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   2021| October-December  | Volume 37 | Issue 4  
    Online since October 1, 2021

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The future of the artificial kidney
Santhosh Nagasubramanian
October-December 2021, 37(4):310-317
End-stage renal disease (ESRD) is increasing worldwide. In India, diabetes mellitus and hypertension are the leading causes of chronic kidney disease and ESRD. Hemodialysis is the most prevalent renal replacement therapy (RRT) in India. The ideal RRT must mimic the complex structure of the human kidney while maintaining the patient's quality of life. The quest for finding the ideal RRT, the “artificial kidney”– that can be replicated in the clinical setting and scaled-up across barriers– continues to this date. This review aims to outline the developments, the current status of the artificial kidney and explore its future potential.
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It is easy to become an author in scientific journals now but, what are the implications?
Apul Goel
October-December 2021, 37(4):303-306
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Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy for hilar versus nonhilar tumors: A propensity-matched analysis
Shantanu Tyagi, Gopal Sharma, Girdhar S Bora, Ravimohan S Mavuduru, Aditya Prakash Sharma, Sudheer Kumar Devana, Ujjwal Gorsi, Nandita Kakkar, Shrawan K Singh
October-December 2021, 37(4):318-324
Introduction: Hilar tumors are a unique subset of complex renal masses posing a potential surgical challenge during partial nephrectomy. The outcomes of hilar masses have not been compared to non-hilar renal masses of similar RENAL nephrometry score (RNS). In this study, we analyzed the outcomes of hilar versus nonhilar masses after a propensity score matching. Methods: Prospectively maintained database of patients who underwent robot assisted PN between November 2014 and December 2018 was abstracted for hilar and nonhilar tumors. We performed propensity matching for baseline variables such as age, sex, body mass index, comorbidities, preoperative glomerular filtration rate, and RNS for each patient on the basis of propensity scores. Results: We included 48 patients with hilar tumors and 153 with nonhilar tumors. On propensity matching, 41 patients were included in each group. The mean operative time (162.4 ± 48.9 min vs. 144.1 ± 38.8 min, P = 0.48), warm ischemia time (29.0 ± 8.8 min vs. 24.4 ± 8.2 min, P = 0.12), and the estimated blood loss (201.8 ± 184.7 ml vs. 150.6 ± 160.5 ml, P = 0.37) were not significantly different between the hilar and the nonhilar groups. Trifecta was achieved in only 14/41 (34.1%) of the patients in the hilar group as compared to 24/41 (58.5%) in the nonhilar group (P = 0.027). Logistic regression analysis identified that hilar location of the tumors was not an independent predictor of overall complications (OR 6.37, confidence interval [CI] 0.5–69.4, P = 0.4), trifecta (OR 0.38, CI 0.14–1.0, P = 0.051), and pentafecta outcomes (OR 0.4, CI 0.1–1.51, P = 0.17). Conclusions: Hilar location was associated with poorer trifecta outcomes compared to the nonhilar tumors. However, hilar location per se was not an independent predictor of overall complications and trifecta and pentafecta outcomes.
