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   2003| July-December  | Volume 20 | Issue 1  
    Online since November 27, 2007

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Management of proximal ureteral stones - comparison of outpatient ureterolithotripsy with in-situ shock wave lithotripsy (SWL)
Harbans Singh, Vipul Tandon, US Dwivedi, Mufti Mahmood, Arif Hamid, Gopi Kishore, PB Singh
July-December 2003, 20(1):23-27
Objectives: The aim of this study is to review the feasi­bility and effectiveness of ureteroscopy with intracorporeal lithotripsy under intravenous sedation on outpatient basis as a primary procedure in patients with proximal ureteral calculi and its comparison with in situ SWL. Methods: From January 2000 to December 2001, 56 patients with proximal ureteral calculi underwent uretero­lithotripsy and 32 patients underwent in situ shock wave lithotripsy (SWL). Ureterolithotripsy was performed with 8.0 Fr Wolf rigid ureteroscope and Swiss Lithoclast on daycare basis. Results: In patients managed with ureterolithotripsy, stone was successfully reached and fragmented in 47(83.93%) patients. Complete stone fragmentation and spontaneous passage occurred in 40 (71.4%)patients with single session. Seven (12.5%) patients required more than one session for complete clearance. JJ stent was required in 13(23.2%) patients. One case of ureteral perforation was managed successfully with JJ stent. In SWL group, 28 (87.5%) patients became stone free at 3 months. Seven­teen patients (53.2%) required retreatment and adjuvant procedure was done in 6 patients (18.7%). Conclusions: Ureterolithotripsy and in situ SWL are equally effective for proximal ureteral stone. Ureterolitho­tripsy for proximal ureteral calculi has high success rate with low morbidity. It can be done safely with intravenous sedation and local anesthesia. Ureteroscopic stone re­moval can be considered as primary approach in patients with proximal ureteral calculi reserving SWL for those who can afford it.
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The steinstrasse : A legacy of extracorporeal lithotripsy
Mufti Mahmood, Arif Hamid, Vipul Tandon, US Dwivedi, Harbans Singh, PB Singh
July-December 2003, 20(1):46-49
Objectives: To determine the causes of steinstrasse and to assess the success of primary ureteroscopic removal using pneumatic lithotripsy. Methods: Three hundred and two patients with urinary stones (242 renal and 60 ureteric) underwent extracor­poreal shock wave lithotripsy treatment using Stonelith electrohydraulic lithotripter from June 1999 to July 2002 in the Department of Urology, Institute of Medical Sci­ences, Banaras Hindu University. Of these, 29(9.6%) de­veloped steinstrasse. There were 23 males and 6 females in the age group of 24-66 years. After ESWL the patients were followed weekly using plain films and ultrasonogra­phy for the 1 st month and thereafter monthly for 2 months. Their radiological appearance was classified into 3 types. Majority of the patients developing steinstrasse had a stone size of 2-3 cm and most of the steinstrasse was found in the lower ureter usually after 6001-9000 shocks at a mean power of >16 kv. The length of the steinstrasse was 3-4 cm in the majority of patients. Results: Conservative management was successful in 15 patients (51.7%); repeated ESWL in 4 (13.8%). Ureteroscopic removal using pneumatic lithotripsy under i/v sedation was successful in 10(34.5%) patients. Conclusions: Large stone burden (>2 cm) and use of high energies (>16 kv) are leading factors responsible for the development of steinstrasse. Ureteroscopic removal using pneumatic lithotripsy is a definitive and predictable treatment modality with a high success rate.
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Single step access into the pelvicalyceal system using the webb target dilator for PCNL and comparison with sequential dilatation technique
Apul Goel, Monish Aron, Rajiv Goel, NP Gupta, AK Hemal, PN Dogra, Amlesh Seth
July-December 2003, 20(1):14-17
Objectives: To evaluate the effectiveness and safety of the single step dilatation of the pelvicalyceal system using the Webb target dilator. Methods: Thirty consecutive patients who underwent PCNL using the Webb dilator were compared with 30 pa­tients in whom sequential dilatation was done. The two groups were similar as regards age, stone location and degree of hydronephrosis. Results: The Webb dilator was associated with a lesser time for tract dilatation as compared to the sequential dila­tation group. There were no significant complication in either group. There was a higher incidence of failure of adequate access to pelvicalyceal system with the Webb dilator group if the pelvicalyceal system was not dilated. Conclusions: The Webb target dilator is a safe, rapid and effective method of tract dilatation during PCNL and is associated with significantly shorter time in tract dila­tation as compared to the sequential dilatation group. How­ever it is not suitable for non-dilated pelvicalyceal systems.
