Ashok Kumar Sokhal

Clinical spectrum of electrical burns – A prospective study from the developing world

INTRODUCTION Electrical burns are devastating, posing development of multiple injuries with high morbidity and mortality. Electrical burn management benefits from a multidisciplinary, multispecialty collaborative approach to improve outcomes. OBJECTIVE To highlight the clinical spectrum of electrical burns in the developing world, including common etiologies, presentation, intervention, associated injuries, and complications. MATERIALS AND METHODS A prospective study was conducted from January 2010 to December 2015 that included 78 patients (75 men and 3 women), who presented with a history of electrical burns. Patients were interviewed for detailed clinical history and physical examination. RESULTS The study comprised 78 patients (high-voltage group: 38.46% and low-voltage group: 61.54%). The most affected age group was the 21-40 year age group. High-voltage injuries were more devastating. The most common complication was septicemia in 24.4% of the patients, which included 43.3% from the high-voltage group. CONCLUSION Electrical burns affecting young adult men can impose a significant burden in developing countries. Electrical burns, especially due to high voltage, involve multiple organs benefitting from multidisciplinary management and have significant residual sequelae. Public awareness and education and proper training of industry workers remain the best way to minimize the prevalence of electric burns in the developing world.

WITHDRAWN: Transurethral Resection of Prostate and Bleeding: A Prospective Randomized, Double-blind, Placebo-controlled Trial to See Efficacy of Short-term Use of Finasteride and Dutasteride on Operative Blood Loss and Prostatic Microvessel Density

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Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: A retrospective outcome analysis

Purpose: The purpose of this study was to evaluate the clinical outcome and efficacy of transurethral resection of the prostate in patients of benign prostatic enlargement (BPE) with underactive bladder. Materials and Methods: Retrospective study of 174 patients, who underwent transurethral resection of prostate (TURP) between 2008 and 2015, for lower urinary tract symptoms with BPE with bladder underactivity. Clinical history, physical examination, renal function test, urinalysis, cystourethroscopy, transabdominal or transrectal ultrasonography, and urodynamic study were recorded. Patients having a history of neurologic conditions, spinal trauma or surgery, pelvic trauma or surgery, diabetes mellitus with end organ damage, urethral pathology or surgery, and prostatic cancer were excluded from the study. Results: The mean follow-up period was 22.4 ± 6.2 months. Mean prostate volume was 42.8 ± 6.4 ml and mean serum prostate-specific antigen was 2.3 ± 1.8 ng/ml. The International Prostate Symptom Score changed from 24.6 ± 4.2 preoperatively to 10.8 ± 5.8 postoperatively which was found statistically significant. Quality of life (QOL) score changed from 4.8 ± 1.2 to 2.6 ± 0.4. Twenty-two patients out of 174 remained on a per-urethral catheter or clean intermittent catheterization due to voiding failure after TURP beyond 1 month. Conclusions: TURP should be considered a viable treatment option in men with enlarged prostate with underactive detrusor who had poor response to medical treatment. Preoperative counseling and postoperative follow-up are crucial in the management of such patients.

Giant Hydronephrotic Kidney Masquerading as Urinoma: A Rare Presentation with Review of Literature

Giant hydronephrosis (GH) is a condition in which pelvicalyceal system contains more than 1000 ml of urine. Common causes of GH are uretero-pelvic junction obstruction, renal calculus, abdominal trauma. We are reporting a case of 45 years’ male, who presented with abdominal trauma and haematuria and was suspected a urinoma secondary to renal trauma. Examination revealed soft, cystic abdominal lump. Computed tomography of the abdomen revealed grossly hydronephrotic right kidney. The patient was managed by pyeloplasty after renal scan (estimated plasma renal flow- 91.92 ml/minute). Giant hydronephrotic kidney presenting with history of trauma may be confused with post traumatic urinoma.