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Single ileal segment in a cat-tail configuration for bilateral ureteric strictures
Abhishek Singh, Deval Parikh, Pavan Prabhakar Surwase, Shashank Agrawal, Arvind Ganpule, RB Sabnis, MR Desai
October-December 2021, 37(4):325-330
Introduction: Management of bilateral long length ureteric strictures is difficult with few options for reconstruction. In this report, we describe our experience with the use of a single, 15- 20 cm ileal segment for reconstruction of bilateral long length (involving more than 2/3rd ureter) ureteric strictures. Patients and Methods: A retrospective analysis of 5 cases operated between 2015 and 2020for bilateral long length ureteric strictures, using a single segment ileal interposition in a cat tail configuration was performed. We evaluated renal function, surgical success, incidence of urinary tract infection and complications of the procedure. Surgical success was defined as an asymptomatic patient with no hydronephrosis and/or prompt drainage of the kidney on radiological investigations. Results: The average age of presentation was 42.8 ± 7.4 years (33-53) years). All the cases were secondary to a gynaecological intervention. The mean creatinine prior to surgery was 0.81 ± 0.36 mg % (range 0.5 -1.4 mg%). Mean duration of follow-up was 28.6 ± 20.6 months (Range 10 – 56 months). Mean hospital stay was 14.4 ± 3.36 days (range 12-20 days). Two patients developed ileus and one patient developed deep venous thrombosis in the post-operative period. One patient developed pyelonephritis within one month of surgery. There was no deterioration of renal function with the mean serum creatinine at last follow-up being 0.9 ± 0.36 mg% (range 0.6 – 1.5 mg%). Conclusion: The use of an ileal segment in cat-tail configuration for bilateral simultaneous ileal replacement is a feasible and safe option. The medium-term result states that it is effective in the preservation of renal function and provides a good conduit for drainage.
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Assessing information on YouTube™ as a quality source for the treatment of varicoceles
H Stephen Hong, J Jacob Lang, Shivashankar Damodaran, Puneet Sindhwani
October-December 2021, 37(4):339-344
Introduction: YouTube has grown into one of the largest disseminators of health care information. We assessed the quality of information on varicoceles and their treatment, available on YouTube. Methods: Using a YouTube search query with the keyword “varicocele,” the quality of the first 50, nonrepeat videos in English were assessed as a representative group for the topic. DISCERN and Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) standardized tools were utilized by three independent reviewers to grade the quality of these videos based on content, understandability, and actionability. Results: The average and median DISCERN score was 31.34 (±9.37) and 31 (interquartile range 25–35), respectively, indicating poor quality. The interrater reliability (IRR) scores ranged from 0.51 to 0.93, indicating fair to excellent reliability. The average PEMAT-AV understandability and actionability scores were 69.8% ±15.4% and 11.0% ±24.6%, respectively, indicating mostly understandable but poor actionability. The t-test results showed that international videos scored higher without statistical significance in the DISCERN or PEMAT-AV scores (P = 0.18, 0.59, and 0.20). Conclusions: The current quality of videos on YouTube™ on the topic of varicoceles is of poor quality due to a lack of a holistic approach in explaining the wide range of treatment options available. With the ease of access to produce and disseminate health information, there is a need to create high-quality videos on varicoceles that empower a patient to make an informed decision.
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Round up
Swarnendu Mandal
October-December 2021, 37(4):307-309
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Detection of bladder cancer using voided urine sample and by targeting genomic VPAC receptors
Rajendra B Nerli, Shridhar C Ghagane, Shadab Rangrez, Shreya Chandra, Madhukar L Thakur, Leonard Gomella
October-December 2021, 37(4):345-349
Introduction: Cells exfoliated into urine from the bladder can help to diagnose the cancer. The objective of this study was to validate the hypothesis that bladder cancer could be detected noninvasively by a simple and reliable assay targeting genomic VPAC (combined vasoactive intestinal peptide and pituitary adenylate cyclase-activating peptide family of cell surface receptors) receptors expressed on the malignant bladder cancer cells shed in the voided urine. Methods: Patients ≥18 years of age with either imaging (ultrasonography/computed tomography [CT])-confirmed bladder tumors or those who have been previously treated for nonmuscle invasive bladder tumors and were visiting the department for check cystoscopy, formed the study group. Freshly voided urine sample was collected from these patients and sent for conventional cytology examination, 5-aminolevulinic acid (ALA) fluorescent urine cytology, and for positivity of VPAC receptors. Results: A total of 103 patients were prospectively included in the study. Of these, 65 patients (Group I) presented with image-diagnosed (ultrasonography and/or CT) bladder cancer. The remaining 38 patients (Group II) were previously diagnosed cases of nonmuscle invasive bladder cancer and presented for follow-up and check cystoscopy. The sensitivity for VPAC receptor positivity was 89.23% compared to conventional cytology (63.07%) and 5-ALA fluorescent urine cytology (87.69%). The specificity of VPAC receptor positivity was 100% compared to conventional cytology (100%) and 5-ALA-induced fluorescent cytology (90.47%). Conclusions: Our preliminary study shows encouraging results with VPAC receptor positivity studies, which has a high sensitivity when compared to the conventional cytology.