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Virtual cystoscopy - a promising diagnostic technique
C Anand, L Sudhakar, G Sivasankaran, R Jayaganesh, M Ilangovan, N Muthulatha, MG Rajamanickam, R Emmanuel
July-December 2003, 20(1):18-22
Objectives: To determine the diagnostic performance of virtual cystoscopy in patients with bladder diseases in comparison with conventional cystoscopy. Methods: Fifteen patients with different bladder patho­logies underwent volumetric spiral CT of bladder after filling it with contrast media (GE medical system light speed multislice scanner). The data were transferred to Advantage workstation AW4.0-03 and virtual cystoscopy was performed using the special software (Navigator GE medical system). All the patients later underwent conven­tional cystoscopy and the findings of both investigations were compared. Results: Virtual cystoscopy detected all 10 lesions with >5mm size and missed I out of 3 lesions with 5 5mm size. The overall sensitivity was 90%, specificity was 100%, positive predictive value was 100% and negative predic­tive value was 83.3%. The average time taken per proce­dure was 8 minutes. No complications of virtual cystoscopy were encountered in our study. Conclusions: There seems to be good agreement as re­gards the site and size of lesions in both techniques. In the quest for a non-invasive investigation for assessment of bladder diseases, virtual cystoscopy is a promising tech­nology.
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Recurrent and massive bleeding from ileal conduit peristomal varices: A case report
TB Yuvaraja, HB Tongaonkar
July-December 2003, 20(1):63-64
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Prevention of urological cancer
MS Ansari
July-December 2003, 20(1):7-13
Objectives: Many urological cancers like prostate and bladder have protracted course and maybe ideal for chemoprevention strategies. This article reviews the biol­ogy, epidemiology and possible preventive strategies for the various urological cancers. Methods: The author reviewed the relevant articles published in the last 20 years and studied the biology of the various urological cancers. An attempt is made to identify the various dietary, nutritional and occupation­related factors implicated in the onset and progression of various urological cancers. The various interventions and clinical trial results are described to prove the relevance of these factors. Results: Epidemiological reports provide the strongest evidence of protective role for dietary agents in cancer of prostate, bladder and kidney. Cancers of prostate and blad­der are uniquely suitable for chemopreventive strategies. For prostate cancer strong evidence exists for a preven­tive effect of reduced fat intake, vitamin E, selenium, lycopene and soya proteins. Vitamin A administration shows a strong inverse relation to bladder cancer. Better prevention is seen with combination of high doses of vita­mins A, C, E and B6. High-energy intake is related to the higher incidence of renal cell carcinoma (RCC). While vitamins D and E supplementation has resulted in lower incidence of RCC. Conclusions: Numerous studies implicate dietary and nutritional factors in the onset and progression of various urological cancers. Hence, it is possible that bioactive compounds (anti-oxidants) like vits. A, D, C, and E, min­erals like selenium and carotenoids like lycopene along with reduction of animal fat in diet can be a part of pre­ventive strategies for various urological cancers.
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Use of buccal mucosa as onlay graft technique for benign ureteric strictures
Shailesh A Shah, Prakash Ranka, Manish Visnagara, Sharad Dodia, Rajesh Jain
July-December 2003, 20(1):28-32
Objectives: To cure long and multiple ureteric strictures by a simple procedure without the long term complications of bowel interposition or surgery of high magnitude like auto-transplantation. Methods: Ureteric strictures in 5 patients were treated with buccal mucosa onlay grafts with an omental wrap. The underlying etiology was tuberculosis in 4 patients and amyloidosis in I patient. Mean age was 45 years. Three patients had strictures in upper ureter, 1 patient in mid­ureter and 1 patient had panureteric stricture. In all pa­tients length of stricture was greater than 5 cm. Results: Ureteric patency was established in all patients. Four patients have persistent improvement in renal func­tion. In I patient, renal function improved initially (at 6 months follow-up) but subsequently (at 1-year follow-up) the unit was non functioning. Follow-up was in the range of 1.5 year to 3.5 years. Conclusions: In selected patients with complicated be­nign ureteric strictures, buccal mucosal dorsal onlay graft was proved capable of maintaining patency and good uri­nary drainage. The procedure is technically simple and devoid of complications.
