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   2013| April-June  | Volume 29 | Issue 2  
    Online since June 26, 2013

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Spontaneous transvaginal bowel evisceration
Sarabjeet Chhabra, Padmaraj Hegde
April-June 2013, 29(2):139-141
DOI:10.4103/0970-1591.114038  PMID:23956518
Transvaginal prolapse of bowel segments after major abdominal surgery is of rare occurrence and is commonly reported to follow after hysterectomy and enterocele repair. However, spontaneous bowel evisceration through vagina following cystectomy is even rare. We report and discuss a case of spontaneous transvaginal bowel evisceration in a postmenopausal woman with the intent of increasing its awareness among surgeons and proposing a precautionary measure for this entity.
  11,668 86 3
Dorsal onlay vaginal graft urethroplasty for female urethral stricture
Manmeet Singh, Rakesh Kapoor, Deepa Kapoor, Rohit Kapoor, Alok Srivastav, Saurabh Chipde
April-June 2013, 29(2):124-128
DOI:10.4103/0970-1591.114034  PMID:23956514
Introduction: Female urethral stricture is an underdiagnosed and overlooked cause of female bladder outlet obstruction. The possible etiologies may be infection, prior dilation, difficult catheterization with subsequent fibrosis, urethral surgery, trauma, or idiopathic. We present our technique and results of dorsal onlay full thickness vaginal graft urethroplasty for female urethral stricture. Materials and Methods: A retrospective review was performed on 16 female patients with mid-urethral stricture who underwent dorsal onlay vaginal graft urethroplasty from January 2007 to June 2011.Of these, 13 patients had previously undergone multiple Hegar dilatations, three had previous internal urethrotomies. The preoperative work up included detailed voiding history, local examination, uroflowmetry, calibration, and micturating cystourethrogram. Results: All patients had mid-urethral stricture. Mean age was 47.5 years. Mean Q max improved from 6.2 to 27.6 ml/s. Mean residual volume decreased from 160 to 20 ml. Mean duration of follow-up was 24.5 months (6 months to 3 years). Only one patient required self-calibration for 6 months after which her stricture stabilized. None of the patient was incontinent. Conclusion: Dorsal vaginal onlay graft urethroplasty could be considered as an effective way to treat female urethral stricture.
  11,341 232 11
Optimal bone health management strategies in patients with prostate cancer
Gagan Prakash, Gagan Gautam
April-June 2013, 29(2):89-99
DOI:10.4103/0970-1591.114024  PMID:23956508
Bone health is affected in patients with prostate cancer, both by the disease and its treatment. Metastases to bone leads to pain, fractures, and spinal cord compression; bone loss due to androgen deprivation therapy (ADT) leads to osteoporosis and its complications. Both these scenarios are a major cause of morbidity and adversely affect the quality of life of these patients. Maintaining an optimum bone health throughout the natural course of prostate cancer is an important aspect in the management of this disease. An understanding of the complex interplay between osteoclasts, osteoblasts, receptor activator of nuclear factor κB (RANK), and various other tyrosine kinases involved in the pathophysiology of bone metastases is essential. Zoledronic acid (ZA), an intravenously administered bisphosphonate, and Denosumab, a subcutaneously administered inhibitor of nuclear factor B ligand (RANKL), have already been approved by Food and Drug Administration (FDA) for their use in treatment of bone metastases. This article discusses the pathophysiology of bone metastases and bone loss due to ADT in prostate cancer, role of biomarkers, newer modalities of imaging, World Health Organization (WHO)/FRAX nomogram in evaluation of these patients, utility of currently available drugs and evidence supporting their use, and newer therapeutic agents like alpha-emitting Radium-223, endothelin-A receptor antagonists (Atrasentan and Zibotentan) and the proto-oncogene tyrosine-protein kinase (SRC) inhibitor, Dasatinib.
