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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 37 | Issue 3
Page Nos. 207-301

Online since Thursday, July 1, 2021

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EDITORIALS  

National database of urological malignancies: The vision and road ahead p. 207
Girdhar S Bora, Gautam Ram Choudhary, Vijay Kumar Sarma Madduri, Brusabhanu Nayak, Uday Pratap Singh, Gagan Prakash, Rajeev Kumar
DOI:10.4103/iju.iju_219_21  
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The Urological Society of India guidelines on management of benign prostatic hyperplasia/benign prostatic obstruction (Executive summary) Highly accessed article p. 210
Ravindra Bhalchandra Sabnis, Prashant Motiram Mulawkar, Rohit N Joshi
DOI:10.4103/iju.iju_121_21  
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Roundup p. 214
Apul Goel
DOI:10.4103/iju.iju_163_21  
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REVIEW ARTICLES Top

Apolipoprotein A1 as a novel urinary biomarker for diagnosis of bladder cancer: A systematic review and meta-analysis Highly accessed article p. 217
Khaled Tarek Dardeer, Khaled Ashraf Mohammed, Tarek Dardeer Hussein, Mohammed Said Elsheemy
DOI:10.4103/iju.IJU_69_21  
Introduction: The emergence of urinary biomarkers for bladder cancer diagnosis could provide a reliable and less invasive diagnostic method. It could be also used as an adjuvant to the current gold standards of cytology and cystoscopy to improve diagnostic accuracy and decrease the percentage of false positives. Methods: We searched PubMed, SCOPUS, and Web of Science up to March 18, 2020. We selected four studies that assessed the diagnostic accuracy of urinary apolipoprotein A1 (ApoA-1) in detecting bladder cancer and met the inclusion and exclusion criteria. Two authors independently extracted the data and performed quality assessment of the studies. Results: Four studies with 771 participants were selected; 417 were bladder cancer patients and 354 were controls. Bladder cancer was either transitional cell carcinoma or squamous cell carcinoma, the stages varied between Ta to T3, and the grades varied between G1 and G3. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 90.7%, 90%, 9.478, 0.1, and 99.424, respectively. Summary receiver operating characteristic curve showed an area under the curve of 0.9544 and Q* index of 0.8965. Conclusions: ApoA-1 showed high sensitivity and specificity, so it could be a useful biomarker in diagnosis of bladder cancer.
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Perioperative therapy in muscle invasive bladder cancer p. 226
Ambarish Chatterjee, Ganesh Bakshi, Mahendra Pal, Akhil Kapoor, Amit Joshi, Gagan Prakash
DOI:10.4103/iju.IJU_540_20  
Radical cystectomy with bilateral pelvic lymph node dissection is the standard of care for muscle invasive bladder cancer (MIBC). The role of neoadjuvant and adjuvant therapy has evolved over the last 3–4 decades, and neoadjuvant chemotherapy (NACT) has now become the standard recommended treatment. However, there are many nuances to this and the utilization of chemotherapy has not been universal. The optimum chemotherapy regimen is still debated. Adjuvant radiation has a role in high-risk patients although not established and immunotherapy has shown promising results. We reviewed the evidence on NACT and adjuvant chemotherapy (ACT) regimens, NACT versus ACT, and the role of adjuvant radiotherapy and immunotherapy in MIBC.
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ORIGINAL ARTICLES Top

Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus p. 234
Shitangsu Kakoti, Rahul Jena, Sanjoy Kumar Sureka, Aneesh Srivastava, Anil Mandhani, Uday Pratap Singh
DOI:10.4103/iju.IJU_13_21  
Introduction: We aimed to present our experience in managing renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus. Methods: Records of all patients aged 18 years and older, with a diagnosis of primary renal masses with IVC thrombus, presenting to our institute from January 2012 to August 2020 were retrospectively reviewed. Patients with tumor thrombus limited only to renal vein were excluded from the analysis. Their hospital course and outcomes were recorded and evaluated for predictors of survival. Results: During the study period, we treated 61 patients with a renal mass and concurrent IVC thrombus and 56 of these underwent surgery. 7 of them had level III and 6 had level IV thrombus. A total of six patients received neoadjuvant tyrosine kinase inhibitor (TKI) therapy and all of them showed a decrease in size and level of tumor thrombus and cardiopulmonary bypass was safely avoided. Fourteen patients had distant metastasis and underwent cytoreductive surgery and of these 12 patients received TKI therapy after surgery with a mean survival of 26.8 months. The overall survival at 2 and 5 years of nonmetastatic group was 81.1% and 47.5% respectively and in metastatic group was 35.1% and 0%, respectively. Poor performance status, distant metastasis, higher T stage, higher thrombus levels, and positive surgical margins were all predictors of decreased survival. Conclusions: Complete surgical resection in both nonmetastatic and metastatic RCC with IVC thrombus has long-term survival benefits. Neoadjuvant TKI therapy, with adequate preoperative planning, helps in decreasing the size of the thrombus and in safely avoiding bypass in level III and IV IVC thrombi.
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Comparison of estimated glomerular filtration rate of marginal versus standard renal allograft: A prospective cohort study p. 241
Somendra Bansal, Ketankumar G Rupala, Prasun Ghosh, Rakesh Khera, Deepak Kumar, Rajesh Ahlawat
DOI:10.4103/iju.IJU_32_21  
Introduction: The end-stage renal disease (ESRD) population is increasing worldwide and organ shortage is an important issue. The disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidney donors. We assess and compare postoperative estimated glomerular filtration rate (eGFR) in patients who received a graft from marginal renal donor (MRD) versus those who received a graft from standard renal donor (SRD). Methods: A total of 214 patients with ESRD underwent open live donor renal allografting from September 2015 to September 2017. Out of 214 donors, 165 (77.1%) were SRD and 49 (22.9%) were MRD. Post-transplant eGFR was calculated at 2 months for donors and at days 1, 3, 5, and 7 and month 1, 3, 6, and 12 for recipients. Results: There was no statistically significant difference in eGFR of recipients at preoperative and postoperative period between SRD and MRD groups. Although at 12 months of follow–up eGFR was relatively high in SRD group, it did not show any statistically significant difference. The recipient survival rate at 1-year follow-up was 98.2% in SRD and 100% in MRD group. Conclusions: Renal transplant recipients using MRDs have a comparable glomerular filtration rate to SRDs at the end of 1 year. Short-term outcomes in recipients receiving marginal renal grafts were similar when compared to the allograft from standard donors.
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Robotic Freyer's prostatectomy: Operative technique and single-center experience p. 247
Santosh S Waigankar, Thyavihally B Yuvaraja, Preetham Dev, Varun Agarwal, Abhinav P Pednekar, Bijal Kulkarni
DOI:10.4103/iju.IJU_78_21  
Introduction: Transurethral resection of prostate replaced open surgery and remained the gold standard in surgical management of benign prostatic hyperplasia (BPH). Holmium laser enucleation and bipolar resection of prostate managed even larger glands. Open simple prostatectomy remains an option for large glands and concurrent pathologies. Minimally invasive laparoscopic simple prostatectomy lacks general acceptance. Surgeons have now started exploring the robotic platform due to its advantages. Herein, we present the technique and initial outcomes of robotic Freyer's prostatectomy (RFP). Materials and Methods: Thirteen transperitoneal RFPs were performed using the DaVinci Xi platform. We evaluated perioperative characteristics and functional outcomes. Results: Median patient age was 67.8 years and the mean prostate volume was 105.8 ml. The median International Prostate Symptom Score (IPSS) and American Urological Association quality of life (AUA-QoL) score was 19.6 and 5.3. There were no intraoperative complications or conversion to open surgery. The mean console time and estimated blood loss were 107.30 min and 92.5 ml, respectively. One patient required redo-surgery by robotic technique due to urine leak (Clavien-Dindo Grade 3b complication). Mean hospital stay and catheter duration were 4.9 days and 5.2 days, respectively. Change (preoperative vs. postoperative) in IPSS (19.6 vs. 4.67 points), maximum flow rate (6.8 vs. 15.1 ml/s), AUA-QoL score (5.3 vs. 2.2 points) and PVR (179.4 vs 7.1 ml) were significant (P < 0001). Conclusions: RFP is a safe and effective option for managing BPH, especially for large glands. It confers minimally invasive surgery benefits with good functional outcomes.
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Minimizing transrectal prostate biopsy-related infections; A prospective randomized trial of povidone-iodine intrarectal cleaning versus formalin needle disinfection p. 254
Rajesh Raj Bajpai, Shirin Razdan, Marcos A Sanchez-Gonzalez, Sanjay Razdan
DOI:10.4103/iju.IJU_34_21  
Introduction: Transrectal prostate biopsies are associated with post biopsy infection and sepsis. We compared the efficacy of povidone-iodine rectal disinfection versus formalin needle disinfection in preventing post biopsy infection among patients undergoing transrectal ultrasound-guided prostate biopsy. Methods: Patients scheduled to undergo ultrasound-guided transrectal prostate biopsy (n = 621) over 20 months were randomized into 2 groups to receive either povidone-iodine intrarectal disinfection or formalin disinfection of needle after each core. These were compared to assess which methodology better prevented postprocedure infection. Statistical analysis were used to identify independent factors promoting infections. Results: Two hundred and ninety-eight patients from povidone-iodine intrarectal disinfection were compared with 300 from formalin needle disinfection group. Formalin needle disinfection was associated with significantly more infections (P = 0.02). Escherichia coli was the dominant pathogen, with >50% of cases being quinolone resistant. Type of disinfection (P = 0.002), BMI (P = 0.001), chronic prostatitis (P = 0.002), and diabetes mellitus (P = 0.01) were independent predictors of infections. BMI at 28.95 kg/m2 provided the best predictive cut-off point for infections, irrespective of method of disinfection. Area under the curve for all these parameters together was 0.91. Conclusions: We conclude that along with oral cephalosporin prophylaxis, povidone-iodine intrarectal disinfection is a superior to formalin needle disinfection alone in preventing post biopsy infection. Patients with BMI >28.95 kg/m2 should be considered at a higher risk for infections.
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A comparative study between two techniques of laparoscopic orchiopexy for intra-abdominal testis p. 261
Osama Abdullah Bawazir, Abdulrahman M Maghrabi
DOI:10.4103/iju.IJU_507_20  
Introduction: Several techniques have been described for laparoscopic orchidopexy in patients with intra-abdominal testes. We aimed to report our experience with the staged laparoscopic traction orchiopexy (Shehata technique) and to compare it to the Fowler-Stephens orchidopexy (FSLO). Methods: We conducted a retrospective cohort study at two pediatric surgery departments from 2017 to 2020. Fifty-six patients underwent laparoscopic exploration and the testis was intra-abdominal in 41 of them. Patients with vanished testis or those who underwent open orchidopexy or vessel-intact laparoscopic orchidopexy were excluded. Those who underwent FSLO (n = 18), or Shehata laparoscopic orchidopexy (n = 11) were compared. Results: Preoperative data were comparable between both the groups. FSLO had a significantly shorter first-stage operative time (34.61 ± 6.43 vs. 58 ± 9.39 min, P < 0.001), with no difference in the second stage. There was no difference in the initial position of the testes between both the techniques. The testis dropped from the fixation position in three patients in the Shehata group (27.27%), and consequently, the cord did not increase in length by the second stage, and these testes barely reached the scrotum. At 12 months' follow-up, the testes' size, position, and consistency were comparable between the two groups. Conclusion: Staged laparoscopic traction orchidopexy is feasible for the management of intra-abdominal testes, especially in the low-lying testes.
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CASE REPORTS Top