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Distribution and relation of arousal to ejaculatory latency time, erection to ejaculation latency time, and intravaginal ejaculation latency time in Indian men: A pilot study
Shubham Jhanwar, Jitendra Rohilla
October-December 2021, 37(4):335-338
Introduction: Arousal to ejaculation latency time interval (AETI) and erection to ejaculation latency time interval (EETI) are new tools used to measure ejaculatory latency time (ET). Unlike intravaginal ejaculation latency time (IELT), they are applicable for sexual activities other than penovaginal intercourse and do not require penetration. We assessed the distribution and relation between AETI, EETI, and IELT in Indian men. Methods: Voluntary participation was sought to recruit subjects reporting premature ejaculation (PE) and normal ejaculation. Those able to record the ETs correctly were then asked to record their ETs for two subsequent sexual events. Results: A total of 26 subjects (13 – normal and 13 – PE) were able to complete the study. The mean age of the participants was 29.85 ± 4.8 years, with no difference seen between the two groups. The mean AETI, EETI, and IELT were 817 ± 592.016 s, 726 ± 566.346 s, and 582 ± 450.859 s, respectively, in normal subjects. PE subjects had significantly lesser mean ETs, AETI 80.62 ± 24.74 s, EETI 53.46 ± 25.441 s, and IELT 21 ± 14.785 s. Regression analysis found that 131.67 s of AETI and 99.58 s of EETI were equivalent to 60 s of IELT. Conclusions: AETI and EETI have positively skewed distribution similar to IELT. Premature ejaculators had less difference between AETI and EETI, suggesting that sexual cycle gets completed immediately following arousal in these subjects causing PE.
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VISION trial: 177Lu-PSMA-617 for progressive metastatic castration-resistant prostate cancer
Gorrepati Rohith
October-December 2021, 37(4):372-373
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Eosinophilic solid cystic renal cell carcinoma: A series of 3 cases elucidating the spectrum of morphological and clinical features of an emerging new entity
Uma Sakhadeo, Subhash C Yadav, Ganesh Kailsas Bakshi, Gagan Prakash, Aparna Katdare, Santosh Menon, Sangeeta B Desai
October-December 2021, 37(4):350-354
Eosinophilic solid cystic renal cell carcinoma (ESC-RCC) is a recently described entity, which demonstrates distinct clinical, pathological and molecular features. We present a series of three cases, the first to be reported from the Indian subcontinent. All three patients were over 50 years of age; and presented with a large kidney mass. One patient had a locally advanced disease while the other two presented with metastases. Microscopic examination revealed a tumor displaying solid-cystic and/or papillary areas composed of clear as well as eosinophilic cells in all three cases. On immunohistochemistry, all the three cases showed a unique CK20+/α-methyl-acyl-CoA-racemase + immunophenotype. Melan-A was focally positive in Case 2. Cytokeratin 7 was focally but strongly positive in Case 3. The two patients with metastatic disease were diagnosed on core biopsies and were advised oral tyrosine kinase inhibitor therapy. The third patient underwent upfront radical nephrectomy. Due to its peculiar morphology and immunoprofile, the diagnosis of ESC-RCC can be confidently made even on a core biopsy. Most cases reported till date had an indolent course. The metastatic presentation in two of our patients emphasizes the need to gather further evidence to ascertain the biological behavior of this emerging entity.
