Publications by authors named "Rahul Janak Sinha"

81 Publications

Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study.

Int Braz J Urol 2020 May-Jun;46(3):363-373

King George's Medical University, Lucknow, India.

Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018.

Materials And Method: Baseline bone health was assessed using Tc-99 MDP Bone scan/DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared.

Results: A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p < 0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; -0.77, -0.55 and -0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p < 0.05). Pain scores significantly decreased in patients after 12-months of ZA use (-2.92±2.16, p < 0.01).

Conclusion: Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2019.0023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088500PMC
August 2020

Vulvar tuberculosis.

BMJ Case Rep 2020 Feb 11;13(2). Epub 2020 Feb 11.

Pathology, King George Medical University, Lucknow, Uttar Pradesh, India.

Genital tuberculosis (TB) in women is a chronic disease with low-grade symptoms. Genital tract tuberculosis is usually secondary to extragenital TB. The fallopian tubes are most commonly affected, and along with endometrial involvement, it causes infertility in such patients. Involvement of the cervix and the vulva is very rare. We present one such rare case of vulvar tuberculosis presented with a large ulcer diagnosed on histopathology and treated with antitubercular chemotherapy.
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http://dx.doi.org/10.1136/bcr-2019-232880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035815PMC
February 2020

Outcomes of patients with Fournier's Gangrene: 12-year experience from a tertiary care referral center.

Turk J Urol 2019 11 1;45(Supp. 1):S111-S116. Epub 2019 Dec 1.

Department of Urology, King George's Medical University, Lucknow, India.

Objective: To highlight changing trends of the clinical spectrum, and compare the management options and predictors of Fournier's gangrene (FG) outcomes in a tertiary care referral center.

Material And Methods: This study included patients with FG between August 2005 and July 2017. Patients were classified as "responders" and "nonresponders." We compared the baseline characteristics, clinical spectrum, biochemical data, management modalities, outcomes, and FG severity index (FGSI) and age-adjusted Charlson Comorbidity Index (ACCI) between responders and nonresponders.

Results: We studied 72 patients and further divided them to responders (60 patients) and non-responders (12 patients). All were males; the mean age was 56.27+19.27 years (range, 47-85 years). The most common complaints were perineal discomfort (n=62; 86.1%) and fever (n=48; 66.7%). FG originated from the penoscrotal region in 64 patients (88.8%) and perineal region in 8 patients. Diabetes mellitus was the most common comorbidity (36%). The mean duration of the presentation was 10.19 days (range, 7-30 days). Sixteen patients underwent split skin grafting. The mortality rate was 8.3%. Nonresponders had distinct findings relative to responders: advanced age (71.5±7.17 vs. 53.23±19.85 years; p=0.00); high blood sugar (245.83±116.26 vs. 139.06±35.64 mg/dL; p<0.01); leukocytosis (27166.67±10295.75 vs. 10558.4±3130.64 cumm; p<0.01); elevated serum creatinine (3.78±1.43 vs. 1.38±1.00; p<0.01); hyponatremia (127.33±11.84 vs. 137.33±3.42 meq/l; p<0.01), elevated international normalized ratios (1.66±0.28 vs. 1.32±0.07; p<0.01); and high FGSI (9.83±1.11 vs. 6.46±1.68;p<0.01) and ACCI scores (6.33±0.49 vs. 5±0.82; p<0.01). On univariate and multivariate regression analysis, raised blood sugar and deranged international normalized ratios at presentation were significantly associated with decreased response to treatment (p<0.05).

Conclusion: An advanced age, diabetes mellitus, renal impairment, leukocytosis, altered sensorium, shock at presentation, deranged international normalized ratios, and high FGSI and ACCI scores can be used as predictors for poor response. FG risk scores adequately characterize the severity and prognosis of FG, but clinician's judgement is vital. The management comprises of a multidisciplinary approach, including parenteral antibiotics, urgent surgical debridement, and comorbidities optimization.
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http://dx.doi.org/10.5152/tud.2019.39586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922036PMC
November 2019

Genetic susceptibility of CYP1A1 gene and risk of pesticide exposure in prostate cancer.

Cancer Biomark 2020 ;29(4):429-440

Molecular Biology Lab, Center for Advance Research, King George's Medical University, Lucknow, Uttar Pradesh, India.

Background: The etiology of prostate cancer (PCa) is multi-factorial including environmental and genetic factors. Present study evaluates the association between level of pesticides, stress level and CYP1A1 gene polymorphism with PCa patients.

Methods: A case control study was conducted with 102 PCa patients and age match symptomatic (n= 107) and asymptomatic benign prostatic hyperplasia (BPH, n= 70) patients. Pesticide level was characterized by Gas Chromatography. The oxidative stress and scavenging mechanisms were determined by biochemical method. Two polymorphisms of CYP1A1 gene, rs4646903 and rs1048943, were analyzed by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism and allele specific PCR method.

