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Objective: This is a prospective randomized study with the aim of comparing (thulium laser enucleation of the prostate (ThuLEP) and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) treatment. Methods: Patients are assessed preoperatively and up to 6 months postoperatively. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rates (Qmax), international index of erectile function-5 (IIEF-5) and post-void residual volume (PVR) are collected on each follow-up. Results: In comparison to TURP, the ThuLEP group has significantly less need for catheter traction and less need for postoperative irrigation. The operative time is significantly higher in ThuLEP compared to TURP. ThuLEP is significantly superior to TURP in terms of early catheter removal, less drop in haemoglobin, less fall in serum sodium level, and early hospital discharge. ThuLEP and TURP resulted in a significant improvement from baseline in terms of IPSS, PVR, Qmax, and QoL, but there was no significant difference between the 2 groups. The IIEF-5 is the same as the baseline in both groups. Early and late complications are also comparable. Conclusion: The ThuLEP outperforms TURP in terms of blood loss, significantly less need for postoperative catheter traction, bladder irrigations, early catheter removal, and less hospital stay. Transurethral resection of the prostate takes longer operative time in the early stages of experience. The results of both surgeries are comparable in terms of PVR, Qmax, and subjective scoring systems (IPSS, QoL). Transurethral resection of the prostate is a safe and efficient BPH treatment method comparable to the monopolar TURP.

Background: Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that povidone iodine instillation and octreotide has beneficial effects to treat lymphorrhea after renal transplantation. Aims and Objectives: The aim of this study was to compare the povidone iodine instillation and octreotide treatment in lymphorrea after kidney transplantation. To evaluate the efficacy of povidone iodine and octreotide injection in comparison to control group for the treatment of lymphorrhea in renal transplant patient. Materials and Methods: It was comparative analytical study included 60 recipients of both cadaveric and live kidney allografts with posttransplant lymphorrhea including 20 treated with instillation of betadine solution, 20 with octreotide (0.1 mg three times a day subcutaneously), and 20 was control group (no betadine and octreotide was used). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay. Results: The average duration of lymphorrhea was (8.85 ± 0.88) and (11.6 ± 0.94) and (16.15 ± 0.81) days for the betadine groups, the octreotide groups and control groups respectively. (P < 0.05) . No lymphoceles occurred among the betadine group, while three lymphoceles were found among patients treated with octreotide and five lymphocele were found among control groups. No differences were observed for wound infection, graft dysfunction episodes or renal function and death between the groups. No octreotide and povidone related adverse events were noted. Conclusion: The mean length of lymphorrhea was lower with povidone iodine instillation as compared to octreotide treatment. There was a shorter hospital stay and minor patient discomfort in betadine groups. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by betadine instillation as compared to octreotide and control groups.

Background: Bladder cancer, the most common malignancy of the urinary tract is a leading cause of morbidity and mortality. But cystoscopy, which is till now the mainstay of screening, is an invasive, high-cost method with low sensitivity especially for flat lesions. Aim: To find a non-invasive and effective screening method with liquid-based cytology (LBC) using The Paris System (TPS) and CK20 immunocytochemistry. Materials and Methods: It was a prospective study including the patients with clinical or cystoscopic diagnosis of urinary bladder space occupying lesions (SOL). Both conventional (CC) and liquid-based cytology slides were prepared from urine samples. Slides were evaluated by two trained pathologists and categorized according to TPS guidelines. CK20 immunocytochemistry (ICC) was also performed. Consequent formalin-fixed paraffin embedded sections were blindly examined by another pathologist and was taken as gold standard for comparison. Statistical Analysis: All the statistical analysis were done using MedCalc version 15.8 [Mariakerke, Belgium: MedCalc Software 2015]. Results: The study included 150 cases with a mean age of 62.4 years. Five cases revealed unsatisfactory smears. Rest of the cases were categorized as the following: 18.1% as NH-GUC, 8% as LGUN, 22.1% as AUC, 15.4% as SH-GUC, 32.9% as HGUC. Kappa value of CC and LBC were strong (0.854). LBC alone showed very low specificity (58%) and PPV (74.8%) which improved on application of ICC (specificity: 97.4%, PPV: 96.3%). Conclusion: We conclude that CK20 ICC offers potential for accurate, non-invasive detection and surveillance of bladder cancer and is a better tool when combined with liquid-based cytology, reported using The Paris System.

Background: Management of urethral stricture related to lichen sclerosus (LS) is now gradually changing from surgical to nonsurgical due to availability of anti-inflammatory agents such as corticosteroids and calcineurin inhibitors. We determined the clinical impact of these agents in such patients on outpatient department basis in terms of improvement in symptoms on International Prostate Symptom Score (IPSS), external skin appearance, and maximum urinary flow rate (Qmax). Materials and Methods: Eighty patients of meatal stenosis and penile urethral stricture with histopathologically proven LS were divided into two groups, and clinical and predetermined parameters such as Qmax, IPSS, and changes in external appearance were compared between these groups after 3 months of topical and intraurethral application of clobetasol and tacrolimus with self-calibration. Results: A significant intragroup difference was noted in IPSS (P < 0.001) as well as Qmax (P < 0.001); postintervention intergroup difference in IPSS was not significant (P = 0.94) and however postintervention intergroup difference in Qmax was significant in favor of clobetasol (P = 0.007). A significantly increased number of additional procedures were done in the group receiving intraurethral tacrolimus (P = 0.0473) with significantly less number of skin complication in the group with topically applied clobetasol (P = 0.003). Conclusion: Though both clobetasol and tacrolimus, improved symptom score, Qmax and local external appearance yet topical and intra-urethral clobetasol application via urethral self calibration seems to be better option for lichen sclerosus related urethral stricture in terms cost and local complications.

Introduction: Renal transplantation provides the best result as a long-term renal replacement therapy. Lymphorrhea is considered a common surgical complication of renal transplantation. Although nonsurgical factors are also associated, it is primarily due to damage and improper ligation of lymphatic vessels draining donor kidney and perivascular lymphatics of iliac vessels. Lymphorrhea is associated with prolongation of hospital stay and increased chances of infection and it may lead to lymphocele formation. Hence, to localize the origin of postoperative lymphorrhea in transplant recipients in wake for its definitive management, the enzymatic activity of the two enzymes, namely, creatine phosphokinase (CPK) and Lactate dehydrogenase (LDH) in the drain fluid was evaluated. Materials and Methods: A total of 68 renal transplant recipients (including live and deceased-donor [DD] transplantation) were evaluated for2 years. The enzymatic value of CPK and LDH was calculated in perigraft drain fluid. It was compared with the values of CPK and LDH in postradical cystectomy pelvic drain fluid and simple renal cortical cyst fluid. The average value of CPK in pelvic drain fluid and LDH in renal cortical cyst fluid was considered as their baseline value in lymphatics draining lower limb and renal lymphatics, respectively. Results: The source for postoperative lymphorrhea in DD and live-related donor was iliac lymphatics, whereas in live unrelated donor, it was iliac and graft kidney lymphatics. Conclusion: Drain fluid assessment for CPK and LDH activity can localize the origin of lymphatic leak in renal transplant recipients.

