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Introduction: Neoadjuvant chemotherapy (NAC) in the management of muscle-invasive bladder carcinoma has not been adopted universally. We studied the oncological outcomes and complications in patients who underwent radical cystectomy (RC) with or without NAC. Methods: A retrospective review of patients who underwent RC with or without NAC from June 2009 to June 2020 was conducted. Oncological outcomes, overall survival (OS) and recurrence-free survival (RFS), complications, and prognostic factors were analyzed. Results: Of the 314 patients who underwent RC, 83 patients received NAC (Group A), and 231 underwent RC alone (Group B). The median age was 58 years. The median follow-up duration was 22 (3-64) and 24 (3-62) months, respectively. The median OS in Group A was significantly higher than Group B (38 months [confidence interval (CI): 34-42] and 32 [CI: 29-35], respectively, [P = 0.033]). The RFS in Groups A and B was 34 (CI: 30-39) and 31 (CI: 28-34) months, respectively (P = 0.47). Higher pathological T stage (T3/4), node positivity and lymphovascular invasion (LVI) were predictors of poor OS and RFS (P < 0.0001). Clavien grades 3/4 complications were comparable (8 vs. 15; P = 0.19). Glomerular filtration rate (GFR) Conclusion: The OS with NAC was superior to upfront RC. RFS was, however, comparable. NAC was safe and well-tolerated. Pathologically, higher T stage, node positivity, and LVI were associated with poorer OS and RFS. Low GFR negatively influenced postoperative complications., Author(s): E Selvin Theodore Jayanth [1]; Subhash L. Jat [1]; Benedict P. Samuel [1]; Ashish Singh [2]; Nirmal Thampi John [1]; Anjana Joel [2]; Rajiv Paul Mukha [1]; Grace Rebecca [...]

Introduction: Chemotherapy, postchemotherapy retroperitoneal lymph node dissection (pcRPLND), and metastasectomy remain the standard of care for the management of advanced nonseminomatous germ cell tumor (NSGCT). Methods: We retrospectively studied 73 patients who had pcRPLND at a single tertiary-care center (2003-2022). Surgical and clinicopathological features and oncological outcomes are presented. Results: The mean age was 28.27 years (15-48). Three-fourths had Stage III disease at diagnosis. International Germ Cell Cancer Collaborative Group risk stratification was 54.54 and 21.21 in intermediate risk, and poor risk, respectively. Sixty-two patients had Standard, 7 had Salvage and 4 underwent Desperation pcRPLND. Eleven patients (15.06) required adjunctive procedures. Thirteen patients (17.8) had ≥ class 3 Clavien-Dindo complications and postoperative mortality occurred in 5 (6.8) patients. The histopathologies (HPE) of the pcRPLNDs were necrosis, teratoma, and viable tumor in 39.7, 45.2, and 15.1, respectively. Seven patients underwent metastasectomy. An 85 size reduction in the size of RPLN predicted necrosis. There was 71.4 concordance between pcRPLND and metastasectomy HPEs. The median follow-up was 26.72 months (inter-quartile range - 13.25-47.84). The 2-year recurrence-free survival (RFS) rate was 93 (95 confidence interval [CI]-83-97) and the overall survival (OS) rate was 90 (95 CI-80-95). This is the largest series of pcRPLND for NSGCT in India to our knowledge. Conclusion: Although most of the cohort belonged to stage III, an RFS and OS rate of >90 at 2 years was achieved. We believe that successful management of postchemotherapy residual masses in NSGCT is contingent on the availability of multidisciplinary expertise and is therefore best done at tertiary-care referral centers., Author(s): Rakesh Kumar [1,2]; Madhuri Evangeline Sadanala [2]; Santosh Nagasubramanian [2]; Anjana Joel [3]; Arun Joseph Philip George [2]; S Mahasampath Gowri [4]; Partho Mukherjee [2]; Ashish Singh [3]; Rajiv [...]

Byline: Selvin. Jayanth, J. Chandrasingh, Rani. Sahni, Rajiv. Mukha, Santosh. Kumar, Antony. Devasia, Nitin. Kekre Introduction: There are no uniform guidelines on the duration of antibiotic prophylaxis for transurethral resection [...]

Byline: Abhilash. Cheriyan, Arun. Nellickal, Nirmal. John, Lakshmanan. Jeyaseelan, Santosh. Kumar, Antony. Devasia, Nitin. Kekre Introduction: Optimal patient selection plays a vital role in management of renal tumors with the [...]