Results: Higher level of pesticide namely beta-hexachlorocyclohexane (β-HCH), Malathion, Chlorpyrifos and Fenvalerate were found in PCa group (all p value: < 0.05). Kruskal Wallis H test depicted that level of β-HCH and Malathion significantly correlated with higher grade of PCa (all p< 0.05). The PCa Patients with simultaneously low antioxidant activity and high stress level tended to suffer worst clinical outcomes. Dominant model of rs4646903 and rs1048943 suggested that substitution is associated with a higher risk of PCa (OR: 2.2, CI: 1.6-3.8, p: 0.009 and OR: 1.95, CI: 1.1-3.4, p: 0.026; respectively) and this risk was also influenced by smoking and pesticide exposure.

Conclusion: Environmental and genetic factors are reported to raise risk; person with high level of these pesticides especially in high risk genotype might be more susceptible to PCa.
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http://dx.doi.org/10.3233/CBM-190636DOI Listing
August 2021

Prospective randomized comparison of repairing vesicovaginal fistula with or without the interposition flap: Result from a tertiary care Institute in Northern India.

Turk J Urol 2019 09 1;45(5):377-383. Epub 2019 Sep 1.

Department of Urology, King George's Medical University, Lucknow, India.

Objective: Assessment of results of repairing vesicovaginal fistula (VVF) with or without the use of interposition flaps.

Material And Methods: This prospective randomized study was conducted between January 2012 to December 2017 in the Department of Urology, King George's Medical University, Lucknow, India. Obstetric and gynecological simple fistula of ≤4 cm were included for evaluation. Those with complex or complicated fistula or fistula due to malignancy were excluded. Patients were divided into two groups (group 1 and group 2) depending upon route of repair i.e., transvaginal or transabdominal, respectively, as per the characteristics and location of the fistula. These two groups of patients were randomized into two subgroups (1A, 1B and 2A, 2B) based on the inclusion or omission of the interposition flap during fistula repair. Perioperative and postoperative parameters (blood loss, mean operating time, hospital stay, and requirement of analgesics) and success rates of fistula repair were compared. All complications that occurred in the postoperative period till the last follow-up appointment were recorded. The Clavien-Dindo Classification was used to stratify the complications.

Results: Fifty-seven patients underwent transvaginal repair in group 1 (29 with Martius flap: group 1A; 28 without Martius flap: group 1B), while 69 patients underwent transabdominal repair in group 2 (35 with interposition flap: group 2A; 34 without flap: group 2B). Blood loss, mean operating time, hospital stay, and the requirement of analgesics were comparable between each subgroup-1A versus 1B and 2A versus 2B, respectively. The overall success rate of repair across all groups was 96.04% (121/126). The success rate was 93.1% in transvaginal repair with Martius flap versus 96.43% in transvaginal repair with no flap (p=1.0). Success rate was 97.1% in transabdominal repair with an omental flap versus 97.06% in without an omental flap (p=1.0). Mean follow-up period was 39.6 months (range: 6-68 months). Out of 29 patients with Martius flap interposition, 9 (31.03%) of them reported a significantly reduced sensation on the labia majora. Of these 9 patients, 5 reported numbness while the remaining 4 experienced pain as compared to the patients in subgroup IB, who did not report any altered sensation in the labia. (p=0.0019).

Conclusion: The success rates are similar in simple VVF repair (fistula size less than 4 cm) irrespective of the use of interposition flaps. However, overall morbidities following repair with the interposition flap are higher when compared with repair without interposition flap, either by the transvaginal or by the transabdominal route.
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http://dx.doi.org/10.5152/tud.2019.85233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739083PMC
September 2019

Squamous cell carcinoma of skin due to prolonged indwelling percutaneous nephrostomy catheter.

BMJ Case Rep 2019 May 24;12(5). Epub 2019 May 24.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Percutaneous nephrostomy (PCN) catheter placement is a commonly performed procedure in the urological practice for various indications like percutaneous nephrolithotomy, pyonephrosis, infected hydronephrosis and after failed attempt of ureteric stenting. The nephrostomy catheter is usually associated with low complication and morbidity rate, but prolonged indwelling nephrostomy tube may be hazardous in some cases. We hereby report a case of squamous cell carcinoma of skin around the PCN, which was attributed to chronic inflammation and persistent irritation from a long-term neglected indwelling nephrostomy catheter for last 3 years. The patient was managed with wide local excision of skin carcinoma and ureterocalicostomy for pelviureteric junction stricture. The authors report the first documented case with aforementioned presentation.
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http://dx.doi.org/10.1136/bcr-2018-229023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536164PMC
May 2019

Diagnostic utility of GATA3 immunohistochemical expression in urothelial carcinoma.

