Sunny Goel

Prospective randomized comparison of three endoscopic modalities used in treatment of bladder stones.

Introduction The aim of this study was to compare three endoscopic modalities used in the treatment of bladder stones: transurethral use of cystoscope or nephroscope and percutaneous cystolithotripsy (PCCL). Methods This study included 210 patients of bladder stone treated at a tertiary care centre in North India from January 2006 to July 2013 who were randomly assigned into three groups: group 1 (transurethral removal using cystoscope), group 2 (transurethral removal using nephroscope) and group 3 (PCCL). Baseline and perioperative data wererecorded and compared between three groups. Results Baseline parameters were comparable between the three groups. Operating time in group 2 was significantly less than the other two groups. Complete clearance was achieved in all the patients. Group 2 had maximum number of urethral entries. The incidence of perioperative complications (fever, transient haematuria and persistent leakage from suprapubic site) was comparable between these three groups. Till the last follow-up, 3.2% patients (n = 2) developed urethral stricture in group 1, 7.8% (n = 5) in group 2 and no patient developed urethral stricture in group 3 (p = 0.068). Conclusions Removal of bladder stones by the transurethral route, using a nephroscope, is the most effective treatment modality in terms of operative time with long-term urethral stricture rate similar to transurethral cystoscope technique. Comparatively, PCCL is a safe procedure with acceptable morbidity. Overall, all three techniques are equally efficacious in treating bladder stones of size 1-4 cm.

Vesicovaginal fistula following insertion of a foreign body in the vagina for sexual gratification: could it be catastrophic?

In developing countries such as India, the vesicovaginal fistula (VVF) is a commonly found entity in urogynaecology. VVFs secondary to obstructive labour still remain the most common cause in these countries. We report a very unusual case of a VVF in a young woman that developed due to self-insertion of a plastic box for sexual gratification.

Chyluria in young child: a rare presentation

Chyluria, a chronic manifestation of lymphatic filariasis, is rare in children. Clinicians must have a high index of suspicion to diagnose this condition in children as it mimics nephrotic syndrome. We present an unusual case in which a 7-year-old boy hailing from a filarial endemic region presented with a passage of milky urine, which on evaluation was diagnosed as parasitic chyluria. The child showed remission after medical management that persisted until 1 year of follow-up.

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.

Role of gemcitabine and cisplatin as neoadjuvant chemotherapy in muscle invasive bladder cancer: Experience over the last decade

Objective Neoadjuvant chemotherapy followed by radical cystectomy is considered the standard of care for patients with muscle invasive bladder cancer. In the last decade, interest in neoadjuvant chemotherapy has slowly shifted from methotrexate, vinblastine, doxorubicin and cisplatin regime to gemcitabine and cisplatin regime. There are many publications on gemcitabine and cisplatin regime in literature which cover different aspects of treatment. This review aims to summarise the findings published so far on gemcitabine and cisplatin regime and present it in a concise manner. Methods A systematic literature review was conducted searching the PubMed® database in December 2016 using the medical subject heading (MeSH) with the terms gemcitabine, cisplatin, chemotherapy, muscle invasive bladder cancer, and neoadjuvant. All relevant studies were included and results were analysed. Results A total of 13 studies were included which published between 2007 and 2015. These 13 studies comprised of 754 subjects suffering from muscle invasive bladder cancer. The proportion of male patients ranged from 60% to 86.4% and the median age ranged from 54.2 to 77.3 years in various studies. Complete pathological response (pT0) was seen in 30.0% of patients and pathological downstaging (<pT2) was seen in 48.67% of patients. Conclusion As per latest guidelines, neoadjuvant chemotherapy is recommended for patients with muscle invasive bladder cancer. There is substantial pathological downstaging with low toxicity in patients of muscle invasive bladder cancer who receive neoadjuvant gemcitabine and cisplatin regime.

Re: Nasser et al.: Dismembered Pyeloplasty in Infants 6 Months Old or Younger With and Without External Trans-anastomotic Nephrostent: A Prospective Randomized Study (Urology 2016;101:38-44)

Please cite this article as: Sunny Goel, Apul Goel, Ajay Aggarwal, Bimalesh Purkait, Nasser FM, Shouman AM, ElSheemy MS, Lotfi MA, Aboulela W, El Ghoneimy M, Abdelwahab M, Shoukry AI, Ghoneima W, Morsi H, Badawy H. Dismembered Pyeloplasy in Infants Six Months Old or Younger with and Without External Trans-Anastomotic Nephrostent: a Prospective Randomized Study Urology. 2016 Sep 28 doi: 10.1016/j.urology.2016.09.024, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.11.007.

Rare Occurrence of Giant Metastatic Inguinal Lymph Nodes in Carcinoma Bladder

Inguinal lymph node metastasis of a bladder cancer is a rare scenario. As of today, only 4 cases of inguinal lymph node metastasis from bladder cancer have been reported in the literature. We report a rare giant inguinal lymph node metastasis of transitional cell carcinoma of the bladder in a patient after radical cystoprostatectomy. Chemotherapy and radiotherapy were given, but the metastatic tumor remain unchanged.

Spontaneous non-obstructive nephropleural fistula with an autoimmune disorder causing massive urinothorax: a rare association

Urinothorax, an unusual and rare cause of pleural effusion, is usually secondary to urinary obstruction and abdominal trauma. We describe an uncommon case of left-sided urinothorax in a 35-year-old man with diabetes and hypothyroidism associated with an autoimmune disorder without obvious obstructive uropathy. Workup revealed pancytopenia, mild proteinuria, positive anti-nuclear and anti-dsDNA antibodies suggestive of probable systemic lupus erythematosus. Contrast-enhanced CT-chest and abdomen showed hepatosplenomegaly with bilateral renal abscesses and a fistulous connection between left superior calyx and left the pleural cavity. Patient was initially managed by intravenous antibiotics, intercostal tube drainage and ipsilateral double-J stent placement. The definitive management in the form of closure of nephropleural fistula was achieved with sclerotherapy using 0.1% povidone-iodine instillation, while oral steroids were started for the probable autoimmune disorder. To the best of our knowledge, this is the first case of spontaneous non-obstructive nephropleural fistula associated with an autoimmune disorder, managed by minimally invasive methods.

Urethrocutaneous fistula mimicking vesicocutaneous fistula: a rare entity

Urethral fistulas arising from the anterior urethra usually open on the ventral aspect and are located in the penile, scrotal or perineal region. A diabetic 65-year-old man presented with suprapubic urinary fistula that was communicating with a dorsally located internal urethral opening located in the bulbar region. Such unusual fistula has not been described before.

Congenital prepubic sinus (an epispadiac variant of dorsal urethral duplication) with dorsal penile curvature in an adult man: a rare association

Urethral duplication is among a very rare congenital disorder with multiple anatomical variants reported. Urethral duplication of complete type is usually diagnosed during childhood with urinary incontinence or double urinary stream as common presentation. However, patients with incomplete urethral duplication usually present with intermittent mucous discharge from the accessory urethral opening. A 20-year-old man presented to us with intermittent mucous discharge from the accessory opening along with dorsal penile curvature making sexual intercourse very difficult. The epispadiac urethral tract with proximal fibrous tract was excised, and the dorsal penile curvature was corrected by ventral plication, implicating that the fibrous cord may be the causative factor for the development of dorsal curvature.