81. [Full text] |
| 5. | Grant CM, Amdur R, Whalen MJ. Trends in the use of neoadjuvant chemotherapy for bladder cancer with nonurothelial variant histology: An analysis of the national cancer database. Indian J Urol 2019;35:291-8. [Full text] |
| 6. | Singh UP, Sureka SK, Madhavan K, Raj A, Ansari MS, Kapoor R, et al. Safety and outcome of percutaneous nephrolithotomy in patients with solitary kidney: A tertiary care center experience. Indian J Urol 2019;35:287-90. [Full text] |
| 7. | Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: Review and recent trends. Indian J Urol 2019;35:250-8. [Full text] |
| 8. | Sonawane GB, Moorthy KH, Pillai BS. Complete situs inversus – is it a contraindication for organ donation? Indian J Urol 2019;35:303-4. [Full text] |
| 9. | Pandya M, Lal J, Karunakaran R. Transurethral resection of bladder tumor in a case of metastatic carcinoma prostate with penile prosthesis implant. Indian J Urol 2019;35:301-2. [Full text] |
| 10. | Hisamatsu E, Shibata R, Yoshino K. Surgical correction of ectopic scrotum and penile torsion in a 5-year-old boy. Indian J Urol 2019;35:299-300. [Full text] |
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