Kawaljit Singh

Confirmation of the correct placement of lower end of DJ stent during open surgery: point of technique.

A simple technique to confirm the correct placement of the double J (DJ) stent at the time of antegrade insertion during open surgery is described. At the time of antegrade DJ stent placement about 30–50 ml of sterile methylene blue is instilled into the bladder. Appearance of methylene blue from the upper end and side holes of the DJ stent confirms the correct placement of the lower end of the stent.

Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: A prospective randomized study

Aim: Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g. Materials and Methods: This prospective randomized study includes 164 patients. Inclusion criteria were age <75 years after failed or poor response to medical therapy, prostatic size >60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery. Results: Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up. Conclusion: HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria.

Crossed fused renal ectopia with chyluria: a rare presentation

Fusion anomalies of the kidney are uncommonly encountered in clinical practice. These are broadly divided into two distinct varieties: horseshoe kidney (most common) and crossed fused renal ectopia (second most common).1 Crossed fused renal ectopia has an incidence of 1:1000 to 1:7500 and is more common in males (2:1), with left to right ectopia being three times more common than right to left ectopia.2 According to Turkvatan et al ,3 the most common variant of crossed fused renal ectopia forms when the upper pole of the inferiorly positioned crossed-ectopic kidney is fused to the lower pole of the superior, normally placed kidney. The presence of chyluria in the setting of crossed fused ectopic kidney is uncommonly reported. We report a unique case of chyluria in a middle-aged man with crossed fused renal ectopia associated with a large calculus in the middle one-third of the crossed ureter. A 35-year-old man presented with intermittent mild left flank pain and milky urine, with no history of urinary tract infections, trauma or instrumentation. Chyluria was confirmed by the presence of chyle and triglycerides in postprandial urine. A plain X-ray KUB and intravenous pyelography (IVP) showed non-opacification of the right kidney and a malrotated left kidney with mid-ureteric calculus in the crossed ureter (figure 1). On ultrasonography of the kidney, ureter and urinary bladder, the right kidney was present on the left side, fused at its upper pole with the lower pole of the left, normally located kidney (figure 2). Contrast-enhanced CT of the kidney, ureter and urinary bladder showed a slightly smaller sized right kidney (crossed to the left side and fused with the lower pole of the normal placed left kidney at its upper pole), revealing moderate hydroureteronephrosis as a result of 17 mm calculus present in the middle one-third of …

Page kidney: A rare but surgically treatable cause of hypertension

The Page kidney is a rare phenomenon. External renal parenchymal compression is the culprit. We report two cases of young males with flank pain, renal mass, and hypertension with history of blunt abdominal trauma. Initially, hypertension was controlled by angiotensin-converting enzyme (ACE) inhibitors but gradually became refractory to medical treatment. Laparoscopic nephrectomy was performed in both patients. We emphasize the Page kidney as a cause of hypertension in young patients, presenting with flank pain and renal mass with or without complications of hypertension. Management is aimed to control blood pressure by ACE inhibitors, aspiration of the hematoma, open hematoma evacuation, or nephrectomy.

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.

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.

MP40-17 PROSPECTIVE RANDOMIZED COMPARISON OF REPAIRING SIMPLE VESICOVAGINAL FISTULA WITH OR WITHOUT INTERPOSITION FLAP: A TERTIARY CARE HOSPITAL STUDY FROM NOTHERN INDIA

CONCLUSIONS: Use of third line therapy for OAB has been reported to be less than 5%. This rate is higher at our institution, likely due to access to multiple FPMRS providers. The authors also use a care pathway that emphasizes early patient education on available options should they fail first and second line treatments. Even in a tertiary referral center it is likely that third line therapy is not being offered to many patients who would benefit from it. Our data demonstrate an opportunity for urologists to improve the quality of care and treatment success rates for OAB patients.

Nephrolithisis in a newborn: a rare case and review of literature

Nephrolithiasis, although a common entity in adults, is less common in children and rare in newborns. The evaluation and management strategies of renal stones in neonates are unclear. We report a rare scenario of renal calculus in a newborn aged 3 days presenting with decreased urine output, fever and crying during micturition. Patient was thoroughly investigated and managed conservatively. Further follow-up showed increase in stone size with recurrent urinary tract infections, hence shock wave lithotripsy was performed to successfully break and clear the stone fragments. Patient recovered well and was doing fine until last follow-up.