Indian J Pathol Microbiol 2019 Apr-Jun;62(2):244-250

Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India.

Aims: This study aims to explore the utility of GATA binding protein 3, a zinc finger transcription factor, expression in genitourinary carcinoma, especially urothelial carcinoma.

Settings And Design: It is a prospective study where 74 consecutive cases of urothelial carcinoma along with 10 cases each of prostatic adenocarcinoma (PC) and conventional clear cell renal cell carcinoma were included between August 2016 and January 2017.

Methods And Materials: All the cases were histopathologically evaluated and immunohistochemically stained for GATA binding protein 3. Only nuclear positivity was considered as positive. Immunoreactivity score for GATA expression was calculated based on the staining intensity as well as percentage.

Statistical Analysis Used: The statistical analysis was done using Statistical Package for Social Sciences Version 15.0 statistical analysis software. P value of <0.05 was considered statistically significance.

Results: GATA3 expressions were seen in 77% of the cases of urothelial carcinoma, whereas none of the clear cell renal cell carcinoma and prostatic adenocarcinoma cases was GATA3 positive. GATA3 expression significantly correlated with histological grade and muscle invasion with a weaker or negative expression in high-grade muscle invasive tumor as compared to low-grade and noninvasive neoplasm. Significantly weaker expression of GATA3 was found in cases with severe nuclear pleomorphism, mitosis >10/10 hpf, presence of necrosis, and tumor-infiltrating lymphocytes. No significant change in the status of GATA3 expression was seen in follow-up cases between initial Transurethral resection of bladder tumor (TURBT) and post-recurrence TURBT or radical cystectomy specimens.

Conclusions: GATA3 as a sensitive and specific marker for urothelial carcinoma can be effectively used to exclude other genitourinary malignancies, PC, and renal cell carcinoma, at metastatic site. This marker can also be effectively used in predicting the probable grade and invasion in biopsy material with poor morphological characteristics, thereby helping in appropriate management in such cases.
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http://dx.doi.org/10.4103/IJPM.IJPM_228_18DOI Listing
August 2019

Implications of the Fracture Risk Assessment Algorithm for the assessment and improvement of bone health in patients with prostate cancer: A comprehensive review.

Turk J Urol 2019 07 20;45(4):245-253. Epub 2019 Feb 20.

King George Medical University (KGMU), Lucknow, India.

Objective: Maintaining the optimum bone health is one of the important concerns in patients with prostate cancer, but it usually remains neglected. Failure to screen these patients is detrimental to both the length and the quality of life. The estimation of bone mineral density (BMD) and more recently the World Health Organization's fracture risk assessment (FRAX) algorithm in appropriate patients is recommended by several specialty organizations/associations at the time of instituting androgen deprivation therapy (ADT) for metastatic and high-risk individuals. It provides a 10-year risk evaluation of hip and major osteoporotic fractures (MOF). Using this web-based new investigating tool, candidates at high risk of fractures can be predicted more accurately according to clinical risk factors (CRF) alone or in combination with the femoral neck BMD. The FRAX application for senile osteoporosis has been studied and reviewed extensively, but no systematic review has ever been conducted for assessing the implication of FRAX in prostate cancer. This review article will give insight about the validity, role, and utility of this investigating tool in clinical practice for fracture risk assessment in these individuals.

Material And Methods: This systematic review was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and Cochrane review principles. We searched the PubMed, Cochrane database of systematic reviews, and the EMBASE electronic database until December 2018 using the medical subject heading terms prostate cancer and FRAX.

Results: A total of nine studies meet the inclusion criteria and were included in the review. These studies enrolled a total of 3704 patients (sample size range, 78-1220) of localized, metastatic, castration resistant prostate cancer with or without ADT and/or on photon or radiotherapy. The factors that influenced FRAX included age, ethnicity, baseline BMD, duration of ADT, presence of CRF, and measurement methods (CRF, with/without BMD, computed tomography based). An advanced age and duration of ADT were the most robust risk factors. A 10-year MOF and hip fracture risk estimation was higher when the femoral neck BMD was not incorporated in the FRAX measurement. Despite several well-known strengths of using FRAX in the fracture risk assessment of suitable candidates with prostate cancer, several risk factors such as the mode/duration of ADT, mode of radiotherapy, Vitamin D levels, bone remodeling markers, and recent/recurrent fractures need to be incorporated in the FRAX calculator for improving the predictive ability. In contrast to senile osteoporosis with a longer life expectancy, the fracture risk in patients with prostate cancer need to be measured more frequently and for a shorter time. Therefore, models like Garvan calculator with both 5- and 10-year risk estimates have to be developed for these patients. Additionally, its utilization is of limited value in the presence of recurrent fractures or falls.

