Vipul Tandon

Artificial neural networks in predicting optimum renal stone fragmentation by extracorporeal shock wave lithotripsy: a preliminary study

To assess the ability of artificial neural networks (ANNs) to predict optimum renal stone fragmentation in patients being managed by extracorporeal shock wave lithotripsy (ESWL).

Bladder mucosal autografts for repair of vesicovaginal fistula.

Twenty‐two women with primary and secondary (five patients) vesicovaginal fistula attending a tertiary level urological unit in India were treated by repair of the fistula using bladder mucosal autografts. The fistula was approached transabdominally or via a combined abdominal and vaginal approach (for those involving the trigone). After closure of the vaginal layer, bladder mucosa was harvested from the dome of the bladder and laid over the fistula with sutures at each corner to fix it in place. Patients were catheterised for 12–14 days. At follow up after 3 to 12 months, 20 out of 22 patients were continent, with no other symptoms. The two failures had undergone two previous repairs each. This series is the first from India, and demonstrates the efficacy of bladder mucosal autografts for managing large fistulae, those where a previous repair has failed and fistulae adjacent to the ureteric orifice without the need for uretero‐neocystostomy.

Transitional Cell Carcinoma of Kidney with Extension into Renal Vein and Inferior Vena Cava: A Report of Two Rare Cases and Review of the Literature

We report two cases of transitional cell carcinoma (TCC) of the right kidney with extension into renal vein and inferior vena cava (IVC). Based on radiological findings, the patients were diagnosed having renal cell carcinoma with tumor thrombus in the vena cava pre-preoperatively. Radical nephrectomy with thrombectomy was performed. A literature review of 18 reported cases revealed that 14 cases (77.8%) were diagnosed as renal cell carcinoma preoperatively. TCC should be included in the differential diagnosis of renal tumors that can cause IVC thrombosis. Prognosis of TCC with vena cava thrombus is relatively poor compared to that of renal cell carcinoma with a large vein tumor thrombus.

Ileal Neo-bladder: A Decade Experience with “Pouch First and Ileal Neo-urethra”: Our Modification

Objective: To show the efficacy and ease of our modified technique of constructing orthotopic neo-bladder after radical cystectomy for carcinoma bladder. Materials and methods: A total number of 76 patients with invasive carcinoma of bladder underwent radical cystectomy and orthotopic neo-bladder construction at this tertiary care hospital. We modified the conventional Hautmans technique. In this we constructed the ileal pouch first on the abdominal surface after making a neo-urethra utilizing a “U” shaped flap of dependent ileal segment. Then at the end of the procedure, anastomosis is performed between the neo-urethra and the membranous urethra. These cases are followed up at regular intervals with usual protocols with special stress on uroflowmetry and complete urodynamic assessment in selected patients. Results: Out of 76 patients who had a follow up of more than 10 years, only 1 patient developed total incontinence, which developed early local recurrence. Day and night time continence rates were ach...

Angiogenesis and Histologic Scoring in Prostatic Carcinoma—A Valuable Cost Effective Prognostic Indicator

Objective: To find any correlation between microscopic angiogenesis grading system (MAGS) score and Gleason score and serum prostate specific antigen (S.PSA) in carcinoma of prostate. Study design: Examination of 30 patients with prostatic carcinoma compared with an age matched control group of 30 patients having histopathologically proven benign prostatic Hyperplasia. The Preoperative serum PSA level was determined in all patients. Histopathological examination for MAGS score was done in all patients and Gleason scoring was done for cases of prostatic carcinoma. Result: MAGS score had a definite correlation with Gleason score (Correlation coefficient, ). Studying the relationship between MAGS score and S.PSA, a statistically significant difference is found between S.PSA levels in study and control groups, and in the three MAGS score groups namely 21–30, 31–40 and 41–50. Conclusion: Gleason score and MAGS score are well related to each other. As tumor becomes more poorly differentiated with rising Gleason...

Staging of Bladder Carcinoma: MRI—Pathologic Correlation

Objective: To evaluate the accuracy of MR imaging in the staging of bladder carcinoma and to correlate the results with pathological stage. Material and methods: Through June 2001 to January 2003, 20 patients of newly diagnosed bladder carcinoma with a mean age of 45±9.94 years who were candidates for radical cystectomy were included in the study. Patients with distant metastases or those with past history of malignancy elsewhere were excluded. The clinical stage for each patient was determined from the results of the conventional techniques. To avoid artifacts and edema of the bladder wall, cystoscopy and cold cup biopsy / transurethral resection was performed at best 2–3 weeks before magnetic resonance imaging (MRI). MRI was performed with a 0.2 tesla permanent magnet system (Sigma 0.2T System GEM SO CO1). Within 3 weeks after MRI all patients underwent radical cystectomy. MRI images were prospectively interpreted by two radiologists and reviewed for consensus by one urologist without knowledge of the f...