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A randomized comparative study of tamsulosin vs placebo in the treatment of benign prostatic hyperplasia
NK Mohanty, RP Arora, Rajiba L Nayak, Vineet Malhotra
July-December 2003, 20(1):40-45
Objective: The rationale of using α1, blockers in the man­agement of benign prostatic hyperplasia (BPH) is based upon blocking the adrenergic receptors which regulate urinary outflow The prostate adenoma is predominantly stromal, having 40% of smooth muscle innervated by sym­pathetic adrenergic nerves stimulation of which accounts for 50% of outflow obstruction. Tamsulosin is an uroselective α1a/d blocker, controls both the lower urinary irritative and obstructive symptoms. The present study is a placebo controlled study evaluating the efficacy, safety and advantages of tamsulosin in the management of BPH. Methods: A total number of 72 patients between 40-80 years of age were randomized to two groups. One group (38 patients) received tamsulosin (0.4 mg) daily and the other group (34 patients) received placebo for a period of two months with periodic follow up at 2nd , 4 th and 8 th week with IPSS (International Prostate Symptom Score) and uroflowmetry and ultrasonography at 8 th week. Results: Our results show tamsulosin to be very effec­tive in the management of BPH cases, not requiring sur­gery, with few side effects and good patient compliance. The improvement was seen both in IPSS (total, obstruc­tive and irritative) and in urodynamic parameters. The differences were consistently superior with tamsulosin as compared to placebo in both the IPSS as well as uroflow­metry measurements. Conclusion: Tamsulosin was found to be a very safe, well tolerated drug showing significant improvement in urinary outflow symptoms, reducing post void urine volume and decreasing IPSS with minimal tolerable adverse events.
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Tension free vaginal tape in the management of genuine stress incontinence in women - the Indian experience
N Rajamaheswari, Karthik Gunasekaran
July-December 2003, 20(1):33-36
Objectives: To study retrospectively the results of the Tension Free Vaginal Tape (TVT), a new ambulatory sur­gical procedure for the treatment of stress urinary incon­tinence (SUI) among Indian women. Methods: TVT implies the implantation of a prolene tape around the mid-uretha via a minimal vaginal incision. TVT was done on 54 patients diagnosed to have Genuine Stress Incontinence (GSI). The procedure was done either under regional anaesthesia (RA) or under local anaesthesia (LA) with IV analgesics. Results: Thirty-eight patients underwent only the TVT procedure and in 16 patients concomitant procedures were done along with the TVT The TVT was done as the pri­mary procedure for GSI in 46 patients. Eight patients had prior surgery for stress incontinence. All patients were followed up from 6 months to 2 years. Forty-eight (88%) patients reported complete cure. There was significant improvement of symptoms in 4(7.4%) patients and in 2(3.7%) the surgery failed. Conclusions: These results prove that the TVT proce­dure is a minimally invasive, safe and effective method for the treatment of SUI in women.
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Congenital bladder diverticulum: Report of three cases
Sajni Khemchandani, Prakash Ranka
July-December 2003, 20(1):65-67
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Laparoscopic radical nephrectomy: Is it ontologically safe?
Apul Goel, Ashok K Hemal
July-December 2003, 20(1):1-6
Objectives: Laparoscopic radical nephrectomy (LRN) is emerging as a viable alternative to open radical ne­phrectomy for treatment of patients with localized renal cell carcinoma (RCC). However, data regarding the onco­logic effectiveness of this minimally invasive treatment option is still scarce. We review the literature regarding the oncologic efficacy of this treatment, including our own experience. Methods: The current literature on LRN for treatment of patients with localized RCC, available on Medline, was reviewed. Results: Although the long-term results are not known current literature suggests that LRN is as effective as open radical nephrectomy for localized RCC. Conclusions: LRN is a safe and effective modality of treatment for patients with localized RCC. It does not pose any extra risk for port-site recurrence, local recurrence and distant metastasis over open radical nephrectomy. The survival outcomes are similar in both the techniques even at long term follow-up of 10 years.