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Detection of SARS-CoV2 virus using the real-time reverse transcriptase polymerase chain reaction in semen and seminal plasma from men with active COVID-19 infection – A pilot study
Pankush Gupta, Aashish Choudhary, Giridara Gopal, Rajeev Kumar, Arbind Kumar, Pawan Tiwari, Neena Malhotra
October-December 2021, 37(4):331-334
Introduction: SARS-CoV-2 has been detected in various body fluids. Its presence in semen has been tested with contradictory results. This study aimed to detect the presence of SARS-CoV-2 virus using the real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) in semen and seminal plasma from men with active COVID-19 infection. Methods: In a cross-sectional study at a COVID facility, men aged 20–45 years with active COVID-19 infection provided semen samples within 7 days of symptom onset or 5 days of nasopharyngeal rRT-PCR test positivity in asymptomatic men. Testing of SARS-CoV-2 was performed using rRT-PCR and semen analysis was done for sperm counts and motility as per the WHO (2010) standards. Results: A total of 37 men with a mean age of 32.2 ± 5.6 years were tested. SARS CoV-2 virus could not be isolated in any of the samples. Further, microscopic analysis done on 17 samples showed normal semen parameters during the active phase of disease. Conclusion: Men with mild COVID-19 disease or asymptomatic individuals do not shed virus in their semen, ruling out sexual contact as a mode of transmission in this subset of population.
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Pembrolizumab in bacillus Calmette-Guérin unresponsive nonmuscle-invasive bladder cancer; a difficult to treat disease (KEYNOTE-057)
Bhuwan Kumar
October-December 2021, 37(4):367-368
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Gastrointestinal stromal tumor presenting with lower urinary tract symptoms – A series of five cases with unusual clinical presentation
Subhash C Yadav, Santosh Menon, Ganesh Bakshi, Aparna Katdare, Mukta Ramadwar, Sangeeta B Desai
October-December 2021, 37(4):357-360
Spindle cell tumors of the prostate are very uncommon and the majority involve the prostate secondarily from adjacent organs. Gastrointestinal stromal tumors (GISTs) are specific C-kit (CD 117) expressing mesenchymal tumors occurring in the gastrointestinal tract, commonly in the stomach and intestine; however, it is seldom seen involving the prostate. Although primary prostatic GISTs have been described, majority of them are secondary involvement from rectal GIST. The patient usually presents with urinary tract symptoms or prostate enlargement simulating a prostatic neoplasm. GIST as a differential diagnosis for prostatic mass is never thought of. We present a series of five cases of GIST arising from/involving the prostate mimicking a primary prostatic malignancy and the challenges associated with them for diagnosis and treatment.
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Checkmate 274 trial: Is Nivolumab the new standard in adjuvant setting for high-risk muscle invasive urothelial carcinoma?
Naveen Kumar
October-December 2021, 37(4):369-371
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Thrombus Masquerading a Double J Ureteric Stent
Ankit Misra, Manoj Kumar Das, Swarnendu Mandal
October-December 2021, 37(4):361-362
Renal cell carcinoma (RCC) is the most common renal parenchymal malignancy found in adults. When these tumors are located centrally in the kidney and do not enhance well on contrast imaging, they may be mistaken to be urothelial in origin, and the diagnosis is established on histopathology. We present an interesting case of RCC with an atypical vermiform thrombus projecting into the urinary bladder.
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Nectin-4 inhibitors: An ace up our sleeve against advanced urothelial carcinoma
Santosh Kumaraswamy
October-December 2021, 37(4):365-366
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Management of bleeding from ileal conduit using arterial angioembolization
Mihir Pandya, Ravikumar Karunakaran, Surdas Radhakrishnan
October-December 2021, 37(4):355-356
Ileal conduit is usually created for urinary diversion after radical cystectomy. The complications of ileal conduit are mainly metabolic. The management of ileal conduit bleeding is challenging, especially in non-cirrhotic patients. We report a patient with gross haematuria from an ileal conduit where super selective arterial embolization was successfully performed after all conservative measures failed.
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Miniaturized percutaneous nephrolithotomy: Is smaller really better?
Gopal Sharma
October-December 2021, 37(4):363-364
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