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2020| July-September | Volume 36 | Issue 3
Online since
July 1, 2020
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REVIEW ARTICLES
Clinical and therapeutic implications of sex steroid hormone receptor status in urothelial bladder cancer
H Krishna Moorthy, G G Laxman Prabhu, P Venugopal
July-September 2020, 36(3):171-178
DOI
:10.4103/iju.IJU_320_19
Studies on the clinical profile of urothelial bladder cancer (UBC) have shown significant gender differences, namely, higher occurrence in males (male-to-female ratio of 3.5:1) and an advanced stage of disease at the time of diagnosis with rapid progression of the disease after initial diagnosis seen more commonly in females. The relationship between gender and UBC is complex and probably influenced by biological and epidemiological factors. Potential contributory factors such as sex steroid hormone pathway, gender difference in environmental carcinogen exposure, metabolic enzyme activity, and disparities in the intensity of diagnostic evaluation could probably explain the demographic trends in UBC. This comprehensive review of Medline publications during the period 2009–2019 attempts to identify the possible role of sex hormone receptors in gender variation and sexual dimorphism in the occurrence and progression of UBC. The clinical implications of identifying sex steroid receptors on factors such as disease prognostication and the therapeutic role of anti-androgens in the prevention and progression of UBC are critically reviewed. There is now significant evidence in literature to suggest the possible role of sex steroid hormone receptor-mediated signals in the genesis and progression of UBC. These receptors include androgen receptors, estrogen receptors, progesterone receptors, and various other orphan receptors. Excessive or reduced expression of these receptors, as well as alterations in their upstream or downstream pathways, correlate well with the clinical and therapeutic outcomes of UBC.
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COVID-19 and its impact on genitourinary malignancies
C Danny Darlington, Rohan J Mammen, Kim J Mammen
July-September 2020, 36(3):163-170
DOI
:10.4103/iju.IJU_167_20
The severe acute respiratory syndrome coronavirus 2 has emerged as an alarming disease since December 2019, claiming the lives of thousands across the world to date. This pandemic has burdened healthcare systems all over the world due to its heavy death toll. Researchers are actively working on effective treatment strategies, the scope of vaccination and the production of more medical equipment to tackle this crisis. However, it is important to note that the management of patients with malignancy also needs to be prioritized during such times. Some urological malignancies need early diagnosis and treatment while the diagnosis and treatment of several others can be safely delayed. Hence, we searched MEDLINE for evidence on the optimal management of urological cancers during the coronavirus disease (COVID-19) pandemic. Studies published from December 2019 to April 2020 were included in the review. Guidelines formulated by international and national urological societies were also included. This review aims to summarize the present evidence on effective triage and safe management of urological cancers amid COVID-19 pandemic to ensure efficient usage of healthcare resources during these unprecedented times.
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EDITORIALS
Changing urological practice during COVID-19
Sudheer Kumar Devana, Kapil Chaudhary, Aditya Prakash Sharma, Shrawan Kumar Singh
July-September 2020, 36(3):153-158
DOI
:10.4103/iju.IJU_269_20
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ORIGINAL ARTICLES
Localization and restaging of carcinoma prostate by
68
Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence
Nikhil Seniaray, Ritu Verma, Sudhir Khanna, Ethel Belho, Ankur Pruthi, Harsh Mahajan
July-September 2020, 36(3):191-199
DOI
:10.4103/iju.IJU_275_19
Introduction:
Radical prostatectomy (RP) and radical radiotherapy (RT) are well established primary curative options for localized prostate cancer. Despite technical improvements, prostate-specific antigen (PSA)-recurrence after RP and RT is a common clinical scenario. We aimed to assess the role of
68
Gallium (
68
Ga) prostate-specific membrane antigen positron emission tomography computed tomography (PSMA PET/CT) in patients with biochemical recurrence of prostate cancer after RP or RT for the detection and localization recurrent and metastatic disease.