Introduction: Exponential increase in the number of chronic kidney disease cases and shortage of living renal donors have increased the demand of deceased donor renal transplant (DDRT) in India. Delayed graft function (DGF) is more commonly observed in deceased donor renal transplant recipient and is a risk factor for early graft loss. Materials and Methods: An ambispective observational analysis was conducted over 63 recipients of DDRT performed in our institute from January 2012 to January 2022. The donor factors, recipients' characteristics, and perioperative factors were analyzed for the association with DGF. Statistical analysis was undertaken using SPSS 27.0 software, considering P < 0.05 as statistically significant. Results: Among the 63 deceased donor renal transplant recipients, 16 (25.39%) developed DGF. The incidence of DGF was more in recipients with greater body mass index and previous sensitization. Recipients receiving kidneys from older, male, and hypertensive donors with less terminal urinary output were found to be more susceptible to develop DGF. Cold ischemia time was significantly prolonged in patients who developed DGF. The duration of hospital stay and serum creatinine level at the time of discharge and also during follow-up after 3 months were significantly higher in the DGF group. Although the stated observations persisted in the patients during the 12 months of follow-up, no statistically significant differences were found in the number of functional grafts. Conclusion: DGF has a detrimental effect on graft as well as recipient survival. A coordinated approach between the transplant team and intensivist can circumvent most of the factors leading to DGF, thus improving the overall outcome.

Introduction: Renal length and volume are important indicators for the presence or progression of disease in urology and nephrology. Estimation of renal volume by Ultrasonography (USG) has clinical utility for the physician, nephrologist, and urologist. Aim: To measure individual renal volume by ultrasonography and determine its relationship with renal function as measured by the Diethylene Triamine Penta-acetic Acid (DTPA) in normal adults. Materials and Methods: It was a cross-sectional study conducted on fifty patients who underwent DTPA scans both in Outpatient (OPD) and In-Patient Department in the Department of Urology, of a tertiary care centre from January 2020 to December 2020. All the transplant donors who underwent donor nephrectomy were included in the study. A sonographic assessment was done and the Glomerular Filtration Rate (GFR) was calculated by Technetium (Tc)-154 DTPA. The primary outcome was to determine the relationship between renal volume with renal function in normal adults. The secondary outcome was to measure individual renal parameters sonographically. They were assessed for correlation between renal parameters (mainly renal volume) and DTPA using Pearson’s coefficient. Results: The age range of the subjects was 18-70 years. GFR calculated by DTPA for the right kidney had a better correlation with renal volume (r=0.241) on the right and 0.162 on the left, both with a p-value of 0.001). GFR of the left kidney had a better correlation with left kidney volume (r=0.184) than right kidney volume (r=0.130). No correlation was found between GFR with renal Anteroposterior (AP) dimension, renal width, and renal length. The kidney volume was more significant on the left-side (r=0.351) than on the right kidney (r=0.263). Conclusion: Renal volume correlated well with renal function. Sonographic assessment of renal volume rather than renal length would serve as a tool to evaluate renal status for evaluation and follow-up.

Introduction: Prostate cancer is a common malignancy affecting men and the second leading cause of cancer related death in India. Numerous molecular biomarkers have been evaluated for their potential role in predicting disease progression, their response to therapy and survival. Erythroblast Transformation Specific (ETS) related Gene (ERG) is one of the newest addition in the existing list of biomarkers of prostate cancer. Aim: To analyse the expression of ERG in prostatic adenocarcinoma and to evaluate its association with World Health Organisation (WHO) grade group. Materials and Methods: This was a prospective observational study was conducted in the Department of Pathology in association with Department of Urology, IPGME&R, SSKM Hospital, Kolkata, West Bengal, India. The duration of the study was 1.5 years, from January 2019 to June 2020. A total of 267 cases of Transrectal Ultrasound (TRUS) guided tru-cut biopsy was included. Clinical data including preoperative Prostate Specific Antigen (PSA) level, Digital Rectal Examination (DRE) were obtained. Histopathological reports were prepared by two pathologists along with Gleason scoring and WHO grading as per 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Formalin Fixed Paraffin Embedded (FFPE) sections of representative blocks of each tumour was selected for Immunohistochemistry (IHC) study. Only the cases which had more than 10% nuclear staining were considered as positive. Statistical analysis was performed with help of Epi Info (TM) 7.2.2.2 and Chi-square test was used to test the association of different study variables. Results: The mean age of the study participants was 65.55 years, and the age range was 45-93 years. Among the 80 malignant cases where, ERG immunostaining was assessed, 28 cases (35%) showed positive expression. Among these positive cases, 50% cases were weakly positive, 28.57% showed moderate positivity and 21.43% had strong positive expression. Highest positivity was observed in WHO grade group V (44.83%). The intensity of ERG expression was also higher in high grade group (13) than low grade group cancer patients. Conclusion: ERG expression in the prostate cancer can be a prognostic factor as the expression and intensity of expression both increases with higher grade group of cancer.

Introduction: The etiology of lower urinary tract symptoms (LUTS) is multifactorial with causes attributed either to the dysfunction of the bladder or its outlet. Although the etiologies are well studied in aged men, very limited research trials are available in young men with LUTS. Most of the time young men presenting with chronic irritative or obstructive symptoms are labeled with chronic prostatitis or prostatodynia and are treated empirically. In this study using videourodynamics, we prospectively investigated the etiologies of LUTS and low uroflow in young men. Materials and Methods: Fifty male patients, 18–50 years of age attending the urology outpatient department at a tertiary care center from January 2021 to December 2021 with symptoms suggestive of chronic LUTS and low uroflow (maximum urinary flow rate [Qmax] 150 ml) were included in the study and underwent multichannel videourodynamic study (VUDS). Clinical characteristics and urodynamic results in different diagnostic groups were tabulated and analyzed. The P ≤ 0.05 was considered statistically significant. Results: Out of 50 enrolled patients, primary bladder neck obstruction was seen in 21 patients (42%), dysfunctional voiding in 14 (28%), impaired detrusor contractility (IDC) in 9 (18%), and benign prostatic obstruction (BPO) was noted in 6 patients (12%). The mean age and size of the prostate of patients with BPO were greater than those in the remaining groups and patients with IDC had lower Qmax and Pdet at Qmax than those in the remaining patients. Conclusion: Chronic LUTS in young men has a variety of underlying etiologies and VUDS in this population is helpful in attaining an accurate diagnosis and thus may guide toward efficient management.

Background: Renal replacement therapy is the gold standard treatment of end-stage renal disease. Since the number of cases of chronic kidney diseases are increasing exponentially in our country, only live-related transplant is not enough to bridge the gap between disease and their treatment which increased the demand for deceased renal transplant program in our country. Objective: The objective is to study donors and recipients' characteristics for association with survival of patients in deceased renal allograft transplant. Materials and Methods: It is an ambispective observational analysis of 42 deceased donor renal transplants performed in our institute from January 2012 to December 2019. The difference among donors and recipients' characteristics was analyzed for association with the outcome for survival or death of the patient. Statistical analysis was done using SSPS 21.0 software and P value < 0.05 was taken as statistically significant. Results: In association with survival and expired outcomes, donors and recipients age, donors sex, cause of brain death (traumatic/nontraumatic), standard or extended criteria of donor, serum creatinine at the time of death, dialysis vintage period, warm and cold ischemia time, duration of hospital stay had shown no significant association with survival. While donors' urine output at the time of death, recipients sex, previous sensitization of recipients either by previous episodes of blood transfusion or pregnancy, achievement of normal renal function at day 14 of transplant, and tacrolimus level at 1 month of transplant shown significant association with the outcome. Conclusion: Deceased donors' characteristics, mainly urine output at death, recipients characteristic, namely any previous sensitization, achievement of normal renal function at day 14, serum tacrolimus level at 1-month posttransplant have a significant association with survival of deceased renal allograft transplant recipients. Sepsis and severe acidosis were the main complications contributing to mortality.

