Nikhil A. Patil

Identification of mineral compositions in some renal calculi by FT Raman and IR spectral analysis

We present in this paper accurate and reliable Raman and IR spectral identification of mineral constituents in nine samples of renal calculi (kidney stones) removed from patients suffering from nephrolithiasis. The identified mineral components include Calcium Oxalate Monohydrate (COM, whewellite), Calcium Oxalate Dihydrate (COD, weddellite), Magnesium Ammonium Phosphate Hexahydrate (MAPH, struvite), Calcium Hydrogen Phosphate Dihydrate (CHPD, brushite), Pentacalcium Hydroxy Triphosphate (PCHT, hydroxyapatite) and Uric Acid (UA). The identification is based on a satisfactory assignment of all the observed IR and Raman bands (3500-400c m(-1)) to chemical functional groups of mineral components in the samples, aided by spectral analysis of pure materials of COM, MAPH, CHPD and UA. It is found that the eight samples are composed of COM as the common component, the other mineral species as common components are: MAPH in five samples, PCHT in three samples, COD in three samples, UA in three samples and CHPD in two samples. One sample is wholly composed of UA as a single component; this inference is supported by the good agreement between ab initio density functional theoretical spectra and experimental spectral measurements of both sample and pure material. A combined application of Raman and IR techniques has shown that, where the IR is ambiguous, the Raman analysis can differentiate COD from COM and PCHT from MAPH.

Para-meatal urethral cyst with bladder calculi: A case report and review of the literature.

Para-meatal urethral cyst or median raphe cyst of the glans penis is a benign cystic lesion uncommonly encountered in prepubertal age group. Approximately, about 50 cases have been reported till date in the world literature. Herein we report a case of para-meatal urethral cyst concurrent with urinary bladder calculi.

Posthysterectomy ureteric injuries: Presentation and outcome of management

Purpose: The purpose of the study was to evaluate the presentation and management of posthysterectomy ureteral injuries. Patients and Methods: Fourteen patients with ureteric injuries after hysterectomy for benign diseases were evaluated. The diagnosis was done based on clinical presentation, intravenous urogram, computed tomography, cystoscopy, and retrograde pyelogram (RGP) depending on the clinical situation. Results: Sixteen iatrogenic ureteric injuries in 14 patients over a 2-year period were evaluated. Hysterectomy was the cause of injury in all the cases, 12 abdominal and 2 were vaginal. Two patients presented with anuria, one had ureteric, and bladder injury with hemoperitoneum underwent emergency laparotomy and bilateral ureteral reimplantation. Another patient underwent RGP followed by stenting on the right side, left side unable to put stent so percutaneous nephrostomy (PCN) was done followed by antegrade stenting later. Two patients presented with septicemia and pyonephrosis were managed initially with PCN followed by balloon dilatation and JJ stenting. RGP and retrograde stenting was done in seven of the remaining ten patients and ureteric reimplantation in three patients. Conclusion: Patient with ureteric injury should be evaluated and intervened at the earliest. Patients presenting early, within 2 weeks after hysterectomy have higher chances of success with endourological procedures, obviating the need for open surgery.

Re: Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial: M. Marconi, C. Palma, P. Troncoso, A. Dell Oro, T. Diemer and W. Weidner J Urol 2015; 194: 1323–1327.

To the Editor: We read this article with great interest. Chronic scrotal content pain (CSCP) has complex and extensive etiologies. CSCP constitutes a challenging problem to evaluate and treat. We appreciate the effort to prospectively evaluate patients with CSCP first using a spermatic cord block with levobupivacaine and 1 week later a sham block with saline. According to the authors, evaluation of response to spermatic cord block preoperatively permits appropriate selection of ideal candidates for microsurgical spermatic cord denervation (MSCD). As an explanation for “no obvious effects in some patients following standardized nerve dissection,” the authors state that these patients may have nociceptive stimuli of branches from the pudendal nerve running through the posterior aspect of the scrotum, specifically between the dartos and parietal layer of tunica vaginalis. They explain that since these branches never enter the spermatic cord, MSCD must fail in these cases. We believe that if spermatic cord block is a prerequisite for selection of candidates for MSCD, and branches of the pudendal nerve never enter the spermatic cord, then 1) failure cannot be attributed to pudendal nerve involvement as the nonresponders to spermatic cord block have already been excluded from the study, and 2) response to spermatic cord block cannot be considered a sensitive tool for selection of ideal candidates for MSCD if the pudendal nerve also has an important role in CSCP. We appreciate the attempt to use a simple spermatic cord block to select candidates for MSCD. At the same time we opine that pudendal nerve involvement in CSCP may not be a reasonable explanation for the failure of MSCD as its involvement has already been excluded by spermatic cord block response testing. We suggest that in individuals who do not respond to spermatic cord block or MSCD a test should be devised to confirm pudendal nerve involvement or affirm the role of the pudendal nerve in CSCP to avoid failure in cases managed by MSCD.

Female urethral anomalies in pediatric age group: Uncovered

Female urethral anomalies such as epispadias and hypospadias have been rarely reported in the literature. Clinical diagnosis of female urethral anomalies is significant for management. Diagnosis may be missed leading to mismanagement of the clinical condition. Herein, we report a case of female epispadias and hypospadias managed by us at Tertiary Care Center.

Xanthogranulomatous Prostatitis: A Rare Case Report

Xanthogranulomatous prostatitis is one such rare benign inflammatory lesion of prostate. Herein we report a rare case of xanthogranulomatous prostatitis concurrent with benign prostatic hyperplasia. The exact cause of xanthogranulomatous prostatitis remains unknown. Xanthogranulomatous prostatitis is rare condition both clinically and microscopically. There are no specific radiological features. Serum prostatic specific antigen is non-specific. Only ten cases of xanthogranulomatous prostatitis have been reported till date throughout the world.

Conservative management of accidental gall bladder puncture during percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PCNL) has been an excellent option for the management of kidney stones. There have been many complications in regards to solid organ injury during PCNL. Here we discuss an interesting case of 45-year-old woman, who underwent PCNL for right renal staghorn calculus, and had an accidental puncture of the gall bladder. Post operatively, the patient was conservatively managed and recovered well. A small number of cases has been reported until now in literature.

Make the technology count.

Good judgment comes from experience and experience comes from bad judgment – Rita Mae Brown In spite of advances in imaging techniques, PCNL continues to be a blind procedure. Gallbladder puncture during PCNL has been a described complication, sometime resulting in biliary peritonitis and even mortality [1]. Very few cases concerning conservative management of gallbladder puncture during PCNL have been reported in literature to date [2]. It is important to document the solid organ injury and maintain a registry of this. Voilette and Denstedt have given a major contribution by introducing standard protocol for documentation of PCNL complications [3]. A structured apprenticeship program is required to train fellow residents [4]. Recent advances in imaging, establishment of advanced training centres, and development of simulators have decreased the incidence of complications significantly by improving technical skills. However, complications continue to plague even the most experienced surgeons. The occurrence of complications can be decreased only by gaining more experience and by learning from past mistakes. The two–dimensional information provided by X–ray/ultrasound guided tracking does not provide an assessment of calyceal depth during needle puncture [5]. Neuronavigation (i.e. stereotactic surgery) has been a promising step in the field of neurosurgery [6]. Application of stereotactic surgery in the field of endourology may help in obtaining real time imaging and 3–D localization of the pelvicalyceal system, thereby reducing the complications significantly.