Manish Garg

Prevention of Prostate Cancer with Vitamins - Current Perspectives

Cancer prostate is the most common solid malignancy in males of developed countries. With increasing knowledge of the aetiology, pathogenesis and natural history of the disease, influences of dietary factors on prostate cancer development have become more evident. There is ample evidence in the literature of significance of dietary constituents for prostate cancer including vitamins A, D and E. Different vitamins have been found to effect the growth and proliferation of prostate cancer cells as evident in epidemiological, experimental and clinical studies. Various factors play the major role in determining the relationship between these vitamins and prostate cancer in terms of environmental, pharmacological, or genetic aspects. To explore these aspects, the present article reviews the literature on the present status of vitamin use for prevention and management of prostate cancer.

Full-term broad ligament pregnancy.

A broad ligament pregnancy is an extremely rare condition. The eventuality of such pregnancies reaching full term is even rarer. A full-term broad ligament pregnancy occurring through a rent in a previous lower segment caesarean scar has only been mentioned in literature but not reported. Our patient is an unbooked case, reported to us at 39 weeks of pregnancy. On clinical examination, an ultrasound and an MRI, a diagnosis of abdominal pregnancy was made. Ultimately the final diagnosis was made only on laparotomy. A broad ligament pregnancy was found with a rent in the previous caesarean scar communicating the fetal sac.

Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults

OBJECTIVE To determine the subjective and objective outcomes of retroperitoneoscopic vs open pyeloplasty with minimal incision in a prospective randomized comparison study. METHODS In this study between August 2011 to July 2013, 30 patients underwent retroperitoneal laparoscopic pyeloplasty and 30 open pyeloplasty with minimal incision (incision length <10 cm) after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Success rates were evaluated by improvement in pain score and objectively by diethylene triamine penta-acetic acid renal scan and other parameters. Statistical analysis was performed with SPSS version 16.0 (IBM) with P <.05 considered statistically significant. RESULTS The difference in the visual pain score (5.6 vs 3.2 on day 1; 3.8 vs 1.5 on day 2) and the diclofenac requirements (333.3 vs 178.75 mg) were statistically significant and more in the open pyeloplasty. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Success rate was found to be 96.67% with 1 failure in each group. Two patients in retroperitoneoscopic group required conversion. Both groups showed significant improvement in pain score and drainage pattern on diethylene triamine penta-acetic acid scan with decrease in hydronephrosis on ultrasound evaluation. CONCLUSION Although subjective and objective outcomes are equivalent in both the groups, the retroperitoneoscopic approach is associated with significantly less pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison with open pyeloplasty.

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.

Effectiveness of single-dose fosfomycin as antimicrobial prophylaxis in transrectal ultrasound-guided biopsy of the prostate.

with a much lower rate of infectious complications. Rectal cultures obtained before TRUS biopsy facilitated targeted antibiotic prophylaxis, and thus reduced infectious complications as described by Duplessis et al. [4] . In a recent study [1] , the authors used 500 mg ciprofloxacin twice daily starting 1 day before the biopsy and continued for a total of 5 days in patients undergoing transrectal prostate biopsy. However, according to current guidelines [5] issued by the American Urological Association, even a single-dose protocol was as effective as the threeor five-days dosing. In addition, 5 patients who received fosfomycin also developed either febrile or afebrile urinary tract infection. The reason of septicemia in We appreciate Ongün et al. [1] as they very well infer the positive effects of fosfomycin for prophylaxis against septicemia after prostate biopsy. Various antibiotic protocols and methods have been described in the literature to reduce risk of sepsis after prostate biopsy. Pace et al. [2] in a prospective, randomized, double-blind study described the use of periprostatically administered ceftriaxone along with oral ciprofloxacin and found it to be effective in the control of infections caused by fluoroquinolone-resistant Escherichia coli . In a another prospective study in 530 patients by Gil-Vernet Sedo and Alvarez-Vijande García [3] , intrarectal use of 30 g of 10% povidone-iodine before prostate biopsy was associated Received: March 8, 2013 Accepted: March 8, 2013 Published online: June 6, 2013

Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India.

