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ORIGINAL ARTICLES |
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Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome - a review  |
p. 111 |
NP Gupta, MS Ansari Purpose: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital malformation characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract butfunctional ovaries. We review the embryological, endocrinological, clinical, diagnostic, psychosocial and therapeutic features of this syndrome.
Material and Methods: We performed a computerised Medline search and manual bibliographical review of more than 100 relevant articles on MRKHS published in the last 25 years. A thorough analysis of embryological, endocrinological, clinical, psychosocial, diagnostic and therapeutic features of this syndrome was performed and the important findings are summarised.
Results: Embryologically, MRKHS appears to be the result of non fusion of the mesonephric duct (MD) with the Wolff an (WD). The various Mullerian defects found are agenesis of vagina or uterus, rudimentary vagina or uterus with normal ovarian function. Nearly 50% of these patients have renal anomalies like renal agenesis, ectopic kidney, fusion anomaly like horse-shoe kidney and vesicoureteric reflux. Skeletal abnormalities are found in 10% of these patients, 2/3 of whom have anomalies of the spine, ribs or limbs. Clinical observations also support the view that 2 or more syndromes lie behind the title of MRKH syndrome, namely an isolated form of congenital agenesis of the vagina and uterus (typical/type A) and a more generalized condition, in which agenesis of the vagina and uterus is a major and perhaps even an obligatory characteristic (atypical/type B).
Conclusion: Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) is a congenital malformation characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract but functional ovaries. The various urinary tract anomalies described are renal agenesis, pelvic kidney, fusion anomaly like horse-shoe kidney and vesicoureteric reflux. It is not only worthwhile to be alert for these anomalies but also to study the skeletal and auditory systems in these patients. The technology of in vitro fertilization enables a woman without a uterus to have her own genetic children. |
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Total correction of bladder exstrophy - our experience in 37 patients |
p. 117 |
AK Ray, NN Mukherjee, S Mukherjee, P Mukherjee All cases of exstrophy epispadias complex carried out in our centre between the period from February 1990 to December 1999. Total 37 cases of exstrophy epispadias complex were dealt with. Out of these, 30 cases underwent primary closure of bladder with or without osteotomy. 7 babies had very small fibrotic patch bladder primarily or secondary to failed primary closure and they went on forpermanent diversion in the form of ileocaecal bladder
Out of 30 cases, 20 underwent Jeffs' closure with osteotomy and in 10 cases primary closure was done without osteotomy.
In 19 patients we have completed all the stages of operation, that is, primary closure, epispadias repair and bladder neck reconstruction.
The main problems in exstrophy bladder repair remained the, failure of bladder to heal, vesical fistula formation, development of inguinal hernia in postoperative stage.
The dry interval period, following total correction of exstrophy bladder remains I to 2 hours with growing age. The children are in follow-up for 10 years now. |
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Tuberculosis of prostate |
p. 120 |
Dilip Kumar Pal Tubercular involvement of prostate is rare. Though the symptoms are nonspecific, haemospermia is an important clinical symptom. Asymmetry of prostatic lobes or nodular fibrotic prostate on digital rectal examination is an importantphvsical6nding. Altered echotexture of the prostate or hypoechoic nodules on USG leads to suspicion. AFB staining or AFB culture of seminal fluid or trucut needle biopsy of the prostate gives the definite diagnosis. |
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Complicated nosocomial UTI caused by nonfermenters |
p. 123 |