Pediatric nephrolithiasis (NL) or Kidney stone disease (KSD) is an untethered topic in Asian population. In Western countries, the annual incidence of paediatric NL is around 6–10%. Here, we present data from West Bengal, India, on lower age (LA, 0–20 years) NL and its prevalence for the first time. To discover the mutations associated with KSD, twenty-four (18 + 6) rare LA-NL patients were selected for Whole Exome Sequencing (WES) and Sanger sequencing, respectively. It was found that GRHPR c. 494G>A mutation (MZ826703) is predominant in our study cohort. This specific homozygous mutation is functionally studied for the first time directly from human peripheral mononuclear cell (PBMC) samples. Using expression study with biochemical activity and computational analysis we assumed that the mutation is pathogenic with loss of function. Moreover, three genes, AGXT, HOGA1 and GRHPR with Novel variants known to cause hyperoxaluria were found frequently in the study cohort. Our study analyses the genes and variations that cause LA-NL, as well as the molecular function of the GRHPR mutation, which may serve as a clinical marker in the population of West Bengal, Eastern India.

Introduction: Chronic Urinary Retention (CUR) due to prostatomegaly causes impaired detrusor function, secondary to obstruction-related changes in the bladder wall. Urodynamic study is the “gold standard” to determine detrusor function in CUR patients. Traditional management of all CUR patients due to Benign Prostatic Hyperplasia (BPH) is temporary catheter drainage of the urinary bladder, so that detrusor impairment may be corrected. There is no consensus regarding the ideal timing of prostate operation in Bladder Outlet Obstruction (BOO) patients presenting with CUR due to BPH. Aim: To assess the ideal timing of Transurethral Resection of the Prostate (TURP) in chronic urinary retention patients due to BPH. Materials and Methods: This was a prospective, longitudinal study of 57 eligible patients with non neurogenic lower urinary tract symptoms, who presented with chronic urinary retention due to benign prostatic hyperplasia and attended the Department of Urology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital (IPGME&R SSKM) hospital, Kolkata, West Bengal, India from August 2019 to July 2022. Four serial Urodynamic Studies (UDS) were performed after initial catheterisation in sterile urine culture on the day 5, day 14, day 30, and at 6th week. As per UDS findings, patients were classified into Preserved Detrusor function group (n=18), at peak flow rate (Qmax) {Detrusor Pressure (Pdet) at peak flow rate} >30 cm H2O and Impaired Detrusor function group (n=39), Pdet at Qmax ≤30 cm H2O. Descriptive statistics were performed as means, standard deviations and ranges using Microsoft Excel software. For categorical variables percentages were used. The Student’s paired-test and Chi-square test were used for statistical analysis. The p-value 30 cm H2O and only n=3 (7.7%) patients had Pdet at Qmax≤ 30 cm H2O (p-value

ABSTRACT: BACKGROUND: Sexually active female patients often present with urinary tract infection. Recurrent urinary tract infections negatively affect a patient's social and sexual life, leading to deterioration of overall life quality. OBJECTIVE: This study aimed to determine the prevalence of sexual dysfunction in recurrent urinary tract infection patients of reproductive age, and the association between recurrent urinary tract infections and sexual dysfunction. STUDY DESIGN: A total of 697 women of reproductive age with urinary tract infection attending a urology outdoor patient department in a tertiary-care center in eastern India were evaluated with a comprehensive history (including a validated questionnaire), physical examination, and relevant investigations. To assess sexual dysfunction and sexual distress profiles, the Female Sexual Function Index scale and the revised Female Sexual Distress Scale were used. RESULTS: Recurrent urinary tract infection was found in 143 of 697 (20.5%) patients. Women with recurrent urinary tract infection had a lower Female Sexual Function Index score (11), suggestive of sexual dysfunction, in 59.4% and 58.1% of cases, respectively (P11. CONCLUSION: Nearly 60% of sexually active women of reproductive age with recurrent urinary tract infection had low Female Sexual Function Index and high Female Sexual Distress Scale scores, which are suggestive of sexual dysfunction. Thus, every patient with recurrent urinary tract infection should be evaluated for sexual dysfunction to improve quality of life.

Renal artery pseudoaneurysm after nephrolithotomy or pyelolithotomy is rare, but is more often following Percutaneous Nephrolithotomy (PCNL) or renal biopsy. It is a potentially life-threatening condition, with an incidence of 0.1 to 0.3% after nephrolithotomy or pyelolithotomy. Manifestation may vary, from asymptomatic to symptoms like local bloody discharge, haematuria, pain, high blood pressure, and rupture causing a life-threatening condition. A minimally invasive technique, selective or super-selective angioembolisation is the treatment of choice. This case series reports, five cases presented with either bloody wound discharge or intermittent haematuria in the Emergency Department, post nephrolithotomy. All patients were resuscitated in the Emergency Department with intravenous fluid and packed red blood cell transfusion. After resuscitation, three patients were diagnosed with renal artery pseudoaneurysm on Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) and angiography, and two patients with digital subtraction angiography during the intervention. All were treated with super-selective renal artery angioembolisation, with endovascular coiling of different sizes. All patients made an uneventful recovery, and on followup no complication was evident. Now-a-days the popularity of angioembolisation for renal artery pseudoaneurysm has increased, which shows a paradigm shift from a traditional surgical intervention.

Intravesical immunotherapy with Bacillus Calmette–Guerin (BCG) is a standard of care therapy for non-muscle invasive bladder cancer (NMIBC), which accounts for about 75% of newly diagnosed urothelial cancer. However, given the frequent recurrence and progression, identification of a pre-treatment biomarker capable of predicting responsiveness to BCG in NMIBC is of utmost importance. Herein, using multiparametric flow cytometry, we characterized CD8+ T cells from peripheral blood and tumor tissues collected from 27 pre-BCG patients bearing NMIBC to obtain immune correlates of bladder cancer prognosis and responsiveness to BCG therapy. We observed that intratumoral CD8+ T cell subsets were highly heterogenous in terms of their differentiation state and exist at different proportions in tumor tissues. Remarkably, among the different CD8+ T cell subsets present in the tumor tissues, the frequency of the terminally exhausted-like CD8+ T cell subset, marked as PD1+CD38+Tim3+ CD8+ T cells, was inversely correlated with a favorable outcome for patients and a responsiveness to BCG therapy. Moreover, we also noted that the intratumoral abundance of the progenitor exhausted-like PD1+CD8+ T cell subset in pre-BCG NMIBC tumor tissues was indicative of better recurrence-free survival after BCG. Collectively, our study led to the identification of biomarkers that can predict the therapeutic responsiveness of BCG in NMIBC.

