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Primary urethral cancer is a rare condition often manifesting in the sixth decade of life and is typically associated with urethral stricture disease. A 65-year-old male, a known case of stricture urethra, underwent perineal urethrostomy 10 years back. He presented with a growth at the urethrostomy site and the biopsy revealed squamous cell carcinoma. Magnetic resonance imaging of the pelvis revealed that the lesion extended into the penile and prostatic urethra with possible involvement of the corpus spongiosum, bulbospongiosus, and the bladder neck. Radical cystectomy, penectomy, scrotectomy, and bilateral orchiectomy with ileal conduit were performed. At 18-months of follow-up, the patient is recurrence-free. [ABSTRACT FROM AUTHOR]

Background: Perianal sepsis and anal fistula are troublesome diseases in the field of colorectal surgery due to recurrence and fecal incontinence. Aim: To investigate the role of "one-stage complex anal fistula resection with anal sphincter reconstruction without stool diversion" on fecal incontinence and recurrence. Methodology: This is a prospective cohort study of 350 patients with complex perianal fistulas who underwent fistulectomy and anal sphincter reconstruction (primary suture repair) without stool diversion; Patients were followed up for 1 year after the operation after complete healing of the wound. Suppression of stool and gas was assessed using the Wexner score and fistula recurrence was assessed clinically and radiologically using MRI. Out of 350 patients, only 8 had different degrees of fecal incontinence: 4 had gas incontinence, 4 had soil incontinence, and 16 had relapse after 3 months. 12 people relapsed after 6 to 9 months. Confirmatory MRI was also performed at the end of the follow-up period and two patients had hidden fistula ducts leading to the upper abscess cavity. This resulted in 32 recurrent cases. 10 patients had delayed wound healing. Conclusion:As compared to other treatment methods for complex anal fistulas described in the literature, one-stage surgery (hemorrhoidectomy with primary sphincter repair) has a lower risk of incontinence, a lower recurrence rate, and better anal fistula formation. It gave good results in terms of wound healing. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare the incidence of ureteric strictures between holmium:yttrium aluminum garnet and thulium fiber laser following ureteroscopic laser lithotripsy. In the present era of miniaturization of endourologic armamentarium and better optics, how safe are lasers to fire inside ureter? Materials and Methods: It is a prospective comparative study over a period of 2 years that included patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Patients were randomly divided into 2 groups: group A underwent holmium:yttrium aluminum garnet laser lithotripsy and group B underwent thulium fiber laser lithotripsy. Results: A total of 478 patients were analyzed after excluding patients not willing to participate and patients lost to follow-up. Two hundred forty patients underwent holmium:yttrium aluminum garnet laser lithotripsy (group A) and 238 patients underwent thulium fiber laser lithotripsy (group B). The demographic data of 2 groups were comparable. The mean age of patients in group A and group B was 36.5 ± 12.52 years and 38.62 ± 10.71 years, respectively. The mean operative time in group A and group B was 47 ± 15 and 36 ± 13 minutes, respectively, while the mean laser time in group A and group B was 13.5 ± 45 minutes and 9.25 ± 3.2 minutes, respectively. Four (1.67%) patients in group A and 11 (4.62%) patients in group B developed ureteric strictures during follow-up, and the difference was statistically significant (P < .001). The mean length of stricture was 2.67 ± 1.27 cm in group A and 4.42 ± 2.2 cm in group B, and the difference was statistically significant. Conclusion: Thulium fiber laser, projected as safe laser previously, has a higher incidence of ureteric strictures compared to holmium:yttrium aluminum garnet laser when used for ureteroscopic laser lithotripsy. [ABSTRACT FROM AUTHOR]

