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Byline: Ankush. Modi, Prabhjot. Singh, Amlesh. Seth, Rajeev. Kumar Introduction: Elevated serum prostate-specific antigen (PSA) is the most common trigger for a prostate biopsy. However, the range of normal PSA [...]

Introduction: The blood-based inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), is a reliable prognostic biomarker for several cancers. Although the literature supports the correlation between preoperative NLR, clinicopathological characteristics, and oncological outcomes in upper tract urothelial carcinoma (UTUC), the cutoff of NLR is still debated. This study aimed to determine the prognostic value of NLR in patients with UTUC. Methods: This was a retrospective analysis of prospectively collected data from July 2012 to December 2022 evaluating patients with UTUC who underwent radical nephroureterectomy (RNU). NLR was calculated using the neutrophil and lymphocyte counts obtained a day before the surgery and the cutoff value was set as 2.5. Kaplan-Meier and Cox's proportional hazards regression were used to analyze the association between NLR and the oncological outcomes. Results: The study included 91 patients (78 males, 13 females) in the final analysis with a median follow-up of 49 months (8-130). The mean age of the patients with NLR <2.5 and NLR >2.5 was 56.88 years and 56.35 years, respectively, and the pathological stage was pT1 in 48%, pT2 in 20.88%, pT3 in 27.47%, and pT4 in 3.30% of the patients. Multivariable Cox regression analysis showed that the preoperative NLR >2.5 was significantly associated (Hz = 7.17) with higher T stage, lymphovascular invasion, necrosis, nodal involvement, adjuvant chemotherapy, and worse overall survival (OS) (Hz = 9.87). The Kaplan-Meier analysis revealed an improved OS in patients with NLR <2.5, but a statistically significant difference in the recurrence-free survival was not found. Conclusions: Preoperative NLR is an easily available, inexpensive, and important prognostic biomarker of survival in patients with UTUC and has a potential role in risk stratification by predicting adverse clinicopathological characteristics. [ABSTRACT FROM AUTHOR]

Byline: Prashant. Sharma, Sridhar. Panaiyadiyan, Santosh. Kurra, Raman. Kumar, Brusabhanu. Nayak, Seema. Kaushal, Alpana. Sharma, Rajeev. Kumar, Amlesh. Seth, Prabhjot. Singh We appreciate the author's interest in our recently published [...]

Byline: Harshit. Garg, Amlesh. Seth, Rajeev. Kumar Introduction: Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as 'high-risk' prostate cancer (PCa). However, among Indian men, PSA [...]

Introduction: Abnormal levels of heavy metals (HM) and trace elements (TE) affect body metabolism and can induce carcinogenesis. This study aims to evaluate the role of HM and TE in carcinoma urinary bladder (CAUB). Methods: Patients with biopsy-proven CAUB (n = 100) were taken as the study group, while age-and sex-matched healthy volunteers were taken as control (n = 100). Blood and urine samples were compared for Arsenic (As), Copper (Cu), Manganese (Mn), Selenium (Se), Cadmium (Cd), Lead (Pb), and Mercury (Hg) levels. Serum glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and lipid peroxidation (LPO) levels were assessed to know the redox status between the two groups. Results: A significantly higher blood level of As, Mn, and Pb was observed in CAUB cases as compared to controls. Blood Se level was significantly lower in CAUB patients. On comparing urinary levels, CAUB patients had a higher As, Mn, and Pb levels compared to controls. Further, 68% and 59% of patients had their blood and urinary HM and TE levels above the permitted level, respectively. CAUB cases also had a lower GSH-Px (113.5 ± 44.7 vs. 163.9 ± 120.5, P = 0.0002), lower SOD levels (11.35 ± 5.6 vs. 13.75 ± 3.9, P = 0.008), and a higher LPO levels (15.5 ± 14.7 vs. 11.18 ± 11.2, P = 0.02) in the serum. Conclusions: A significantly higher concentration of As, Mn, and Pb was noted in the blood and urine of CAUB patients compared to controls. CAUB cases also had lower serum GSH-Px and SOD levels with a concomitant increased serum LPO assay suggesting underlying oxidative stress. [ABSTRACT FROM AUTHOR]

Byline: Devanshu. Bansal, Brusabhanu. Nayak, Prabhjot. Singh, Rishi. Nayyar, Rashmi. Ramachandran, Rajeev. Kumar, Amlesh. Seth We thank the authors for their kind appreciation and keen observations. We performed a randomized [...]