Introduction: Stones are common cause of obstructive uropathy which may lead to decrease in renal function. Though endourological procedure like Ureteroscopic Lithotripsy (URSL) is commonly done, yet, Medical Expulsive Therapy (MET) is often offered as a first line therapy for mid and distal ureteric stones of size less than one cm. Aim: To compare the effect of Tamsulosin and URSL on renal function and stone free rate for solitary mid and distal ureteric stone. Materials and Methods: This prospective interventional study was done in IPGME&R and SSKM Hospital, Kolkata, West Bengal, India, from May 2020 to October 2020, on the total study population of 50 patients with 26 patients in MET and 24 patients in URSL group. Parameters measured and compared were changes in Glomerular Filtration Rate (GFR) and stone free rate after six weeks of intervention. Numerical variables and categorical variables were compared between two groups using independent t-test and Chi-square test respectively. Results: The mean age of patients in MET (n=26) and URSL group (n=24) was 37.12 years and 33.63 years, respectively. GFR was significantly increased after completion of treatment in individual groups (p-value=0.01) and in final study population but change in GFR was not significant, when compared between the groups (p-value=0.372). Difference in stone clearance rate between two groups was also insignificant (p-value=0.902) whereas, within the groups was significant (p-value

Apart from other risk factors, chronic inflammation is also associated with the onset of Prostate Cancer (PCa), wherein pathogen infection and tissue microbiome dysbiosis are known to play a major role in both inflammatory response and cancer development. However, except for a few studies, the link between microbes and PCa remained poorly understood. To explore the potential microbiome signature associated with PCa in Indian patients, we investigated differential compositions of commensal bacteria among patients with benign prostatic hyperplasia (BPH) and PCa using 16S rRNA amplicon sequencing followed by qPCR analyses using two distinct primer sets. Using two independent cohorts, we show that Prevotella copri, Cupriavidus campinensis, and Propionibacterium acnes represent the three most abundant bacteria in diseased prostate lesions. LEfSe analyses identified that while Cupriavidus taiwanensis and Methylobacterium organophilum are distinctly elevated in PCa samples, Kocuria palustris and Cellvibrio mixtus are significantly enriched in BPH samples. Furthermore, we identify that a number of human tumor viruses, including Epstein-Barr virus (EBV) and hepatitis B virus (HBV), along with two high-risk human papillomaviruses - HPV-16 and HPV-18, are significantly associated with the PCa development and strongly correlated with PCa bacterial signature. The study may thus offer to develop a framework for exploiting this microbial signature for early diagnosis and prognosis of PCa development.

Xanthogranulomatous Pyelonephritis (XGPN) is a chronic inflammatory disease usually associated with renal stones, mimicking several malignant and benign pathology causing diagnostic dilemma. A rare case of XGPN of renal pelvis has been presented here. A 34-year-old female presented with left renal colicky pain, with gross haematuria without any palpable renal lump. Computed Tomography (CT) scan showed a 4.5×4.3×4.0 cm sized heterogeneous solid cystic non enhancing Space Occupying Lesion (SOL) in left renal pelvis. It was provisionally diagnosed as transitional cell carcinoma of left renal pelvis and patient underwent laparoscopic nephroureterectomy. Histopathology revealed it as XGPN. This highlights the fact that there are several overlaps of clinical and radiological findings of these entities making its diagnosis a challenging task.

Introduction: Lower Urinary Tract Symptoms (LUTS) are responsible for negative impact on quality of life of women. Urodynamic Study (UDS) is gold standard objective investigation in evaluating bothersome LUTS. Cystoscopy is important where UDS is difficult or unavailable. Despite vital role and unique properties of UDS and cystoscopy, the role of UDS and cystoscopy in the assessment of bothersome LUTS in young females continues to be heavily debatable subject as there is limited study in this age group. Aim: To evaluate causes of LUTS in young female patients and associate them with urodynamic and cystoscopic findings. Materials and Methods: This was a prospective observational study conducted in IPGMER and SSKM Hospital, Kolkata, West Bengal, India, from July 2019 to December 2020. A total of 100 female patients from adulthood to menopause were evaluated having decreased quality of life due to LUTS called bothersome LUTS in the form of history taking, clinical examination, basic biochemical tests, ultrasonography followed by urodynamic and cystoscopic examination. Patients were classified according to their LUTS into three groups: storage dysfunction, urinary incontinence and bladder emptying dysfunction. Association of UDS parameters like Idiopathic Detrusor Overactivity (IDO), IDO with detrusor underactivity, Compensated Bladder Outlet Obstruction (CBOO) was made with cystoscopic findings like dilated veins with cystitis, lax urethra, bladder trabeculations, diverticula, urethral stricture. Results were analysed using Microsoft Excel spreadsheet and International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0. Results: In storage dysfunction group, frequency with nocturia (53.3%) and in urinary incontinence group, stress urinary incontinence (58.3%) was predominant bothersome symptom. In storage dysfunction group 73.3% patients had IDO and 26.7% patients had normal UDS findings. In these patients on cystoscopic examination, 83.3% patients had dilated veins with cystitis changes. In urinary incontinence group 70.8% patients had IDO and 29.2% patients had IDO with detrusor underactivity on UDS examination. In these patients cystoscopic examination 54.2% had lax urethra with cystitis changes. In bladder emptying dysfunction group on UDS examination, all patients had CBOO and 75% had urethral stricture on cystoscopy. Conclusion: Significant association exists between UDS and cystoscopic findings on evaluation of LUTS in young females patients. Storage dysfunction symptoms were the most common in young age group followed by urinary incontinence symptoms. Bladder emptying dysfunction symptoms were least common.

Sacral agenesis is a rare developmental disorder, in which there is absence of part or all of two or more sacral vertebral bodies. It is mostly associated with dysfunction of bowel, bladder and neuromuscular system of lower limbs. Voiding impairment (neurogenic bladder), Vescico-Ureteric Reflux (VUR) together with urinary tract infection contribute to renal injury. Here authors are reporting an 11-year-old female, who was diagnosed to have sacral agenesis with anorectal malformation at the age of six month, leading to anal trans-positioning done at that age, she presented to the Urology Department with acute kidney injury. On evaluation, she was found to have overactive bladder with increased bladder capacity and bilateral grade 5 VUR. After recovery from acute kidney injury with conservative management and catherization, she was discharged with the advice of clean intermittent catheterization and anticholinergic drug. On follow-up, she was doing well. Early diagnosis and long term follow-up is required in the patients having sacral agenesis with multidisciplinary team including urologist, as these patients may develop lower urinary tract symptoms, VUR and kidney injury at any time in their growth period.