Conclusion: The FRAX algorithm is beneficial in identifying patients who require early intervention or bone-directed therapy as an early step to decrease skeletal-related events and other morbidity. Several risk factors need to be added for improving the FRAX predictive value. This model is still underutilized in the clinical practice and increasing the awareness among treating physicians will help in optimizing the bone health and the quality of life of this important population subgroup.
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http://dx.doi.org/10.5152/tud.2019.11736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619849PMC
July 2019

Analysis of anastomotic urethroplasty for pelvic fracture urethral distraction defect: Decadal experience from a high-volume tertiary care center.

Urol Ann 2019 Jan-Mar;11(1):77-82

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Context: Pelvic fracture urethral distraction defect (PFUDD) may be challenging for the treating urologist. Anastomotic urethroplasty is the established surgical procedure for the treatment of PFUDD. Few studies in literature focus purely on PFUDD, and majority of the studies include anterior urethral stricture as well. The period of these studies is relatively short. We conducted a retrospective analysis of patients who underwent primary or redo anastomotic urethroplasty for PFUDD over a period of 12 years at a tertiary care center in northern India.

Aims: The aim is to study anastomotic urethroplasty for pelvic fracture urethral distraction defect with regard to long-term success rate and complications.

Settings And Design: This was a retrospective study. Subjects and.

Methods: This retrospective study was conducted in the Department of Urology, King George's Medical University, Lucknow, India, from August 2004 to July 2016. All patients who underwent progressive perineal anastomotic repair of PFUDD were included in this study. Demographic findings, type of pelvic fracture, length of distraction defect as per retrograde urethrography (RUG) and micturating cystourethrography, any history of erectile dysfunction in the preoperative or postoperative phase, and urinary incontinence in postoperative phase were analyzed. Decision regarding catheter removal was taken after pericatheter RUG at 4 weeks. Follow-up was done at 3 and 6 months in postoperative period.

Results: A total of 226 anastomotic repairs were done in 221 patients. Of the 221 patients, 51 (23%) were redo urethroplasty. The mean age of patients was 27.6 years. The mean length of distraction defect was 2.7 cm. The mean duration of hospital stay was 6 days. Primary urethroplasty was successful in 163 (93.14%) of 175 patients and redo urethroplasty in 44 (86.27%) of 51 patients. Out of 165 patients, 18 (10.9%) patients reported occasional incontinence while 6 (3.63%) patients reported mild incontinence.

Conclusions: Anastomotic urethroplasty is the definitive procedure for PFUDD. Our success rate for primary deferred anastomotic urethroplasty is 93.14% and for redo anastomotic urethroplasty is 86.27%.
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http://dx.doi.org/10.4103/UA.UA_48_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362775PMC
February 2019

Chain of migrating ureteral calculi: a cat and mouse game.

BMJ Case Rep 2018 Dec 22;11(1). Epub 2018 Dec 22.

Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.1136/bcr-2018-226833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307556PMC
December 2018

Medullary sponge kidney and Caroli's disease in a patient with stricture urethra: look for the hidden in presence of the apparent.

BMJ Case Rep 2018 Dec 3;11(1). Epub 2018 Dec 3.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Caroli's disease is a rare congenital disorder with incidence rate of approximately 1 in 1 000 000 population. Renal anomalies which may be associated with Caroli's disease include medullary sponge kidney (MSK), cortical cysts, adult recessive polycystic kidney disease and rarely autosomal dominant polycystic kidney disease. Exact incidence of MSK in patients of Caroli's disease is not known. There are only a handful of reported cases of this association in literature. We hereby report a case of Caroli's disease with MSK with nephrocalcinosis. He presented to primary health centre with symptoms of urethral stricture due to lichen sclerosus et atrophicus and was managed with repeated co-axial dilatation but was never evaluated for underlying chronic renal insufficiency due to MSK. The thorough clinical examination and proper evaluation is important in patient of urethral stricture with underlying chronic renal insufficiency to avoid delayed diagnosis, management and related complications.
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http://dx.doi.org/10.1136/bcr-2018-226746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301632PMC
December 2018

Large anterior urethral calculus masquerading as periurethral abscess.

BMJ Case Rep 2018 Nov 8;2018. Epub 2018 Nov 8.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Urethral calculus causes variety of symptoms from simple dysuria to acute urinary retention. The diagnosis is many times not easy. A plain X-ray of the pelvis may aid in diagnosis. Due to variety of symptomatic presentations sometimes it is not the first diagnosis that comes to one's mind. Management is by removal of the calculus via various methods ranging from endoscopic to open surgery. We present the case of an adult male, who was initially thought to have periurethral abscess due to stricture urethra but during investigations was found to have urethral calculus as the cause for his symptoms.
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http://dx.doi.org/10.1136/bcr-2018-225831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6229136PMC
November 2018

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

BMJ Case Rep 2018 Oct 21;2018. Epub 2018 Oct 21.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

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.
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http://dx.doi.org/10.1136/bcr-2018-226819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203057PMC
October 2018

Pelvic hydatid: the great masquerader.

