Search

Background: Fournier’s gangrene is a life-threatening necrotizing fasciitis of the perineal, genital and perianal region, which leads to thrombosis of the small subcutaneous vessels and results in the development of gangrene of the overlying skin. The aim of this study was to analyze the clinical and epidemiological characteristics of the patients with FG, discuss the validity of FGSI for predicting the disease severity and patient survival. Methods: This is prospective study carried out in department of surgery of our institution between July 2011 to June 2014.The data were evaluated about medical history, symptoms, physical examination findings, vital signs laboratory tests, total body surface area involved, timing and extent of surgical debridement, and antibiotic treatment used. All the patients had radical surgical debridement. The Fournier’s gangrene severity Index was used in our study. This index calculates a score relating to the severity of the disease. The data were assessed according to whether the patient survived or died. Results: Of the 57 patients studied, 13 died and 44 survived; the overall mortality was 22.8%. The survivors (mean age 57.78±11.16 years) were younger than the non-survivors (mean age 63.14±9.97 years) but it did not reach statistical significance (p=0.281). The median extent of the body surface area involved in the necrotizing process in patients who survive and did not survive was 2.8% and 4.8%, respectively (p=0.067). The abdominal wall involvement (22.72% vs 61.53% p=0.015) was associated with patient mortality. DM was most common comorbidity found in 24 (42.1%), most common predisposing factor is anorectal infection present in 21 (36.84%) patients. Mean FGSI score was increased in patients who died compared to survivors (8.14±5.87 vs 4.21±4.3) but this difference was not significant (p=0.126). Conclusions: Fournier’s gangrene is still a very severe disease with high mortality rates. The FGSI score did not predict the disease severity and the patient’s survival. For its proper treatment a high diagnostic suspicion and early recognition, surgical treatment and aggressive antibiotic therapy are still necessary.

Von Hippel-Lindau (VHL) disease is a rare autosomal dominant syndrome manifested by a spectrum of tumours in the central nervous system (CNS) and other visceral organs. We herein report a case of 35 years aged newly diagnosed diabetic female patient presented with headache, gait instability, loss of vision in both eyes, left sided hearing impairment and subsequently diagnosed to have VHL disease. The pathophysiology involves the inactivation of the VHL tumour suppressor gene. Early recognition and treatment remains the mainstay of management. Even many years after the complete tumour excision, newer neoplasms may develop. Increasing knowledge about the molecular enabled us to investigate the role of anti-angiogenic drugs. Continuous surveillance at regular interval must be conducted in patients with VHL disease.

Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. A patient underwent ileal ureteral substitution using a reconfigured ileal segment of Yang-Monti principle in our clinical centre. Authors report a case of a 41year old male involved in a homicidal stab injury with isolated renal pelvis injury underwent Thompson’s renal capsular flap repair. After 6 weeks, double J (DJ) stent was removed and following that patient developed urinoma. Percutaneous drain was placed to drain urinoma on emergency basis and again 6 Fr DJ stent was inserted but patient had recurrent fever and chills. On CECT evaluation authors noticed that DJ stent was outside the upper urinary tract. And then patient was re-explored where authors found 6 cm stricture of the proximal left ureter. A reconfigured small bowel tube was interposed between inferior calyx and proximal ureteral stumps. This technique offers certain distinct advantages. A short ileal segment is included with the consequent absence of metabolic complications. Yang-Monti Principle is a safer and efficient technique for clinical partial and complete ureteral defects with sustained, good, long-term results. Yang-Monti reconfigured tube seems to be promoted an equally efficient urine transport mechanism that persists unaltered for long periods if patients and potential risks could be well prepared.