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Monotherapy with docetaxel in treatment of hormone resistant cancer of the prostate - our results
NK Mohanty, Vineet Malhotra, Rajiba L Nayak, RP Arora
July-December 2003, 20(1):54-58
Objectives: Management of hormone resistant prostate cancer (HRCaP) is always a challenge to urologist. Mi­crotubule inhibitors have been in focus as chemothera­peutic agents in carcinoma prostate, docetaxel being the most active among such drugs. The present study aims to evaluate the efficacy and safety of docetaxel as a single agent in the management of HRCaP. Methods: Twenty patients of HRCaP between 58-82 years of age were enrolled to receive docetaxel 75mg/sq.m. intravenously every 3'd week with a minimum 6 dose sched­ule. A total number of 136 doses were used. All patients were D3 stage disease and symptomatic. Median prostate specific antigen (PSA) at the time of entry was 180ng/ml and the median follow up was for 28 months. Results: An objective response in PSA reduction by = 80% was observed in 5 patients (25%) and more than 25% reduction seen in 12 patients (60%). Seventy percent of the patients showed improvement in symptoms on treat­ment. In 12 patients (60%), the disease was stable and showed response for a median period of 18 months. The median overall survival was 22 months. Adverse reaction in the form of anaemia, neutropenia, leucopenia was seen in 20 patients (100%), stomatitis, fever and alopecia was seen in 12 patients (60%). Four developed oral thrush (20%). Mortality occurred in 5 patients (25%) during the study, 2 died from pulmonary metastasis and 3 had cer­ebral metastasis with paraplegia. Conclusions: The response seen in this study is very encouraging and suggests substantial durable activity of docetaxel as a single therapy in HRCaP
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Endourological interventions in the diagnosis and management of upper urinary tract fungal infections - our experience
S Joseph Philipraj, M Joseph Thomas, Sudha Bhat
July-December 2003, 20(1):50-53
Objectives: We have analyzed the incidence and man­agement options of upper urinary tract obstructions caused by fungal infections during January 2000-December 2001. Methods: Four patients with upper urinary tract fun­gal infections underwent endourological interventions and received antifungal therapy. Results: All 4 patients underwent double J stenting, of which one patient underwent bilateral stenting. Percuta­neous nephrostomv to irrigate was done in one patient in whom the filling defect caused by the fiungal ball persisted even after 4 weeks of oral antifungal therapy. Nephroureterectomy was done in 1 patient as the renal function did not recover even after 4 weeks of appropriate therapy. Three patients had good recovery of renal func­tion. Conclusions: Endourological interventions help in re­lieving and treating obstructions caused by fungal infec­tions.
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Primary papillary mesothelial hyperpla­sia of the renal capsule - an unusual cause of renal calcification
Sanjay P Kolte, Neelam Charles, Girish Moghe, Sameer Choube
July-December 2003, 20(1):59-60
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An unusual presentation of penile can­cer recurrence
Suresh Bhat, Muhammed Fassaludeen, Jacob Cherian, Appu Thomas
July-December 2003, 20(1):64-65
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Hemangiopericytoma of pelvis: A case report
Vishwajeet Singh, M Raghavendran, Rakesh Kapoor
July-December 2003, 20(1):62-63
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Massive hematuria due to delayed spon­taneous rupture of post-traumatic renal artery pseudoaneurysm : A case report
Uttam K Mete, Pamposh Raina, AK Mandal, J Rajiv Bapuraj, SK Singh, AK Goswami, SK Sharma
July-December 2003, 20(1):68-70
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Midurethral bulbocavernous muscle sling for genuine stress incontinence - an alternative to synthetic slings?
N Rajamaheswari, Karthik Gunasekaran
July-December 2003, 20(1):37-39
Objectives: To assess the efficacy of midurethral bulbo­cavernous muscle sling (BCMS) in the treatment of genu­ine stress incontinence in women. Methods: A prospective study comprising 25 women was carried out at the Govt. Kasturba Gandhi Hospital, Chennai. The women whose age was in the range of 30-65 years had GSI as proved by urodynamic evaluation. The bulbocavernous muscle sling implies the approximation of both the bulbocavernous muscles around the midurethra with prolene sutures. The procedure is done under regional anaesthesia. Results: These patients were followed up for 2 years. Eighteen (72%) women reported complete cure, 4 (16%) were significantly improved and in 3 the surgery failed. Conclusions: The bulbocavernous muscle sling is a promising new procedure for genuine stress incontinence. There is no need for intraoperative cystoscopy and the chances of bladder injury are nonexistent. Larger sample with long term follow up and randomized controlled trials comparing it with the other surgical techniques may prove its true efficacy.
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Vesicocutaneous fistula : A rare delayed complication of polypropylene mesh hernioplasty
Apul Goel, Amlesh Seth, Rajeev Kumar
July-December 2003, 20(1):60-61
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Calyceal-cutaneous fistula - an unusual complication in a series of 1020 renal transplantations
Shailesh A Shah, Prakash Ranka, Sharad Dodiya, Manish Visnagra, Rajesh Jain, Sajni Khemchandani, HL Trivedi
July-December 2003, 20(1):67-68
  2,024 0 -
Tubercular autocystectomy with vesico­colic fistula - a case report
Hemendra N Shah, Anjali A Bokil, Percy Jal Chibber
July-December 2003, 20(1):71-72
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Congenital anterior urethral diverticu­lum in an adult patient with end stage renal disease
Pranjal Ramanlal Modi, P Jacob John, Deepak Pravinbhai Joshi, Rohit Naranbhai Joshi
July-December 2003, 20(1):70-71
  1,855 0 -
Routine HIV testing - the need for a rationalized approach
Anindya Chattopadhyay
July-December 2003, 20(1):73-73
  1,796 0 -
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