Priyank Yadav

Ureterocalicostomy for Reconstruction of Complicated Ureteropelvic Junction Obstruction in Adults: Long-Term Outcome and Factors Predicting Failure in a Contemporary Cohort

Purpose: Ureterocalicostomy is a well established treatment option in patients who have recurrent ureteropelvic junction obstruction with postoperative fibrosis and a relatively inaccessible renal pelvis. We evaluated the long‐term outcome of ureterocalicostomy and factors predicting its failure. Materials and Methods: We retrospectively analyzed data on 72 patients who underwent open or laparoscopic ureterocalicostomy from 2000 to 2014. Variables that may affect the outcomes of ureterocalicostomy were assessed with regard to primary pathology findings, patient age, serum creatinine, preoperative renal size (less than and greater than 15 cm), renal cortical thickness (less than and greater than 5 mm), hydronephrosis grade and preoperative renal function (glomerular filtration rate less than and greater than 20 ml/minute/1.73 m2). The surgery outcome was calculated in terms of success or failure. Factors predicting failure were evaluated by univariate and multivariate analysis. Failure was defined as an additional procedure required postoperatively due to persistent symptoms and/or followup renal scan showing persistent significant obstruction with deterioration of renal function on at least 2 occasions 3 months apart. Patients with less than 2‐year followup were excluded from study. Results: We analyzed data on 72 patients who underwent ureterocalicostomy during this period. Mean ± SD age of the study group was 28.9 ± 12.3 years and mean baseline serum creatinine was 1.1 ± 0.3 mg/dl. The mean glomerular filtration rate was 27.8 ± 11.6 ml/minute/1.73 m2 and mean cortical thickness of the operated kidney was 7 ± 3.86 mm. Common indications for ureterocalicostomy were failed previous pyeloplasty and/or endopyelotomy in 35 patients (48.6%) and secondary ureteropelvic junction obstruction after pyelolithotomy or percutaneous nephrolithotomy in 24 (33.3%). The most common complication was urinary tract infection, which was seen in 22 patients (30.6%). At a mean followup of 60.3 ± 13.6 months 50 patients (69.5%) had a successful outcome. Treatment failed in 22 patients (30.5%), including 6 who required nephrectomy, while 13 were treated with frequent changes of Double‐J® stents or with balloon dilation. In 3 patients ureterocalicostomy was repeated. The rate of failed ureterocalicostomy was higher in patients with a low preoperative glomerular filtration rate (less than 20 ml/minute/1.73 m2), attenuated cortical thickness (less than 5 mm) and higher creatinine (greater than 1.7 mg/dl) on univariate analysis. However, on multivariate analysis poor cortical thickness and a low glomerular filtration rate were independent predictors of failure. Conclusions: Ureterocalicostomy is an acceptable salvage option with a satisfactory long‐term outcome. Patients with a low preoperative glomerular filtration rate (less than 20 ml/minute/1.73 m2) and a thinned out cortex (less than 5 mm) showed a poor outcome after ureterocalicostomy.

WITHDRAWN: Transurethral Resection of Prostate and Bleeding: A Prospective Randomized, Double-blind, Placebo-controlled Trial to See Efficacy of Short-term Use of Finasteride and Dutasteride on Operative Blood Loss and Prostatic Microvessel Density

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Foreign Bodies in the Urinary Bladder and Their Management: A Single-Centre Experience From North India

Purpose This study was performed to characterise the nature, clinical presentation, mode of insertion, and management of intravesical foreign bodies in patients treated at our hospital. Methods Between January 2008 and December 2014, 49 patients were treated for intravesical foreign bodies at King George Medical University, Lucknow. All records of these patients were retrospectively analysed to characterise the nature of the foreign body, each patient’s clinical presentation, the mode of insertion, and how the case was managed. Results A total of 49 foreign bodies were retrieved from patients’ urinary bladders during the study period. The patients ranged in age from 11 to 68 years. Thirty-three patients presented with complaints of haematuria (67.3%), 29 complained of frequency of urination and dysuria (59.1%), and 5 patients reported pelvic pain (10.2%). The circumstances of insertion were iatrogenic in 20 cases (40.8%), self-insertion in 17 cases (34.6%), sexual abuse in 4 cases (8.1%), migration from another organ in 4 cases (8.1%), and assault in 4 cases (8.1%). Of the foreign bodies, 33 (67.3%) were retrieved by cystoscopy, while transurethral cystolitholapaxy was required in 10 patients (20.4%), percutaneous suprapubic cystolitholapaxy was performed in 4 patients (8.1%), and holmium laser lithotripsy was performed in 2 patients (4.08%). Conclusions Foreign bodies should always be included in the differential diagnosis when evaluating a patient who presents with chronic lower urinary tract symptoms. A large percentage of foreign bodies can be retrieved using endoscopic techniques. Open surgical removal may be performed in cases where endoscopic techniques are unsuitable or have failed.