  6,245 380 2
Sexual outcomes after organ potency-sparing surgery and glans reconstruction in patients with penile carcinoma
Gaetano Gulino, Francesco Sasso, Giuseppe Palermo, Alfonso D'Onofrio, Marco Racioppi, Emilio Sacco, Francesco Pinto, Michele Antonucci, Alessandro D'Addessi, PierFrancesco Bassi
April-June 2013, 29(2):119-123
DOI:10.4103/0970-1591.114033  PMID:23956513
Introduction: Radical surgery is the "gold standard" for treatment of invasive penile carcinoma but very poor aesthetic, functional and psychological outcomes have been reported. Our purpose was to assess the impact of organ potency-sparing surgery in locally confined carcinoma of the penis. Materials and Methods: We evaluated retrospectively 42 patients with early penile cancer (Ta,T1,T2), treated with glandulectomy and glanduloplasty with urethral mucosa and sparing of cavernosal apexes, or glandulectomy and limited apical resection in cases of Stage T2. Sexual function, ejaculation and libido were evaluated with an IIEF-15 questionnaire before the appearance of neoplasia (about three months before the surgery) and six months after surgery. Quality of life was evaluated by the Bigelow-Young questionnaire. The scores relating to two weeks prior to the surgery have been compared to those obtained six months after surgery. The statistical analysis was conducted using t-Student for repeated measures and analysis of variance. Results: Six months after surgery 73% of patients reported spontaneous rigid erections, 60% coital activity while 76% of the group treated with urethral glanduloplasty reported normal ejaculation and orgasm, regained an average of 35 days after surgery. The average IIEF-15 scores reported in the entire series in the domains of erection, libido and coital activity of the pre-cancer period were not statistically different than those recorded six months after surgery. In the group treated with glandular reconstruction, pre-and postoperative IIEF-15 mean scores related to ejaculation and orgasm domains were not significantly different. Mean scores of Bigelow-Young questionnaires related to sexual pleasure, familial, social and professional relationships showed significant improvement after surgery. Conclusions: Potency sparing-sparing surgical treatments have a positive impact on a wide spectrum of the patient's life including family relationships, and social and working conditions.
  5,222 105 9
Partial reimplantation of Tenckhoff catheter for channel perforation and aneurysm: A case series
Shrawan K Singh, Dig Vijay Singh, Vivekanand Jha, Vinay Sakhuja
April-June 2013, 29(2):133-135
DOI:10.4103/0970-1591.114036  PMID:23956516
Tenckhoff catheter placement is a well established procedure to facilitate continuous ambulatory peritoneal dialysis (CAPD) in end-stage renal disease (ESRD) management. The removal and replacement of the catheter following complications adds morbidity in an already immunocompromised patient of ESRD. A salvage procedure with partial replacement was undertaken in four patients on CAPD. By catheter repositioning, the complications of catheter removal (like wound hematoma, abscess, need of break-in period hemodialysis) and of reinsertion (like leak, obstruction, migration, infection and failure) are avoided. It also reduced the economic burden of insertion in a new catheter.
  4,311 84 1
Living donor transplant options in end-stage renal disease patients with ABO incompatibility
Santosh S Waigankar, Madhav H Kamat, Shriram Joshi, Bhupendra V Gandhi, Madan Bahadur, Rushi V Deshpande
April-June 2013, 29(2):114-118
DOI:10.4103/0970-1591.114031  PMID:23956512
Introduction: The options available to CKD 5 patients with donor shortage due to incompatibilities is to either get enlisted in cadaver transplant program or opt for three other alternatives viz; ABO-incompatible transplant (ABO-I), ABO-incompatible transplant with Rituximab (ABO-R) or paired-kidney exchange transplant (PKE). At our institute we have performed ABO-I, ABO-R and PKE transplants and we are presenting the results of these transplants performed at our institution. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Objective: To review the options available to CKD 5 patients with incompatible donor. Materials and Methods: Between January 2008 and June 2011, 7 PKE, 26 ABO-I and 7 ABO-R transplants were carried out at our institute. Evaluation of both the recipients and donors involved biochemical, serological and radiological investigations. In case of PKE, recipients were operated simultaneously in different operation theaters. In ABO-I splenectomy was done while in ABO-R was given. Post-transplant the recipient management protocol remained the same. Expenditure following each transplant was calculated. Results: The graft and patient survival of ABO-I, ABO-R and PKE transplants 12-18 months after transplant were 78.9%:80%, 85.7%:85.7% and 100%:100%, respectively. Conclusions: The inclusion of Rituximab in the transplant protocol appears promising. The existing donor shortage could be addressed by encouraging other options like PKE. The limiting factor for ABO-R and PKE transplants is time and cost, respectively. The decision depends on the informed consent between the patient and the nephrologists.
  4,179 184 2
Deceased donor renal transplantation at army hospital research and referral: Our experience
Yogesh Kumar Swami, Dharam Vir Singh, Sanjay K Gupta, Aditya A Pradhan, Yajvender P. S. Rana, Sandeep Harkar, M Shafi Wani
April-June 2013, 29(2):105-109
DOI:10.4103/0970-1591.114029  PMID:23956510
Context: In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation. Aims: We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOT Materials and Methods: Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function. Results: We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%. Conclusion: Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool.