BMJ Case Rep 2018 Oct 17;2018. Epub 2018 Oct 17.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.1136/bcr-2018-227409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254374PMC
October 2018

Gossypiboma masquerading as nephrocutaneous fistula.

BMJ Case Rep 2018 Sep 27;2018. Epub 2018 Sep 27.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Nephrocutaneous fistula is a rare complication of surgical procedures involving the kidney. Fistula formation is also a complication seen in gossypiboma. We present the case of a patient who was initially suspected to have nephrocutaneous fistula after open pyelolithotomy. Later while undergoing open resection of fistula, he was found to have a retained surgical sponge (gossypiboma) near the lower pole of kidney. Gossypiboma is a term used for mass formed around a surgical sponge accidentally left in the body. It is most of the times not diagnosed by radiological imaging and thus results in unnecessary investigations to rule out other causes for the patient's symptoms. Having a high index of suspicion may lead to an earlier diagnosis. But the prevention of gossypiboma is of the utmost importance. A meticulous approach while operating by the surgeon and operating rooms staff is very important in doing so.
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http://dx.doi.org/10.1136/bcr-2018-225992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169637PMC
September 2018

Delayed pressure urticaria due to non-invasive blood pressure monitoring in a previously non-atopic man.

BMJ Case Rep 2018 Sep 15;2018. Epub 2018 Sep 15.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.1136/bcr-2018-227267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144342PMC
September 2018

Posterior urethral valve presenting with impacted prostatic urethral calculus: a diagnostic challenge.

BMJ Case Rep 2018 Sep 11;2018. Epub 2018 Sep 11.

Department of Urology, King George's Medical University, Lucknow, Uttar-Pradesh, India.

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http://dx.doi.org/10.1136/bcr-2018-227317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144351PMC
September 2018

Post-traumatic bony impingement into vagina: a rare cause of urethrovaginal fistula.

BMJ Case Rep 2018 Aug 10;2018. Epub 2018 Aug 10.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

A 22-year-old woman met with road traffic accident 6 months back following which she underwent exploratory laparotomy with intraperitoneal bladder rupture repair. She presented with urethrovaginal fistula due to a fragment of fractured pubic bone impinging into the anterior vaginal wall. The findings were confirmed on CT scan and cystoscopy. The patient was managed with removal of the bony spicule and transvaginal repair of urethrovaginal fistula with Martius fat pad interposition.
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http://dx.doi.org/10.1136/bcr-2018-226004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088322PMC
August 2018

Embryonal rhabdomyosarcoma of urinary bladder in an adult patient: an unusual manifestation.

BMJ Case Rep 2018 Apr 13;2018. Epub 2018 Apr 13.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

An adult man presented with off and on painless haematuria, which was diagnosed as bladder mass on contrast-enhanced CT. He underwent transurethral resection of bladder tumour with complete resection. A diagnosis of embryonal rhabdomyosarcoma was made following histopathology and immunohistochemistry report. The patient was planned for radical cystectomy but was found to have large recurrent infiltrating bladder mass with liver and bone metastasis. Hence, the plan for radical cystectomy was deferred and the patient was counselled regarding chemotherapy (vincristine, cisplatin and doxorubicin regime). The patient tolerated the first cycle of chemotherapy, but his condition deteriorated prior to the second cycle and the patient expired.
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http://dx.doi.org/10.1136/bcr-2018-224255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905795PMC
April 2018

Stent extrusion on the external surface of the transplanted kidney: unusual occurrence.

BMJ Case Rep 2017 Dec 14;2017. Epub 2017 Dec 14.

Department of Transplant Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

Here we present the case of a 40-year-old man, who underwent deceased donor renal transplantation. Towards the end of this operation, open-ended double J stent was inserted in the transplanted kidney. Modified Lich-Gregoir ureterovesical anastomosis was performed. Prior to the abdominal closure, it was discovered that proximal end of the stent had pierced the renal parenchyma and extruded on the external surface of the transplanted kidney. We contemplated removing the stent and reinserting it but decided against that due to various reasons. The stent was left as such. The patient was managed conservatively with satisfactory outcome in the postoperative period. To the best of our knowledge, this is first such report of conservative management of stent extrusion in transplanted kidney in the literature.
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http://dx.doi.org/10.1136/bcr-2017-221783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753728PMC
December 2017

Long-term outcome of laparoscopic vesicouterine fistula repair: Experience from a tertiary referral centre.