Materials and Methods:
We ambispectively (70 retrospective and 100 prospective) analyzed the data of men with biochemical recurrence post-RP and post-RT who were evaluated by
68
Ga PSMA PET/CT at our institute. We aimed to assess the relationship between serum PSA levels and the probability of having a positive scan in patients with recurrent prostate cancer.
Results:
The study included 170 men, all had adenocarcinoma of the prostate, 124/170 had previous RP and 46/170 had prior RT. The median serum PSA in the RP group was 1.8 ng/ml and 5.2 ng/ml in the RT group. In the post-RP cohort, the detection rate of
68
Ga PSMA PET/CT was 39.3% for PSA 0.2 to <0.5 ng/ml, 47.3% for PSA 0.5 to <1 ng/ml, 68.4% for PSA 1 to <2 ng/ml and 93.1% for PSA ≥2 ng/ml. In the post-RT group, the detection rate was 88.8% for PSA 2 to <4 ng/ml and 100% for PSA ≥4 ng/ml.
Conclusions:
68
Ga PSMA PET/CT provides a novel imaging modality for the detection of prostate cancer recurrence and metastases at low posttreatment PSA levels, which may help in directing appropriate salvage treatments.
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Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?
MA Elbaset, Osama Ezzat, Mostafa Elgamal, MA Sharaf, AM Elmeniar, Abdalla Abdelhamid, Yasser Osman
July-September 2020, 36(3):205-211
DOI
:10.4103/iju.IJU_109_20
Introduction:
Some patients with ureteropelvic junction obstruction (UPJO) have supranormal differential renal function (snDRF). We aimed to study the outcomes of pyeloplasty in adult patients with UPJO and either snDRF or normal differential renal function (nDRF) and to identify preoperative factors responsible for the snDRF phenomenon.
Materials and Methods:
We retrospectively retrieved data for all patients who underwent pyeloplasty and had snDRF (differential renal function [DRF] ≥55%) and nDRF (DRF between 45 and 55%) preoperatively. Preoperative radiological data using computed tomography or magnetic resonance imaging were correlated with the presence of snDRF phenomenon. In addition, scintigraphic findings pre- and post-operatively were also assessed to evaluate the functional outcomes.
Results:
Of a total of 856 patients, 31 had snDRF (group 1) and 42 had nDRF (group 2). After a mean of 37 months' follow-up in Group 1, 22 patients developed DRF reduction with non-obstructive pattern. Mean DRF % decreased from 59 ± 2.8 to 48 ± 13 (
P
< 0.0001). However, in Group 2, five patients had DRF decrease. Four patients developed snDRF phenomenon postoperatively. Increased renal pelvis volume ≥50 mm
3
and increased anteroposterior pelvic diameter (APD) ≥37 mm were found to predict snDRF phenomenon. The same findings, in addition to preoperative snDRF, correlated with postoperative DRF decrease.
Conclusion:
SnDRF function could be expected in patients with increased renal pelvis volume and APD. The absolute value or changes in DRF are not reliable to judge treatment failure.
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Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: A case-control study
Amit Agrawal, Susanta Tripathy, Deepak Kumar
July-September 2020, 36(3):212-215
DOI
:10.4103/iju.IJU_145_20
Introduction:
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating illness characterized by urinary frequency, urgency, and pelvic pain. IC/BPS adversely affects the sexual well-being of the patients. We used the Female Sexual Function Index (FSFI) to compare sexual dysfunction (FSD) in women with IC/BPS versus controls in an Indian cohort where such data is lacking.
Materials and Methods:
This case–control study was designed to compare the FSDs in patients with IC/BPS to that of asymptomatic controls. Pelvic Pain and Urgency/Frequency (PUF) Questionnaire scores and FSFI scores were used as tools for this study.