SK Meharwal, Neelam Taneja, SK Sharma, Meera Sharma Aerobic nonfermenting gram-negative bacilli (nonfermenters) usually considered as contaminants are emerging as important nosocomial pathogens. 110 such strains obtained from 4200 consecutive urinary tract specimens were characterized by a battery of biochemical tests. Antibiotic susceptibility was tested against gentamicin, amikacin, netilmicin, ceftazidime, piperacillin and ciprof oxacin. Significance was assigned by taking into account clinical details and isolation of the same organism in the repeat specimen. Pseudomonas spp. (45.5%) were the commonest followed by Acinetobacter spp. (39%), Alcaligenes spp. (8%) and Flavobacter spp. (3.63%). Two strains of Weeksella virosa, and one each of Xanthomonas rnaltophilia and CDCllg were also recovered. Pseudomonas aeruginosa and Acinetobacter baumanii were the most common significant isolates (62.9% and 25.9% respectively). Alcaligenes spp. was found to be etiologically significant in 5 out of 7 cases. In only 2 cases (4%) isolation of a Pseudomonas spp other than Paeruginosa was considered significant. Out of 4 strains of Flavobacter spp. only one could be confirmed as significant. Postoperative period (42.6%) followed by obstructive uropathy (32%) and surgery on urinary tract (8%) were commonest risk factors. All strains except a few showed high level of drug resistance. |
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Supernumerary nipples and urinary tract abnormalities |
p. 129 |
Suresh Bhat, Appu Thomas, RN Sharma, Jacob Cherian, Shanmughadas A high rate of association between supernumerary nipples (SNN) and genitourinary abnormalities has been reported previously. We examined all patients attending one particular unit, in the age group between 12 and 20 years for the presence of SNN and urinary tract abnormalities. We could find only a weak association between these two conditions. |
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Helical CT angiography : A single imaging modality to evaluate a live renal donor |
p. 131 |
Waheed Zaman, Anant Kumar, Rajshekhar Gupta, Subodh Das, Anil Mandhani, Aneesh Srivastava, Archana Gupta Introduction: Traditionally live related renal donors are evaluated with intravenous urography and renal arteriography. The computerized tomographic angiography (CTA) can offer a less invasive alternative to demonstrate the necessary anatomical and functional information. The present study evaluates the accuracy of helical CTA in depicting renal vascular and parenchymal anatomy in live renal donors.
Patients and Methods: During March 1999 to March 2000 all live donors were evaluated with ultrasound abdomen (USG), intravenous urography (IVU) and helical CT (Picker PQ 5000, Picker Intl. USA). Renal arterial and venous anatomy was documented prospectively by a radiologist, which was correlated with the operative findings. Sensitivity, specificity and accuracy of CTA in depicting the renal vascular anatomy were assessed.
Results: Of 120 live donors evaluated, overall concordance between CT angiography and operative findings in delineating the arterial anatomy was found in 110 (91.6%) and venous in 116 (96.6%) donors. The sensitivity, specificity, and accuracy of CTA in depicting arterial anatomy was 91.6%, 98.2% & 91.6% and for venous anatomy was 96.7%, 90.0% and 97.0% respectively. We could not gather any additional information by performing intravenous urography.
Conclusions: Helical CT angiography, which is highly specific for arterial and venous anatomy as well as other anatomical and functional details, can become the single imaging modality for preoperative assessment of potential donors in place of conventional angiography and IVU. CTA, being minimally invasive and cost effective, is well accepted by a normal healthy donor |
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Carcinoma-in-situ bladder -an early indication for cystectomy? |
p. 136 |
V Kumar, AH Lawson Carcinoma in situ bladder is a high grade and aggressive manifestation of transitional cell carcinoma of bladder that has highly variable course. The purpose of this study is to analyse how this serious disease is dealt with, most effective treatment option available and its clinical progression inspite of intervention.