Introduction: Human papillomavirus (HPV) is a known risk factor of penile cancer (PeCa). However, studies evaluating its true association are limited. In this study, we aimed to estimate HPV prevalence and its true association with PeCa in terms of molecular biological activities. Materials and Methods: This single-institutional prospective observational study was conducted between June 2016 and August 2019. We included 40 men with PeCa as a study group and 20 age-matched uncircumcised men who underwent circumcision for phimosis as a control group. Both the groups underwent deoxyribonucleic acid isolation for HPV subtyping followed by evaluation of relative E6/E7 messenger ribonucleic acid (mRNA) expression profile and relative telomerase activity in tissue samples. HPV-16 and -18 were categorized as high-risk, whereas HPV-6 and -11 were categorized as low-risk subtypes. Results: The mean (±standard deviation) age of PeCa was 51 ± 15.9 years. The majority of patients had stage II disease, and the most common procedure done was partial penectomy. The overall prevalence of HPV in PeCa was 42.5% (n = 17) as compared to 20% (n = 4) in controls. Among the subtypes, the most common subtype was HPV-16 noted in 33.3% (8/24) of cases, followed by HPV-18 in 29.2% (7/24) of cases. PeCa tissues had a significantly higher relative E7 mRNA expression for HPV-18 than the control group (P = 0.016). The mean relative telomerase activity was significantly higher in the PeCa tissues than the control group (138.66 vs. 14.46, P < 0.001). A significantly higher relative telomerase activity was noted in the PeCa tissues positive for high-risk HPV subtypes than controls (141.90 vs. 14.46, P = 0.0008), but not between high-risk HPV-positive and HPV-negative PeCa cases (141.90 vs. 137.03, P = 0.79). High-risk subtypes were not associated with tumor stage (P = 0.76) or lymph node metastasis (P = 0.816). Conclusions: HPV was associated in 42.5% of PeCa cases based on our experience from a single institution. PeCa tissues had a higher relative E7 mRNA expression for HPV-18 and relative telomerase activity as compared to controls suggesting their potential role as surrogate markers of virus-induced tumorigenesis. [ABSTRACT FROM AUTHOR]

Byline: Tapan. Agrawal, Rajeev. Kumar, Prabhjot. Singh, Ashish. Saini, Amlesh. Seth, Premnath. Dogra Introduction: Apart from the complexity of procedure and surgeon's experience, surgical complication rates depend on case definition [...]

Byline: Prabhjot. Singh, Siddharth. Yadav, Sanjay. Mahapatra, Amlesh. Seth Introduction: We aimed to study the outcomes of retroperitoneal lymph node dissection (RPLND) in postchemotherapy residual masses in advanced testicular germ [...]