Results:
Thirty-two patients were recruited in each group. Patients with IC/BPS had a significantly higher PUF score as compared to the control group (7.843 vs. 3.656). These patients also scored worse on the total adjusted FSFI score (18.678 ± 4.531 vs. 28.05 ± 4.318;
P
< 0.05) and individually in all domains of sexual function. Twenty-nine (90.62%) patients of the IC/BPS group had FSD as compared to 12 (37.5%) of patients in the control group. Pain was the most common presenting complaint and was seen in 65.25% of patients in the IC/BPS group as compared to only 31.25% of patients in the control group.
Conclusion:
The results of our study show that women with IC/BPS have more pain and sexual dysfunction than controls.
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EDITORIALS
Webinars on journalology in times of a pandemic
Rajeev Kumar
July-September 2020, 36(3):151-152
DOI
:10.4103/iju.IJU_332_20
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CASE REPORTS
Pulmonary lymphangitis carcinomatosa in a patient with carcinoma of urinary bladder
Tarun Jindal, M Dhanalakshmi, Pravin Pawar
July-September 2020, 36(3):216-218
DOI
:10.4103/iju.IJU_148_20
Pulmonary lymphangitis carcinomatosa occurs due to dissemination of cancer cells in pulmonary lymphatics. It is only rarely seen with urological malignancies and portends a grave prognosis. Its presence in patients with urothelial carcinoma of the urinary bladder is uncommon. We present a case of a nested variant of transitional cell carcinoma of the urinary bladder associated with pulmonary lymphangitis carcinomatosa. We also discuss the symptoms and radiological features that might aid in timely diagnosis of this entity.
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A rare indication for scrotal exploration
Ulanbek Zhanbyrbekuly, Yernur Aynayev, Ilyas Kairgaliyev
July-September 2020, 36(3):219-220
DOI
:10.4103/iju.IJU_337_19
A young man presented with a suspected hematocele. On exploration of the scrotum, the pathology was identified as a ruptured proximal end of the adductor longus muscle. Muscle rupture occurred as a result of the abduction of the thigh during rehabilitation exercise. This report describes the anatomy, pathophysiology, and treatment of this case.
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EDITORIALS
Round-up
Apul Goel
July-September 2020, 36(3):159-162
DOI
:10.4103/iju.IJU_346_20
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LETTERS TO EDITOR
COVID-19: Urologist's perspective and urology practices
Deepak Kumar Ranjan, Gautam Ram Choudhary
July-September 2020, 36(3):234-235
DOI
:10.4103/iju.IJU_126_20
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Re: Maheshwari PN, Arora AM, Sane MS, Jadhao VG. Safety, feasibility, and quality of holmium laser en bloc resection of nonmuscle invasive bladder tumors: A single-center experience. Indian J Urol 2020;36:106-11
Swarnendu Mandal, Suvradeep Mitra, Sumit Agrawal, Manoj K Das, Prasant Nayak
July-September 2020, 36(3):236-236
DOI
:10.4103/iju.IJU_198_20
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Authors Reply Re: Maheshwari PN, Arora AM, Sane MS, Jadhao VG. Safety, feasibility, and quality of holmium laser en bloc resection of nonmuscle invasive bladder tumors: A single-center experience. Indian J Urol 2020;36:106-11
Pankaj N Maheshwari, Amandeep M Arora
July-September 2020, 36(3):237-238
DOI
:10.4103/iju.IJU_212_20
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Re: Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R,
et al
. Randomized controlled trial to compare outcomes with and without the enhanced recovery after surgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95-100
Ankit Misra, Swarnendu Mandal, Manoj K Das, Prasant Nayak
July-September 2020, 36(3):239-240
DOI
:10.4103/iju.IJU_174_20
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Author Reply Re: Bansal D, Nayak B, Singh P, Nayyar R, Ramachandran R, Kumar R, Seth A. Randomized controlled trial to compare outcomes with and without the enhanced recovery after surgery protocol in patients undergoing radical cystectomy. Indian J Urol 2020;36:95-100
Devanshu Bansal, Brusabhanu Nayak, Prabhjot Singh, Rishi Nayyar, Rashmi Ramachandran, Rajeev Kumar, Amlesh Seth
July-September 2020, 36(3):240-241
DOI
:10.4103/iju.IJU_195_20
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ORIGINAL ARTICLES
Management of donor kidneys with double renal arteries with significant luminal discrepancy: A retrospective cohort study
Pankaj Panwar, Devanshu Bansal, Ruchir Maheshwari, Samit Chaturvedi, Pragnesh Desai, Anant Kumar
July-September 2020, 36(3):200-204
DOI
:10.4103/iju.IJU_196_20
Introduction:
Side-to-side pantaloon anastomosis for renal grafts with double renal arteries (RA) with significant luminal discrepancy between graft arteries has not been reported. We hypothesized that the pantaloon technique is feasible and safe in these cases.
