Madhusudan Patodia

Prospective randomized comparison of three endoscopic modalities used in treatment of bladder stones.

Introduction The aim of this study was to compare three endoscopic modalities used in the treatment of bladder stones: transurethral use of cystoscope or nephroscope and percutaneous cystolithotripsy (PCCL). Methods This study included 210 patients of bladder stone treated at a tertiary care centre in North India from January 2006 to July 2013 who were randomly assigned into three groups: group 1 (transurethral removal using cystoscope), group 2 (transurethral removal using nephroscope) and group 3 (PCCL). Baseline and perioperative data wererecorded and compared between three groups. Results Baseline parameters were comparable between the three groups. Operating time in group 2 was significantly less than the other two groups. Complete clearance was achieved in all the patients. Group 2 had maximum number of urethral entries. The incidence of perioperative complications (fever, transient haematuria and persistent leakage from suprapubic site) was comparable between these three groups. Till the last follow-up, 3.2% patients (n = 2) developed urethral stricture in group 1, 7.8% (n = 5) in group 2 and no patient developed urethral stricture in group 3 (p = 0.068). Conclusions Removal of bladder stones by the transurethral route, using a nephroscope, is the most effective treatment modality in terms of operative time with long-term urethral stricture rate similar to transurethral cystoscope technique. Comparatively, PCCL is a safe procedure with acceptable morbidity. Overall, all three techniques are equally efficacious in treating bladder stones of size 1-4 cm.

Management of renal caliceal diverticular stones: A decade of experience

Objective: The objective of this study is to evaluate our methods for management of renal caliceal diverticular stones (CDS). Materials and Methods: We conducted a retrospective study from January 2005 to July 2015 and included patients who were treated for renal CDS. Patients were evaluated for treatment modality, puncture site (in case percutaneous nephrolithotomy [PCNL] attempted), operative time, stone clearance rate, and complications. During PCNL, if the infundibulum was found to connect the diverticulum to the calyx, then a double J stent was placed. No attempt was made to dilate the diverticular neck or to create a neoinfundibulum. Results: Twenty-four patients were treated for CDS during the study period. Two patients underwent shockwave lithotripsy, and 22 were managed by PCNL. Mean stone size was 16.37 mm (range: 6–35 mm) and mean diverticulum size was 20.62 mm (range: 12–37 mm). No fulguration was done in initial 17 patients, while fulguration by Holmium Laser was performed in the last five cases treated with PCNL. Mean operative time was 70.31 min (range: 47–90 min). Mean follow-up was 34 months, diverticulum resolved in 14 patients and reduced in size in 7 patients. Conclusion: Caliceal diverticular calculi can be treated most efficiently by PCNL. Stone-guided puncture and no attempt to dilate or create neoinfundibulum reduces operative time and morbidity while yielding high stone-free rate.

Bladder calculus leading to acute renal failure in a girl child: a rare cause

A 10-year-old girl presented with acute renal failure (ARF) with a serum creatinine of 7.5 mg/dL. Imaging showed bilateral hydroureteronephrosis and a large bladder stone (75×55 mm). The large bladder stone was probably the aetiology of bilateral hydronephroureter and ARF as no other cause could be found. An open cystolithotomy was performed. Ten days after the surgery, serum creatinine decreased to 0.7 mg/dL. In this report, we highlight an unusual cause of renal failure.

Early removal of urinary catheter after excision and primary anastomosis in anterior urethral stricture.

OBJECTIVE To investigate the feasibility of removing the urinary catheter 7 days after excision and primary anastomosis (EPA) performed with the indication of anterior urethral stricture disease. MATERIAL AND METHODS Retrospective review of medical records of the patients who had undergone EPA between January 2005 and December 2010 was performed. These patients were divided into 2 groups: Group 1 (urethral catheter removed on or before 7. postoperative day) and Group 2 (urethral catheter removed on 8. postoperative day or later). We compared 2 groups as for the frequency of extravasation as detected on retrograde pericatheter urethrogram (PUG) and recurrence rate till the last follow-up. RESULTS PUG was performed on an average day 7 and 14 in Groups 1 (n=102) and 2 (n=134), respectively followed by removal of the catheter. Extravasation on the first PUG was detected in 6.8% of the patients in Group 1, and in 4.5% of the cases in Group 2 had extravasation on the first PUG. Urethral catheter was left in situ in these patients and a repeat PUG after one week was performed which was normal in all cases. The incidence of extravasation and recurrence rate did not differ significantly whether catheter was removed on day 7 or 14 (6.8% vs. 4.5% and 4.9% vs. 5.2% respectively) (p>0.5). CONCLUSION We conclude that removal of the catheter on postoperative day 7 after EPA does not increase the rate of extravasation and recurrence during long-term follow-up. Urethral catheter restricts physical activity in the postoperative period which is bothersome to the patient. Hence early removal of a catheter should be offered to men after EPA.

Prostato-inguinal fistula: An unusual site of voiding.

An 8-year-old boy presented with voiding from the right inguinal region, which on evaluation was diagnosed as prostato-inguinal fistula. We discuss the pathophysiology of this fistula.

Synchronous ipsilateral adrenocortical carcinoma and renal cell carcinoma: a rare clinical entity

Synchronous ipsilateral adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC) are rare. Radiological imaging may not in all cases differentiate between the two tumours due to their proximity to each other. We encountered a case where preoperative diagnosis of renal cell carcinoma was made based on the radiological imaging but, following radical nephrectomy, this was found to be synchronous ACC and RCC after histopathological examination. The patient is doing well at 12 months of follow-up, with no clinical or radiological recurrence.

Isolated renal echinococcosis: a rare disease

Primary renal hydatid cyst is a rare disease.1 A 35-year-old woman presented with heaviness and a mass on the right side of her abdomen for 1 year. No history of loss of appetite, generalised weakness or weight loss was present. The medical history was unremarkable. On examination, a firm globular bimanually palpable mass was present in the right lumbar area extending from the right subcostal margin to the right iliac fossa. Ultrasonography revealed a right cystic renal mass (figure 1A). MRI detected an ill-defined …