Diagnosis and management of symptomatic residual ureteral stump after nephrectomy

An 8-year-old boy presented with a history of open nephrectomy 1 year prior for non-functioning right kidney with recurrent febrile urinary tract infection (UTI) with bilateral vesicoureteric reflux (VUR) (right grade V and left grade IV). One month after surgery, he did not have any episodes of febrile urinary tract infection but had recurrent right abdominal pain. He had a good urinary stream …

Bilateral Transvesicoscopic Cross-trigonal Ureteric Reimplantation in Children: Surgical Subtleties and a Prospective Summary

OBJECTIVE To prospectively evaluate the surgical technique and results of bilateral transvesicoscopic cross-trigonal ureteric reimplantation (TVUR) in children with vesicoureteric reflux (VUR) and compare the results and surgical subtleties with the existing literature. MATERIALS AND METHODS From January 2010 to December 2015, children between 2 and 14 years of age with bilateral primary VUR grades II-IV underwent bilateral TVUR at a tertiary referral center in Northern India. The grade of VUR was II in 12 patients, III in 19 patients, and IV in 3 patients. All surgeries were performed by a single surgeon. Success was defined as the absence of VUR on direct radionuclide cystogram at 8 weeks. RESULTS Seventeen patients (34 refluxing ureters) underwent bilateral TVUR during the study period. They included 13 girls and 4 boys. The median age was 4.6 years (range: 2-14 years). Two patients required conversion to open surgery. Resolution of VUR was seen in 16 patients (32 out of 34 ureters). Hydronephrosis resolved on postoperative ultrasonography in all patients with low-grade reflux (lower than grade IV) and all except one patient with grade IV reflux. CONCLUSION TVUR is a feasible method with success rate equal to that of open technique if patient selection is good. Success rate is low in high-grade reflux, and dilated and tortuous ureter. Subtle modifications in the surgical steps can make significant contribution toward learning this minimally invasive technique.

Interiliac Ureter: A Rare Venous Anomaly Causing Hydronephrosis

Most of the developmental anomalies of inferior vena cava are asymptomatic. The retrocaval and retroiliac ureter, however, commonly present with symptoms due to ureteric obstruction. We present interesting computed tomography images of a 30-year-old male who was symptomatic for right upper ureteric obstruction and the ureter was coursing between the 2 common iliac veins that were uniting abnormally high at the level of right renal hilum with absence of infrarenal inferior vena cava.

Isolated clival metastasis: a rare presentation of renal cell carcinoma

Renal cell carcinoma accounts for 3% of all adult malignancies. Usual sites of metastasis are lymph nodes, lungs, bone, liver and brain. We describe a patient who presented with complaints of holocranial headache and diplopia. MRI of the head showed a clival-based lesion with associated bony erosion. With suspicion of a metastatic lesion, an ultrasonogram of the abdomen was done which showed a left renal mass that enhanced on contrast-enhanced CT. There were no other metastatic foci. Patient underwent radiotherapy for the clival lesion. This case report emphasises on the evaluation of clival lesion with cranial neuropathies for a possibility of a renal primary tumour.

Spontaneous Extradural Hemorrhage in a Patient with Chronic Kidney Disease: A Case Report and Review of Literature

BACKGROUND Spontaneous extradural hemorrhage is a rare entity. It is usually reported in association with locoregional disease, which is often infective, inflammatory, and hematologic. Chronic kidney disease with hemodialysis is one of the most infrequent causes. The exact association or pathogenesis remains elusive, although possible mechanisms have been suggested. The presentation, associated comorbid conditions, and management vary among the reported cases. CASE DESCRIPTION A 39-year-old man with hypertension, well controlled with medications, and chronic kidney disease was on maintenance hemodialysis. He later underwent Tenckhoff catheter insertion for peritoneal dialysis; 2 weeks later, when peritoneal dialysis was started, he developed breathlessness. The Tenckhoff catheter was removed. However, the patient developed ascitic leak from the surgical site, which was repaired under general anesthesia. In the immediate postoperative period, he developed sudden, severe headache and was found to have bifrontal extradural hemorrhage. He underwent prompt drainage of the hematoma and was discharged on the fifth postoperative day in stable condition. CONCLUSIONS We report a rare case of spontaneous bilateral frontal extradural hemorrhage in the immediate postoperative period in a patient on hemodialysis. In addition, we review the existing literature on the topic.

An audit of early complications of radical cystectomy using Clavien-Dindo classification

Introduction: Despite the major improvements in surgical technique and perioperative care, radical cystectomy (RC) remains a major operative procedure with a significant morbidity and mortality. The present study analyzes the early complications of RC and urinary diversion using a standardized reporting system. Materials and Methods: Modified Clavien-Dindo classification was used to retrospectively assess the peri-operative course of 212 patients who had RC with urinary diversion between October 2003 and October 2014 at a single institution. The indications for surgery were muscle invasive urothelial carcinoma, high-grade nonmuscle invasive bladder cancer (BC), and Bacillus Calmette-Guerin-resistant nonmuscle invasive BCs. Data on age, sex, comorbidities, smoking history, American Society of Anaesthesiologists score, and peri-operative complications (up to 90 days) were captured. Statistical analysis was performed using SPSS 20.0 software (Chicago, USA). Results: The mean age was 56.15 ΁ 10.82. Orthotopic neobladder was created in 113 patients, ileal conduit in 88 patients, and cutaneous ureterostomy in 11 patients. A total of 292 complications were recorded in 136/212 patients. 242 complications (81.16%) occurred in the first 30 days, with the remaining 50 complications (18.83%) occurring thereafter. The rates for overall complication were 64.1%. The most common complications were hematologic (21.6%). Most of the complications were of Grade I and II (22.9% and 48.9%, respectively). Grade IIIa, IIIb, IVa, IVb, and V complications were observed in 10.2%, 8.9%, 3.4%, 2.7%, and 2.7% of the patients, respectively. Conclusions: RC and urinary diversion are associated with significant morbidity. This audit would help in setting a benchmark for further improvement in the outcome.

Adrenocortical carcinoma with inferior vena cava tumour thrombus: multidetector CT (MDCT) evaluation and management

A 58-year-old man, a farmer, who was a known hypertensive poorly controlled on metoprolol, amlodipine and enalapril, presented with sweating and giddiness for 10 months and pedal oedema for 3 months. On ultrasonography, a heteroechoic mass was found near the upper pole of his left kidney. Multidetector CT of the abdomen showed an 11×8×5 cm heterogeneous mass arising from the left adrenal gland, with an attenuation of 28 HU on non-contrast CT …