Materials and Methods:
A retrospective review of all consecutive, open, live-related renal transplants with double RA with significant luminal discrepancy performed at our center from January 2014 to September 2018 was undertaken. Significant luminal discrepancy was defined as smaller RA constituting 30% ± 5% of total RA diameter on preoperative computed tomography angiogram. Three groups were defined: Group A - pantaloon anastomosis, Group B - end-to-side anastomosis of smaller to main RA, and Group C - separate implantation of each artery. The primary objective was to study feasibility and safety of pantaloon anastomosis measured by recipient serum creatinine levels, Doppler ultrasound, and vascular complications (vascular thrombosis and anastomotic bleed). Secondary objectives included measurement of cold ischemia time, warm ischemia time in recipient (WIR), and nonvascular recipient complications.
Results:
Fifty-eight recipients had donors with double RA with significant luminal discrepancy. Group A - included 40, Group B – 5, and Group C - 13 patients. Recipient creatinine at day-7, -30, and -90 were similar among the groups. The 30-day perioperative complication rate was also similar. Group A and B had significantly lower WIR and higher cold ischemia time compared to Group C.
Conclusion:
Pantaloon anastomosis is feasible in renal grafts with double RA with significant luminal discrepancy and offers advantage of lower WIR compared to separate implantation technique.
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Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience
Abhishek Laddha, Appu Thomas, Deepak Chandran Nair, Greeshma C Ravindran, Ginil Kumar Pooleri
July-September 2020, 36(3):179-183
DOI
:10.4103/iju.IJU_344_19
Introduction:
Prostate cancer is now the second-most common cancer in many parts of India. Despite being the second-largest population in the world, data regarding outcomes of biopsy in Indian men are limited. We report the correlation of biopsy finding with prostate-specific antigen (PSA) level in Indian men undergoing biopsy for either elevated PSA and/or abnormal digital rectal examination (DRE) findings.
Materials and Methods:
We retrospectively analyzed data of 853 men who underwent TRUS-guided prostate biopsy in a single institution from January 2014 to October 2019. The biopsy was performed when serum PSA was more than 4.00 ng/mL and/or DRE findings were suspicious for malignancy.
Results:
Overall cancer detection rate was 38.8%. Patients were classified in five groups based on PSA levels, irrespective of DRE findings (0–3.99 ng/mL, 4.00–9.99 ng/mL, 10.00–19.99 ng/mL, 20.00–39.99 ng/mL, and ≥40 ng/mL). Overall prostate cancer detection rates at corresponding at PSA levels were 3/23 (13%), 62/282 (21.9%), 86/226 (38.05%), 66/126 (52.3%), and 165/196 (84.18%), respectively. 331 (38.8%) patients of the total 853 had suspicious DRE, the cancer detection rate in corresponding PSA groups, based on DRE alone was 3/23 (13.04%), 23/42 (54.76%), 39/56 (69.64%), 43/52 (82.69%), and 157/160 (98.13%), respectively.