Objective: Lymphatic complications (lymphorrhea or lymphocele) are one of the most common and frustrating complications of renal transplantation. It was well documented in literatures that excessive lymphatic leak in the early postoperative period leads to lymphorrhea, which may transform into lymphocele. Povidone-iodine has been used as a sclerosant in lymphocele management for the past 30 years. In this study, our aim is to establish the role of povidone-iodine to prevent lymphorrhea after kidney transplant surgery. Materials and Methods: A total of 106 (live donor transplant patient = 63 and deceased donor transplant patient 43) patients had undergone renal transplantation from May 2019 to May 2020. Those patients were randomized into three groups – Group A (n = 35): where 1% povidone-iodine was used, Group B (n = 35): where 5% povidone-iodine was used, and Group C (n = 36): control group, where povidone-iodine was not used. Fifty milliliters of 1% or 5% povidone-iodine was used to wash the bed and kept for 5 min in contact with the bed and again 1% (Group A) or 5% (Group B) povidone-iodine wash was given after completion of ureteroneocystostomy and was kept for 5 min. Results: On postoperative day 6, there is a statistically significant decrease in drain output in the 5% and 1% povidone-iodine groups in comparison with the control group, but no statistically significant difference exists between 5% versus 1% povidone-iodine group. Conclusion: Intraoperative instillation povidone-iodine is a cheap, safe, and very effective procedure to prevent lymphorrhea following renal transplant surgeries.

Introduction: Bladder cancer is the most common malignancy of the urinary tract, and recurrence following transurethral resection poses the biggest challenge. Intravesical Bacillus Calmette–Guerin (BCG) maintenance with the Southwest Oncology Group (SWOG) protocol remains the gold standard but with poor patient compliance.Materials and Methods: The present study aims to compare the SWOG maintenance protocol with a monthly maintenance protocol comprising 12 monthly doses of intravesical BCG. Patients are included in the study only if induction BCG is completed and cystoscopy at 3 months is negative. All patients receive 80 mg BCG in each dose with strict cystoscopic surveillance every 3 months.Results: Patient demographics and tumor characteristics were similar in the two groups. There were no statistically significant differences in outcome in terms of recurrence, progression, and adverse reactions in both the groups. Although a larger number of patients in the SWOG maintenance group were lost to follow-up, the difference was not statistically significant proportions.Conclusion: From this study, we can conclude that monthly maintenance BCG for 1 year is comparable in terms of outcome with SWOG protocol maintenance BCG. A greater percentage of patients in the monthly maintenance protocol completed the treatment as planned.

Context: Doctor–patient relationship has gone through some troubled times in the recent past. Quality data regarding this is lacking in the Indian setting. Aims: The study aim was to find the perception of doctors regarding doctor–patient relationship. Settings and Design: The study was conducted at a tertiary health-care center in West Bengal. It was a qualitative study including in-depth interviews and focus group discussions (FGDs). Subjects and Methods: The study comprised of in-depth interviews (IDI) of thirty residents and three FGDs, involving 33 residents. Statistical Analysis Used: Data analysis was performed manually by deductive approach. Descriptive “codes” of the text information were done. The consolidated criteria for reporting qualitative research guidelines were followed. Results: Doctor–patient relationship was perceived as of mutual trust and respect. Overburdened doctors, impatient patients, unrealistic expectations from the treatment, and lack of infrastructure were some of the agreed-upon factors for the strained relationship. A combined corrective effort is needed to salvage the current situation. Conclusions: A healthy doctor–patient relationship is instrumental in the holistic picture of health care. Doctors, patients, administration, and media have shared causation to the problem and have equal responsibility for its amendment.

Introduction: Numerous biomarkers have been investigated for the diagnosis and follow-up of patients with bladder cancer, but none has achieved desirable acceptability. In the search of biomarkers, minichromosome maintenance protein 2 (MCM2), a cell cycle regulatory protein, was investigated and the preliminary results were promising. Hence, we conducted a study to investigate the role of immunocytochemical (ICC) detection of MCM2 in voided urinary samples of patients with bladder cancer in an Indian population. Materials and Methods: A prospective comparative observational study was performed. One hundred and fifty patients with a mass lesion in the bladder and 100 controls were enrolled in this prospective study from June 2017 to–December 2018. Fifty-milliliter of voided urine sample was collected and processed for ICC staining of MCM2. Results: Fifty, 100, and 200 positive MCM2 cells as a cutoff value has shown a sensitivity of 87.33% (80.93%–92.20%), 84.67% (77.89%–90.02%), and 80.67% (73.43%–86.65%), respectively. The specificity of 50, 100, and 200 positive MCM2 cells was 97% (91.48%–99.38%), 99% (94.55%–99.97%), and 100% (96.38%–100.0%), respectively. Conclusion: ICC detection of MCM2 in voided urinary samples has good sensitivity and specificity for the detection of bladder cancer. Hence, it can be used as a potential marker for the detection of bladder cancer.

Most paediatric patients attend Urology Outpatient Department with diagnosis of pelviureteric junction obstruction. Nowadays laparoscopic pyeloplasty is increasingly been used for the pelviureteric junction obstruction in paediatric patients. In the present case series, four paediatric patients of pelviureteric junction obstruction with age group of six, seven, eight and 12 years underwent laparoscopic pyeloplasty with adult sized laparoscopic instruments with ports size of 5 mm and 10 mm. Outcomes were measured in terms of mean operative duration, mean hospital stay and complications and improvement in Glomerular Filtration Rate (GFR). Mean operative duration was 211 minutes, mean blood loss of 96.25 mL and mean hospital stay was 5.75 days. Mean preoperative and mean postoperative GFR (at three months) were 53.19 mL/min and 55.35 mL/min respectively. In postoperative period one patient had increased drain output of more than 250 mL up to postoperative day three. All four patients had minor complications like postoperative fever on postoperative ileus which were managed conservatively. Mean postoperative follow-up duration was six weeks when Double-J (DJ) stent was removed. All patients had good outcome in terms of being asymptomatic and decreased hydronephrosis on follow-up renal ultrasonography and increased function of operated kidney on renal scan at three months. Based on intraoperative and postoperative observations, adult sized laparoscopic instruments can be used with ease with changes in port position and length of instrument inserted , adult sized laparoscopic instruments can be a useful armamentarium for paediatric laparoscopic pyeloplasty in cases of unavailability or intraoperative instrumental damage.

Pelvic Lipomatosis (PL) is a rare benign disease of unknown aetiology characterised by intrapelvic overgrowth of mature fatty tissue. Although non malignant, the adipose tissue is infiltrative and causes compression of the pelvic structures-the genito urinary tract, lower gastrointestinal tract or the vascular system leading to a broad range of symptoms. With limited cases of PL reported in the literature there are no clear-cut guidelines for its management and both conservative and surgical modalities have been described with varying results. This report describes a case of PL in a young 34-year-old male which was associated with bilateral hydroureteronephrosis and was well managed conservatively. PL is also known to be associated with complications like hypertension, severe upper tract obstruction, renal failure and rarely pulmonary thromboembolism, portal vein thrombosis and adenocarcinoma bladder, thus commanding early diagnosis of the disease and long-term follow-up in all the patients.