Byline: Partho. Mukherjee, Kapil. Chaudhary, Bijesh. Yadav, Santosh. Kumar, Nitin. Kekre, Antony. Devasia Introduction: Evidence-based medicine requires systematic access and appraisal of contemporary research findings, followed by their application in [...]

Byline: Selvin. Jayanth, Anuj. Dangi, Rajiv. Mukha, Santosh. Kumar, Santosh. Varughese, Vinoi. David, Anna. Valson, J. Chandrasingh, Antony. Devasia, Nitin. KekreIntroduction: Literature regarding the outcomes of renal transplant in patients [...]

Byline: Benedict. Samuel, Joy. Michael, J. Chandrasingh, Santosh. Kumar, Antony. Devasia, Nitin. Kekre Introduction: The aim was to study the accuracy of Xpert® (Cepheid Inc., Sunnyvale, CA, USA) Mycobacterium tuberculosis/rifampicin [...]

Byline: Rajat. Arora, Nitin. Abrol, B. Antonisamy, S. Vanitha, J. Chandrasingh, Santosh. Kumar, Nitin. Kekre, Antony. Devasia Introduction: Fetuin-A is a glycoprotein secreted by liver and has been shown to [...]

Byline: Onkar. Singh, Partho. Mukherjee, Antony. Devasia A case of chronic ureteral obstruction secondary to radiation-related ureteral stricture producing a classic “negative pyelogram” on intravenous urography is presented. Introduction The [...]

Byline: Vivek. Venkatramani, Santosh. Kumar, J. Chandrasingh, Antony. Devasia, Nitin. Kekre Introduction: The aim of the study was to determine whether perioperative complications and postoperative outcomes varied with the indication [...]

Byline: Vivek. Venkatramani, Arun Jacob. George, J. Chandrasingh, Arabind. Panda, Antony. Devasia A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age [...]

Byline: Nitin. Abrol, Gayatri. Harshe, Antony. Devasia A case of medullary type papillary necrosis diagnosed on nephrostogram is presented showing characteristic egg-in-cup appearance. Introduction Papillary necrosis can be seen in [...]

Byline: Nitin. Abrol, Arabind. Panda, Nitin. Kekre, Antony. Devasia Stone formation in the urinary tract is a common phenomenon with associated morbidity. The exact physicochemical factors responsible for stone formation [...]

Objective: To determine if the interpretation of urodynamic studies (UDS) in children without a rectal catheter may be similar to multi-channel studies, as UDS in children are challenging and can sometimes be difficult to interpret. Patients and methods: In this retrospective pilot study, 115 paediatric pressure–flow studies were included. A blinded investigator was given two sets of UDS traces. The first set had the vesical trace of all children and the second set had the multi-channel trace. The agreement between the interpretations of both the sets was tested by Cohen's κ, and sensitivity, specificity, and predictive values were expressed with 95% confidence intervals (CIs). The voiding pattern was compared and Pearson's correlation coefficient was used to analyse the pressure at maximum urinary flow (Qmax). Results: The most common indications for UDS were neurogenic bladder and posterior urethral valves. The interpretation of compliance and detrusor overactivity by single-channel analysis had a positive predictive value of 92.1% (95% CI 84.7–96.1%) and 89.4% (95% CI 78.3–95.6%), respectively, and a negative predictive value of 100% and 97.1% (95% CI 89.5–99.2%) respectively, in comparison to multi-channel analysis. Children with underactive detrusor were identified reliably by analysing the straining pressure pattern and flow curve. Amongst children who voided, the pressure at Qmax showed a moderate correlation (Pearson's coefficient = 0.53) between the two groups. Conclusion: Rectal catheters may be avoided in a carefully selected group of children undergoing UDS who only need filling phase assessment. Abbreviations: DO: detrusor overactivity; EBC: expected bladder capacity; Pabd: abdominal pressure; Pdet: detrusor pressure; PUV: posterior urethral valve; (N)(P)PV: (negative) (positive) predictive value; Pves: vesical pressure; Qmax: maximum urinary flow rate; UDS: urodynamic studies; UI: urinary incontinence [ABSTRACT FROM AUTHOR]

Byline: Gaurav. Gupta, Mukha. Paul, Santosh. Kumar, Antony. Devasia, N. Mahendri, Prasanna. Samuel, Nitin. Kekre, Ninan. Chacko Objective: To identify the differences in urinary profile of a stone former and [...]

Byline: Francis. Katumalla, Antony. Devasia, Ramani. Kumar, Santosh. Kumar, Ninan. Chacko, Nitin. Kekre Aim : To assess the need of a second transurethral resection (TUR) in select T1G3 bladder tumor [...]