Renal artery thrombosis and mucormycosis in a COVID-19 patient p. 267
Tarun Singh, Rajeev Chaudhari, Aman Gupta
DOI:10.4103/iju.IJU_76_21  
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COVID-19 and fatal renal mucormycosis: Contributory or coincidental? p. 270
Gautam Ram Choudhary, Amit Aggarwal, Vidhi Jain, Rahul Jena
DOI:10.4103/iju.iju_197_21  
Association of mucormycosis with COVID-19 disease is emerging as a matter of concern, with multiple reports of rhino-cerebral-orbital and pulmonary involvement. The association of isolated renal mucormycosis in a patient with a history of COVID-19 infection is unknown. The immune dysregulation associated with COVID, along with the use of steroids, mechanical ventilation, and interleukin-6-directed therapies, predisposes to the development of mucormycosis. We report a rare case of primary renal mucormycosis in a young male following recovery from COVID-19. The unusual mode of presentation, rapidly progressive disease course, and the ensuing dilemmas in diagnosis and treatment merit critical analysis.
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Systemic Bacillus Calmette–Guerin infection secondary to inadvertent intravenous injection p. 274
Mudasir Farooq, Santhosh Nagasubramanian, Benedict Paul Samuel
DOI:10.4103/iju.IJU_638_20  
Disseminated BCG infection (BCG-osis) secondary to intravesical BCG given for high-risk non-muscle invasive bladder cancer has been reported. We report the successful management of two cases of BCG-osis secondary to inadvertent intravenous BCG injection. Both cases are recurrence-free at the follow-up of 12 and 18 months, respectively. There is only one such case reported in English literature so far to the best of our knowledge.
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Adrenocortical oncocytoma associated with androgen excess: A rare cause of hirsutism p. 277
Prachi , Hema Malini Aiyer, Vikas Jain
DOI:10.4103/iju.IJU_636_20  
Adrenal oncocytomas are rare neoplasms that are usually benign and nonfunctional, and often detected incidentally. Very few cases have been reported of functioning adrenal oncocytomas. We report a rare case of adrenocortical oncocytoma in a 29-year-old female presenting with hirsutism and irregular menstrual history. The tumor was functional and was successfully managed by laparoscopic adrenalectomy. Detailed radiological, histological, and immunohistochemical workup was done to come to a definitive diagnosis of adrenal oncocytoma.
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Non-urological cause of bilateral hydroureteronephrosis p. 281
Jatin Soni, Nitesh Jain, Mathisekaran Thangarasu, Sanjay Prakash
DOI:10.4103/iju.IJU_611_20  
Bilateral hydroureteronephrosis in a patient with central diabetes insipidus is a rare condition. This rare presentation poses unique diagnostic and therapeutic challenges. Herein, we report a case of diabetes insipidus associated with bilateral hydroureteronephrosis and discuss its clinical and radiographic findings with a special focus on the urological aspects. Dramatic improvement, both clinically and radiologically, was seen after the administration of desmopressin therapy.
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Posterior urethral mini-valves causing urinary tract infection: A report of 3 cases p. 283
P Ashwin Shekar, Anuj Dumra, Dinesh Reddy, Hardik Patel
DOI:10.4103/iju.IJU_563_20  
Posterior urethral valves have myriad presentations based on the severity of obstruction with the milder end of spectrum often termed as mini-valves. The simultaneous occurrence of ureteropelvic junction obstruction and urethral valves has not been described before and is most likely coincidental. Herein, we discuss the management of three boys who had febrile urinary tract infection following pyeloplasty and on evaluation were found to have valves. This article highlights the need for considering these mini-valves as a possibility in boys presenting with symptoms following pyeloplasty so as to avoid delay in diagnosis and unnecessary morbidity in these children.
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UROPATHOLOGY Top