Turk J Urol 2017 Dec 1;43(4):512-516. Epub 2017 Dec 1.

Department of Urology, King George Medical University, Lucknow, India.

Objective: Vesicouterine fistula (VUF) is an uncommon cause of female genito-urinary fistula. Most of these fistulas are due to lower segment uterine cesarean section (LSCS). Traditionally, open surgical repair has been the traditional treatment. However, laparoscopic repair of VUF is a minimally invasive technique and few case reports have been published with short term follow up. In the present study, we are presenting our long- term outcome of laparoscopic repair of VUF.

Material And Methods: A retrospective analysis of 8 patients with VUF was performed from 2010 to 2015. Approval of Institutional Review Committee was obtained. All had history of LSCS of whom 3 had history of prolonged obstructed labor. Radiological imaging included ultrasound of kidney, ureter and bladder for all patients and hysterosalphingography in 4 patients and contrast enhanced computed tomography scan in 4 patients.

Results: Median age of the patient was 25.5 years (range, 22-32), and median follow up was 2.3 years (range, 1 -4). The most common presentation was cyclical menstrual bleeding through urine (menouria) in all, associated amenorrhea in 6 and vaginal leakage of urine in 2 cases. All patients underwent laparoscopic repair with successful outcomes. The mean operating time was 155±14.5 min (range, 135-186 min) with a median blood loss of 100 mL (range, 50-210 mL). Successful pregnancy was completed in 2 patients and other patients were taking contraceptives.

Conclusion: Laparoscopic repair of VUF is a safe and effective minimally invasive technique with successful pregnancy in long- term follow up.
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http://dx.doi.org/10.5152/tud.2017.45389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687217PMC
December 2017

Is circumferential urethral mobilisation an overdo? A prospective outcome analysis of dorsal onlay and dorso - lateral onlay BMGU for anterior urethral strictures.

Int Braz J Urol 2018 Mar-Apr;44(2):323-329

Department of Urology, King George's Medical University, Lucknow, India.

Introduction: For dorsal onlay graft placement, unilateral urethral mobilization is less invasive than standard circumferential urethral mobilization. Apart from success in terms of patency of urethra, other issues like sexual function, overall quality of life and patient satisfaction remain important issues while comparing outcomes of urethroplasty.

Aim: To prospectively compare the objective as well as subjective outcomes of two approaches.

Materials And Methods: Between July 2011 and January 2015, 136 adult males having anterior urethral stricture with urethral lumen ≥ 6 Fr. were prospectively assigned between two groups by alternate randomization. Operative time, complications, success rate (no obstructive symptoms, no need of any postoperative intervention, Q max > 15mL/sec), sexual functions (using Brief Male Sexual Function Inventory) were compared.

Results: Baseline parameters were similar in both groups (68 in each group). Overall success rate was similar in both groups (89 % and 91 % respectively). Improvement in total LUTS scores was similar in groups. Changes in overall health status (VAS and EQ 5D) was equal in both groups. Erectile function score was significantly decreased in DO than DL group while ejaculatory function and sexual desire remained stable after urethroplasty in both groups.

Conclusions: In anterior urethral stricture buccal mucosa graft provides satisfactory results as onlay technique. No technique whether dorsolateral and dorsal techniques is superior to other. Dorsolateral technique needs minimal urethral mobilization and should be preferred whenever feasible.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2016.0599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050550PMC
May 2018

Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature.

Turk J Urol 2017 Sep 31;43(3):313-318. Epub 2017 Jul 31.

King George Medical University, Lucknow, Uttar Pradesh, India.

Objective: The incidence of ureteral stricture is showing a rising trend due to increased use of laparoscopic and upper urinary tract endoscopic procedures. Boari flap is the preferred method of repairing long- segment ureteral defects of 8-12 cm. The procedure has undergone change from classical open (transperitoneal and retroperitoneal) method to laparoscopic surgery and recently robotic surgery. Laparoscopic approach is cosmetically appealing, less morbid and with shorter hospital stay. In this case series, we report our experience of performing laparoscopic ureteral reimplantation with Boari flap in 3 patients.

Material And Methods: This prospective study was conducted between January 2011 December 2014. The patients with a long- segment ureteral defect who had undergone laparoscopic Boari flap reconstruction were included in the study. Outcome of laparoscopic ureteral reimplantation with Boari flap for the manangement of long segment ureteral defect was evaluated.