  3,901 178 5
Paratesticular rhabdomyosarcoma in young adults: A tertiary care institute experience
Ritesh Kumar, Rakesh Kapoor, Divya Khosla, Narendra Kumar, Sushmita Ghoshal, Arup Kumar Mandal, Bishan Das Radotra, Suresh Chander Sharma
April-June 2013, 29(2):110-113
DOI:10.4103/0970-1591.114030  PMID:23956511
Introduction: Paratesticular rhabdomyosarcoma (RMS) is a rare tumor arising from the mesenchymal tissues of the spermatic cord, epididymis, testis and testicular tunics. It represents only 7% of all patients entered in the Intergroup Rhabdomyosarcoma Study (IRS) and 17% of all malignant intrascrotal tumors in children less than 15 years old. We present our experience in combined modality management of 10 successive patients of paratesticular RMS. Material and Methods: We retrospectively reviewed 10 patients of paratesticular RMS treated in our institute from July 2004 to December 2010. Clinical characteristics and treatment modality in form of surgery and chemotherapy (CCT) were noted. Statistical analysis was done with regards to progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis. Results: The median age of the patients was 16.5 years. The median duration of symptoms was 5 months. Five patients had retroperitoneal lymphadenopathy (RPLAP) while three had lung metastases and one had orbital metastases. All patients underwent high inguinal orchidectomy followed by systemic chemotherapy (CCT). Retroperitoneal node dissection was not a required staging procedure. Four patients had partial response to treatment while six had complete response. Mean duration of PFS was 48 months and mean OS was 56 months. Conclusions: Paratesticular RMS are rare neoplasms with aggressive growth patterns. Cure rates have dramatically improved and 60% of patients in our series had complete response. This success is due to development of multimodality and risk adapted treatment approaches.
  3,885 153 4
Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa
Shanmugasundaram Rajaian, Muthukrishna Pandian Rajadoss, Sukriya Nayak, Nitin S Kekre
April-June 2013, 29(2):148-150
DOI:10.4103/0970-1591.114041  PMID:23956521
Rectourethral fistula is an uncommon but devastating condition. Traumatic rectourethral fistula is still uncommon and repair of traumatic rectourethral fistula involves a complex procedure. Most of the urologists would prefer to repair the fistula through perineal route especially when urethral reconstruction is also required. The repaired ends of the fistula are separated with various interposition flaps and grafts in order to prevent recurrence. Gracilis interposition muscle flap is commonly used. We describe the first case of traumatic rectourethral fistula repair in a 45-year-old man using interposition of a porcine small intestinal submucosal (Biodesign™ (Surgisis ® ) graft.
  3,803 78 3
Role of sonography-guided lithotripsy in renal stone with angiomyolipoma
Sameer Parmar, Samir Desai
April-June 2013, 29(2):151-153
DOI:10.4103/0970-1591.114042  PMID:23956522
Treatment of angiomyolipoma (AML) of kidney with stone has been challenging for urologists. We present our experience of treating the renal stone in the presence of AML with shockwave lithotripsy (SWL). Position of the patient with respect to the direction of the shockwaves and accurate knowledge of the dimension of the focal zone are critical aspects of SWL. Keeping the AML safely away from the focal zone at all times during the procedure is only possible by usage of real-time ultrasonography in lieu of fluoroscopy.
  3,536 71 1
Complications of laparo-endoscopic single-site surgery in urology
Hagop Sarkissian, Brian H Irwin
April-June 2013, 29(2):100-104
DOI:10.4103/0970-1591.114028  PMID:23956509
The objective was to give a general overview of common complications and rates reported in the current literature during performance of a variety of urologic procedures using laparo-endoscopic single-site surgery or LESS. A search of published reports using Pubmed and MEDLINE was performed with the following search terms: laparo-endoscopic single-site surgery, LESS or laparo-endoscopic single-site surgery complications within the date range of 2005--2011. Studies that were deemed appropriate and relevant to the current symposium were chosen for review. Overall complication rates were reported as ranging between 10% and 25%. In general, reconstructive procedures had consistently higher rates of complications than their extirpative/ablative counterparts (27% vs. 8%). There remain insufficient data to comment on differences in the rates or types of complications related to variations in the approach (transperitoneal vs. retroperitoneal), site of surgery (upper tract vs. lower tract) or specific technique used (instruments, access devices, robotic platforms, etc.). Complication rates associated with LESS in urology appear only slightly higher than with conventional laparoscopy. However, with proper patient selection and careful application of these techniques, proofs of concept and technical feasibility have been shown in several series. There continues to be a need for more standardization of the technique and reporting as well as more collaborative efforts to fully address questions of safety and efficacy of these new procedures.
