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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 [...]

Objective: To ascertain whether low‐dose tadalafil (5 mg) is more efficient than tamsulosin (0.4 mg) in facilitating calculus expulsion in those receiving extracorporeal shockwave lithotripsy for solitary upper urinary tract calculi. Patients and Methods: This was a triple‐blinded, prospective, superiority, randomized controlled, single‐centre trial. A total of 250 patients with solitary renal or ureteric calculus measuring 6–24 mm were randomized (1:1) to receive either 0.4 mg tamsulosin or 5 mg tadalafil daily for 30 days or until calculus clearance, whichever was earlier. Results: There was no difference in the primary outcome, namely, calculus expulsion rate at 30 days (tamsulosin vs tadalafil, n (%) 99 [81.1%] vs 98 [80.3%] respectively, 95% confidence interval = 0.8% [−9.0, 10.7], P = 0.874). Similarly, a lack of difference was also noted in the secondary outcome, number of days to expulsion (tamsulosin vs tadalafil, geometric mean [SD] 13.59 [2.39] vs 13.74 [2.39] respectively, P = 0.928). Four patients discontinued the drug due to adverse drug reactions in the tadalafil group. Conclusions: Low‐dose tadalafil is not superior to tamsulosin in improving calculus expulsion when used as an adjunct to shockwave lithotripsy. In this study, we also noted that tadalafil was less tolerated. [ABSTRACT FROM AUTHOR]

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 [...]