Introduction: Giant encephalocele are encephalocele more than the size of head from which it arises. They pose a management challenge in view of risk of associated anomaly, challenges in anaesthesia and surgical management. There is no literature available from peripheral tertiary care centres from India apart from few case reports. Methods: This case series comprises of seven cases operated at our institute from 2014 to 2021. After routine clinical examination, patients subjected to recommended radiological investigations. Patients were anaesthetised with standard protocol with intubation in lateral or supine position with head hanging at edge of table and supported at table. Surgery carried out in lateral position with complete excision of sac with CSF diversion if pre existing hydrocephalus was present. Results: Out of seven cases, 3 were males and four female with age range from 12 days to 14 Mo. All patients were anaesthetised with standard protocol and had excision of sac with CSF diversion if required with satisfactory outcome in post operative phase and follow up. No death was recorded. Conclusion: With careful assessment and all recommended investigation with standard practice of anaesthesia and surgery, acceptable outcomes can be expected. Emphasis should be laid for good antenatal folate supplementation and possible antenatal diagnosis of meningoencephaloceles. [ABSTRACT FROM AUTHOR]

Esophagectomy, followed by esophageal replacement using gastric/colonic conduits, is a complex surgical procedure with significant perioperative morbidity. The most significant and potentially life-threatening complication associated with esophageal replacement is conduit ischaemia, resulting in anastomotic leak and conduit necrosis. Ensuring adequate perfusion of the conduit remains the key to preventing conduit ischaemia. Indocyanine green (ICG) enhanced near-infrared fluorescence imaging is a novel technique which has been used for assessing bowel perfusion. While numerous studies have focused on ICG fluorescence imaging for assessment of gastric conduit perfusion after esophagectomy, data regarding its use for colonic conduits is limited to case reports. ICG fluorescence imaging can help in resolving intraoperative issues by predicting the adequacy of colonic conduit perfusion, thereby preventing postoperative morbidity. To the best of our knowledge, this is the first report in Indian literature describing the utility of ICG fluorescence imaging for assessment of perfusion of colonic interposition. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of percutaneous nephrostomy (PCN) in patients of carcinoma bladder presenting with obstructive uropathy. Material and Methods: We evaluated medical records of 33 patients of bladder cancer with obstructive uropathy that presented to a tertiary care hospital in north India from January 2015 to December 2016. Outcome measures included technical success rates, change in blood urea and serum creatinine (measured on Day 1, 7, and 14); and complications of PCN according to Society of Interventional Radiology Guidelines for Percutaneous Nephrostomy. Results: PCN was done in 30 patients. The mean age of patients was 51 years (range 42-67). 24 patients were male and 6 patients were female. The technical success rates for PCN placement were 93.33%. In 12 patients there was no improvement after PCN insertion. Improvement in clinical condition/kidney function occurred in 18 patients. Out of these 6 patients underwent radical cystectomy with ileal conduit formation and palliative radiotherapy/chemotherapy was given to 5 cases. In the remaining 7 patients, after an initial improvement that lasted for 2 weeks after PCN progressive renal dysfunction developed due to malignancy. Minor complications of PCN were seen in 16.6% of patients and major complications were seen in 10 % of cases. Conclusion: In selected patients with bladder carcinoma with obstructive uropathy, PCN insertion may improve kidney function tests to normal levels and enable them to receive tumor-specific curative/palliative treatment. [ABSTRACT FROM AUTHOR]

Introduction: The Mitrofanoff principle was originally described as a method to provide an alternative means to access the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent, or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic Mitrofanoff appendicovesicostomy to promote a catheterizable abdominal stoma. Materials and Methods: A 4-port transperitoneal approach was used to create a complete laparoscopic Mitrofanoff appendicovesicostomy. Results: Six children with a mean age of 12.8 years (range 9-16 years) underwent laparoscopic Mitrofanoff appendicovesicostomy. Mean operative time was 139.6 min and Mean estimated blood loss was 46 cc. No cases of urinary leaks were noted. There have been no cases of either stomal stenosis or appendicovesical stenosis noted. Conclusions: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis. [ABSTRACT FROM AUTHOR]