Does prostate size predict the urodynamic characteristics and clinical outcomes in benign prostate hyperplasia

Aims: Bladder outlet obstruction (BOO) in large and small prostates is managed in a similar manner despite considerably different pathophysiology, which can result in higher failure rates. We investigate the clinical and urodynamic features and study the outcome of patients with benign prostate hyperplasia (BPH) according to their prostate size. Subjects and Methods: We prospectively analyzed 100 BPH patients undergoing urodynamic study between January 2015 and August 2016 and divided them into two groups according to their prostate size: small (≤30 mL) and large prostate (>30 mL) groups. We compared the groups regarding age, International Prostate Symptom Score, maximal flow rate (Qmax), postvoided residual, serum prostate-specific antigen (PSA), prostate volume measured by ultrasonography (USG), and urodynamic findings. Statistical Analysis Used: For testing the hypothesis, we used the Chi-square test, Students t-test, and one-way analysis of variance when comparing between groups and conducted the logistic regression analysis for determining predictive factors of BOO. Results: Although the total prostate volume significantly correlated with the PSA, patients with a small prostate had lower Qmax (5.27 ± 4.8 mL/s vs. 6.14 ± 6.66 mL/s; P= 0.74), higher incidence of abnormal baldder capacity (39.9% vs. 31.25%), lower voiding efficiency (39.3 ± 40.5% vs. 40.57 ± 32.11%), low compliance (44.4% vs. 31.3%), higher incidence of indeterminate detrusor contractions (38.9% vs. 37.5%), lower incidence of detrusor underactivity (33.3% vs. 28.1%), lower BOO index (40.9 ± 43.2 vs. 49.10 ± 44.48), lower bladder contractility index (77.8 ± 48.84 vs. 92.09 ± 52.79), and lower PdetQmax (51.44 ± 42.23 vs. 61.38 ± 42.01 cmH2O). Small prostates had higher failed voiding trials postsurgery. Conclusions: BOO patients with a small prostate showed poor urodynamic parameters and reported higher postoperative complications.

Rare Occurrence of Giant Metastatic Inguinal Lymph Nodes in Carcinoma Bladder

Inguinal lymph node metastasis of a bladder cancer is a rare scenario. As of today, only 4 cases of inguinal lymph node metastasis from bladder cancer have been reported in the literature. We report a rare giant inguinal lymph node metastasis of transitional cell carcinoma of the bladder in a patient after radical cystoprostatectomy. Chemotherapy and radiotherapy were given, but the metastatic tumor remain unchanged.

Outcome analysis of transurethral resection versus potassium titanyl phosphate-photo selective vaporization of the prostate for the treatment of benign prostatic hyperplasia; a randomized controlled trial with 4 years follow up

OBJECTIVE Photovaporization of prostate (PVP) is a newer surgical modality of benign prostatic hyperplasia (BPH) which is gaining importance recently. There are a few randomized controlled trials that showed safety and efficacy of PVP in comparison with transurethral resection of prostate (TURP) with limited follow-up period (<2 years). Here, we are presenting a comparative study performed on potassium titanyl phosphate (KTP) PVP laser versus TURP for the treatment of BPH with long-term follow-up period. MATERIAL AND METHODS After institutional ethical clearance, 150 patients were prospectively included in the study from January 2010 to March, 2012. Improvement of International Prostate Symptoms Score (IPSS), Qmax, post-void residual (PVR) urine, International Index of Erectile Function (IIEF)-5 score and complications were assessed at 12, 24, 36 and 48 months. RESULTS Mean age of the study group was 65.3±7.86 years in the TURP and 63.6±8.12 years in the PVP groups (p=0.45). IPSS symptom score improved significantly in both TURP and KTP groups (p<0.003). There was improvement in Q max during follow-up in both groups (p<0.001) which was maintained at 48 months. Most of the patients in both groups were satisfied with symptoms and bothersome at 48 months. All the sexual parameters are similar to both groups except retrograde ejaculation. Overall complication noted in 23 patients (15.33%). CONCLUSION Both KTP Laser PVP and TURP afford durable relief from symptoms of BPH at 48 months follow-up. Both procedures are safe and associated with minimal complications. Both procedures do not have any detrimental effect on sexual function on long-term follow-up. Quality of life remains high even at 4 years in both groups.

