Bhupendra Pal Singh

Retrograde Intrarenal Surgery vs Extracorporeal Shock Wave Lithotripsy for Intermediate Size Inferior Pole Calculi: A Prospective Assessment of Objective and Subjective Outcomes

OBJECTIVE To assess objective and subjective outcomes of retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (SWL) for the treatment of intermediate size (1-2 cm) inferior calyceal (IC) stones in a prospective randomized fashion. METHODS Between March 2011 and January 2013, 70 symptomatic adults who had isolated IC stone between 10 and 20 mm underwent RIRS or SWL by computer-generated pseudorandom assignment (1:1). Success rate, mean procedure time, hospital stay, pain score on day 1 and 2 using visual analog scale, analgesic requirement after discharge, complications, retreatment rate, auxiliary procedure, and patient-reported outcomes (using self-made nonvalidated questionnaire) were compared. RESULTS Baseline parameters and mean stone size (SWL 16.45 ± 2.28 mm, RIRS 15.05 ± 3.56 mm; P = .0542) were comparable. Success rate was significantly higher after a single session of RIRS compared with 3 sessions of SWL (85% vs 54%; P = .008). Retreatment rate (65% vs 5.7%; P = .0001) and auxiliary procedure (45% vs 8%; P = .0009) were significantly higher in SWL. Pain score on postoperative day 1 and 2 was significantly higher in RIRS, but patients with SWL required significantly more analgesics afterward. Most of the complications were of Clavien grade I and/or II in both groups. Average time to return to normal activity and voiding symptoms were significantly higher in RIRS. Overall satisfaction score (2.17 ± 1.24 vs 2.82 ± 1.17; P = .026) was significantly higher in RIRS than SWL. CONCLUSION For the treatment of intermediate size IC calculi, RIRS is superior to SWL in terms of objective and subjective outcomes.

A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments

To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL).

Null genotypes at the GSTM1 and GSTT1 genes and the risk of benign prostatic hyperplasia: a case-control study and a meta-analysis.

Benign prostatic hyperplasia (BPH) is an age related non‐malignant disease diagnosed as lower urinary tract symptoms and prostatic enlargement. Null genotypes in drug detoxification glutathione‐S‐transferase genes/enzymes, such as GSTT1 and GSTM1 have been reported to increase risk of several cancers including prostate. Meta‐analysis on PC also suggested significant impact of GSTM1 null genotype but not that of GSTT1; however, BPH data have not been subjected to meta‐analysis.

Primary synovial sarcoma of kidney: A rare tumor with an atypical presentation

Synovial sarcoma (SS) is a tumor of the soft tissues with a unique chromosomal translocation t(X;18)(p11.2;q11.2) that can be detected by polymerase chain reaction in tissue homogenates. Here we present a case of a 20-year-old female presenting PSS of the left kidney with caval thrombus. The diagnosis was corroborated by reverse transcription polymerase chain reaction (RT-PCR). Similar cases of PSS of kidney with tumor extension in the inferior vena cava are extremely rare and to date, approximately three cases have been reported in the literature.

Comparison of Extracorporeal Shock Wave Lithotripsy for Inferior Caliceal Calculus Between Children and Adults: A Retrospective Analysis—Why Do Results Vary?

OBJECTIVE To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for inferior caliceal calculi ≤ 20 mm in size and compare the results between children and adults. MATERIALS AND METHODS From January 2004 to January 2012, ESWL was performed for inferior caliceal calculi in 230 children and 1006 adults. The Dornier compact alpha-K1025163 (Dornier Med Tech) was used. The success rates, number of ESWL sessions required, and auxiliary procedures used were evaluated in a comparative manner. RESULTS The overall stone-free rate (for both stone sizes) was 82.2% for children and 40% for the adults. Of the children, 17% had a residual stone compared with 47.8% of the adults. ESWL was unsuccessful in 0.8% of children and 12.2% of adults. The mean number of ESWL sessions required in children and adults was 1.43 (range 1-4) and 2.13 (range 1-4), respectively. Repeat treatment was required in 31% of the children and 65% of the adults. Auxiliary procedures were required in 5.2% of the children and 16.2% of the adults. Complications were seen in 5.6% of the children and 15% of the adults. CONCLUSION The results of ESWL for inferior caliceal calculi ≤ 20 mm in adults remains poor but not so in children. Children can achieve high stone-free rates, require a fewer number of ESWL sessions than adults to be stone free, and have a lower need for repeat treatment and auxiliary procedures, and have fewer complications.