All patients diagnosed to have CIS bladder histologically in Harrogate District Hospital from August 94 to August 99 were included in the study. All data concerning the management, treatment and subsequent follow-up were collected from the patients' records and analysed in a systematic way. A total of 20 patients were included in the study. Analysis showed that there was no age or sex predilection and the age group ranged from 36 to 75. It occurs either alone or with papillary bladder tumour. It is found to be poor prognostic indicator for subsequent ttunour recurrence. Mitomvcin was the least effective and BCG is the most effective form of intravesical treatment. Failure on BCG therapy is an earlvpredictorforaggressive treatment i.e. Radical Cystectomy. Eventually 1/3 of all patients diagnosed to have CIS progressed to muscle invasive disease requiring radical treatment. |
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Posterior urethral valves: Transperineal ultrasonography - a diagnostic tool: Pictorial essay |
p. 140 |
Dhiraj Nandi Chowdhury, Sankar Prasad Kabiraj, Anup Kumar Kundu Posterior urethral valves (PUV) is a singular structure, often incorrectly referred as plural, an obstructive uropathy in male infants and neonates. This congenital abnormnality is diagnosed by non-invasive investigation - perineal ultrasonography. |
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Fracture penis : A complication of sildenafil citrate!  |
p. 143 |
Anup Kumar Kundu, Goutam Ghosh, Sankar Prasad Kaviraj Our experience with 6 consecutive cases of fracture penis, a rare urological injury, in normal male without any erectile dysfunction, who consumed Sildenafil Citrate for prolonged sexual enjoyment out of curiosity. All of them were properly worked up and treated surgically resulting in excellent recovery of function. |
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Role of cold saline enema in management of priapism  |
p. 146 |
Pankaj Khurana, AR Bansal, Hemant Kamal, Vinod Malik Priapism, the prolonged erection of penis is a urologic emergency. Untreated, the patient can land up in impotence. Various methods have been described for its treatment but the initial management remains conservative. The authors present their experience with use of sedation followed by ice-cold saline enema in management of priapism. |
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CASE REPORTS |
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Primary benign para-adrenal teratoma in an adult |
p. 148 |
JN Chakraborty, NK Mondol, P Mahapatra, B Mukherjee A 38-year-old male presented with right hypochondralgia and backache for two rears. Plain X-ray KUB showed a radio-opaque calculus in the left renal area. Urinalysis and culture were negative. IVU (after a normal serum urea and creatinine report) showed the characteristic tooth-like calcification to be situated above and medial to the upper pole of left kidney which itself is deformed and pushed downwards. CT scan with contrast showed a mass of approx. 6.5 x 6.5 cm with central hypodense area and surrounding dense wall adherent to the adjacent retroperitoneum and major vessels. A solid calcified element (dermoid plug) was seen projecting into the cavity. On exploration, the para-adrenal mass was found to be adherent to the aorta and adjacent structures. The offensive cheesy content was first removed, followed by gradual and careful separation of the wall in parts, thus avoiding injury to the major vessels. The wall contained several abortive tooth structures, hair shafts and skin-like lining. Histopathology showed several ectodermal structures (tooth, hair follicles, sweat and sebaceous glands etc), but no immature element. The patient recovered uneventfully and is doing well at present. |
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Renal cell carcinoma in autosomal dominant polycystic kidney disease |
p. 150 |
M Raghavendran, Rakesh Kapoor, Anant Kumar, Waheed Zaman, Aneesh Srivastava, Anil Mandhani |
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Multilocular cystic renal cell carcinoma (MLCRC): A rare clinical entity |
p. 152 |
Tulasi Prasad Mohapatra, Ramesh Chandra Rath, Kamala Kanta Panigrahi Multilocular cystic renal cell carcinoma (MLCRC) is a low-grade tumour which arises from cystic lesions in the renal parenchvma. High index of suspicion, helps to detect this tumour in otherwise benign cystic lesions. Nephron-sparing suugery can be implemented in pre-operatively diagnosed cases. |
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Cystic renal leiomyosarcoma : An aggressive tumour |
p. 153 |
M Raghavendran, Anant Kumar, Raj Shekhar Gupta, Aneesh Srivastava |
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Asynchronous ureteral stump metastasis from papillary renal adenocarcinoma |
p. 155 |
Viswaroop S Bobby, Susy Kurien, Ganesh Gopalakrishnan, Nitin S Kekre |
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Papillary mucoid adenocarcinoma of renal pelvis and ureter - a case report |
p. 156 |
SR Rane, SB Patankar, AG Sathe |
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Medullary sponge kidney and congenital hemihypertrophy : A case report |
p. 157 |
H Singh, S Pandey, LN Dorairajan, S Kumar |
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Uretero-sigmoid fistula - a rare complication of vaginal hysterectomy |
p. 159 |
AS Albert, Sara Ammu Chacko, PR Saju, George Mathew |
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Primary adenocarcinoma of renal pelvis & ureter: Report of three cases |
p. 160 |
Anup Kumar Kundu, Amita Giri, Sankar Prasad Kaviraj 3 rare cases of primary adenocarcinoma of renal pelvis and ureter are illustrated here.