Evaluation of Impact of Voiding Posture on Uroflowmetry Parameters in Men

Purpose To evaluate the impact of voiding position on uroflowmetry parameters and to assess its potential clinical implications. Materials and Methods We conducted a prospective study from 2013 to 2015 and included men between 18 and 77 years old who were either healthy volunteers with an International Prostate Symptom Score (IPSS) ≤7 or men with benign prostate enlargement that were on alpha-blocker medication and had an IPSS <10. Participants underwent uroflowmetry and post-void residual urine (PVRU) measurements twice, once in a sitting position and once in a standing position. The participants were divided into 4 groups based on age (35 years or younger, 36 to 50 years, 51 to 60 years, and older than 60 years). Results A total of 740 men with a mean age of 40.35 years were evaluated. There was no significant difference in uroflowmetry parameters until the age of 50 years between the voiding positions. However, in those older than 50 years, PVRU volume was significantly lower in the sitting position than the standing position, whereas voiding time was significantly higher in the sitting position than the standing position. Other uroflowmetry parameters, including maximal and average urine flow rates, were non-significant. Conclusions The voiding position plays an important role in the uroflowmetry parameters of elderly men. Voiding in the sitting position was found to be optimal for elderly men, whereas the role of the voiding position in healthy young men could not be determined. More research is needed to further study this issue.

MP50-20 DOES PREOPERATIVE ALPHA BLOCKERS FACILITATES URETEROSCOPE INSERTION AT VESICO URETERIC JUNCTION? AN ANSWER FROM A PROSPECTIVE RANDOMIZED STUDY.

INTRODUCTION AND OBJECTIVES: While single session bilateral ureteroscopy (URS) (SSBU) has the advantage of one anesthetic procedure, some may pursue a staged approach due to the potential higher risk of complications and patient discomfort with two ureteral stents. The aim of this series is to compare outcomes of patients undergoing SSBU to those undergoing staged URS for bilateral nephrolithiasis. METHODS: We retrospectively identified patients undergoing SSBU and staged URS for nephrolithiasis between September 2007 and January 2014. Preoperative characteristics, intraoperative techniques, and postoperative outcomes were compared. Stone burden was calculated as cumulative stone diameter. Residual stone fragments were defined as any stone visible on postoperative imaging. RESULTS: Sixty-three nonconsecutive patients underwent SSBU and 37 underwent staged URS. Patients undergoing SSBU had significantly more stones in mid pole calyces (28% versus 16%, P 1⁄4 0.0008) and the renal pelvis (5% versus 2%, P 1⁄4 0.048), though both groups had similar stone burden based on cumulative maximal diameter (Table 1). Patients undergoing SSBU had longer operative time when compared to any single stage URS, however, total operative time was significantly longer for staged URS (139 versus 86 minutes, P < 0.0001) (Table 1). Patients undergoing staged URS were more likely to require laser lithotripsy per renal unit (RU) (99% versus 71%, P 1⁄4 0.0001) and have a ureteral stent placed at the end of the procedure (96% versus 81% RUs, P 1⁄4 0.003). There were no significant differences in complications, emergency room (ER) visits, need for additional procedures, or stone free rates (SFR). CONCLUSIONS: SSBU is safe and effective with overall shorter operative times and similar SFR compared to staged URS. For patients with bilateral nephrolithiasis, urologists should strongly consider SSBU to limit anesthetic exposure, overall operative time, and health care costs.

Urethrocutaneous fistula mimicking vesicocutaneous fistula: a rare entity

Urethral fistulas arising from the anterior urethra usually open on the ventral aspect and are located in the penile, scrotal or perineal region. A diabetic 65-year-old man presented with suprapubic urinary fistula that was communicating with a dorsally located internal urethral opening located in the bulbar region. Such unusual fistula has not been described before.