Samarth Agarwal

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

Purpose To see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King Georges Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi. Materials and Methods We retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge. Results Out of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission. Conclusions The readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.

Horseshoe kidney with unilateral single ectopic ureter

The horseshoe kidney (HSK) is not an uncommon entity with an incidence of about 1 in 400 or 0.25% of the general population. It is also more commonly found in men as compared with women in a ratio of 2:1.An increased association of genitourinary anomalies have been found with HSK.Duplication of ureters occurs in 10% of HSKs. However, the association of HSK with single-system ectopic ureter is extremely rare. To our knowledge, no case with similar presentation has been reported in literature. Most cases of HSK with bilateral single ectopic ureters have been described. The aim of this report is to highlight the radiological and surgical findings in a case of HSK with unilateral single ectopic ureter.

Posterior urethral valve associated with a foreign body in posterior urethra: a first of its kind report

Posterior urethral valve and foreign body are among the important causes of male urethral obstruction. Although one is congenital and the other is acquired, both entities are rare in children with only a few reported cases. Because of myriad of symptoms associated with both conditions, a conclusive diagnosis requires both physical examination and radiological imaging. We report a first of its kind association of posterior urethral valve with foreign body in the posterior urethra in a 6-year-old male child which was eventually managed by endoscopic intervention.

Post-traumatic bilateral vesicocutaneous fistula of thighs treated with buccal mucosa graft urethroplasty and cyanoacrylate glue instillation: a novel treatment for management of a complicated fistula

Post-traumatic vesicocutaneous fistula (VCF) is a rare variant of urinary fistulas. These fistulas may externally communicate to abdomen, perineum, buttocks, scrotum or very rarely thigh. These fistulas usually develop at a variable time duration after trauma and are usually preceded with thigh swelling or abscess formation followed by spontaneous rupture. We, hereby, report a case of VCF of bilateral thighs with associated penobulbar urethral stricture after road traffic accident which was managed with dual modality of buccal mucosa graft urethroplasty surgery and cyanoacrylate glue injection in the fistulous tracts. To the best of our knowledge, this is first report of bilateral VCFs communicating externally to thighs. In literature, very few cases of VCFs of thigh are reported and are rarely managed with adhesive glue application.

Benign fibroepithelial bladder polyp: a rare cause of childhood haematuria

Haematuria in paediatric population is common yet alarming. It warrants a thorough physical examination and other investigations. Of late, a number of extremely rare aetiology of childhood haematuria have come to forefront. One such uncommon cause is benign fibroepithelial urinary bladder polyp. The presentation is of a child with intermittent haematuria exacerbated by physical/sports activity associated with or without suprapubic pain. Diagnosis is usually made by ultrasonography and cystoscopy and confirmed by histopathological examination. Treatment is surgical and involves cystoscopic transurethral resection of the mass. The exact aetiology of benign fibroepithelial polyp is uncertain with no clear guidelines on long-term surveillance. However, these cases should be subjected to cystourethroscopy if haematuria recurs. Treatment is surgical with good long-term prognosis. Not much is written in literature about benign fibroepithelial bladder polyp.

Acute mechanical duodenal obstruction due to giant hydronephrosis: an unusual cause of acute abdomen

Giant hydronephrosis (GH) is a rare clinical entity with about 600 cases and defined as the adult renal pelvis containing greater than 1 L of fluid, or at least 1.6% of the body weight or kidney occupying the hemiabdomen. The pelvic-ureteric junction (PUJ) obstruction is the most frequent cause of GH. We thus report a case of massive abdominal distension due to GH secondary to PUJ obstruction who presented with acute duodenal obstruction due to extrinsic compression and was managed with percutaneous nephrostomy followed by open nephrectomy.

Giant urinary bladder (11 000 mL in volume) with bilateral lower limb oedema: an unusual cause of inferior vena cava obstruction

An 80-year-old man with diabetes with history of spinal cord injury 15 years back now presented to us with complaints of painless progressive abdominal distension for 10 years and lower limb swelling for thexa0last 4 months. He also had history of recurrent urinary infections, constipation, lower limb weakness, urinary incontinence, abdominal straining during micturition and voiding lower urinary tract symptoms. There was no history ofxa0fever, vomiting, breathlessness, weight loss and melena. On general physical examination, pitting oedema of both lower limbs was noticed. Abdominal examination revealed diffuse, symmetrical, non-tender, massive abdominal distension with shifting dullness and dilated superficial abdominal veins. On digital rectal examination, reduced anal tone was noted. Prostatic examination was unremarkable. Blood serum chemistries revealed uncontrolled diabetes (random blood sugar:xa0 226u2009g/dL; haemoglobinxa0A1c: 7.8%), mildly deranged renal function tests (blood urea nitrogen:xa051 mg/dL; serum creatinine:xa01.4 mg/dL) and a normal serum Prostate Specific Antigen (3.8u2009ng/mL). Other laboratory investigations including urine analysis and culture were unremarkable.nnUltrasound of the abdomen suggested a large fluid-filled …

Misplaced Foley catheter in ureter in a female with neurogenic bladder: a rare complication report

Accidental placement of Foley catheter in ureter is a rare phenomenon. It is more common in females with neurogenic bladder who have hypocontractile bladder or there can be iatrogenic placement during surgical procedures. We describe a case of a female suffering from upper motor neuronal lesion due to trauma at T8 level (American Spinal Injury grade A) following which she developed neurogenic bladder. A Foley catheter was unintentionally placed in the ureter and subsequently removed through a novel technique of percutaneous ultrasound-guided balloon puncture. It is not only imperative to diagnose and manage such an aberrant Foley catheter placement but also more importantly proper steps must be taken to prevent such a complication from occurring in these patients.

Post-extracorporeal shockwave lithotripsy perirenal haematoma

A previously healthy 50-year-old man presented with intermittent left flank pain for 3 months. The patient denied any history of diabetes and hypertension. On evaluation with X-ray Kidney-Ureter-Bladder and ultrasound (USG) of abdomen, he was found to have left upper ureteric calculus (size: 13u2009mm) with left mild hydronephrosis and normal right kidney. He subsequently underwent uneventful extracorporeal shockwave lithotripsy (ESWL) with Dornier compact alpha electromagnetic lithotripter for the calculus. Three thousand shockwaves were delivered to the stone. The procedure was uneventful and the patient was discharged. Twenty-fouru2009hours later, the patient presented with severe left flank pain. On clinical examination, he had tachycardia (pulse rate: 100/min), normal blood pressure (138/76u2009mm Hg) and tenderness in the left flank region. Laboratory examination revealed the following parameters:

Continent cutaneous diversion pouch calculi

A 62-year-old female patient who presented at our centre with dull aching right flank pain of 6 months duration. She had axa0history of radical cystectomy and cutaneous continent urinary diversion (Indiana pouch) done 20 years ago for muscle invasive urothelial carcinoma of urinary bladder. Thexa0patient followedxa0up regularly since operation. However, for last 3u2009years, thexa0patient was lost to follow-up. On further eliciting the history, she mentioned her inability to perform pouch irrigation and clean intermittent catheterisation regularly during this period.nnOn examination, a lump was palpable in the right lumbar region in the region of continent pouch. It was firm in consistency around 5×5u2009cm in size and did not move with respiration. There was no pain/tenderness on palpation. The stoma was healthy, flush to skin, functioning and easily catheterisable.nnHer complete haemogram including renal function test …