Background: Urethral stricture is a relatively common disease. The choice of surgery is based on the stricture location, length of the stricture and etiology. Buccal mucosal graft (BMG) urethroplasty with Asopa and Kulkarni techniques, revolutionized the approach to anterior urethral stricture repair. Objective of the study was to compare both the dorsal onlay BMG urethroplasty technique of Kulkarni and the dorsal inlay BMG urethroplasty technique of Asopa for the management of long anterior urethral stricture. Methods: From January 2015 to October 2019, a total of 90 patients with long anterior urethral strictures were randomized into two groups. Group A (42 patients) managed by Kulkarni technique. Group B (48 patients) managed by Asopa technique. BMG urethroplasty was considered successful if no further procedure required postoperatively with maximum flow rate >15 ml/s during the follow-up period.Results: The success rate in group A and B were 80.9% and 87.5%, respectively. The mean operative time was significantly longer in group A (175±22.6 min) than in group B (102±18.14 min, p-value

Background: Although clear cell renal cell carcinoma (ccRCC) is the most common histological variety of malignant renal tumor, histological variants are often encountered in clinical practice which behaves differently. Paucity of such tumors makes them a subject of interest worldwide. As per European Association of Urology, since ccRCC is a non-designation, they included all non-clear cell RCC under one nomenclature as rare kidney cancer (RKC). The objective of our study is to determine influence of inflammatory markers on the prognosis of RKC.Methods: Data from cancer registry was retrieved and all rare kidney cancer patient’s data were analysed particularly the markers of inflammation like neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory immune index (SIII) and C reactive protein (CRP) to albumin ratio and their probable influence on cancer free survival (CFS), progression free survival (PFS) and overall survival (OS).Results: Data of 33 cases of rare kidney cancers were included in this study. The follow up duration ranges from 6.8 months to 38.6 months. In the univariate analysis, NLR had a significant influence on CFS, PFS and OS (cutoff value-3.2, 95% confidence interval [CI], CFS: p

Background: Intravesical prostatic protrusion (IPP), a morphological change resulting from enlarged lateral and median lobe of prostate. It could be for assessment of BOO (Bladder outlet obstruction). MetS is one of the causative factors for the development of Benign Prostatic Enlargement (BPE) and associated LUTS. The aim of this study is to assess the association of components of MetS and MetS with IPP, TPV and International Prostatic Severity Symptoms Score (IPSS).Methods: This is a single centre cross-sectional study in Department of Urology, GMCH, Guwahati, Assam, India between March 2016 and May 2018, 114 consecutive men aged >50 years presenting with LUTS suggestive of BPE (PSA 0-4ng/ml). MetS was defined according to International Diabetes Federation criteria. We have analysed IPSS and IPP of these patients. Patients were classified into 3 groups each for IPSS and IPP (IPSS: group I - 0-7, II -8-19, III ->20 and IPP: Group I- 10 mm).Results: We have correlated these groups with each component of MetS and MetS. IPSS group III had significant correlation with hyperglycaemia (HG), hypertriglyceridemia (HTG), hypertension (HTN) and HDL cholesterol (HDL), group II had significant correlation with HG, HTN and HDL and group I had significant correlation with HTN (p

Micropapillary carcinoma is an uncommon variant of urothelial carcinoma with high metastatic potential. Usually seen in elderly individual, we herein report a case of 42 years old man presented with macroscopic hematuria for 1 month. Evaluation with CECT whole abdomen revealed irregularly marginated hyperattenuated mildly enhancing intraluminal mass lesions in right lateral wall and in floor of urinary bladder. No perivesical infiltration and no regional lymphadenopathy were detected. TURBT done and subsequent histopathological examination showed a high-grade transitional cell carcinoma with micropapillary variant. He was subjected to radical cystoprostatectomy with pelvic lymph node dissection. The pathological examination revealed a high-grade transitional cell carcinoma with micropapillary variant invading the perivesical adipose tissue. No tumor recurrence or metastasis was reported at the 18-months follow-up.

Isolated renal pelvis injuries are uncommon in a case of penetrating injury. These injuries are associated with other solid or hollow viscous injuries or fractures of transverse process of the adjoining vertebrae. We report a case of a 41year old male involved in a homicidal stab injury. This patient presented with pain abdomen and protrusion of omentum at wound side while CECT whole abdomen revealed extravasation of contrast from left renal pelvis at L3 vertebral level into retroperitoneum with localized collection. He underwent exploratory laparotomy which revealed isolated (Grade III) injury in left renal pelvis with no associated renal parenchymal injury.