Prasad Mylarappa

Comparative efficacy of tadalafil versus tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial.

Introduction In recent years, medical expulsive therapy has been used in the management of distal ureteric stones as a supplement to conservative treatment. Therefore, we conducted a prospective randomized study to evaluate the possible role of tadalafil individually in comparison with proven tamsulosin therapy in ureteric stone expulsion. The aim of this study is to compare the safety and efficacy of a phosphodiesterase-5 inhibitor (tadalafil) and an α-1 blocker (tamsulosin) as medical expulsive therapy for distal ureteric calculi. Material and methods Between August 2014 and October 2015, 207 patients who presented with distal ureteric stones of size 5–10 mm were randomly divided into two groups: tadalafil (Group A) and tamsulosin (Group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, endoscopic treatment and adverse effects of drugs were noted. Both groups were compared for normally distributed data by percentage, analysis of variance, and T-test. All the classified and categorical data were analyzed for both groups using the chi-square test. Results A statistically significant expulsion rate of 84.0% in Group A compared with 68.0% in Group B (P value = 0.0130), and shorter stone expulsion time in Group A (14.7±3.8) in comparison to Group B (16.8 ±4.5) was observed. Statistically significant differences were noted in renal colic episodes and analgesic requirement in Group A than Group B. No serious adverse effects were noted. Conclusions Tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones. This study showed that tadalafil increases ureteric stone expulsion quite significantly along with better control of pain and significantly lower analgesic requirement.

Transplant renal artery stenosis: The impact of endovascular management and their outcomes

Introduction: Transplant renal artery stenosis (TRAS) is a well-known vascular complication of renal transplantation. The aim of this analysis was to assess the short and midterm outcomes of endovascular therapy to salvage transplant kidney. Methods: We retrospectively analyzed our transplant database from 2000 to 2015. Percutaneous transluminal angioplasty/stenting was done in 24 patients (22 men and two women) with significant TRAS. The mean age was 59 ± 12 years. The parameters analyzed were: Technical success, pre- and post-treatment serum creatinine and number of antihypertensive drugs before and after treatment and vessel patency on Doppler ultrasonography at 3 and 6 months. Results: Overall incidence of TRAS in this study was 5.06%. Incidence of TRAS following live donor transplantation was 4.68% while that in deceased donors was 11.5%. Technical success was 100%. There were no periprocedural deaths. Renal function was improved from 2.32 ± 0.5 mg/dL to 1.72 ± 0.3 mg/dL (P < 0.001) and number of antihypertensive medications after the procedure was reduced from 2.9 ± 0.7 to 2 ± 0.6 (P < 0.001) at 6 months follow-up. One patient developed restenosis within 5 months (4.2%). Clinical success at 6 months follow-up was 79.2%. Conclusions: Endovascular treatment of TRAS has high technical success with minimal complications. It also provides satisfactory clinical success with improvement in overall transplant renal function and renovascular hypertension in early follow-up.

Virilizing lipoadenoma of the adrenal gland in a pre-pubertal girl: A rare case.

We report a case of a 12-year-old girl who presented with the history of hirsutism. On evaluation, she was found to have testosterone secreting adrenal gland tumor. Histopathological examination of the adrenalectomy specimen revealed a lipoadenoma.

Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature.

Extracorporeal shock wave lithotripsy (SWL) is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus.

A prospective analysis of emphysematous pyelonephritis at a tertiary care centre

Purpose: To evaluate the presentation and diagnostic criteria of emphysematous pyelonephritis and different modalities of their management at our instititute. Methods: A prospective study of 5 years in which patients who were diagnosed to have emphysematous pyelonephritis confirmed by a non contrast CT presenting at our centre were included in this study and baseline information, a brief clinical history with a written consent was collected from each patient. The course of the patient along with investigations and interventions done from admission were recorded. Results: 72 patients were included in this study with a mean age of 55.4 +/-12.1 years (30 to 75 years ), comprising of 47 females and 25 males. Common presentation was tachycardia (94.5 %) and fever associated with burning micturition (75.3%) followed by loin pain on the affected side (71%). 31 cases which formed a majority were diagnosed to have right sided emphysematous pyelonephritis (41.9%), 28 had left sided (38.35%) and 14 bilateral (19.17%) in our series. 90.41 % of the patient were diagnosed to have diabetes mellitus of which 34 patients (46.57 %) presented with high sugars. Urine cultures were positive in only 41% of the patients with the most common organism being E. coli (68%) followed by Klebsiella pneumoniae (14%). 64.8% of the patients diagnosed were treated conservatively with IV antibiotics and 34.24% by endoscopic management. Conclusions: In this study we have shown that a medical line of management with appropriate endoscopic intervention is the present choice of management of emphysematous pyelonephritis irrespective of the CT grade of the disease. Level of evidence: Not applicable for this multicentre audit.