Results: The procedure was performed on 3 patients, and male to female ratio was 1:2. One patient had bilateral and other two patient had left ureteral stricture. The mean length of ureteral stricture was 8.6 cm (range 8.2-9.2 cm). The mean operative time was 206 min (190 to 220 min). The average estimated blood loss was 100 mL (range 90-110 mL) and mean hospital stay was 6 days (range 5 to 7 days). The mean follow up was 19 months (range 17-22 months). None of the patients experienced any complication related to the procedure in perioperative period.

Conclusion: Laparoscopic ureteral reimplantation with Boari flap is safe, feasible and has excellent long term results. However, the procedure is technically challenging, requires extensive experience of intracorporeal suturing.
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http://dx.doi.org/10.5152/tud.2017.44520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562251PMC
September 2017

Does prostate size predict the urodynamic characteristics and clinical outcomes in benign prostate hyperplasia?

Urol Ann 2017 Jul-Sep;9(3):223-229

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Aims: Bladder outlet obstruction (BOO) in large and small prostates is managed in a similar manner despite considerably different pathophysiology, which can result in higher failure rates. We investigate the clinical and urodynamic features and study the outcome of patients with benign prostate hyperplasia (BPH) according to their prostate size.

Subjects And Methods: We prospectively analyzed 100 BPH patients undergoing urodynamic study between January 2015 and August 2016 and divided them into two groups according to their prostate size: small (≤30 mL) and large prostate (>30 mL) groups. We compared the groups regarding age, International Prostate Symptom Score, maximal flow rate (Qmax), postvoided residual, serum prostate-specific antigen (PSA), prostate volume measured by ultrasonography (USG), and urodynamic findings.

Statistical Analysis Used: For testing the hypothesis, we used the Chi-square test, Student's -test, and one-way analysis of variance when comparing between groups and conducted the logistic regression analysis for determining predictive factors of BOO.

Results: Although the total prostate volume significantly correlated with the PSA, patients with a small prostate had lower Qmax (5.27 ± 4.8 mL/s vs. 6.14 ± 6.66 mL/s; = 0.74), higher incidence of abnormal baldder capacity (39.9% vs. 31.25%), lower voiding efficiency (39.3 ± 40.5% vs. 40.57 ± 32.11%), low compliance (44.4% vs. 31.3%), higher incidence of indeterminate detrusor contractions (38.9% vs. 37.5%), lower incidence of detrusor underactivity (33.3% vs. 28.1%), lower BOO index (40.9 ± 43.2 vs. 49.10 ± 44.48), lower bladder contractility index (77.8 ± 48.84 vs. 92.09 ± 52.79), and lower PdetQmax (51.44 ± 42.23 vs. 61.38 ± 42.01 cmHO). Small prostates had higher failed voiding trials postsurgery.

Conclusions: BOO patients with a small prostate showed poor urodynamic parameters and reported higher postoperative complications.
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http://dx.doi.org/10.4103/0974-7796.210029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532887PMC
August 2017

Outcome analysis of transurethral resection versus potassium titanyl phosphate-photo selective vaporization of the prostate for the treatment of benign prostatic hyperplasia; a randomized controlled trial with 4 years follow up.

Turk J Urol 2017 Jun 18;43(2):176-182. Epub 2017 Apr 18.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Objective: Photovaporization of prostate (PVP) is a newer surgical modality of benign prostatic hyperplasia (BPH) which is gaining importance recently. There are a few randomized controlled trials that showed safety and efficacy of PVP in comparison with transurethral resection of prostate (TURP) with limited follow-up period (<2 years). Here, we are presenting a comparative study performed on potassium titanyl phosphate (KTP) PVP laser versus TURP for the treatment of BPH with long-term follow-up period.

Material And Methods: After institutional ethical clearance, 150 patients were prospectively included in the study from January 2010 to March, 2012. Improvement of International Prostate Symptoms Score (IPSS), Qmax, post-void residual (PVR) urine, International Index of Erectile Function (IIEF)-5 score and complications were assessed at 12, 24, 36 and 48 months.

Results: Mean age of the study group was 65.3±7.86 years in the TURP and 63.6±8.12 years in the PVP groups (p=0.45). IPSS symptom score improved significantly in both TURP and KTP groups (p<0.003). There was improvement in Q max during follow-up in both groups (p<0.001) which was maintained at 48 months. Most of the patients in both groups were satisfied with symptoms and bothersome at 48 months. All the sexual parameters are similar to both groups except retrograde ejaculation. Overall complication noted in 23 patients (15.33%).

Conclusion: Both KTP Laser PVP and TURP afford durable relief from symptoms of BPH at 48 months follow-up. Both procedures are safe and associated with minimal complications. Both procedures do not have any detrimental effect on sexual function on long-term follow-up. Quality of life remains high even at 4 years in both groups.
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http://dx.doi.org/10.5152/tud.2017.20586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503438PMC
June 2017

Renal fistulae: different aetiologies, similar management.

