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Objective: Histopathological changes in oral (buccal or lingual) mucosa after exposure to urine are still not completely understood. We evaluated these changes in free oral mucosal graft integrated in human urethra. Material and methods: Total 19 patients with recurrent urethral stricture after oral mucosa urethroplasty (buccal 12 and lingual 7) were prospectively evaluated. Intraoperatively integrated buccal or lingual mucosal graft sample that was previously engrafted to urethra was completely excised along with healthy oral mucosa, and it was sample processed for histopathological evaluation by dedicated pathologist. Preoperative clinical data were properly collected from all the study participants. Results: The mean age of the patients was 30 years, and the mean preoperative peak flow rate was 4.2 mL/s. Etiology of initial stricture was idiopathic in 13 (68.42%) patients and traumatic urethral catheterization in 6 (31.58%) patients. Mean interval from previous buccal mucosal urethroplasty to current urethroplasty was 21.9 months (range 12-46 months). On repeat urethroplasty, the mean stricture segment length was 59.2 (38-77) mm [60.08 (38-74.6) mm buccal, and 58.32 (39.6-77) mm lingual]. These integrated oral mucosal grafts maintained their histopathological characteristics in all patients except some kind of changes like submucosal fibrosis in seven (58.33%) cases of buccal and vacuolar degeneration in five (71.42%) cases of lingual mucosal urethroplasty. Conclusion: Histopathological characteristics of integrated oral (buccal and lingual) mucosal grafts were maintained even on exposure to urine except some changes like submucosal fibrosis and vacuolar degeneration. Impact of these changes require further research. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of silodosin, solifenacin, tadalafil and their combinations in reducing double J (DJ) stent-related symptoms (SRS). Material and methods: A total of 335 patients who underwent DJ stenting and develop SRS at 1st week were randomized into eight groups. Ureteral stent symptom questionnaire (USSQ) and Quality of life (QOL) scores were noted in each group: Group A-Silodosin (8 mg OD)+ Solifenacin (10 mg OD)+ Tadalafil (5 mg OD), B - Silodosin 8 mg OD, C - Solifenacin 10 mg OD, D- Tadalafil 5 mg OD, E- Silodosin (8 mg OD) + Solifenacin (10 mg OD), F- Silodosin (8 mg 0D)+ Tadalafil (5 mg OD), G- Solifenacin (10 mg OD)+ Tadalafil (5 mg OD) and H-placebo. Analgesic (diclofenac 50 mg) was given as per requirement. All groups received the drugs for 14 days and again USSQ, QOL score with analgesic requirement were noted in each group. Results: USSQ score was similar in all groups at 1st week but all groups (Groups A-G) led to significant decrease in USSQ score at 3rd week as compared to Group H with less requirement of analgesic. However when we compared groups with each other we found that mean USSQ score and analgesic requirement was favoring Group E as compared to other groups. Quality of life score was also best in Group E (mean 1.5) (p<0.05). Conclusion: Combination therapy with silodosin and solifenacin (group E) was effective for relieving SRS with improved quality of life and less requirement of analgesic than any other groups and should be considered in patients who develop SRS. [ABSTRACT FROM AUTHOR]

Neurilemmomas are benign, slow growing, encapsulated nerve sheath tumor. These tumors arise from the schwann cells of neural crest. Neurilemmomas can manifest in various form according to site, extent and severity of involvement of organ. Diaphragmatic neurilemmomas are very unusual and even difficult to diagnose on preoperative imaging. We will report a case of 39 year old male, who presented with complaints of occasional left flank pain for one year and subsequently investigated, which showed left adrenal cyst with haemorrhagic fluid content. On the contrary, when surgical exploration of the lesion was done, it showed a cyst within the diaphragm, completely separated from left kidney and left adrenal with haemorrhagic content in situ. Histopathological examination of the lesion showed it to be a benign neurilemmoma with cystic degeneration. Post opearatively patient did well. We believe that this is the first case report, which is addressing such kind of initial manifestation of diaphragmatic neurilemmomas. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of silodosin and tadalafil in ease of negotiation of large size ureteroscope (8/9.8 Fr) in the management of ureteral stone. Material and methods: Between June 2015 and May 2016, 86 patients presented with ureteral stone of size 6-15 mm were on consent randomly assigned to 1 of 3 outpatient treatment arms: silodosin (Group A), tadalafil (Group B), and placebo (Group C). After two weeks of therapy 67 patients underwent ureteroscopy, and ureteral orifice configuration, ureteroscopic negotiation, ureteral dilatation, operating time, procedural complication and drug related side effects were noted in each group. Results: Ureteral negotiation was significantly better in Groups A (73.9%) and B (69.6%) as compared to Group C (38.1%) (p<0.01). Statistically significant difference was noted in the requirement for dilatation in Group C (71.4%) as compared to Groups A (26.1%) and B (39.1%) (p<0.01). Ureteral orifice was found to be more dilated in Groups A (69.6%) and B (60.9%) as compared to Group C (28.6%). Mean operating time was statistically lower in Groups A (35.2 min) and B (34.91 min) as compared to Group C (41.14 min) (p<0.01). Conclusion: Both silodosin and tadalafil not only relax ureteral smooth muscle but also help in forward propagation of large size ureteroscope (8/9.8 Fr) without any significant risk of adverse events. [ABSTRACT FROM AUTHOR]

Objective: Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. Material and methods: Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. Results: Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was nonsignificant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis. Conclusion: Sonoelastography estimates stricture site and length better in comparison with RUG and SUG. It estimates degree of spongiofibrosis which serves as an important prognostic factor for stricture recurrence more accurately than SUG. [ABSTRACT FROM AUTHOR]