Introduction: Very few randomized controlled trials are available globally to support routine use of enhanced recovery after surgery (ERAS) protocol after radical cystectomy (RC), and none so far has been conducted in the Indian subcontinent. The aim of the present study was to evaluate hospital stay and 30-day perioperative outcomes following RC with the implementation of the ERAS protocol. Materials and Methods: Fifty-four patients undergoing open RC were randomized to ERAS versus conventional surgical care (CSC) at our center from April 2017 to May 2018. Key interventions included avoidance of mechanical bowel preparation, early nasogastric tube removal, early enteral feeding, and early obligatory ambulation. Follow-up was done till 30-day postoperatively or till discharge, whichever longer. Results: Twenty-seven patients in each group were analyzed. The demographic profile of the groups was similar. Length of stay in each group (8 days [5–57] ERAS vs. 9 days [5–31] CSC group, P = 0.390) was similar, with time to recovery of bowel function being significantly less in ERAS group (12 h [12–108] vs. 36 h [12–60] for bowel sounds [P = 0.001], 48 h [12–108] vs. 72 h [36–156] for passage of flatus [P = 0.001], and 84 h [36–180] vs. 96 [60–156] for passage of stools [P = 0.013]). Perioperative complication rate (12 patients (44.4%) vs. 14 (51.9%), P = 0.786) was similar. Conclusions: ERAS protocol leads to faster bowel recovery compared to conventional care in patients undergoing open RC but fails to demonstrate a shorter length of stay and lower complication rate. [ABSTRACT FROM AUTHOR]

Byline: Amlesh. Seth, Ishwar. Ram A rare case of squamous cell carcinoma of bladder occurring in a 36-year-old female with persistent cloacal anomaly who presented with frequency, urgency, dysuria, and [...]

Byline: Anand. Bhageria, Amlesh. Seth, Girdhar. Bora Refractory bleeding following percutaneous nephrolithotomy (PCNL) is mainly due to formation of pseudoaneurysm. Transarterial embolization is required to control the bleeding in such [...]

Byline: Rishi. Nayyar, Prabhjot. Singh, Narmada. Gupta, Ashok. Hemal, Prem. Dogra, Amlesh. Seth, Rajeev. Kumar Dear Editor, We thank Dr. Gautam [sup][1] for his comments on the subject.[sup][2] We totally [...]

Byline: Rishi. Nayyar, Sabyasachi. Panda, Ashish. Saini, Amlesh. Seth, Shiv. Chaudhary Leiomyosarcoma of inferior vena cava (IVC) involving bilateral renal veins presents a surgical challenge. Herein, we report the successful [...]

Byline: Rishi. Nayyar, Prabhjot. Singh, Narmada. Gupta, Ashok. Hemal, Prem. Dogra, Amlesh. Seth, Rajeev. Kumar Objectives : To assess the accuracy of Gleason grading/scoring on preoperative needle core biopsy (NCB) [...]

Byline: Narmada. Gupta, Surendra. Kolla, Amlesh. Seth, Prem. Dogra, Ashok. Hemal, Rajeev. Kumar, Sabyasachi. Panda We present the outcomes of a large series of patients treated with radical cystectomy and [...]

Introduction: To investigate the role of GSTM1 and T1 null genotypes as risk factors for prostate cancer in north Indian population. Methods: The subjects appraised were 150 cases and 172 healthy males. Peripheral blood was collected along with the demographic and anthropometric data. DNA was extracted by proteinase K/SDS digestion and GSTM1 and GSTT1 polymorphisms were analyzed by a multiplex-PCR. Results: GSTM1 and GSTT1 null genotype was found to confer 2.45 (OR= 2.45; 95% CI = 0.56-3.82; P-value=0.00008) and 2.39 (OR=2.39; 95% CI=1 36-4.20; p-value=0.02) fold higher risk of prostate cancer independent to each other. Also, null genotype at either loci, GSTM1 or GSTT1, increased the risk by 2.84 folds (OR=2.84; 95% CI=1.76-4.51; P value= 0.0002).The null genotype at both loci was assessed to be a significant risk factor of prostate cancer (OR= 4.08, 95% CI= 1.93-8.61, P value = 0.0002). Smoking imparted a 2.08 fold higher risk of prostate cancer (OR=2.08, 95% CI=1.31-3.30, P value = 0.00002). Factors like alcohol consumption, tobacco chewing, consumption of vegetarian/ non-vegetarian food, literacy levels, occupation pursued and residential locality were not found to be significant in risk prediction. Conclusions: GSTM1 and GSTT1 null genotypes and smoking are associated with high risk of prostate cancer. [ABSTRACT FROM AUTHOR]