Of the approximately 80,000 new cases of all cancers detected every year in India, 10-15% are gynecological malignancies. As per population-based registries under the National Cancer Registry Program, the leading sites of cancer among women are the cervix uteri, breast, and oral cavity. About 50-60% of all cancers among women in India are mainly of the following four organs: cervix uteri, breast, corpus uteri, and ovaries. Over 70% of these women report for diagnostic and treatment services at an advanced stage of disease, resulting in poor survival and high mortality rates. Among all gynecological cancers, ovarian cancer is the deadliest one and, in 2/3rd of the cases, is detected in an advanced stage. But, in India and in other developing countries, due to inadequate screening facilities for the preventable cancer cervix, this kills more women than any other cancer in females. Gynecology Oncologist as a sub-specialist has an immensely important role in curtailing the menace of gynecological malignancies by providing comprehensive preventive, curative, palliative and follow-up services, with the aim of assuring a good quality of life to women as a cornerstone of cancer management. [ABSTRACT FROM AUTHOR]

Radical cystectomy remains the standard treatment for muscle-invasive carcinoma bladder. Various methods have been described for the urinary diversion. In the last 150 years urinary diversion has evolved from cutaneous ureterostomy to the orthotopic neobladder. Especially during the last 20 years, much advancement has been made. We hereby have reviewed the current approaches being used at different centers in India. We have also analyzed the evolution of diversion from conduit to the orthotopic substitution at our center. [ABSTRACT FROM AUTHOR]

Authors from India describe their experience using a sigmoid orthotopic neobladder in patients who have had a radical cystectomy. They found a fairly high complication rate, with nocturnal incontinence occurring in 97% of their patients. Other complications were relatively few, and the authors felt that their sigmoid neobladder presented a valuable option for diverting urine after radical cystectomy. OBJECTIVE To determine the long-term results of constructing a sigmoid neobladder after radical cystectomy for transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS The study included 170 patients with TCC of the bladder and a normal sigmoid colon. After radical cystectomy the neobladder was formed by completely detubularizing an isolated sigmoid colon segment. Subsequently patients were followed by clinical, biochemical, radiological and urodynamic assessments. RESULTS Four patients died soon after surgery; the neobladder-related delayed complications were death in three patients, loss of five renal units, and electrolyte imbalance in five patients. Uretero-intestinal anastomotic narrowing was another frequent delayed complication. Most (97%) patients had nocturnal incontinence, and most voided with a good stream with a minimal postvoid residual urine volume. CONCLUSION The sigmoid neobladder, despite some limitations, is the best option for diverting urine after radical cystectomy. [ABSTRACT FROM AUTHOR]

Aim: To assess impact of primary fulguration v/s diversion on renal outcome in patients with Posterior Urethral Valve (PUV). Material and Methods: Patients with PUV admitted in Department of Pediatric Surgery, KGMU, Lucknow between January 2000 - Jan 2007, were included. They were divided into three groups according to their renal profile. Group I (n=41) - normal serum creatinine at presentation; Group II (n=33) - elevated serum creatinine at presentation responding to catheter drainage; Group III (n=38) - elevated serum creatinine not responding to catheter drainage. The patients were further subdivided according to urological ultrasound (hydronephrosis, echogenic kidney) and/or MCU (VUR) findings. Renal outcome and improvement of radiological abnormalities were evaluated. Results: 112 patients of PUV were admitted in department from 1998-2006. Of the 41 patients in Group I 26 were treated by primary fulguration and 15 by vesicostomy followed by delayed fulguration and vesicostomy closure. All have normal renal profile after mean follow up of 40 months. The radiological abnormalities resolved in 55% of cases. In Group II 20 patients were treated by primary fulguration and 13 by vesicostomy followed by delayed fulguration and vesicostomy closure. After mean follow up of 31 months, 30 patients have normal renal profile although upper tract abnormalities resolved in only 38% of cases. In Group III patients (n=38), 21 were treated by diversion (vesicostomy=13, pyelostomy-3, ureterostomy=5), 9 by primary fulguration and 8 patients expired. After mean follow up of 36 months, only 15% patients had improvement in renal profile and upper tract abnormalities resolved only in 10% of patients. In all three groups, the improvements of renal and radiological abnormalities were not dependent upon treatment done. Conclusion- Primary fulguration is preferred option in all patients with PUV and proximal urinary diversion does not affect the renal outcome. The least improvement is expected in children who have an elevated serum creatinine that is not responsive to catheterizing. [ABSTRACT FROM AUTHOR]