V. Saxena

Safety and efficacy of PCNL for management of staghorn calculi in pediatric patients.

OBJECTIVES There are few reports on the use of PCNL for staghorn calculi in children. We evaluated the safety and efficacy of this technique, using adult equipment, in children below 16 years of age. METHODS Data for pediatric patients undergoing PCNL for staghorn renal calculi was prospectively recorded. A staghorn calculus was defined as a branched stone occupying more than one part of the collecting system. A standard fluoroscopy guided PCNL was performed in the prone position using adult nephroscopes. Stone clearance was assessed on fluoroscopy and X-ray in all patients and an ultrasound or CT scan in selected cases. RESULTS Beginning October 2007, 33 pediatric patients underwent 34 PCNLs at our center. 12 of these children had staghorn calculi. All patients had normal renal function and no metabolic abnormality. One child had a solitary kidney. In 5 children, the primary tract was placed into the superior calyx and 4 of these were above the 12th rib. A 21Fr nephroscope was used through a 24Fr tract in 9 children while a 26Fr nephroscope was used through a 30Fr tract in 3 cases. 10 children were managed through a single tract. One patient each required SWL and ureteroscopy for residual fragments. 11 patients had complete clearance while 1 had insignificant residue. One child required intravenous antibiotics for post-operative fever while another developed an abdominal collection that was managed conservatively. CONCLUSIONS PCNL is safe and effective in the management of pediatric staghorn calculi.

Herbo-mineral supplementation in men with idiopathic oligoasthenoteratospermia : A double blind randomized placebo-controlled trial

Introduction: There is insufficient scientific data on the medical management options for idiopathic oligoasthenoteratospermia (iOATs). We conducted a double blind, randomized, placebo-controlled trial to assess the efficacy and safety of the herbo-mineral supplement, Addyzoa®, in infertile men with iOATs. We also evaluated its effect on semen reactive oxygen species (ROS) levels, total antioxidant capacity (TAC) and DNA fragmentation index. Materials and Methods: Fifty infertile men with iOATS were recruited into an institutional ethics committee approved protocol from April to August 2009. Randomization was done using numbered, identical containers. Baseline semen samples were evaluated for routine parameters, ROS level, DNA fragmentation index and TAC. Drug/placebo was administered at a dose of two capsules twice a day for 3 months. All parameters were reassessed at 3 months and clinical side-effects were recorded. The study was registered with the Clinical Trials Registry of India and is available at www.ctri.in as study protocol number CTRI/2009/091/000551. Results: Forty-four subjects completed the study, 21 in the drug arm and 23 in the placebo arm. There was no difference in baseline parameters between the two groups. Men in the drug group had significant improvement in mean total motility from 23.2 ± 17.3% to 33.4 ± 23.2% (P-value: 0.008) and mean progressive (Type A+B) motility from 15.7 ± 12.6% to 22.6 ± 18.0% (P-value: 0.024). ROS, TAC and DFI did not change significantly in either group and did not show any correlation with other semen parameters. Conclusions: Treatment with Addyzoa resulted in a significant improvement in total and progressive motility in the semen of men with iOATs after 3 months of therapy. There was no change in the sperm concentration, ROS, DFI or TAC levels.

Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience.

Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI), prostate specific antigen (PSA) level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%). The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP) is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

Bilateral Ureteric Quadruplication With Renal Calculus

Ureteric quadruplication is an extremely rare congenital anomaly. We present radiologic images of a young woman with a renal calculus with bilateral ureteric quadruplication. She presented with right flank pain, and the intravenous urogram revealed a calculus in the superior calyx that drained into the upper most moiety of a partially quadruplicated ureter.

Delayed Multiple Port Sites Metastases After Laparoscopic Radical Prostatectomy

Introduction: Laparoscopic port site metastases are recurrent nodular lesions developing locally in the abdominal wall within the scar tissue of one or more trocar sites. We are reporting an extremely rare case of delayed multiple port site metastases 3 years after laparoscopic radical prostatectomy. In this case, 3 port site metastases appeared 3 years after laparoscopic radical prostatectomy. Case Description: A 65-year-old man was evaluated for lower urinary tract symptoms and found to have raised serum prostate-specific antigen of 9.06 ng/mL. Transrectal ultrasonography-guided biopsy of the prostate revealed an adenocarcinoma of the prostate (Gleason score 3 4 7), with 5 of 12 cores positive for tumor. Contrast-enhanced computed tomography showed localized disease with no involvement of seminal vesicle or lymph nodes. The bone scan was normal. He underwent laparoscopic radical prostatectomy for localized carcinoma of the prostate. He developed 3 port site metastases 3 years after surgery. In view of multiple port site metastatic disease, bilateral orchiectomy was done. The patient is doing well after 1 year of follow-up. Conclusion: We report an occurrence of delayed multiple port site metastases after laparoscopic radical prostatectomy. The 3 sites of metastases in our case included the extraction site, the most active instrument site, and the drain placement site.