PD27-06 THULIUM LASER VAPORESECTION OF THE PROSTATE AND BIPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA – SINGLE CENTER PROSPECTIVE RANDOMIZED STUDY

reviewed for complications up to October 2016 and recorded in accordance with the Clavien-Dindo classification system. Statistical analysis was performed using a Mann-Whitney U test. RESULTS: 969 cases of HoLEP were performed at our centre between December 2003 and October 2016. There was a statistically significant improvement in both urinary flow rate and post-void residual volumes (p<0.0001). Median pre-operative flow rate was 8.4ml/s (range 1-26.3) (n1⁄4536) and post-operative flow rate was 19.5ml/s (range 1.868.4) (n1⁄4649). Median pre-operative post-void residual volumes were 263mls (range 0-5000) (n1⁄4718) and post-operative residual volumes were 71mls (0-1000).188 patients (23.6%) were discharged from hospital on the day of surgery; 479 (60.1%) on day 1; 85 (10.7%) on day 2; 45 (5.6%) stayed 3 days or more (n1⁄4797). Post-operative early and late complications are recorded within the table. CONCLUSIONS: HoLEP is an effective and safe treatment for bladder outflow obstruction associated with few early and late complications.

MP90-20 SHOULD WE SUSPEND MEDICAL EXPULSIVE THERAPY: A PROSPECTIVE RANDOMIZED TRIAL

INTRODUCTION AND OBJECTIVES: In recent years, medical expulsive therapy has been questioned in the management of distal ureteric stones. Therefore, we conducted a prospective randomized study to evaluate the possible role of tadalafil individually and in comparison with proven tamsulosin as well as a placebo therapy in distal ureteric stone expulsion. METHODS: Between January 2015 and March 2016, 327 patients who presented with distal ureteric stones of size 5e10 mm were randomly divided into three groups: tadalafil (Group A), tamsulosin (Group B), and placebo (Group C). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, endoscopic treatment and adverse effects of drugs were noted. RESULTS: A statistically significant expulsion rate of 86.0% in Group A compared with 66.0% in Group B and 38.0% in Group C was observed. Also a shorter stone expulsion time in Group A (13.5 2.5) in comparison to Group B (16.4 3.5) and Group C (24.8 4.5) was observed. Statistically significant differences were noted in renal colic episodes and analgesic requirement in Group A in comparison to Group B and Group C. No serious adverse effects were noted. CONCLUSIONS: Tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones. This study showed that tadalafil increases ureteric stone expulsion quite significantly along with better control of pain and significantly lower analgesic requirement.

Evaluation and outcome of M plasty for the management of doughnut scrotum

Introduction: Penoscrotal transposition is a rare anomaly of the external genitalia. They can be classified as complete or incomplete based on degrees of positional exchange between the penis and the scrotum. Both forms are known to be associated with hypospadias and multiple surgeries are required for complete correction. Most surgeries performed for the correction of penoscrotal transposition involve making a complete circular incision around the root of the scrotum, which often results in massive penile lymphoedema and often delays the correction of hypospadias. The M plasty technique can prevent the incidence of lymphoedema by preserving the dorsal penile skin. Objective: To evaluate the effectiveness of M plasty for the correction of penoscrotal transposition. Materials and methods: Sixteen patients underwent M plasty for incomplete penoscrotal transposition. An ‘M’-shaped incision was made at the base of the scrotum and the scrotal halves were dissected and brought down posterior and caudal to the penis and sutured primarily. Results: All patients showed excellent cosmetic results. There was minimal postoperative oedema with no vascular compromise to penile or scrotal skin. Conclusion: M plasty is an excellent technique for the correction of penoscrotal transposition. The low incidence of penile lymphoedema could be attributed to the preservation of the dorsal penile skin. This procedure provides an excellent cosmetic appearance and also allows for early correction of hypospadias.

Psuedo-aneurysm following Renal Transplantation Presenting as Extensive Ileofemoral Thrombosis

Pseudo Aneurysm of the arterial anastomosis is a rare complication seen in less than 1% of recipients and pseudo aneurysm of ileofemoral thrombosis is even rarer. Herein, we report a case of pseudo aneurysm of the anastomotic site following renal transplantation with extensive ileofemoral thrombosis with literature review. The intension of this paper is to provide an update on the varied clinical presentation, early diagnosis and management of this rare case presentation.