Factors affecting response to medical management in patients of filarial chyluria: A prospective study

Introduction: Filarial chyluria is a common problem in filarial endemic countries. Its management begins with medical therapy but some patients progress to require surgery. The present study aimed to determine factors affecting response to medical management in patients of filarial chyluria. Materials and Methods: This prospective study conducted between August 2008 and November 2012, included conservatively managed patients of chyluria. Demographic profile, clinical presentation, treatment history and urinary triglycerides (TGs) and cholesterol levels at baseline were compared between the responders and non-responders. Apart from the clinical grade of chyluria, hematuria was evaluated as an independent risk factor. Results: Out of the 222 patients (mean age, 37.99 ± 13.29 years, 129 males), 31 patients failed to respond while 35 had a recurrence after initial response; the overall success rate being 70.3% at a mean follow-up of 25 months. No difference was observed in demographics, clinical presentation, presence of hematuria, disease duration and mean urinary TGs loss between responders and non-responders. On multivariate analysis, patients with treatment failure were found to have a higher-grade disease (14.3% Grade-I, 36.6% Grades-II and 60% Grade-III), higher number of pretreatment courses (1.59 ± 1.08 vs. 1.02 ± 0.79) and heavier cholesterol (26.54 ± 23.46 vs. 8.81 ± 8.55 mg/dl) loss at baseline compared with responders (P < 0.05). Conclusion: Conservative management has a success rate in excess of 70%, not affected by the disease chronicity, previous episodes and recurrent nature. However, higher-grade disease, extensive pre-treatment with drugs and higher urinary cholesterol loss at baseline are the predictors of poor response. Hematuria is not an independent poor risk factor for conservative management.

Cystographic images of Youssef syndrome: flower on top of the bladder.

Vesicouterine fistula after obstructed labor is very rare. Hysterosalpingography is the investigation of choice. Cystography primarily does not demonstrate the fistula because the intrauterine pressures are higher than the vesical pressure. A 38-year-old woman presented to us with vecisovaginal fistula and vesicouterine fistula that had developed 13 years earlier after obstructed labor and vaginal delivery of a stillborn neonate. She was found to have normal renal function, but she had developed small capacity bladder and the cystogram performed with Foley catheter showed contrast spilling into the uterus. She was managed by continent urinary diversion.

Sexual dysfunctions and lower urinary tract symptoms in ankylosing spondylitis.

To determine sexual dysfunctions and urinary symptoms in male ankylosing spondylitis (AS) patients and their association with various disease and patient factors.

Re: Li et al.: Percutaneous Nephrolithotomy Under Local Infiltration Anesthesia: A Single-center Experience of 2000 Chinese Cases (Urology 2013;82:1020-1025)

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Effect of intravesical immunotherapy on sperm parameters in young patients with non--muscle-invasive bladder carcinoma: prospective analysis.

INTRODUCTION To investigate the effects of intravesical immunotherapy on semen parameters in young patients with non-muscle invasive bladder tumour. METHODS A total of 17 sexually active male patients < 45 years of age underwent transurethral resection of bladder tumour (TURBT) from Jan 2010 to Dec 2012. On HPE analysis, T1 high grade was found in 16 patients and Ta grade high grade in 1 patient. Associated CIS was found in 4 patients. Induction course of 6 weeks of adjuvant BCG therapy was given. Semen analysis was done 1 week prior to BCG therapy and 3 months after BCG therapy. Serum levels of hormones like total testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were also measured. RESULTS Mean age of patients at diagnosis was 34.6 (29-43) years. Total semen volume was found to be decreased in 2 patients. Main parameter which was deteriorated was total sperm concentration which was significantly decreased in 12 patients and 5 patients even had their counts below oligospermia levels. Seven patients had associated decrease in sperm motility. However, no patient showed significant difference in other semen parameters. Also no patient had any change in androgen hormonal status except 2 patients in which serum testosterone was found to be non-significantly decreased. CONCLUSION Intravesical therapy with BCG was found to adversely affect spermatogenesis and cause oligospermia. It is important that relatively young patients must be informed of these effects and advised to have sperm preservation before instillation of BCG therapy to avoid fertility issues in future.