BMJ Case Rep 2017 Jul 14;2017. Epub 2017 Jul 14.

Department of Urology, King George's Medical University, Lucknow, India.

Iatrogenic renocolic fistulae, although have been described in literature, is a rare clinical complication. Recently its incidence is on rise due to advent of minimally invasive surgery and percutaneous surgery of kidney. It has been reported after percutaneous nephrolithotomy but its incidence after percutaneous nephrostomy is quite uncommon and rarely reported. Though spontaneous renocutaneous fistula has been reported, acquired renocutaneous fistula is very uncommon and fistula after gun shot injury has not been reported to the best of our knowledge. Herein, we present two different varieties of renal fistula with completely different history and presentation. But the interesting point is that both were managed conservatively in a similar fashion and both of them responded well.
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http://dx.doi.org/10.1136/bcr-2017-219678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534845PMC
July 2017

Large bladder calculus masking a stone in single-system ureterocele.

BMJ Case Rep 2017 Jun 14;2017. Epub 2017 Jun 14.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Ureterocele in an elderly is a rare entity. The presence of stone within ureterocele along with a large bladder calculus is an even rarer presentation. This phenomenon has not been reported so far to the best of our knowledge. We present an unusual case of a large bladder calculus with a concomitant stone in the associated ureterocele. The diagnosis was missed in the first instance due to the masking effect by the larger bladder calculus. Herein, we discuss this case and its management.
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http://dx.doi.org/10.1136/bcr-2017-219418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534717PMC
June 2017

Management of renal caliceal diverticular stones: A decade of experience.

Urol Ann 2017 Apr-Jun;9(2):145-149

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Objective: The objective of this study is to evaluate our methods for management of renal caliceal diverticular stones (CDS).

Materials And Methods: We conducted a retrospective study from January 2005 to July 2015 and included patients who were treated for renal CDS. Patients were evaluated for treatment modality, puncture site (in case percutaneous nephrolithotomy [PCNL] attempted), operative time, stone clearance rate, and complications. During PCNL, if the infundibulum was found to connect the diverticulum to the calyx, then a double J stent was placed. No attempt was made to dilate the diverticular neck or to create a neoinfundibulum.

Results: Twenty-four patients were treated for CDS during the study period. Two patients underwent shockwave lithotripsy, and 22 were managed by PCNL. Mean stone size was 16.37 mm (range: 6-35 mm) and mean diverticulum size was 20.62 mm (range: 12-37 mm). No fulguration was done in initial 17 patients, while fulguration by Holmium Laser was performed in the last five cases treated with PCNL. Mean operative time was 70.31 min (range: 47-90 min). Mean follow-up was 34 months, diverticulum resolved in 14 patients and reduced in size in 7 patients.

Conclusion: Caliceal diverticular calculi can be treated most efficiently by PCNL. Stone-guided puncture and no attempt to dilate or create neoinfundibulum reduces operative time and morbidity while yielding high stone-free rate.
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http://dx.doi.org/10.4103/UA.UA_95_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405657PMC
May 2017

Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: A retrospective outcome analysis.

Urol Ann 2017 Apr-Jun;9(2):131-135

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Purpose: The purpose of this study was to evaluate the clinical outcome and efficacy of transurethral resection of the prostate in patients of benign prostatic enlargement (BPE) with underactive bladder.

Materials And Methods: Retrospective study of 174 patients, who underwent transurethral resection of prostate (TURP) between 2008 and 2015, for lower urinary tract symptoms with BPE with bladder underactivity. Clinical history, physical examination, renal function test, urinalysis, cystourethroscopy, transabdominal or transrectal ultrasonography, and urodynamic study were recorded. Patients having a history of neurologic conditions, spinal trauma or surgery, pelvic trauma or surgery, diabetes mellitus with end organ damage, urethral pathology or surgery, and prostatic cancer were excluded from the study.

Results: The mean follow-up period was 22.4 ± 6.2 months. Mean prostate volume was 42.8 ± 6.4 ml and mean serum prostate-specific antigen was 2.3 ± 1.8 ng/ml. The International Prostate Symptom Score changed from 24.6 ± 4.2 preoperatively to 10.8 ± 5.8 postoperatively which was found statistically significant. Quality of life (QOL) score changed from 4.8 ± 1.2 to 2.6 ± 0.4. Twenty-two patients out of 174 remained on a per-urethral catheter or clean intermittent catheterization due to voiding failure after TURP beyond 1 month.

Conclusions: TURP should be considered a viable treatment option in men with enlarged prostate with underactive detrusor who had poor response to medical treatment. Preoperative counseling and postoperative follow-up are crucial in the management of such patients.
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http://dx.doi.org/10.4103/UA.UA_115_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405654PMC
May 2017
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