Introduction: To determine the effect of Tamsulosin, as adjunctive medical therapy on the outcome of extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteric calculi. Methods: From Jan 2007 onwards, a prospective, randomized controlled study was conducted in patients with solitary renal or ureteral calculus measuring less than 20 mm undergoing ESWL. The Study group (n=62) received 0.4 mg of Tamsulosin daily till stone clearance or a maximum period of 12 weeks and control group (n=58) received ESWL only. Parameters assessed were stone size, composition, location, stone clearance, mean time to clearance, analgesic requirement, steinstrasse, need for hospitalization and/or auxiliary procedures. Results: There was no difference between the 2 groups with regards to age, stone size, location or composition. The complete clearance rate for renal stones was 62.7% and 36.5% (P=0.004) and for ureteric stone was 89.4% and 58.8% (P=0.03) in study and control groups, respectively. The control group had a higher rate of clinically insignificant residual fragments (CISF i.e. <3mm), 12.9% vs. 35.4% (P=0.002).There was no significant difference in the mean time to stone clearance (P=0.07) or in the incidence of steinstrasse formation (P=0.12). The mean analgesic requirement (P=0.01), need for auxiliary procedures and hospitalization (P=0.03) was significantly was higher in the control group. Conclusions: Tamsulosin increase the complete clearance rate and decrease the incidence of CISF. It also reduces analgesic requirement, need of additional procedures and hospitalization rate and might be useful as a routine adjunctive therapy following ESWL. [ABSTRACT FROM AUTHOR]

Introduction: Various biomedical imaging modalities are under investigation for real time tissue imaging of periprostatic nerves with the idea of improving upon the results of nerve sparing radical prostatectomy. We explored the use of Multiphoton microscopy for this purpose. The unique advantage of this technique is the acquisition of high resolution image without requiring any extrinsic labeling agent and almost no phototoxic effect on tissue. Methods: The prostate and cavernous nerves were surgically excised in male Sprague-Dawley rats. An Olympus BX61WI upright fluorescence microscope was utilized. A femtosecond pulsed Titanium/sapphire laser at 780nm wavelength was used to excite the tissue. Second Harmonic Generation (SHG) signals were collected at 390 (± 35 nm) and the autofluorescence was collected at 380-530nm. The images were then merged and pseudocolors imparted for better appreciation of details. The corresponding tissues were subjected to H&E for histologic confirmation. Results: High resolution images of prostate capsule, underlying acini and the individual cell outlining the glands, fat and the neural tissues were obtained. Histologic confirmation and correlation of the prostate gland, fat, cavernous nerve and major pelvic ganglion validated the findings of multiphoton microscopy. Conclusions: Real time imaging and microscopic resolution of rostate and periprostatic neural tissue using multiphoton microscopy is feasible without the need for any extrinsic labeling agents. Integration of this imaging modality with operative technique has the potential to improve the precision of nerve sparing prostatectomy. [ABSTRACT FROM AUTHOR]