  3,411 189 -
Cloacal anomaly with bladder tumor
Amlesh Seth, Ishwar Ram
April-June 2013, 29(2):142-144
DOI:10.4103/0970-1591.114039  PMID:23956519
A rare case of squamous cell carcinoma of bladder occurring in a 36-year-old female with persistent cloacal anomaly who presented with frequency, urgency, dysuria, and recurrent urinary tract infection is reported. Contrast Enhanced Computed Tomography with three dimensional reconstruction showed presence of bladder tumor and persistent cloaca. She underwent pelvic exenteration and wet colostomy. Histopathologic findings revealed locally advanced moderately differentiated squamous cell carcinoma.
  3,496 69 -
Robotic repair of a rare case of symptomatic "Ureterosciatic Hernia"
Iqbal Singh, Bhavin Patel, Ashok K Hemal
April-June 2013, 29(2):136-138
DOI:10.4103/0970-1591.114037  PMID:23956517
Ureterosciatic hernia (USH) is a rarely described entity and is an extremely rare cause of refractory flank pain. We report the diagnostic dilemma, and sequential endourological and finally the successful robotic management of one such symptomatic USH in an elderly woman who had presented with ipsilateral refractory flank pain, hydroureteronephrosis, and compromised renal function. We have also reviewed the current literature regarding the etiopathogenesis, presentation, diagnosis, and management of USHs. To the best of our knowledge, this is the first such case to describe the robotic-assisted laparoscopic management of a case of USH.
  3,422 67 5
Bilateral vesical inguinal hernia: A perineal 'Mickey mouse'
Aastha Sagar, Sagar Sabharwal, Nitin S Kekre
April-June 2013, 29(2):154-155
DOI:10.4103/0970-1591.114043  PMID:23956523
Bladder being a content of inguinal hernias is a rare event and it being the sole component is extremely uncommon. Usually, elderly obese males are affected and symptomatology depends on the extent of bladder involvement. However, recognition of this entity is important in the treatment of LUTS as well as to avoid inadvertent bladder injury during hernia repair.
  3,321 95 2
Plagiarism: Is it time to rethink our approach?
Arabind Panda, Nitin S Kekre
April-June 2013, 29(2):87-88
DOI:10.4103/0970-1591.114016  PMID:23956506
  3,205 176 -
Unexplained occurrence of multiple de novo pseudoaneurysms in patients with chronic kidney disease undergoing angioembolization for bleeding following percutaneous renal intervention: Are we dealing with infection or vasculitis?
Debansu Sarkar, Anupam Lal, Mayank M Agarwal, Ravimohan S Mavuduru, Santosh Kumar, Shrawan K Singh
April-June 2013, 29(2):129-132
DOI:10.4103/0970-1591.114035  PMID:23956515
Background and Objectives: Patients with chronic kidney disease (CKD) are more prone for bleeding following percutaneous renal intervention, as compared to those with normal renal function. Causes are multi-factorial. Finding multiple aneurysms away from the site of renal intervention following initial angioembolization for hemorrhage is very unusual in these patients. Materials and Methods: Clinical and radiological findings of all the patients who underwent renal angiography for post-intervention bleed for a period of 5 years were reviewed and analyzed. Results: A total of 29 patients required angiography for post-intervention hemorrhage. Six patients had recurrence of hemorrhage for which they underwent repeat angiography. Four of these patients had appearance of multiple new aneurysms away from the site of percutaneous nephrostomy (PCN)/percutaneous nephrolithotomy (PNL) puncture and the site of previous bleeding. All the patients had CKD (creatinine >2.5 mg/dl). They were on prolonged preoperative urinary diversion and had polymicrobial urinary infection. Three patients had candiduria. None of these patients had re-bleeding after repeat embolization and treatment with antibacterial and antifungal agents. Conclusions: Development of multiple aneurysms away from the sites of punctures in patients with CKD following percutaneous intervention is very unusual. Its causation including infection with bacteria and fungus, reaction of embolizing material, and angiopathy needs to be explored.
  3,151 84 -
Primary renal angiosarcoma
Sagar Sabharwal, Nirmal Thampi John, Ramani M Kumar, Nitin S Kekre
April-June 2013, 29(2):145-147
DOI:10.4103/0970-1591.114040  PMID:23956520
Primary angiosarcoma of the kidney is a rare tumor with only a few case reports in the literature. Management is not standardized and the prognosis is poor. However, clinicians need to be aware of this uncommon entity.
  3,094 78 3
Trans-umbilical laparo-endoscopic single-site donor nephrectomy without the use of a single-port access device
Deepak Dubey, RP Shrinivas
April-June 2013, 29(2):156-157
DOI:10.4103/0970-1591.114044  PMID:23956524
  2,512 78 -
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April-June 2013, 29(2):88-88
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