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Case report : Duplication of the IVC with ectopic kidney and PUJ obstruction |
p. 163 |
Viswaroop S Bobby, L Raghuram, K Ninan Chacko |
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Duplication of the inferior vena cava: Clinical implication during live donor nephrectomy and the role of preoperative CT angiography |
p. 164 |
Raj Shekhar Gupta, Waheed uz Zamman, Aneesh Srivastava, Anant Kumar |
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Leiomyoma of the urinary bladder |
p. 166 |
CL Subudhi, S Panda, D Pradhan, N Pati A rare case of leiomyoma of the urinary bladder in a 13-year-old girl is reported and its management discussed. |
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Primary localized amyloidosis of urinary bladder : A case report |
p. 168 |
Anil Kumar Goswami, Purshotam Kumar Puri, Bishan Dass Radotra, Shrawan Kumar Singh, Surinder Kumar Sharma |
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Congenital bladder diverticulum - a rare cause of bladder outlet obstruction in children |
p. 169 |
Anjali A Bokil, Hemendra N Shah, Percy Jal Chibber |
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Leiomyosarcoma of the prostate - a case report |
p. 171 |
G Jayant Sastri, Sambit K Mohanty, A Munshi, S Ghosal, SC Sharma, FD Patel Leiomyosarcoma of the prostate is a rare entity. It is the most common prostate sarcoma in the elderly. We report a case of prostatic leiomyosarcomia in a 60-year-old male. |
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Urethral cancer in a patient on CIC: A case report |
p. 172 |
Ajay Kanbur, Arundhati Kanbur, Nisar Ansari |
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Zoon's balanitis - diagnosis and follow-up  |
p. 173 |
Datteswar Hota, Rajarshi Basu, Rabinarayan Senapati Zoon's balanitis, is a chronic erosive lesion on glans penis, which on biopsy shows a plasma cell infiltrate in dermal layers. It is typical in uncircumcised males. We are reporting a rare case of Zoon's balanitis in our institution. A 21-year-old unmarried male presented with pain and discharge from penis. A velvety patch was noted over glans. He underwent circumcision and the patch was excised and sent for biopsy. Histopathological report was consistent with balanitis circumscripta plasmacellularis. We reviewed the literature about similar reports. |
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Mesothelial cyst of epididymis - a rare presentation |
p. 175 |
Shubha N Rao, Erel Diaz, Shivananda Prabhu, TK Susheel Kumar, Paul Jose Mesothelial cysts of epididymis are very rare. Their clinical significance lies in their presentation as discrete testicular masses often diagnosed as hydroceles prior to removal.