Byline: Shanmugasundaram. Rajaian, Santosh. Kumar, Ganesh. Gopalakrishnan, Ninan. Chacko, Antony. Devasia, Nitin. Kekre Purpose : To evaluate the outcome of shock wave lithotripsy (SWL) as monotherapy for solitary renal stones [...]

Byline: Marie. Manipadam, Anila. Korula, J. Chandrasingh, Antony. Devasia We report two cases of chromophobe renal cell carcinoma with unusual histological features; one case of eosinophilic variant of chromophobe renal [...]

Byline: G. Prasad, Chacko. Ninan, Antony. Devasia, Lionel. Gnanaraj, Nitin. Kekre, Ganesh. Gopalakrishnan Objectives: Euro-Collins and University of Wisconsin are preferred solutions in cadaveric renal transplantation. There are no guidelines [...]

Background: Polymorphisms in genes encoding glutathione S-transferase (GST) may affect susceptibility to develop urothelial carcinomas (UCs). One of the extensively studied genes in this group is GST P1 (GSTP1), but studies of the relationship of polymorphisms of GSTP1 and UC of the bladder have been equivocal. Hence, we assessed the association between genetic polymorphism of GSTP1 gene and the development of UC of the urinary bladder. Materials and Methods: This prospective, case–control study was conducted in the departments of urology and clinical genetics at a tertiary care teaching hospital in South India, which included 52 patients with histopathologically confirmed UC bladder and matched with 46 controls from August 2012 to July 2013. The study participants provided a single venous blood sample for extraction of genomic DNA. Laboratory personnel was blinded to sample groups. The primary outcome of the study was to detect association of genetic polymorphism of GSTP1 gene with UC of the bladder. The secondary outcome was to assess if the risk of urothelial bladder cancer is increased in smokers with polymorphism of GSTP1 gene. Statistical Analysis Used: We used the Chi-square or Fisher's (F) exact test to compare discrete variables. Unconditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. Results: Although the heterozygous polymorphic genotype ile/val (AG) was seen more frequently in cancer group (34.6% vs. 23.9%), the difference was not statistically significant (P = 0.202). None of the smokers had homozygous polymorphic valine allele and GSTP1 did not add to the susceptibility of UC bladder even among smokers. Conclusions: A lack of association between GSTP1 313 G/G polymorphism and urothelial cancer of bladder was observed. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to study the accuracy of Xpert® (Cepheid Inc., Sunnyvale, CA, USA) Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay as compared to a composite gold standard (urine culture, imaging, and biopsy) and to asses its utility as the initial test compared to smear microscopy to diagnose urinary tuberculosis. Methods: This prospective study included adult patients suspected to have urinary tuberculosis from March 2014 to December 2017. Three urine samples were collected from each patient and were subjected to Xpert MTB/RIF assay, acid-fast bacillus (AFB) smear microscopy, and liquid media (BACTEC Mycobacteria Growth Indicator Tube [MGIT] 960) culture. Imaging and tissue biopsies were performed as clinically indicated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the bootstrap method for 95% confidence intervals for the Xpert assay. Results: Xpert MTB/RIF assay was found to be superior to the currently best available light-emitting diode fluorescent smear microscopy as the initial test for urinary tuberculosis (sensitivity of 69.09% vs. 32.72%). The Xpert MTB/RIF polymerase chain reaction test was found to have a moderate sensitivity (69.09%) and high specificity (100%) as compared to the composite reference standard. The sensitivity of liquid AFB culture MGIT 960 as compared to the reference standard was 90.32%. Conclusions: Xpert MTB/RIF assay on an early morning first void urine specimen can replace smear microscopy as the initial diagnostic test for urinary tuberculosis. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) is the most common malignancy that results in venous tumor thrombosis. Transitional cell carcinoma of the renal pelvis with renal or vena cava thrombus is extremely rare. Fewer than 40 cases have been reported. We report a similar case of a patient who underwent radical nephrectomy with a preoperative diagnosis of RCC. [ABSTRACT FROM AUTHOR]

Malignant neoplasm of the penis is a rare cancer in industrialized countries but is not uncommon in India. Nearly 95% of penile cancer is squamous cell carcinoma. Malignant neoplasms of the sebaceous glands, which are mostly confined to the head and neck region, are even rarer. We present a 74-year-old male with sebaceous cell carcinoma of the penis. He underwent excision of the primary lesion with bilateral inguinal lymph node dissection followed by adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]