Introduction: Lower Urinary Tract Symptoms (LUTS) in association with Benign Prostatic Hyperplasia (BPH) are common in elderly males. Almost half of this age group over fifth-decade of age complain of moderate to severe degree of LUTS which impedes their Quality of Life (QoL). Aim: To assess the QoL in patients with LUTS due to BPH and compare the outcomes on modified BPH-QoL scale and International Prostate Symptom Score (IPSS) scale. Materials and Methods: An observational study was conducted from November 2019 to November 2020. A total of 400 men were selected for the study. The responses on both the scales (IPSS and BPH specific QoL scale) were noted and the total score was calculated. The BPH-specific QoL was compared with the IPSS scale by using the Pearson coefficient relation test. Results: Most men were in age group 50-60 years with median age of 58 years. The correlation of BPH-specific QoL scale questions with QoL question of IPSS was found to be statistically significant. The correlation coefficients of BPH-specific QoL questionnaire were found to be r=0.560 (p

Percutaneous Nephrolithotomy (PCNL) has routinely been performed in prone position as a treatment for calyceal diverticular stone. PCNL is performed supine as an alternate modality for calyceal diverticular stones. The objective of the procedure is to reduce operative time and anaesthetic morbidity during supine tubeless PCNL in calyceal diverticular stone. The series is about three patients with calyceal diverticular stones. These patients underwent supine tubeless PCNL in Galdakao modified supine Valdivia position. There was no intraoperative, postoperative or on follow-up complications in any of the the patients. In all the patients stones were cleared completely in single sitting. Supine PCNL in calyceal diverticular stone could be an alternative with similar outcomes to the standard prone PCNL. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time and also reduces anaesthesia complications.

Introduction: Multiparametric Magnetic Resonance Imaging (MRI) of prostate including Diffusion Weighted Imaging (DWI) is greatly evolving as a diagnostic tool in prostate cancer. Incidence of prostate cancer in India is on rise with most of the cases been diagnosed in late stages. In this scenario, DWI imaging can pick up the cases at an earlier stage causing a significant impact in the patient management. Aim: To assess the role of DW-MRI as a non invasive initial investigation tool in prostate carcinoma prior to biopsy. Materials and Methods: The study was a prospective observational study conducted during April 2014 to March 2015 in the Department of Radiodiagnosis in collaboration with Department of Urology in a hospital in Kolkata. A total of 34 patients with a clinical suspicion of prostate cancer underwent prostate DWI-MRI by a 3T scanner before Transrectal Ultrasound (TRUS)-guided biopsies. IBM Statistical Package for Social sciences (SPSS) version 17.0 was used for statistical analysis and the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were determined. Results: All patients (100%) with biopsy proven adenocarcinoma showed diffusion restriction. A total of 95.8% were PI-RADS 5. False positive results were found in two patients. The sensitivity, specificity, PPV and NPV were 100% (95% CI= 85.75% to 100.00%), 80% (95% CI= 44.39% to 97.48%), 92.31% (95% CI= 74.87% to 99.05%) and 100% (95% CI=63.06% to 100.00%) Conclusion: From the present study, it was noted that sensitivity of DWI is very high (100%). DWI also has a high specificity and positive predictive value. Hence, DWI is one of the most effective adjunct non invasive tools for initial investigation in prostate carcinoma which improves the diagnostic performance and helps in performing targeted biopsies from the suspicious prostatic lesion.

Agenesis of penis is a very rare developmental anomaly, which is usually associated with scrotal hypoplasia or other urological developmental anomalies. Here we psesent such a case who presented to us with stenosis of newly constructed urethra.

Cutaneous horns are cornified hyperkeratotic lesions on the skin, usually present on photo-exposed areas such as the face and scalp. Its presence on the penis is very rare. Here, we report a 35-year-old male presenting with penile cutaneous horn with successful management with wide local excision along with a review of other modalities of treatment of this rare entity.

Teratomas are tumors consisting of two or three germ layers, seen commonly during childhood. Mature teratomas are benign and demonstrate well differentiated tissues such as sebaceous glands, hair, and teeth. Bladder is a very rare extragonadal site for teratoma, moreover so in adults. Presentation may vary from with irritative lower urinary tract symptoms or urinary retention to pilimiction (passage of hair in the urine). We hereby present a case of mature teratoma of the urinary bladder, with a classical symptom of pilimiction, in a 22-year-old male patient, which to our knowledge is the first male case reported in the literature.

Context: Urological complications are inevitable in renal transplantation; however, their occurrence and brunt on graft survival can be downsized. The aim of our study was to analyze and review the literature on various urological complications and their management in renal transplant patients. Materials and Methods: We reviewed all cases of urological complications in renal transplantation managed at our institution from January 2010 to March 2017. Results: Urological complications arose in 29 renal transplant patients amidst the study period with median identification time of 24 days (range 0–1500 days). Ten (34.5%) patients developed complications pertaining to ureteric handling and reimplantation followed by significant lymphocele in 9 (31%) patients. Four (13.8%) cases succumbed to vascular anastomosis-related complications. Out of 29 patients, 45% of these complications manifested within a month posttransplant. Complications were tackled individually. Sixteen (55%) cases were treated with either endoscopic or minimally invasive methods, whereas 13 (45%) cases required open surgery. Two grafts were lost as a consequence of vascular complications and a fatality which was directly or indirectly linked with urological complication. Remaining all treated patients improved on follow-up. Conclusion: Comprehensive preoperative recipient evaluation, meticulous organ procurement, and integrated multidisciplinary teamwork are helpful in achieving optimal outcome of transplant. Endourological and minimally invasive procedures are emerging as main modality in the management of these complications; however, many cases still requires contemporary surgical management.

Penile strangulation is a challenging clinical situation and usually requires prompt treatment. Penile strangulation by a nonmetallic or thin metallic ring is easily overcome by severing/cutting the object; however, a heavy and long metal ring causing penile strangulation is not only difficult to sever but also it may worsen the scenario if removal is tried with inappropriate method. Here, we report four cases of penile strangulation by different objects which were successfully removed by aspiration and string method. We found that instead of using heavy cutting instruments and other surgical methods, string and aspiration technique is much better.

Introduction: Office cystourethroscopy is one of the common and most frequent urological procedures. Pain and anxiety during the procedure might lead to noncompliance and incomplete cystoscopic examination. Negotiating cystoscope through external sphincter is the most painful and uncomfortable distressing part of cystoscopy. To overcome this, manual compression of irrigation bag during cystoscopy has been used and found to be helpful. Numerous other methods were also studied. Despite these, cystoscopy is still painful and causes anxiety in patients. External sphincter gets relaxed naturally during the act of micturition. Based on this principle, pain and anxiety were studied with voiding instruction during cystourethroscopy. Objective: To study the effect of voiding instruction on anxiety and pain during cystourethroscopy using the Hamilton Anxiety Rating Scale (HAM-A) and visual analogue scale (VAS), in a well-matched Eastern Indian male patient population in a prospective, randomized pattern. Methods: A total of 100 male patients were recruited from those who underwent cystourethroscopy examination in SSKM Hospital and were prospectively randomized into two groups: cystoscopy with or without voiding instruction. Pre- and postprocedure HAM-A score and postprocedure VAS score were recorded. Results: The mean postprocedural pain (VAS) score between voiding instructed and noninstructed groups reached statistical significance: 3.06 ± 1.98 (Range, 2–5) and 5.16 ± 2.86 (Range, 4–8), respectively (P < 0.001). Preprocedure HAM-A score was similar between both groups. Postprocedure median HAM-A score was statistically significantly lower (mean 17.86 ± 2.8 vs. 19.76 ± 3.12; P < 0.001) in voiding instructed group. Conclusion: Pain and anxiety level during cystourethroscopy examination in males can be significantly reduced when the patient is instructed to void during cystourethroscopy examination.