We report our experience of a cyst lined by mesothelial cells lying at the upper pole of the testes, from the epididyinis. |
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Primary vaginal calculus in an operated case of mclndoe vaginoplasty |
p. 176 |
VD Trivedi, Sujata Salve, Bajpai Rajesh, Pankaj Dangle, Anurag Awasthi |
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Vesicocutaneous fistula associated with osteomyelitis of pubic bone - a rare delayed complication of ovarian tumour surgery |
p. 177 |
Tejanshu P Shah, Kirtipal N Visana, Himanshu R Shah, Prakash Ranka, Rajesh R Chaudhary |
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Abnormal bone scan : Importance of clinical correlation |
p. 179 |
Dharm Raj Singh, K Gaitonde, N Santoshi, N Patil, V Srinivas A case of renal cell carcinoma which was diagnosed to have metastatic disease on the basis of two hot spots in ribs on bone scan, is presented. After careful and thorough history, it turned out to be fracture ribs which occurred due to bad positioning during radical nephrectoiny. This case highlights the importance of clinical judgement especially in the modern era of sophisticated investigations. |
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Carcinoma in third testis in a case of polyorchidism and persistent mullerian structure syndrome : A case report and review of literature |
p. 181 |
S Kumar, R Tandon, AN Srivastava, D Dalela Polyorchidism is a rare but distinct genital anomaly in which supernumerary testes are present usually within the scrotum. A unique case of germ cell tumour arising in one of the two cryptorchid abdominal testes with persistent mullerian structure syndrome is presented. He had single testicle in the scrotum, inguinal hernia and a single fallopian tube on exploration. This case is being reported for its extreme rarity and clinical issues involved. |
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Ovarian dermoids perforating into the urinary bladder |
p. 183 |
Padmaraj Hedge, K Natarajan, Joseph Thomas, K Sasidharan |
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Spontaneous rupture of a simple renal cyst |
p. 184 |
Mahesh Rao, K Natarajan, Arun Chawla, SJ Philipraj, K Sasidharan |
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Skeletal metastasis as primary presentation of squamous cell carcinoma of renal pelvis |
p. 186 |
Arun Chawla, Mahesh Rao, Sridhar Reddy, SJ Philipraj, K Sasidharan |
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Retroperitoneal cystic neurilemmoma |
p. 187 |
K Natarajan, Mahesh Rao, Padmaraj Hedge, Joseph Thomas, K Sasidharan, Manna Valiathan, Sudha S Bhat |
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Urethral rhinosporidiosis |
p. 188 |
Suresh Bhat, Appu Thomas, Jacob Cherian, Reghunath , Shanmughadas |
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Homonymous hemianopsia: An unusual complication after transurethral resection of bladder tumor |
p. 189 |
Tulasi Prasad Mohapatra, Prasanna Kumar Mishra, Maya Gantayat |
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POINT OF TECHNIQUE |
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A modified method of retroperitoneal drain placement following open surgery for kidney and upper ureter |
p. 193 |
Mitul Y Doshi, BD Kashyapi, AV Rao |
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CORRESPONDENCE |
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Laparoscopic urologic surgery: Can our patients benefit while we learn? |
p. 195 |
AK Hemal, Mani Menon |
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Stent block following extra corporeal shock wave lithotripsy of a renal calculus |
p. 197 |
AR Jayadev, C Panchakshari, Prashant Bhat, N Ganesh Prasad, V Sivakumar |
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EDUCATION |
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Towards excellence in scientific clinical research : The shift from case management record review to planned clinical research |
p. 199 |
Santosh Kumar Case Management Record Reviews have limited scientific value and there is a need to make a shift from these to Planned Clinical Research. The purpose of this article is to help clinicians in making this shift. This article describes the basic concepts of research, the stages in the shift from Case Management Record Review to Planned Clinical Research, the limitations of Case Management Record Review, Case Management Proforma, Clinical Management Protocol, Clinical Research Plan, the process of Planned Clinical Research including research designs and the benefits of carrying out scientific research. |
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The relevance of spirituality in medical profession |
p. 207 |
Santosh Kumar Patients expect holistic care from the medical profession. In holistic care, the whole person comprising bodv, mind and spirit is given attention and six dimensions of health (physical, mental, emotional, spiritual, social and environmental) are recognised as being equally important. Patients' needs and expectations have forced the medical profession to recognise spiritual and religious factors in medical care. This article describes in detail the relevance of spirituality and religion in medical pr ofession and suggests guidelines, for doctors for handling the spiritual and religious beliefs of patients. |
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"The stepladder approach" for education in laparoscopic surgery and an action plan for laparoscopic surgery education in Indian urology |
p. 213 |
Santosh Kumar Attention is being paid to the education in laparoscopic urological surgery which has become an important treatment method. This article briefly describes the challenges of different types of surgeries and the basic concepts of educational process. "The Stepladder Approach" for laparoscopic surgery education is suggested and its two components "The Stepladder of Educational Objectives" and "The Stepladder of Educational Experiences" are described along with the examples of evaluation methods. Finally, an action plan for laparoscopic surgery education in Indian urology is suggested. |
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