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Objective: Objective of the study was to compare the efficacy and the complications of tension-free vaginal tape (TVT) and Burch colposuspension in the treatment of female genuine stress incontinence (GSI). Methods: In this controlled, prospective, randomized study, participated 35 patients who underwent Burch colposuspension and 36 patients that underwent TVT procedure. Patients with prolapse more than first degree, previous surgical treatment of stress urinary incontinence (SUI) and detrusor instability were excluded from the study. Results: The operative time for TVT was significantly shorter compared to BC. The severity and duration of postoperative pain for TVT was significantly less compared to BC. The necessary time for return to normal activity was 10 days for TVT and 21 days for BC. The cure rate after 24 months of follow-up was as follows: TVT: 84% and BC: 86%, while the improvement was 7% for TVT and 6% for BC. Conclusions: TVT and Burch colposuspension are equally effective in the management of female GSI at two years follow-up. TVT procedure requires much less operative time, has much shorter hospitalization time, with significantly less postoperative pain and faster return to normal daily activities than Burch colposuspension. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and 68Ga prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT) and respective quantitative parameters (Ktrans - influx rate contrast, Kep - efflux rate constant, ADC - apparent diffusion coefficient, and SUVmax ratio - prostate SUVmax to background SUVmax ratio) in detection and localization of clinically significant prostate cancer (CSPCa) in D'Amico intermediate- and high-risk group patients (prostate-specific antigen [PSA] >10 ng/ml). Methodology: The study included thirty-three consecutive adult men with serum prostate specific antigen >10ng/ml, and systematic 12 core prostate biopsy proven prostate cancer. All the 33 patients, were evaluated with mpMRI, and 68Ga PSMA PET-CT. The biopsy specimens and imaging were evaluated for 12 sectors per prostate by a predetermined scheme. Results: MpMRI Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score =3 showed higher sensitivity than 68Ga PSMA PET-CT (96.3% vs. 82.4%), with similar specificity (54.5% vs. 54.5%) (n = 33 patients, 396 sectors). Combined use of MRI and 68Ga PSMA PET-CT in parallel increased sensitivity (99.5%) and NPV (98.7%) for detection of CSPCa and combined use of MRI and 68Ga PSMA PET-CT in series increased specificity (71.8%) and PPV (71.5%) (n = 33 patients, 396 sectors). ADC showed a strong negative correlation with Gleason score (r = -0.77), and the highest discriminative ability for detection and localization of CSPCa (area under curve [AUC]: 0.91), followed by Ktrans (r = 0.74; AUC: 0.89), PI-RADS (0.73; 0.86), SUVmax ratio (0.49; 0.74), and Kep (0.24; 0.66). Conclusion: MpMRI PI-RADS v2 score and 68Ga PSMA PET-CT (individually as well as in combination) are reliable tool for detection and localization of CSPCa. Quantitative MRI and 68Ga PSMA PET-CT parameters have potential to predict Gleason score and detect CSPCa. [ABSTRACT FROM AUTHOR]

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 [...]

A case of priapism following the consumption of a single dose of sildenafil is reported. A 25-year-old unmarried healthy man consumed non-prescribed 50 mg sildenafil purchased over the counter. He developed painful priapism 30 min after the drug intake that had lasted for 4 days (96 h) when he sought medical advice as an emergency. The corpus spongiosum and glans was soft and the corpus cavernosa was rigid. Winter′s shunt was done. Fifteen milliliters of dark blood was aspirated with 16 G needle. Detumescence was achieved within 30 min. He was discharged after 12 h. On one month follow-up, he had normal morning erections. A genetic basis with cross-reactivity of PDE-3 in addition to PDE-5 resulting in a cumulative erection effect may be possible elucidation for this unwanted side effect in rare cases. However, the number of cases reported with this side effect is still too less to draw further conclusions.

Objective: Investigators have extensively explored the short-term safety and efficacy data on 177Lu-PSMA-617 radioligand therapy (RLT) in mCRPC patients. However, scarce literature is reported on the long-term outcome of these patients. The current goal of this study is focused on the long-term outcome of mCRPC patients treated with 177Lu-PSMA-617 RLT. Methods: Among 135 patients, 121 mCRPC patients fulfilled the eligibility criteria and were included in the final analysis. Patients received a median of 3 cycles of 177Lu-PSMA-617 RLT at 6 to 12-week intervals. Primary endpoint included overall survival (OS) and secondary endpoints involved progression-free survival (PFS), predictive factors of OS and PFS, PSA response rate, molecular response, clinical response, and toxicity assessment. Results: The median administered cumulative activity was 20 GBq (3.7–37 GBq). The median follow-up duration was 36 months (6–72 months). The estimated median PFS and OS were 12 months (mo) (95% CI: 10.3–13 mo) and 16 mo (95% CI: 13–17 mo), respectively. Any PSA decline and PSA decline >50% was achieved in 73% and 61% of the patients, respectively. Multivariate analysis revealed only failure to achieve >50% PSA decline as a significant factor associated with a poor PFS. Prognostic factors associated with reduced OS included, failure to experience >50% PSA decline, heavily pre-treated patient cohort who received >2 lines of prior treatment options, and patient sub-group treated with ≥2 lines of chemotherapy. Patients re-treated with additional treatment options after attaining 177Lu-PSMA refractory disease showed a remarkably prolonged OS. A significant clinical benefit was achieved post 177Lu-PSMA-617 RLT. The most common toxicities observed were fatigue (34.7%), followed by nausea (33%), and dry mouth (24.7%). Conclusion: The current study supports the short-term safety and efficacy results of high response rates, prolonged PFS and OS, improved quality of life, and low treatment-related toxicities in patients treated with 177Lu-PSMA-617 radioligand therapy. [ABSTRACT FROM AUTHOR]

The diagnosis of bladder cancer and necessity of urostomy is profoundly life changing. This qualitative study was conducted in order to assess lived experiences of patients who had received urostomy due to bladder cancer or any other urinary pathology. The sample included 30 patients with urostomy admitted in the Urology ward, AIIMS, New Delhi. Purposive sampling was used and data was collected using semi structured interviews. Narrative data was analysed using Colaizzi’s steps of analysis for qualitative data. Ten themes emerged from the analyses which were further categorized into sub themes. The theoretical framework of the themes and subthemes defined the phenomenon of living with urostomy in entirety. [ABSTRACT FROM AUTHOR]

Objectives: ABO blood grouping is a well-proven prognostic factor in many malignancies. This study aims to study the association and impact of ABO blood group on disease recurrence and progression in bladder carcinoma. Material and methods: Patients with bladder carcinoma undergoing transurethral resection of bladder tumor (TURBT) were studied prospectively for at least 1-year follow-up for recurrence and progression of the disease. Demographic profile along with blood group was noted. Results: Two hundred patients were included in the study and 194 patients were included in the final analysis. Muscle-invasive bladder cancer was present in 39 (20.1%) patients and the high-grade tumor was present in 88 (45.3%) patients. There was no statistical significance between the association of blood grouping and grade (p =0.29) and stage of the disease (p =0.20). During the follow-up period, there were 100 (64.5%) recurrences and 15 (9.7%) patients with non-muscle-invasive bladder carcinoma had progression. The association of blood group with recurrence (p =0.66) and progression (p =0.11) of disease was not statistically significant. Conclusion: There is no association between bladder cancer and ABO blood group in terms of grade and stage of the disease. The recurrence and progression of the disease did not differ significantly in different blood groups. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

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 [...]