Purpose: This study aims to compare the various distraction methods used during office cystoscopy to decrease pain and dissatisfaction among patients. Materials and Methods: Two hundred patients undergoing rigid cystoscopy between January 2017 and July 2017 were randomized into four groups of 50 patients: (1) Group I: Patients who listened to music during the cystoscopy, (2) Group II: Patients allowed real-time visualization of the cystoscopy, (3) Group III: Patients who listened to music and had real-time visualization of the procedure, (4) Group IV: Control group undergoing cystoscopy without any distraction used. A visual analog scale (VAS) (1–10) was used for a self-assessment of pain, satisfaction, and willingness for repeat cystoscopy. Results: Demographic characteristics, mean age, procedure duration, and procedure indications were statistically similar between the four groups. The mean VAS pain score were significantly lower in the three study Groups (I, II, and III) where distraction methods were used during cystoscopies as compared to the control Group IV (P < 0.001) and the satisfaction VAS scores and VAS scores for willingness to undergo a repeat procedure were significantly higher in the study groups (P < 0.001). Statistically significant decreased postprocedural pulse rate and blood pressure in comparison with to their preprocedural values were observed when distraction methods were used (P < 0.01). Patients undergoing cystoscopies listening to music and real-time visualization (Group III) had better VAS scores than the others (P < 0.01). Conclusions: Distraction methods reduce pain and increase satisfaction among patients. Best results are with combined listening to music and direct real-time visualization.

The presence of an ectopic ureter may be indicated by continuous wetting, seen especially in girls. In majority of such cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. A 32-year-old female presented with urinary incontinence with normal voiding episodes and right flank pain. On investigation, she was found to have duplex moiety on the right-side with partially duplicated ureter and quadruple moiety on the left-side with partially duplicated quadruple ureter with ectopic opening of ureters. The patient also had right upper calyceal stone. It was successfully managed with totally minimal invasive technique with retrograde intrarenal surgery for right nephrolithiasis and left laparoscopic ureteric reimplantation for ectopic ureter. Patient was continent during the follow-up period of nine months with no significant complications. Developmental anomalies of kidney and ureter though rare, can be managed with total minimal invasive techniques, requires proper planning, instruments and its implementation.

Introduction: Retrocaval ureter is a rare congenital anomaly which remains silent until the 3rd or 4th decade of life. But once a patient develops symptoms, it mandates treatment in the form of surgical management. Open surgery has traditionally been considered as the standard of care but it has its own downside or limitations. It requires a relatively large skin incision causing significant postoperative pain and thus prolonging convalescence. Transperitoneal laparoscopic approach is the preferred approach by most surgeons owing to large working space and familiar anatomy. Aim: To compare the safety and efficacy of transperitoneal laparoscopic and open surgery for definitive management of retrocaval ureter. Materials and Methods: Clinical data of fifteen patients, that underwent surgery for retrocaval ureter from December 2013 to January 2020 and the study of this data was done from June 2020, at Urology Department were analysed retrospectively. Out of 15 patients, seven were treated by open surgery while eight underwent transperitoneal laparoscopic surgery. Ureter was transpositioned to normal anatomic position followed by ureteroureterostomy. Student t-test was applied to interpret and analyse the data obtained in both the groups using Statistical Package for the Social Science (SPSS) version 24. Results: Total of 15 patients data was studied (7 open surgery + 8 transpertional laparoscopic surgery, age group between 21- 45 years). Intraoperative and postoperative data were compared between the transperitoneal laparoscopic and open surgery group. A statistically significant difference was found for operative time (p-value

Ureteral entanglement in ring Inferior Venacava (IVC) also called Periureteric venous ring is a rare developmental anomaly, where right ureter passes through a slit like opening in a partially duplicated infrarenal IVC, this results in a dilated upper urinary tract. Authors hereby report a case of a 25-year-old married female presented with flank pain of right side of abdomen for seven months. On Contrast Enhanced Computed Tomography of Kidney, Ureters and Bladder (CECT KUB) with urography diagnosed as retrocaval ureter with right hydronephrosis. The patient was planned for right ureteroureterostomy. During surgery, it was found that right ureter was entangled in between slit like opening of inferior venacaval ring. Preureteral venacava with ring IVC is a rare phenomenon. Clinically it is very difficult to distinguish between the causes of ureteric obstruction. There is scarcity of such cases in the literature. The index case was also diagnosed intraoperatively and managed successfully.

Introduction: There is a general consensus that results of hypospadias repair surgery, done on children, seem to have a better outcome when compared to the adults. Hypospadias cases in adults can present as primary or with complications resulting from an attempted repair. Aim: To assess any difference in outcome of surgeries done among the adolescent and adult population and to evaluate the use of a Tunica Vaginalis (TV) second layer barrier flap in preventing complications such as urethrocutaneous fistula. Materials and Methods: This was a single centre retrospective observational assessment of the adolescent and adult hypospadias surgeries conducted at a Tertiary Care Hospital from January 2016 to July 2019. The assessment was based on the presentation, site of hypospadias meatus, previous surgery and development of any complications or recurrence. Routine surgeries as per the hospital protocol were done in these patients. Follow-up was done for the next 12 months. For data analysis tables, columns and pie charts were used. Fisher’sexact test was used to find the association and calculate the p-value with the help of SPSS 21.0 software. Results: Total 28 patients were assessed, of which 17 patients were adolescents (mean age 14.6±1.66 years) and 11 (mean age 22.7±3.51 years) were adult. There was no significant (p-value 0.581) difference in the final outcome of hypospadias repair surgery between the adolescent and adult population. Use of TV interposition barrier flap prevented development of complications. Urethrocutaneous fistula was the most common form of complication noted in both the groups overall rate of complication was 14.2%. Conclusion: When hypospadias repair in adolescents and adults is done in a systematic and meticulous fashion, the outcome was satisfactory and there was no significant difference in outcome among the two age groups. Use of TV flap as a second layer interposition can improve the outcome in such patients.

Neoplasia of the renal pelvis in duplex kidneys is extremely rare, especially in complete renal ureteral duplex cases. A 46-year-old aged male patient had presented with intermittent haematuria for the last seven months. A mildly enhancing well-defined, lobulated mass arising from the pelvis of lower moiety of right kidney was found on evaluation. Confirmatory findings of a renal pelvic malignancy couldn’t be obtained. Infective condition like pyelonephritis couldn’t be excluded. To clear the diagnostic dilemma, flexible ureteroscopy was done which revealed the renal pelvic malignancy. Right lap assisted radical nephroureterectomy was done. Histopathology was suggestive of transitional cell carcinoma. The increased incidence of chronic infection, obstruction and stone formation may be instrumental in producing a higher incidence of renal pelvic tumours in patients with anomalous kidney. Diagnosing a neoplasia originating from a duplex kidney is difficult and often a multiple battery of investigations like intravenous pyelogram, ultrasonography and rigid ureteroscopy may not be useful. Considering the fact that tumour recurrence is high in the ureteric stump after local resection, a total nephroureterectomy seems to be a better treatment choice. Flexible ureteroscope might be the saviour in such doubtful clinical situations to confirm our diagnosis beyond doubt. Partial nephrectomy cannot be recommended unless long-term follow-up reports of such cases are available.