Conclusion:
The overall prostate cancer detection rate at our center was 38.8%, which is much higher as compared to other Indian data. Our study also emphasizes the role of DRE in Indian men presenting with elevated PSA.
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Low-risk prostate cancer in India: Is active surveillance a valid treatment option?
Shanky Singh, Saurabh Patil, Ashwin Sunil Tamhankar, Puneet Ahluwalia, Gagan Gautam
July-September 2020, 36(3):184-190
DOI
:10.4103/iju.IJU_37_20
Introduction and Objective:
Carcinoma prostate is considered highly aggressive in Asian countries such as India. This raises an argument whether active surveillance (AS) gives a false sense of security as opposed to upfront radical prostatectomy (RP) in Indian males with low-risk prostate cancer (PCa). We analyzed our prospectively maintained robot-assisted RP (RARP) database to address this question.
Materials and Methods:
Five hundred and sixty-seven men underwent RARP by a single surgical team from September 2013 to September 2019. Of these, 46 (8.1%) were low risk considering the National Comprehensive Cancer Network criteria. Gleason grade group and stage were compared before and after surgery to ascertain the incidence of upgrading and upstaging. Preoperative clinical and pathological characteristics were analyzed for association with the probability of upstaging and upgrading.
Results:
The mean age was 60.8 ± 6.8 years. Average prostate-specific antigen level was 6.7 ± 2.0 ng/mL. 40 (86.9%) patients had a T1 stage disease and 6 (13%) patients were clinically in T2a stage. A total of 25 (54.3%) cases were either upstaged or upgraded, 19 (41.3%) showed no change, and the remaining 2 (4.3%) had no malignancy on the final RP specimen. Upstaging occurred in 8 (17.4%) cases: 5 (10.9%) to pT3a and 3 (6.5%) to pT3b. Upgrading occurred in 23 (50%) cases: 19 (41.3%) to Grade 2; 3 (6.5%) to Grade 3; and 1 (2.2%) to Grade 4.
Conclusions:
There is a 50% likelihood of upstaging or upgrading in Indian males with low-risk PCa eligible for AS. Decision to proceed with AS should be taken carefully.
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UROLOGICAL IMAGES
Spontaneous bilateral extraperitoneal ureteroinguinal herniation
Mukesh Kumar Gupta, Ashish Khanna, Shrawan Kumar Singh
July-September 2020, 36(3):221-222
DOI
:10.4103/iju.IJU_138_20
We describe the clinical and imaging findings of a 53-year-old male who presented with recurrent urinary tract infections with bilateral inguinoscrotal swelling, diagnosed as spontaneous bilateral extraperitoneal ureteroinguinal herniation.
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UROSCAN
Renal and testicular involvement in COVID-19 patients – implication for the urologist
Abhisek Pandey
July-September 2020, 36(3):223-224
DOI
:10.4103/iju.IJU_172_20
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Open versus robotic radical cystectomy: Results from the 3-year follow-up of the RAZOR trial
Santhosh Nagasubramanian
July-September 2020, 36(3):225-226
DOI
:10.4103/iju.IJU_94_20
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Lutetium-177 prostate-specific membrane antigen-617 theranostics: New therapeutic hope in metastatic castrate-resistant prostate cancer?
Satish Kumar Ranjan
July-September 2020, 36(3):227-228
DOI
:10.4103/iju.IJU_193_20
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Multiparametric magnetic resonance imaging-targeted biopsies in the detection of clinically significant prostate cancer
Fragkoulis Charalampos
July-September 2020, 36(3):229-230
DOI
:10.4103/iju.IJU_182_20
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CheckMate 214 trial: Immune checkpoint regulators for advanced renal cell carcinoma
Rahul Jena
July-September 2020, 36(3):231-233
DOI
:10.4103/iju.IJU_153_20
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© 2006 - Indian Journal of Urology | Published by Wolters Kluwer -
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Online since 1
st
January, 2006