Skin nodules and proptosis in a case of carcinoma urinary bladder: An unusual presentation p. 286
Jeni Elizabeth Mathew, Aditya Prakash Sharma, Debajyoti Chatterjee, Sudheer Kumar Devana
DOI:10.4103/iju.IJU_461_20  
Metastasis to the skin and orbit from bladder cancer is extremely rare. A 76-year-old diabetic male presented with skin nodules and proptosis of the left eye. Punch biopsy from the abdominal wall nodule showed malignant cells with perineural invasion. Immunohistochemistry showed features suggestive of metastatic urothelial carcinoma. We present this case of urothelial carcinoma of the urinary bladder presenting primarily with highly unusual nodular skin metastasis.
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UROSCANS Top

Docetaxel, abiraterone, enzalutamide, apalutamide in patients with metastatic hormone-sensitive prostate cancer p. 288
Harkirat Singh Talwar
DOI:10.4103/iju.IJU_547_20  
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Role of atezolizumab therapy combined with platinum-based chemotherapy in untreated metastatic urothelial carcinoma – The new landscapes (IMvigor130 trial) p. 291
Ankit Misra
DOI:10.4103/iju.IJU_576_20  
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The ARAMIS trial: Why Darolutamide is better than apalutamide and enzalutamide in nonmetastatic castration-resistant prostate cancer p. 293
Sambit Tripathy
DOI:10.4103/iju.IJU_542_20  
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First-line maintenance immunotherapy in advanced urothelial cancers: Practice changing implications of the JAVELIN bladder 100 trial p. 295
Santosh Kumaraswamy
DOI:10.4103/iju.IJU_534_20  
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The SMART trial; does it make us wiser in choosing between sirolimus in preference to cyclosporine – A postrenal transplant? p. 297
Ankit Mishra
DOI:10.4103/iju.IJU_591_20  
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LETTER TO EDITOR Top

Re: Shah R. Twenty five years of the low cost, non-inflatable, Shah Indian prosthesis: The history of its evolution. Indian Journal of Urology 2021;37:113-5 p. 299
GG Laxman Prabhu, P Venugopal
DOI:10.4103/iju.iju_171_21  
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BOOK REVIEW Top

Female bladder outlet obstruction and urethral reconstruction p. 300
Pankaj Joshi
DOI:10.4103/iju.iju_246_21  
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