Introduction: ELAC-2 gene is considered as prostate cancer susceptibility gene. It is located on chromosome 17p11 and is encoded as HPC/ELAC2. Two common polymorphisms i.e. Ser217Leu and Ala541Thr are apparently associated with a modestly increased risk in familial prostate cancer. According to Xu et al. (2006), Ala541Thr polymorphism was not frequent either in control or in sporadic cases of prostate cancer in Americans. The frequency of heterozygous (Ala/Thr) was low in all the groups and homozygous (Thr/Thr) was an occasional occurrence. On the other hand, the Ser217Leu polymorphism has been found to be associated with prostate cancer in familial cases as well as in sporadic cases (Xu et al., 2001). The present study was conducted to find out the association of Ser241Leu genotype in cases of sporadic prostate cancer in Indian population. Methods: In Indian population the number of prostate cancer with familial history was quite negligible. Hence genotype analysis of HPC/ELAC-2 was done on 157 cases of sporadic prostate cancer and 170 age matched controls (having normal serum PSA < 4.0ng/ml and normal digital rectal examination) using RFLP technique. Results: Leu217 homozygous genotype (Leu/Leu) had shown 1.7 fold (0.74-3.92) increased risk of prostate cancer. When data was stratified with staging, the risk was aggravated to 1.86 in metastized cases (95% CI=0.70-4.96). Smokers (OR=3.24; 95% CI=0.80-13.18) and non vegetarians (OR=2.92; 95% CI=0.76-11.24) were at higher risk in developing prostate cancer with this mutant genotype (Leu/Leu). Conclusions: This study stresses the role of gene-environment interaction in the progression and development of prostate cancer. The results were similar to European American population done by Wheeler et al. (2006) indicating its role in the etiology and clinical progression of prostate cancer. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic Retroperitoneal Fibrosis (IRPF) is an uncommon, benign, non-specific inflammatory disease of the retroperitoneum. Surgical ureterolysis and immunosuppression has been the mainstay treatment. Recently, Tamoxifen- a non-steroidal antiestrogen is said to enhance secretion of TGF-β which modulates the action of fibroblasts & immune cells, thereby regulating fibrosis in mesangial cells. This prospective observational study was conducted to describe clinical course & analyse the outcome of patients of IRPF treated with Tamoxifen. Methods: Between July 2005 to July 2007, 11 patients were treated with 60mg Prednisolone with a gradual taper over 4 months. Tamoxifen was administered concurrently & continued for 2 years or upto 6 months following resolution of systemic symptoms and extubation of affected ureters. Baseline & follow up laboratory parameters included ESR, C-reactive proteins and RFT Diagnosis of IRPG was made on basis of CT/MRI and/or HPE. Results: Treatment response was analysed on basis of normalization of laboratory evidence of inflammation & renal function, regression of degree of fibrosis on CT/MRI & relief of obstructive uropathy as gauged by uneventful removal of JJ stent. Marked improvement was seen in 4(36.5%) cases. Results were equivocal in 3 ( 27.5%) cases while surgical intervention was required in 4 (36.5%) cases. Conclusions: Tamoxifen is a safe & efficacious viable therapeutic option in the management of IRPF with no significant side effect. Larger trials are however needed to confirm the results. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the role of an electrothermal bipolar coagulator (Biclamp) on the performance and outcome of open radical cystectomy in comparison with conventional methods of dissection. Methods: Over 1 year period, a prospective study was carried out in patients undergoing open radical cystectomy and urinary diversion for muscle invasive carcinoma bladder employing either conventional ligation/clip in the control group (n=22) or Biclamp device in the study group (n=20). Biclamp was used to divide the posterior and lateral pedicles of bladder. Outcome measures evaluated were estimated blood loss (EBL), transfusion requirement, operating time (total/cystectomy) and postoperative variables such as analgesia requirement, time to drain removal, duration of hospital stay and incidence of complications in both the groups. Results: Both groups were similar with regards to age, sex, BMI, associated co morbidity and clinical stage of the disease. Mean EBL and transfusion requirement in study and control groups were 605 and 1116 ml (P= 0.03) and 1.4 and 2.9 units (P=0.008), respectively. Mean cystectomy and total operating time were 74 and 104 minutes (P=0.02) and 295 and 304 minutes (P=0.76) in study and control groups, respectively. There was no significant difference in respect to analgesic requirement, drain removal, duration of hospital stay and incidence of complication between the groups. Conclusions: Use of Biclamp in radical cystectomy reduces blood loss,saves operating time and is particularly useful in dividing vessels deep in the pelvis where it acts as an viable alternative to hemostatic clips and sutures. [ABSTRACT FROM AUTHOR]