Testicular malignancy in old age men should be thoroughly studied because of low rate of incidence. Incidence of testicular lymphomas have been shown to be nearly 9% among all testicular malignancies and 1-2% of all lymphomas found in human body. The most common hisopathological pattern among lymphomas is B-cell type and of these diffuse large B-cell subtype is commonest; however, less commonly, Burkitt’s lymphoma, anaplastic lymphoma or Hodgkin’s lymphoma may primarily involve the testis. Testicular lymphoma is rare whether as a primary or as a secondary origin. Diffuse Large B-Cell Lymphomas (DLBCL) is the most common histopathological type if primary in origin; however aggressive patterns like, Burkitt’s lymphoma, are more common when there is secondary involvement of testis. Stage of the lymphoma (Ann Arbor staging) determines the prognosis of the disease. Other prognostic factors include presence of B symptoms and International Prognostic Index (IPI) score, involvement of spermatic cord and other testis. Immunohistochemistry should be done after histopathological diagnosis for effective treatment of variants of testicular lymphoma. High inguinal orchiectomy along with chemotherapy with or without radiotherapy is current treatment of choice for these tumours. In this article, the case of testicular lymphoma is presented in a 61-year-old male patient, clinical presentation, investigations and surgical and chemotherapeutic management with discussion with respect to previous clinical studies. In this case report, patient presented with swelling of left scrotum for which he underwent the radiological and biochemical investigations. He was further planned for frozen section biopsy. The histopathological and immunohistochemical analysis was suggestive of DLBCL, as final diagnosis.

Introduction: Prostate neoplasm is a major health problem globally since last two decades. Among the contributory factors in aetiopathogenesis, oxidative stress and one carbon metabolism are also important. Aim: To compare the serum level of vitamin B12, homocysteine and Malondialdehyde (MDA) between prostate cancer, Benign Prostatic Hyperplasia (BPH) and control subjects to find out the status of oxidative stress and one carbon metabolism in prostate tumours. Materials and Methods: Forty patients each with BPH and Prostate cancer along with 40 age matched healthy controls were selected in an observational cross-sectional study, attending the outpatient and inpatient Department of Urology, IPGME&R, Kolkata, West Bengal, India, from January 2018 to June 2019. Oxidative stress for these patients was estimated by measuring lipid peroxidation product MDA by Thiobarbituric Acid Reactive Substances (TBARS) assay with spectrophotometer. Vitamin B12 and homocysteine were also analysed as a marker of one carbon metabolism by chemiluminescent method. Biochemical parameters such as fasting and post-prandial blood sugar, urea, creatinine and liver function tests were measured by autoanalyser to rule out diabetes and any underlying hepatic and renal pathology. All the data were then analysed using statistical software SPSS version 24. The groups were compared using student’s unpaired t-test and Pearson’s correlation coefficient was applied to observe the correlation between variables. Results: A statistically significant rise of oxidative stress was found in BPH and prostate cancer cases compared to age matched control. Regarding one carbon metabolism, this study fails to demonstrate any statistically significant difference of Vitamin B12 level between BPH and control as well as between prostate cancer and control group. However, high serum homocysteine is associated with both BPH and prostate cancer compared to the controls. Conclusion: In the present study, statistically significant increase in oxidative stress and serum homocysteine level and no difference of serum vitamin B12 was found in BPH and prostate cancer cases compared to control group. Longitudinal studies are however required to establish any relationship and to investigate the potential role of homocysteine as a novel tumour marker.

Purpose: The combined interaction of epidemiology, environmental exposure, dietary habits, and genetic factors causes kidney stone disease (KSD), a common public health problem worldwide. Because a high water intake (>3 L daily) is widely recommended by physicians to prevent KSD, the present study evaluated whether the quantity of water that people consume daily is associated with KSD and whether the quality of drinking water has any effect on disease prevalence. Materials and Methods: Information regarding residential address, daily volume of water consumption, and source of drinking water was collected from 1,266 patients with kidney stones in West Bengal, India. Drinking water was collected by use of proper methods from case (high stone prevalence) and control (zero stone prevalence) areas thrice yearly. Water samples were analyzed for pH, alkalinity, hardness, total dissolved solutes, electrical conductivity, and salinity. Average values of the studied parameters were compared to determine if there were any statistically significant differences between the case and control areas. Results: We observed that as many as 53.6% of the patients consumed

Abstract Papua New Guinea (PNG) is saddled with frequent natural disasters like earthquake, volcanic eruption, landslide, drought, flood etc. Flood, as a hydrological disaster to humankind’s niche brings about a powerful and often sudden, pernicious change in the surface distribution of water on land, while the benevolence of flood manifests in restoring the health of the thalweg from excessive siltation by redistributing the fertile sediments on the riverine floodplains. In respect to social, economic and environmental perspective, flood is one of the most devastating disasters in PNG. This research was conducted to investigate the usefulness of remote sensing, geographic information system and the frequency ratio (FR) for flood susceptibility mapping. FR model was used to handle different independent variables via weighted-based bivariate probability values to generate a plausible flood susceptibility map. This study was conducted in the Markham riverine precinct under Morobe province in PNG. A historical flood inventory database of PNG resource information system (PNGRIS) was used to generate 143 flood locations based on “create fishnet” analysis. 100 (70%) flood sample locations were selected randomly for model building. Ten independent variables, namely land use/land cover, elevation, slope, topographic wetness index, surface runoff, landform, lithology, distance from the main river, soil texture and soil drainage were used into the FR model for flood vulnerability analysis. Finally, the database was developed for areas vulnerable to flood. The result demonstrated a span of FR values ranging from 2.66 (least flood prone) to 19.02 (most flood prone) for the study area. The developed database was reclassified into five (5) flood vulnerability zones segmenting on the FR values, namely very low (less that 5.0), low (5.0–7.5), moderate (7.5–10.0), high (10.0–12.5) and very high susceptibility (more than 12.5). The result indicated that about 19.4% land area as ‘very high’ and 35.8% as ‘high’ flood vulnerable class. The FR model output was validated with remaining 43 (30%) flood points, where 42 points were marked as correct predictions which evinced an accuracy of 97.7% in prediction. A total of 137292 people are living in those vulnerable zones. The flood susceptibility analysis using this model will be very useful and also an efficient tool to the local government administrators, researchers and planners for devising flood mitigation plans.

Introduction: Shockwave-lithotripsy (SWL) provides a noninvasive and effective option for the management of ureteric calculi. Several factors may affect the success of SWL. Identification of these predictive factors will both increase the efficacy and decrease the cost. This study was designed to identify factors affecting the outcome of SWL for ureteral stones. Materials and Methods: This study was conducted from March 2012 to November 2014 in patients with solitary ureteric calculi who were managed with SWL. Data were analyzed to identify clinical and radiological factors associated with treatment outcome. Success after SWL was described as complete stone clearance or clinically insignificant residual fragments

Introduction: In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique. Materials and Methods: A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups. Results: The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable. Conclusion: The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.