Aim: Prospective randomized study on transperitoneal laparoscopic ureterolithotomy (TPLU) versus open ureterolithotomy (OU) for treatment of large impacted ureteric stones (≥ 1.5 cm) and assessment of overall results. Material & Methods: In a prospective study between 2010 to 2012, 30 patients underwent TPLU and 30 OU based on 1:1 randomization. The operation was indicated primarily in 44 cases or after failed shock-wave lithotripsy/ureteroscopy in 16 cases. Two groups were compared for operative time, success rate, visual pain score, analgesic requirement, hospital stay, and postoperative complications. Statistical analysis was performed with SPSS® version 16.0 using Fisher exact or Mann-Whitney U tests with p < 0.05 considered statistically significant. Results: The difference in visual pain score (6.2 in TPLU group vs 3.1 in OU group on day 1; 4.8 vs. 2.4 on day 2) and tramadol requirements (184.32 mg in TPLU group vs. 150.87 mg in OU group on day 1; 97.34 mg vs. 65.56 mg on day 2) were statistically significant and more in OU. Hospital stay and convalescence were significantly lower in the TPLU. However, stone removal in one attempt was similar in both the groups. Conclusion: Although successful stone removal rates are equal in both groups, TPLU is associated significantly with less postoperative pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison to OU.

Self-inflicted long complex urethro-vesical foreign body: is open surgery always needed?

In this case report, we describe our experience of a self-inflicted long complex urethrovesical foreign body managed suprapubically through the minimally invasive technique. A 21-year-old man with antipsychotic treatment for the past 10 years presented with a long electric cable wire in his bladder with the distal end in the penile urethra. He presented with symptoms of voiding difficulty and gross haematuria. An attempt of gentle retrieval of wire through the cystoscopic forceps was not successful due to a very complex knot of cable in the bladder. To avoid open surgery such as suprapubic cystotomy, the percutaneous minimally invasive approach was planned. Access to the bladder was achieved by the suprapubic puncture of the bladder, placement of a guide-wire and serial dilation of supra-pubic tract. With the help of nephroscope, through suprapubic tract, the cable wire was retrieved antegradely without causing undue trauma to the bladder or urethra.

Mini incision open pyeloplasty - Improvement in patient outcome.

ABSTRACT Purpose: To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO). Materials and Methods: Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS). For objective assessment, the improvement in differential renal function (DRF) and radio-tracer wash out time (T1/2) on Tc-99m DTPA scan and decrease in hydronephrosis (HDN) on renal ultrasound (USG) and urography (IVU) were assessed. Results: Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124) minutes and 2.5 (2–6) days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001) and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively. Conclusions: Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.

Urethro-Ejaculatory Duct Reflux, a Complication of Peno-Bulbar Urethral Stricture: Case Report with Review of the Literature

Urethro-ejaculatory duct reflux (UEDR) is an uncommonly discussed entity that may result in devastating complications. We discuss the case of a young married male with obstructive voiding symptoms along with intermittent left scrotal pain for last the 2 years. On voiding cystourethrography, he had intravasation of contrast into the prostatic ducts, vas deferens and epididymal ducts suggestive of UEDR which might be the cause of his scrotal pain due to recurrent episodes of epididymitis. Complete resolution of voiding symptoms and recurrent scrotal pain occurred after management of urethral stricture. The possibility of UEDR should be kept in mind while dealing with men suffering from recurrent prostatitis, seminal vesiculitis, epididymitis or, less commonly, infertility.

Short-term morbidity following No-Scalpel Vasectomy: an assessment of clients' perceptions by novel postcard system.

Objective Data on short-term (within a week) morbidity of No-Scalpel Vasectomy (NSV) is lacking. We studied clients’ perceptions of early post-vasectomy morbidity by self innovated postcard pictorial questionnaire. Methods Between March 2011 and April 2012, 821 men underwent NSV and provided pre-printed revalidated pictorial postcards depicting various grades of severity of local pain, swelling, and bleeding. Clients were asked to tick mark their problems and post them on the third day after NSV. Data were compiled and statistically analyzed. Results Completed postcards were returned by 702 clients (85.5%). 25 postcards were excluded due to illegitimate filling of card. About 80.8% of clients complained of pain and minimal, moderate and severe pain was experienced by 77.69%, 18.09% and 4.20%, respectively. 16.24% of clients observed local swelling, which was minimal in 90.9%, moderate and severe in 7.27% and 1.81% of cases. 2.95% of clients noted mild bloody discharge. Most of clients managed their problems by following the instructions given in postcards; level 1 and 2 morbidity did not affect their daily activity. Conclusion Early morbidity after NSV is usually mild in severity and easily manageable. The postcard system is a feasible, effective, and economical way of collecting data and managing short-term post NSV problems.